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Sébastien Bathalon, M.D. Dominique Dorion, M.D., M.Sc. Marcel Martin, M.D. Cognitive Task Analysis, Kinesiology and Mental Imagery: Challenging Surgical.

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Presentation on theme: "Sébastien Bathalon, M.D. Dominique Dorion, M.D., M.Sc. Marcel Martin, M.D. Cognitive Task Analysis, Kinesiology and Mental Imagery: Challenging Surgical."— Presentation transcript:

1 Sébastien Bathalon, M.D. Dominique Dorion, M.D., M.Sc. Marcel Martin, M.D. Cognitive Task Analysis, Kinesiology and Mental Imagery: Challenging Surgical Attrition

2 Introduction See one. Do one. Teach one.* * Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp, 1904 * Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp, 1904

3 The problem… Pressures to change the classical teaching system –Pathologies –Explosion of the surgical armamentarium –Medico-legal issues efficacy efficiency safety cost –Requirement for standardization by accreditation bodies (ACGME. AB) –Attrition of knowledge

4 …the solutions Simulation lab Cognitive task analysis Kinesiology Mental imagery

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6 …the solutions Simulation lab Cognitive task analysis Kinesiology Mental imagery

7 «Cognitive task analysis is a formal way of deconstructing a procedure into its simpler parts» Cognitive task analysis

8 2- laryngeal stabilization 3- incision 1- anatomical landmark identification 4- blunt dissection

9 5- stab incision of CT membrane 6- opening of CT space 7- insertion of canula 8- inflation of tracheotomy tube

10 …the solutions Simulation lab Cognitive task analysis Kinesiology Mental imagery

11 - The study of movements –Applied to surgery, it leads to including aspects of biomechanics (ergonomics), task and movement analysis and correction. Kinesiology

12 …the solutions Simulation lab Cognitive task analysis Kinesiology Mental imagery

13 «Symbolic repetition of a physical action without the muscular counterpart» Richardson A, Mental Imagery, 1969 Richardson A, Mental Imagery, 1969 Mental imagery

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15 Hypothesis The use of - cognitive task analysis - kinesiology - mental imagery in the teaching of rarely performed emergency procedures like cricothyrotomy will improve its acquisition and long-term retention compared to standard teaching

16 Method 44 first-year medical students Teaching session –45-minute timed teaching session –Surgical anatomy –Short lecture on the handling of surgical instruments –Practice on rubber neck model

17 Method Randomized in three groups –Kinesiology alone (KG) –Kinesiology+mental practice (KG+MI) –Control group ATLS

18 Method STEPS 16 marks TIME 7 marks FLUIDITY 2 marks TOTAL 25 marks ∗ Evaluation at 2 weeks; 6 months and 12 months (2 years is planned)

19 Results 2 weeks KG + MI 20,3 +/- 1,5 * (n=15) KG19,3 +/- 2.9 (n=13) ATLS 18,2 +/- 2,5 * (n=16) 6 months 19,7 +/- 2,4 * (n=14) 19,4 +/- 3,4 (n=13) 16,6 +/- 4,8 * (n=15) 12 months 21,5 +/- 1,8 * # (n=15) 19,5 +/- 1,9 # ‡ (n=13) 16,5 +/- 2,9 * ‡ (n=16)

20 Conclusions Educating residents is evolving faster and faster… Cognitive task analysis, kinesiology and mental imagery are new approaches that improve the teaching of rarely performed surgical skills. Applications for these new tools are yet to be explored and will require more work.

21 Conclusions More specifically regarding mental imagery, –How should it be taught? –Who should we teach it to? –Can it be used to select residents? Lots of work is yet to be done…

22 Thanks Dr Marcel Martin Nicolas Fontaine Isabelle and Marie-Eve

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24 Résultats (acquisition 2 semaines ) Étapes (16)Temps ( 7 )Fluidité ( 2 )Total (25) KG +RM 1 (n=15) 14,8 +/- 0,9*3,9 +/- 0,91,6 +/- 0,6*20,3 +/- 1,5* KG 2 (n=13) 14,5 +/- 1,33,2 +/- 1,81,5 +/- 0,7*19,3 +/- 2,9 Contrôle (ATLS) (n=16) 13,2 +/- 1,84,0 +/- 1,41,0 +/- 0,718,2 +/- 2,5

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26 Potential applications of imaginary practice Early stages of learning a basic skill Diminishing the learning curve for a new procedure Transferring skills from an established technique Hindering the decay of skills Pre-op preparation for a complex procedure Hall, American Journal of Surgery, 2002

27 Mental imagery techniques External imagery –The person views himself from the perspective of an external observer (much like in home movies). Internal imagery –approximation of the real life phenomenology –the person actually imagines being inside his/her body –experiencing those sensations which might be expected in the actual situation. MAHONEY and al. Cognit. Ther; 1977

28 Yerkes-Dodson rule Learning potential vs stress

29 Experts Nicolas Fontaine Alain Prost Jacques Laffite Annie Pelletier Sylvie Bernier Eric Lucas Mélanie Turgeon

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31 Résultats (total) GROUPE 2 sem6 mois12 mois KG+RM20,3 +/- 1,5* (n=15) 19,7 +/- 2,4* (n=14) 21,5 +/- 1,8* # (n=15) KG19,3 +/- 2,9 (n=13) 19,4 +/- 3,4 (n=13) 19,5 +/- 1,9* (n=13) ATLS18,2 +/- 2,5 (n=16) 16,6 +/- 4.8 (n=15) 16,5 +/- 3,0 (n=16)

32 Ali et al, American J of Surgery, 2002

33 " J'ai pris les grands moyens avec un entraînement sur glace et hors glace. J'ai également fait beaucoup de visualisation… » José Théodore


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