Development of a mental script for the mental practice of micro suturing: a methodological approach

• Published in: Annals of the Royal College of Surgeons of England Vol. 104; no. 4; pp. 288 - 294
• Main Authors: Rajaratnam, V, Ng, Hjh, Rahman, N A, Dong, C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-04-2022; Royal College of Surgeons
• Subjects: Animal cognition; Clinical Competence; Education and Training; Focus groups; Humans; Instructional design; Laboratories; Microsurgery; Motor Skills; Skills; Surgeons; Surveys and Questionnaires; Sutures; Task analysis; Taxonomy; Hierarchical task analysis; Motor imagery; Surgical skills training; Mental practice; Verbal protocol analysis; Mental script
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2021.0171

Motor imagery and mental practice are important for the acquisition and mastery of surgical skills. The success of this technique relies on the use of a well-developed mental script. In this study, we shared how we developed a mental script for basic micro suturing training by using a low-fidelity rubber glove model.
This study applied the design and development research framework. Five expert surgeons developed a mental script by performing a cognitive walkthrough to repair a vertical opening in a rubber glove model, followed by hierarchical task analysis. A draft script was created, and its face and content validity assessed with a checking-back process. Twenty-eight surgeons used the Mental Imagery Questionnaire (MIQ) to assess the validity of the final script.
The process of developing the mental script is detailed. The assessment by the expert panel showed the mental script had good face and content validity. The mean overall MIQ score was 5.2±1.1 (standard deviation), demonstrating the validity of generating mental imagery from the mental script developed in this study for micro suturing in the rubber glove model.
The methodological approach described in this study is based on a design and development research framework to teach surgical skills. This model is inexpensive and easily accessible, addressing the challenges of reduced opportunities to practise surgical skills. However, although motor skills are important, the surgeon's other non-technical expertise is not addressed with this model. Thus, this model should act as one surgical training approach, but not replace it.