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Cited by 140Surgical Simulation and TrainingSport Psychology and PerformanceSimulation-Based Education in Healthcare

Mental Practice: Effective Stress Management Training for Novice Surgeons

Arora, Sonal, Aggarwal, Rajesh, Moran, Aidan, Sirimanna, Pramudith, Crochet, Patrice, Darzi, Ara, Kneebone, Roger, Sevdalis, Nick·2011·Journal of the American College of Surgeons
DOI 10.1016/j.jamcollsurg.2010.09.025
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Abstract

BACKGROUND: Surgeons are often subject to excessive levels of acute stress that can impair their performance. Mental practice (MP) is a strategy used in other high-performance industries to alleviate anxiety. This study investigated if MP reduces stress in novice surgeons. STUDY DESIGN: A prospective, randomized controlled design was used with 20 novice surgeons recruited by random sampling. After baseline testing, participants underwent training on an evidence-based virtual reality (VR) curriculum. They then performed 5 VR laparoscopic cholecystectomies (LC) after being randomized to MP or control groups. The MP group performed 30 minutes of MP using a validated MP training protocol before each LC; control participants conducted an unrelated activity. Stress was assessed subjectively using the validated State-Trait Anxiety-Inventory (STAI) questionnaire and objectively with a continuous heart rate (HR) monitor and salivary cortisol. Mental imagery was assessed using the validated mental imagery questionnaire. RESULTS: Eighteen participants completed the study. There were no intergroup differences in baseline stress, imagery, or technical ability. Comparing the MP group with controls, subjective stress (STAI) was lower for the MP group (median 8.40 vs 11.31, p < 0.01). Objective stress was also significantly reduced for the MP group in terms of the average HR (median 72 vs 88 beats/minute, p < 0.0001), maximum HR (median 102 vs 119 beats/minute, p < 0.01), and cortisol (median 2.26 vs 3.85 nmol/L, p < 0.05). Significant negative correlations were obtained between stress and imagery, indicating that improved imagery was associated with lower stress (p < 0.05). CONCLUSIONS: A short period of MP reduces the subjective, cardiovascular, and neuroendocrine response to stress on a VR simulator. Additional research should determine whether this effect extends beyond novice surgeons and transfers to the operating room.

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  • Imagination or mental practice prior to performing a task may be expected to lower intrinsic load during actual task performance, counterbalancing the high load resulting from stress, emotions or uncertainty and so improving learning and the ability to deal with stress, emotions or uncertainty in future tasks.

    “For example, imagination or mental practice prior to performing the task may be expected to lower intrinsic load during actual task performance, counterbalancing the high load resulting from stress, emotions or uncertainty and so improving learning and the ability to deal with stress, emotions or uncertainty for future tasks (Arora et al. 2011).”

    From Cognitive Architecture and Instructional Design: 20 Years Later (2019) · cites this paper as Arora et al. 2011

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Authors
Arora, S., Aggarwal, R., Moran, A., Sirimanna, P., Crochet, P., Darzi, A., Kneebone, R., & Sevdalis, N.
Affiliations
  • Imperial College London (GB)
  • University College Dublin (IE)
Corresponding author
Arora, Sonal
ORCID
Venue
Journal of the American College of Surgeons
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-02
Volume
212
Issue
2
Pages
225-233
ISSN
1072-7515 (ISSN-L)
DOI
10.1016/j.jamcollsurg.2010.09.025
OpenAlex
W2051691700
Cited by
140
References
43
Citations by year
2026: 7 · 2025: 10 · 2024: 11 · 2023: 7 · 2022: 11 · 2021: 12 · 2020: 12 · 2019: 9 · 2018: 5 · 2017: 17 · 2016: 8 · 2015: 6 · 2014: 7 · 2013: 7 · 2012: 8
FWCI
7.86
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American College of Surgeons (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Surgical Simulation and Training
  • Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
  • Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
Keywords
mental practice, mental imagery, surgical stress, novice surgeons, virtual reality simulation, laparoscopic cholecystectomy, anxiety, heart rate, salivary cortisol, stress management training
MeSH terms
Workforce, Adult, Anxiety, Computer Simulation, Female, Heart Rate, Humans, Hydrocortisone, Male, Operating Rooms, Physicians, Prospective Studies, Surveys and Questionnaires, Saliva, Stress, Psychological, General Surgery, Task Performance and Analysis, Biomarkers, Treatment Outcome, Imagery, Psychotherapy

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