Optimizing Performance: Mental Skills Training to Make Average Performance Excellent

Presented as a Small Group/Roundtable Discussion at 2020 IUSM Education Day

Surgical Emergencies in the Pregnant Patient

One in 500 to 700 pregnancies in the United States are complicated by an abdominal emergency necessitating surgery. Addressing these emergencies during pregnancy presents several decision making challenges and commonly calls into question the appropriate approach for evaluation and definitive care. Ultimately, surgical intervention can be performed safely during pregnancy independent of trimester and offers definitive therapy and a quicker recovery when performed laparoscopically

Surgeons see anatomical structures faster and more accurately compared to novices: Development of a pattern recognition skill assessment platform

Background This study aimed to identify differences in pattern recognition skill among individuals with varying surgical experience. Methods Participants reviewed laparoscopic cholecystectomy videos of various difficulty, and paused them when the cystic duct or artery was identified to outline each structure on the monitor. Time taken to identify each structure, accuracy and work load, which was assessed using the NASA-Task Load Index (TLX), were compared among the three groups. Results Ten students, ten residents and eight attendings participated in the study. Attendings identified the cystic duct and artery significantly faster and more accurately than students, and identified the cystic artery faster than residents. The NASA-TLX score of attendings was significantly lower than that of students and residents. Conclusions Attendings identified anatomical structures faster, more accurately, and with less effort than students or residents. This platform may be valuable for the assessment and teaching of pattern recognition skill to novice surgeons. Short summary Accurate anatomical recognition is paramount to proceeding safely in surgery. The assessment platform used in this study differentiated recognition skill among individuals with varing surgical experience

Preparedness for Residency: Now More Than Ever

Transitions in medical education, particularly the transition to residency training, are increasingly identified as meriting additional thought and care for the appropriate development of the new physician. In this issue of JAMA Surgery, Engelhardt and colleagues aptly demonstrate that a resident’s sense of preparedness for this transition plays a crucial role in their mental health; the identified association between resident preparedness and meaningful on-call experiences as students likely applies to most specialties requiring in-house call

Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients

Background Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost

Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

The following clinical spotlight review regarding transanal minimally invasive surgery (TAMIS) is intended for physicians who manage and treat rectal pathology. It is meant to critically review this technique and the available evidence supporting its safety and efficacy. Based on the level of evidence, recommendations may or may not be given for its use in clinical practice

Development of a multimedia tutorial to educate how to assess the critical view of safety in laparoscopic cholecystectomy using expert review and crowd-sourcing

We sought to determine the feasibility of developing a multimedia educational tutorial to teach learners to assess the critical view of safety using input from expert surgeons, non-surgeons and crowd-sourcing. We intended to develop a tutorial that would teach learners how to identify the basic anatomy and physiology of the gallbladder, identify the components of the critical view of safety criteria, and understand its significance for performing a safe gallbladder removal. Using rounds of assessment with experts, laypersons and crowd-workers we developed an educational video with improving comprehension after each round of revision. We demonstrate that the development of a multimedia educational tool to educate learners of various backgrounds is feasible using an iterative review process that incorporates the input of experts and crowd sourcing. When planning the development of an educational tutorial, a step-wise approach as described herein should be considered

Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps

Introduction: Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. Materials and Methods: A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. Results: Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. Conclusions: Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training

Push Your Performance to the Next Level: Evidence-based Methods for Surgical Performance Optimization

At the conclusion of this presentation the participant should be able to: 1. Identify the factors impacting the acquisition and decay of surgical skill 2. Discuss the importance of objective performance assessment and coaching for performance improvement 3. Recognize the benefits of simulation training for surgical skill acquisition in laparoscopic and robotic surgery Presentation: 1 hour and 7 minute