Development and Validation of a Mental Practice Tool for Total Abdominal Hysterectomy

Total abdominal hysterectomy (TAH) is a common operation performed by obstetrician-gynecologists. Training opportunities for this procedure are declining. Mental practice (MP), the use of mental imagery to rehearse a task symbolically before performance, has been used successfully in sports and music to enhance skill. This strategy demonstrates benefit in existing surgical education literature. We aimed to develop and validate a MP tool (MPT) for resident training in TAH.

A prospective survey study was performed in a large, urban, academic medical center in Philadelphia, Pennsylvania, USA. A MPT was developed by guiding expert surgeons through a cognitive walk-through of TAH to identify key procedural cues. For validation, a convenience sample of 22 residents and attendings (N = 11 per group) mentally rehearsed TAH. Motivation, confidence, quality of imagery, and utility of the activity were assessed with a previously validated Mental Imagery Questionnaire (MIQ) before and after exposure to the MPT.

Residents, but not attendings, found MP to be useful in preparation for surgery (residents, p = 0.01; attendings, p = 0.34) and had increased confidence following this exercise (residents, p = 0.01; attendings, p = 0.08). Significant improvement in global imagery score after use of the tool was shown by residents (p = 0.01) but not by the attendings (p = 0.08), with residents having lower imagery skills than attendings both pre-MP and post-MP. Reliability testing of the MIQ indicated internal consistency (pre-MPT, 0.91; post-MPT, 0.90).

MP may serve as a potentially effective, portable, and inexpensive resident surgical training tool in preparation for TAH. Attendings may benefit from certain aspects of MP. The MIQ may serve as a measure of imagery skills in future experiments of MP in preparation for surgery.