Mental practice: a simple tool to enhance team-based trauma resuscitation

Abstract

Introduction: Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated. Methods: We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences. Results: Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r = 0.67, p < 0.01. Conclusions: MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.

Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps

“…24 Another recent RCT studied the effects of imagery on emergency, anesthesia, and surgery residents' teamwork (i.e., assessed by expert raters using the Mayo High Performance Teamwork Scale: MHPTS) during a simulated trauma resuscitation scenario. 25 The authors found that the imagery group significantly outperformed controls in teamwork, and concluded that imagery is an effective tool to increase team-based skills. In another recent study of the effects of guided mental imagery on residents' performance on two methods of simulated LCs (i.e., physical task on a torso trainer and VR simulator), Paige et al (2015) found that imagery was related to improved performance of a VR two-hand clip-and-cut task.…”

“…Imagery has been shown to be a cost-effective training supplement to physical practice that cuts down on resource consumption, [12][13]17,23,29,31 and enhances surgeons' performance through improved acquisition and performance of surgical skills, [13][14][15][16][18][19]22,24,[29][30] knowledge, 11,23,26 confidence, 23,[26][27] and team-based skills. 25 …”

Updating our approach to the difficult and failed airway: time to “stop and think”

“…''Mental rehearsal'' or ''cognitive imaging'' allows the opportunity to think through both procedural and crisis management aspects of airway management before intubation. 17,18 This mirrors the preparation by an elite athlete who pre-plans an upcoming ski race or penalty kick or by a pilot who is taught to ''fly ahead of the plane''. Indeed, true airway experts should ensure that patient management, and team performance, never extend beyond where their mind has not already been.…”

“…Regardless, these guidelines also reflect our growing awareness that the potential for errors is common and ubiquitous and far less likely to be a random unpredictable event. 4,17,18 Modernizing our understanding of human errors and airway management…”

“…4 In other words, humans -both seasoned veterans and junior learners-are likely to think and act based on a complex interplay of factors, including the desire to save face, denial, stress, and heuristics. 4,18,19 Accordingly, the 2015 guidelines emphasize that the difficult airway needs to be recognized by ALL team members. To increase recognition, the guidelines wisely emphasize that the difficult and failed airway also needs to be explicitly declared.…”