ABSTRACT
BACKGROUND: Simulation is an effective adjunct to surgical training. There is increasing interest in the use of mental rehearsal as a form of cognitive simulation. The mental visualisation of a motor skill is recognised to enhance performance; a concept not novel to surgeons. Despite this, mental rehearsal has yet to be formally incorporated into surgical training. This study aims to assess the use of mental rehearsal amongst general surgical trainees and consultants. METHOD: A six-item questionnaire was designed and electronically circulated to general surgical core trainees, registrars, fellows and consultants. Qualitative and quantitative analysis was independently performed. RESULTS: 153 responses (consultants = 51.6%, trainees = 48.4%) were received over 3 weeks. 91.5% of surgeons mentally rehearse prior to operating. Its use predominates for complex cases only. There is no difference in case complexity and the surgeon's grade in regard to when mental rehearsal is performed (χ2 = 1.027, p = 0.31). Individual mental rehearsal is preferred. Consultants are more likely to mentally rehearse with others, although there was no statistical difference compared to trainees (χ2 = 0.239, p = 0.63). Clarification, confidence and anticipation of potential difficulties were the perceived benefits of mental rehearsal reported in 58.6% of responses. CONCLUSIONS: Mental rehearsal prior to operating appears instinctive for general surgeons irrespective of seniority and case complexity. Whether the efficacy of mental rehearsal on training is sustained and continues as surgeons progress along the training curve are unknown. Alternative methods of surgical training are very much needed. We propose mental rehearsal.
Subject(s)
Simulation Training , Surgeons , Clinical Competence , Computer Simulation , Humans , Surveys and QuestionnairesABSTRACT
BACKGROUND: Up to 50% of patients develop post-thrombotic syndrome (PTS) following their first proximal deep vein thrombosis (DVT). This meta-analysis aims to evaluate the effectiveness of graduated compression stockings (GCS) in preventing PTS. METHOD: Medline, Embase, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were electronically searched from inception to January 2015 for studies investigating the effect of GCS in preventing PTS. All randomised control trials were considered for inclusion if they compared the efficacy of GCS (30-40 mmHg at the ankle) with either placebo or no stockings in adults with new proximal lower limb DVT. Methodological assessment, using the Cochrane Risk of Bias Tool, and data extraction was performed by two independent reviewers. The effect of GCS was expressed as the risk difference (RD). RESULTS: A total of 686 articles were screened. Three randomised controlled trials inclusive of 1,177 patients were eligible for inclusion. PTS developed in 49-70% of control patients at 5 years. High statistical heterogeneity was observed between trials (all PTS: I(2) = 0.94; severe PTS: I(2) = 0.79). The risk difference in PTS incidence between control and GCS arms varied from 0% to 39% between trials. In trials with a higher baseline prevalence of PTS, a visual trend towards more benefit with GCS was noted. CONCLUSION: Uncertainty because of sampling variability and heterogeneity was too high to conclude in favour or against an effect of wearing compression stockings in preventing PTS. An effect may be present for higher values of baseline risk. Further evidence is needed. Article history.
