A Scoping Review of Mental Practice in Athletes: How can Surgeons Learn?

Mental imagery is a dynamic mental state involving the cognitive visualization and rehearsal of motor movements or positions without overt motor output. Mental imagery is known to have numerous benefits for skill acquisition within athletic performance and is often incorporated into elite athletic training programs. The literature on the effects of mental imagery in surgery, which shares many of the high-performance qualities of elite athletics, remains limited. It may be possible to extrapolate many of the benefits of mental imagery on skill acquisition and sports performance in athletics to the field of surgery. The purpose of the study is to qualitatively assess the components of mental imagery approaches used in high-level athletics to ultimately determine their applicability to surgical training.

A scoping review was conducted using the Ovid Medline, Ovid EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar databases. Two reviewers screened through all abstracts and full texts according to predefined inclusion and exclusion criteria in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. A thematic analysis was then performed on all studies included in the review.

Of 1252 citations, 19 studies met full inclusion and exclusion criteria. Five themes were identified in the thematic analysis (open vs closed events; internal vs external imagery; level of expertise; visual vs kinesthetic; psychological effects and physical factors).

The use of mental imagery to enhance training and performance outside of medicine is widespread in the literature. Numerous studies have shown mental imagery can improve performance, decrease anxiety and shorten the learning curve in elite athletes. Surprisingly, the role of mental imagery within surgical training remains poorly explored. Given that the training undertaken by elite athletes and surgeons has many similarities, our scoping review and thematic analysis has identified 5 key areas for possible transferable practices whereby mental imagery could benefit surgical education.