心理訓練可以改善手術結果


  【24drs.com】根據發表於美國外科醫師學院2014年臨床研討會的一篇研究,心理訓練可以幫助外科醫師改善進階腹腔鏡手術的技術。
  
  多倫多大學外科研究員Marisa Louridas在發表時表示,心理訓練改善了外科實習生的進階腹腔鏡手術技術。
  
  以前的研究指出,心理訓練—任務的認知排演—可以促進運動和音樂的表現。心理訓練對於手術的研究迄今僅限於一般手術,Louridas等人試圖評估心理訓練對於進階腹腔鏡技術與外科醫師面對危急情況之壓力時的影響。
  
  他們要求8名有經驗的減重手術醫師明確說出腹腔鏡Roux-en-Y胃繞道手術的步驟,在每個步驟強調動覺和視覺提示,據以建立了一套腳本。
  
  這些外科醫師將住院醫師曾犯的錯誤納入,例如,住院醫師在視線外抓住腸道,因此,他們無法看到是否施力過大而導致傷害,顧及這些是因為它可能會導致無法確認的腸道傷害。
  
  研究者隨機指定10名資深外科住院醫師到傳統組、10名到心理訓練組;所有住院醫師都曾進行過至少5次的空腸造口術,因為這項手術中的某些經驗對於辨識視覺和動覺提示是必須的。
  
  這20名住院醫師都進行了教學課程且觀看手術影片,此外,心理訓練組的10名住院醫師收到前述的腳本,且接受1名有經驗之表現心理學家的心理訓練。
  
  研究者評估了每名住院醫師在進行訓練前、在模擬手術室(用豬進行手術)中遇到危急情況時的技術,Louridas表示,我們讓它看起來就像是在手術室的感覺,讓參與者盡可能有真實感。
  
  在手術技能和減重技能的客觀化評估方面,相較於傳統組,心理訓練組外科醫師的分數顯著改善(P=.003)。
  
  心理訓練組中的7個外科醫師在危急狀況下的技術表現有改善,其他的表現和開始時一樣。對照組中,4個外科醫師在危急狀況的表現比較不好,其他的表現和開始時一樣。
  
  心理訓練組的心理意象能力顯著改善(P= .01),傳統組則無(P= .08)。
  
  為了評估心理訓練對外科醫師在危急情況時壓力程度的影響,研究者監測了他們的血壓與心律,且讓他們完成「情境-特質焦慮量表」,他們發現兩組之間並無差異。
  
  加州大學洛杉磯分校的外科醫師Areti Tillou評論這篇發表是「傑出」的研究。
  
  Tillou醫師表示,心理訓練對於外科是相當有趣的概念,但是她提醒,相較於試圖獲得技能的新運動員,它對於要精進技能的運動員更有用。
  
  Tillou醫師想瞭解這兩組在開始時的比較。
  
  Louridas報告指出,心理訓練組在開始時的分數是比較高,所以研究者比較的是兩組的分數變化差異而不是實際分數。
  
  發表結束後,一名聽眾問Louridas,這類訓練類型對比較高層次者如教師是否有影響,她表示她認為這對任何層級都會有幫助。另一名聽眾問,心理訓練組是從腳本中的觀點還是從實務中獲得幫助。
  
  Louridas表示,這幾乎是無法分割的,如果我給你腳本讓你讀一遍,我不認為會一樣有效,只是我們沒有第三組來這樣試驗。
  
  資料來源:

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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