Mental Imagery as a Formal Educational Adjunct for Surgical Skills Development in Medical Students: A Scoping Review

The development of surgical skills is a key component of the medical education curriculum. While simulation-based medical education approaches are increasingly adopted to facilitate skills development in a safe, standardized and realistic manner, mental imagery (MI) has been considered as an emerging approach for surgical skills development. MI is defined as the mental rehearsal of tasks without motor performance and has demonstrated effective skills development in industries such as elite sport and aviation. However, its benefit has yet to be explored and utilized in the medical school curriculum. This scoping review seeks to evaluate the current literature to characterize efficacy of MI interventions for the surgical skills development of medical students.

A scoping review was performed following a comprehensive search of Medline, Embase, CINAHL and Emcare databases. Articles evaluating the outcomes related to the impact of MI interventions on the development of technical and nontechnical surgical skills among medical students were included.

MI-based programs among medical students improve certain areas of technical and nontechnical surgical skills performance such as in laparoscopic performance, fluidity and with co-benefits of improved stress management and low cost. However, inconsistencies were observed in findings across studies, with mixed results across the technical and nontechnical surgical skills assessed. This was largely attributed to significant study heterogeneity of the underlying evidence.

Despite the emerging evidence suggesting MI-based programs as an effective adjunct to the current surgical skills development, there are important limitations to the quality of the evidence. Our scoping review highlights the need for prospective research with standardized MI programs assessing surgical skills at the expected scope of competency for medical students to further characterize the utility of MI-based programs in the Accreditation Council for Graduate Medical Education (ACGME) surgical skills curriculum, particularly in areas of medical knowledge, professionalism, interpersonal and communication skills.