心理训练可以改善手术结果


  【24drs.com】根据发表于美国外科医师学院2014年临床研讨会的一篇研究,心理训练可以帮助外科医师改善进阶腹腔镜手术的技术。
  
  多伦多大学外科研究员Marisa Louridas在发表时表示,心理训练改善了外科实习生的进阶腹腔镜手术技术。
  
  以前的研究指出,心理训练—任务的认知排演—可以促进运动和音乐的表现。心理训练对于手术的研究迄今仅限于一般手术,Louridas等人试图评估心理训练对于进阶腹腔镜技术与外科医师面对危急情况之压力时的影响。
  
  他们要求8名有经验的减重手术医师明确说出腹腔镜Roux-en-Y胃绕道手术的步骤,在每个步骤强调动觉和视觉提示,据以建立了一套脚本。
  
  这些外科医师将住院医师曾犯的错误纳入,例如,住院医师在视线外抓住肠道,因此,他们无法看到是否施力过大而导致伤害,顾及这些是因为它可能会导致无法确认的肠道伤害。
  
  研究者随机指定10名资深外科住院医师到传统组、10名到心理训练组;所有住院医师都曾进行过至少5次的空肠造口术,因为这项手术中的某些经验对于辨识视觉和动觉提示是必须的。
  
  这20名住院医师都进行了教学课程且观看手术影片,此外,心理训练组的10名住院医师收到前述的脚本,且接受1名有经验之表现心理学家的心理训练。
  
  研究者评估了每名住院医师在进行训练前、在模拟手术室(用猪进行手术)中遇到危急情况时的技术,Louridas表示,我们让它看起来就象是在手术室的感觉,让参与者尽可能有真实感。
  
  在手术技能和减重技能的客观化评估方面,相较于传统组,心理训练组外科医师的分数显著改善(P=.003)。
  
  心理训练组中的7个外科医师在危急状况下的技术表现有改善,其它的表现和开始时一样。对照组中,4个外科医师在危急状况的表现比较不好,其它的表现和开始时一样。
  
  心理训练组的心理意象能力显著改善(P= .01),传统组则无(P= .08)。
  
  为了评估心理训练对外科医师在危急情况时压力程度的影响,研究者监测了他们的血压与心律,且让他们完成「情境-特质焦虑量表」,他们发现两组之间并无差异。
  
  加州大学洛杉矶分校的外科医师Areti Tillou评论这篇发表是「杰出」的研究。
  
  Tillou医师表示,心理训练对于外科是相当有趣的概念,但是她提醒,相较于试图获得技能的新运动员,它对于要精进技能的运动员更有用。
  
  Tillou医师想了解这两组在开始时的比较。
  
  Louridas报告指出,心理训练组在开始时的分数是比较高,所以研究者比较的是两组的分数变化差异而不是实际分数。
  
  发表结束后,一名听众问Louridas,这类训练类型对比较高层次者如教师是否有影响,她表示她认为这对任何层级都会有帮助。另一名听众问,心理训练组是从脚本中的观点还是从实务中获得帮助。
  
  Louridas表示,这几乎是无法分割的,如果我给你脚本让你读一遍,我不认为会一样有效,只是我们没有第三组来这样试验。
  
  资料来源:

Mental Practice Improves Surgery Outcomes

By Laird Harrison
Medscape Medical News

SAN FRANCISCO — Surgeons performing advanced laparoscopic surgery can improve their skills by mentally practicing procedures, according to a study presented here at the American College of Surgeons 2014 Clinical Congress.

"Mental practice improved the technical performance of surgical trainees in advanced laparoscopic surgery," said presenter Marisa Louridas, MSc, a surgery researcher at the University of Toronto.

Previous research has demonstrated that mental practice — the cognitive rehearsal of a task — can enhance performance in sports and music.

Research of mental practice in surgery has, so far, been restricted to basic operations. Louridas and her colleagues wanted to assess the effects of the technique on advanced laparoscopic skills and surgeon stress levels in a crisis scenario.

They created a script by asking eight experienced bariatric surgeons to speak out loud the steps of a laparoscopic Roux-en-Y gastric bypass, emphasizing the kinesthetic and visual cues at each step.

The surgeons included errors they had seen residents make. For example, "the residents grab the bowel when it's out of sight; therefore, they cannot see if they are applying too much force or have caused injury. This is concerning because it may result in unrecognized bowel injury."

The researchers randomly assigned 10 senior surgical residents to a conventional group and 10 to a mental practice group. All residents had performed at least five jejunostomies each because some experience in the procedure is necessary to identify the visual and kinesthetic cues.

All 20 residents underwent a didactic session and watched videos of the procedure. In addition, the 10 in the mental practice group received the scripts along with training in mental practice from an expert performance psychologist.

The researchers assessed each resident's skills before the training and during a crisis scenario in a simulated operating room, where the procedure was performed on a pig. "We made it look and feel like an OR to make it as realistic as possible for the participants," said Louridas.

Performed Better

On the objective structured assessment of technical skill and bariatric skill, surgeons in the mental practice group improved their scores significantly more than those in the conventional group (P =.003).

Seven of the surgeons in the mental practice group improved their technical performance during the crisis scenario, and the rest performed as well as at baseline. In the control group, four surgeons performed less well in the crisis scenario, and the rest performed as well as at baseline.

Mental imagery ability improved significantly in the mental practice group (P = .01), but not the conventional group (P = .08).

To assess the effect of mental practice on the stress levels of the surgeons during the crisis scenario, the researchers monitored their blood pressure and heart rate, and had them complete the State-Trait Anxiety Inventory. They found no difference between the two groups.

The official discussant for the presentation, Areti Tillou, MD, a general surgeon at the University of California, Los Angeles, called the study "excellent".

"Mental practice is a very interesting concept to be used in surgery," said Dr Tillou, but she cautioned that "it works better on accomplished athletes trying to optimize than on new athletes trying to acquire a skill."

Dr Tillou wanted to know how the two groups in the study compared at baseline.

Louridas reported that the mental practice group had higher scores at baseline, which is why the change in scores between the two groups was compared, rather than the actual scores.

After the presentation, a member of the audience asked if Louridas saw a role for this type of training at higher levels, including faculty. She said she thinks it could help at any level.

Another meeting attendee asked whether the mental practice group benefited more from the insights contained in the script or from the practice.

"It's almost impossible to tease them out," said Louridas. "If I just gave you the script and you just read it once, I don't think it would be as effective, but we did not have a third group who did that."

Ms Louridas and Dr Tillou have disclosed no relevant financial relationships.

American College of Surgeons (ACS) 2014 Clinical Congress. Presented October 28, 2014.

    
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