SURGERY
Mitigating the impact of COVID on surgical skills
How can we mitigate the consequences of decreased surgical workload during the COVID-19 pandemic? Mental training and digital workflows could prove vital, as hospitals seek strategies to ensure theatre teams maintain, improve or develop their surgical skills.
Unfamiliar to the surgical team, mental training (MT) and digital workflows (DW) have in common the identification of procedural phases and a step-by-step instructional framework. We propose that MT and DW may help to alleviate the detriments of reduced practice in crisis. While the first allows for mental rehearsal of step-by-step instructions, the latter makes those surgical steps digitally available during procedures. Accessible anytime and anywhere, their use could help surgeons maintain their skills and enable trainees to improve the acquisition of skills.
Background
The COVID-19 pandemic has led to a dramatic decrease of surgical activities worldwide hindering performance at almost every stage of the learning curve with a possible impact on patient outcomes. In order to retain resources and protect citizens, health authorities suspended elective surgical procedures,
ultimately reducing professionals’ hands-on practice. While undoubtedly necessary, this has been detrimental to surgical skills training for residents and skills maintenance for surgeons.1 Moreover, patients reluctant to attend emergency or elective clinics are further impacting surgical practice, while exposing themselves to the consequences of a delayed diagnosis. We believe the implications of non-practicing may go beyond the simple initial frustration. Furthermore, large simulation centres, attracting thousands of national and international trainees annually, have cancelled their physical courses, reducing further professional development opportunities.
Material and methods While mental practice was born in the tragedy of war, from aviators rehearsing engagements with mental imagery, its developments have been primarily spurred on through sports science. Since the 80s,
meta-analyses from hundreds of RCTs have consistently shown improvement in top athletes’ performance.2
Although surgeons, A decade later,
research in aviation showed robust outcomes on skills acquisition, mental readiness, team training and safety.3
pilots and athletes have in common a high level of skills, high-stake procedures and high levels of stress, MT for surgeons is limited to visionary and educated thoughts. The first qualitative study on mental readiness for expert surgeons came in 1995 from a world class sport psychologist, Terry Orlick, and a surgeon/educationist, Judy McDonald.4
Since surgeons are generally
less familiar with qualitative research, it took 12 years until the first RCT on mental training was carried out with residents at early competency level.
This study conducted in laparoscopy, also by a sport psychologist and a surgeon, showed the mental rehearsal group improved to a significantly greater extent than the other two groups on a task specific checklist.5
While
these studies were catered to more skilled participants, the first trial in surgical novices showed a more significant impact of MT on laparoscopic skills enhancement compared to additional box practice or virtual reality, and reduced variability between participants.6
As
a sequel, a recent study further explored this concept. Kaulfuß et al showed that MT not only significantly maintained and enhanced skills in more complicated tasks over an extended period of 16 months, as shown in Fig.1, but also showed significant impact on performance measures such as mental imagery and procedural planning.7 The profound impact of MT could be
further supported by digital workflows based on the identification and use of similar procedural steps.8,9
A positive impact of this Figure 1 Skills maintenance 16-months after training with novices. NOVEMBER 2020
OR technology is shown on the learning curve of junior surgeons in Fig.2. Powering surgical workflows in the operating room with digital technology is a novel way of
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©Julia Kaulfuss, Christian Meyer ahead of publication
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