Use of motor imagery and mental practice for skill acquisition in surgery - a design and development approach

1. MOTOR IMAGERY AND MENTAL PRACTICE AS
AN AUGMENT FOR SURGICAL TRAINING
Singapore Orthopaedic Association
41st Annual Scientific Meeting
1st November 2018
Presentation A025
Presenter: Hannah Ng Jia Hui
Co-author: Vaikunthan Rajaratnam

2. Introduction
• Competency is acquired after 15,000 – 20,000h1
• Translates to 12.5 years (40 weeks a year, 5 days a
week, 8 hours a day)2
• Reduced training opportunities3
• Need to become an expert with reduced training hours4
• Development of a usable, accessible and affordable
model in skills training5
1 Purcell Jackson & Tarpley (2009)
2 Kavic, M. S. (2012). “Ten years’ duration of effortful activity which can only be sustained for a limited period daily to allow for
recovery from a daily or weekly routine”. Teaching and Learning of Surgery. Journal of the Society of Laparoendoscopic Surgeons.
16(3), 341–344
3 Reznick & MacRae (2006)
4 Dreyfus, S. E. (2004). The Five-Stage Model of Adult Skill Acquisition. Bulletin of Science, Technology & Society, 24(3), 177–181.
5 Kneebone, R., & Aggarwal, R. (2009). Surgical training using simulation. BMJ, 338, b1001.

3. Background
• Reduced opportunities of deliberate practice
• Regulatory requirements of reduced working
time
• Reduced the availability of safe learning
• Residents inability to achieve expert status
The problems with surgical training in Singapore

4. Purpose of this study
• To design, develop and validate a training model for
rapid skill acquisition in basic microsurgery
• To evaluate the effectiveness, the ease of learning and
usability of this model against the current training
module

5. Motor Imagery and Mental Practice

6. Mental Script
• Instructions to aid visualization
• Motor
• Senses / Kinaesthetic Imagery
– Tactile
– Visual
– Acoustic
– Olfactory

7. EXPERT
deliberate
practice
mental
practice
observation
&
kinaesthetic
imagery
New Model of Surgical Training

8. Research Question
• How can a new model for
deliberate practice in basic
microsurgery be designed
using Motor Imagery & Mental
Practice (MIMP) to produce
expert performance amongst
novices?
Observation
Imitation
Modelling
Bandura’s Theory

9. Methodology
Convergent parallel
Design & Development research
10

10. RESULTS
Design and Development of the MIMP script
• Basic microsurgical skill: micro
suturing 8-0 nylon on glove
model
• Experts identified via purposeful
sampling
• Focus group discussion with
focus group specialist
• Overall framework and
description of the procedure

11. RESULTS
Construction of MIMP script
• Cognitive walkthrough for the
procedure
• Imagine themselves performing
the suturing
• Report visual, cognitive, and
kinaesthetic cues
Ericsson, K. A. (2006). Protocol analysis and expert thought: Concurrent verbalizations of thinking during experts’ performance
on representative tasks. The Cambridge Handbook of Expertise and Expert Performance, 223–242.

12. RESULTS
Data analysis
• Checking back process with experts
• Merger to create a single MIMP script
• Final script reviewed for face and content
validity

13. RESULTS
Example of MIMP Script

14. What’s Next?
• Phase 2
– Validation of the script with sample
population
– Experimental study to evaluate the
effectiveness and usability of this model