N. Mulji1, N. Anton1,3, L. Howley1, A. Yurco1, D. Tobben1, E. Bean2, D. Stefanidis1,3 1Carolinas Medical Center,Carolinas Simulation Center,Charlotte, NC, USA 2Get A Strong Mind,San Diego, CA, USA 3Indiana University,Department Of Surgery,Indianapolis, IN, USA
Introduction:
Appropriate management of attentional resources is important for surgeons to maintain focus to prevent compromising patient safety. This is particularly true for surgical trainees, as they may be susceptible to experience cognitive overload due to their inexperience, which can negatively impact their ability to maintain and shift focus effectively. Mental skills curricula incorporate cognitive training techniques (including thought and attention management) to help optimize performance even under challenging conditions. The objective was to assess the efficacy of a novel mental skills curriculum in improving attention management of novice surgical trainees.
Methods:
Volunteer participants (n=60) with no previous exposure to surgery were stratified according to their baseline performance on the Fundamentals of Laparoscopic Surgery (FLS) simulator and randomized to receive mental skills training or no such training during nine proficiency-based laparoscopic training sessions. To assess attentional resources, a previously validated secondary ball and tunnel task that requires participants to distinguish between correct and incorrect patterns superimposed over the laparoscopic display, was used at each training session. To assess training effectiveness, FLS scores and secondary task scores were compared between groups using Wilcoxon Rank Sum test and within groups using Wilcoxon Signed Rank test, before and after training. To assess predictive value of improvement, the d2 Test of Attention and TOPS assessment were administered before baseline and post-test.
Results:
Fifty-five participants completed the study protocol. There were no differences in demographics, FLS performance and secondary task scores between groups at baseline. Both groups demonstrated significant improvements in primary (p<0.001) and secondary task performance (p<0.01) from baseline to post-test. While no significant differences were found between groups in primary and secondary task performance at baseline and post test, only the mental skills training group demonstrated significant improvements in correct secondary task hit rates (i.e., correctly identifying incorrect patterns) at post test compared with baseline (28% vs. 18%, respectively; p<0.05) and displayed a trend towards reduced average response times. The d2 Test of Attention and TOPS assessment did not show significant difference between or within groups at the designated time periods.
Conclusion:
The novel mental skills curriculum used in this study led to improved performance on a visual-spatial secondary task after training completion. Further evaluation of the impact of this curriculum on attentional capacity and how it can be maximized is warranted and is currently underway with more advanced learners (i.e., surgical trainees).