Global surgical education : journal of the Association for Surgical Education最新文献

Purpose: Surgeons often experience stress that may negatively impact performance. Mental skills are psychological techniques designed to prevent skill deterioration under stress and enhance performance. Mental skills curricula have proved effective in other disciplines but are rarely used in surgery. Additionally, research on mental skill use by surgeons has been very limited. The objectives of this study were to (1) explore whether expert surgeons use mental skills to enhance their performance, (2) determine how they implement mental skills, and 3) assess the need for mental skills training in surgical residency.

Methods: After IRB approval, 7 expert surgeons (≥ 15 years of experience, prominence in their respective fields) from general surgery, obstetrics/gynecology, and neurosurgery voluntarily participated in semi-structured interviews. Responses were transcribed and analyzed until themes were identified.

Results: All interviewed surgeons indicated that they regularly use some combination of mental skills to achieve their ideal performance state for surgery, manage intraoperative stress, and manage distractions before and during surgery. Further, all participating surgeons reported feeling responsible, as the leader of the surgical team, to project a calm demeanor during stressful situations to optimize the team's performance. While none of the participating surgeons had received mental skills training, 71% (5 of 7) advocated for the incorporation of mental skills training into surgery residency.

Conclusions: Mental skills are routinely used by expert surgeons to enhance performance and manage stress. While mental skills seem to be acquired over years of practice, experts agree that these skills warrant formal introduction during residency.

Purpose: The purpose of this study was to identify specific simulated scenarios and events for surgeons that discretely and effectively measure non-technical skills (NTS) constructs and appropriately measure NTS using specific behavioral anchors.

Methods: Over the course of two rounds, experts in NTS accumulated a comprehensive list of simulated scenarios used at our institution to evaluate NTS. Utilizing a survey, experts were able to review scenarios, events, and behavioral anchors to evaluate their agreement with the appropriateness of the events and effectiveness of the anchors. Coefficient of variation (CV) was used to evaluate agreement between raters. The highest rated events were identified.

Results: The CV between raters was moderate, and further inspection revealed that 86% of event ratings had discordance within ± 1 point. The highest rated events in terms of appropriateness and behavioral anchor effectiveness evaluated surgeons' leadership and communication.

Conclusions: In this study, experts identified three simulated events that isolate and discretely evaluate specific NTS among surgeons. In the future, these scenarios can be used to effectively evaluate surgeons' NTS.

Supplementary information: The online version contains supplementary material available at 10.1007/s44186-025-00390-6.

Purpose: Our objective was to understand the cognitive strategies used by surgeons to mentally visualize navigation of a surgical instrument through blind space.

Methods: We conducted semi-structured interviews with 15 expert and novice surgeons following simulated retropubic trocar passage on 3D-printed models of pelvises segmented from preop MRIs. Midurethral sling surgery involves blind passage of a trocar among the urethra, bladder, iliac vessels, and bowel while relying primarily on haptic feedback from the suprapubic bone (SPB) for guidance. Our conceptual foundation was based on Lahav's study on blind people's mental mapping of spaces using haptic cues. Participants detailed how they mentally pictured the trocar's location relative to vital anatomy. We coded all responses and used constant comparative analysis to generate themes, confirmed with member checking.

Results: Expert and novice participants utilized multiple cognitive strategies combined with haptic feedback to accomplish safe trocar passage. Some used a step-by-step route strategy, visualizing sequential 2D axial images of anatomy adjacent to the SPB. Others used a map strategy, forming global 3D pictures. Although these mental pictures vanished when they were "lost," a safe zone could be reestablished by touching the SPB. Experts were more likely to relate their body position to the trocar path and rely on minor variations in resistance. Novices were more inclined toward backtracking of the trocar.

Conclusions: Our findings may be extended to any blind surgical procedure. Teaching visualization strategies and incorporating tactile feedback can be used intraoperatively to help learners navigate their instrument safely around vital organs.