Motor learning principle | Study | Design/Setting | Population | Experience | Procedure | Educational intervention | Outcome measurement | Endpoints | Main findings |
---|---|---|---|---|---|---|---|---|---|
Part task practice-Whole task practice | Brydges et al. [9] | RCT (3 arms)/Canada | N = 18 post-graduate surgical residents (1st year) | Unclear experience | Orthopaedic surgical task (bone-plating task on artificial radial bones, with five separate skills) | Group 1: Whole task practice | Motion analysis system: | Pre-test | Post-acquisition-test: |
Group 2: Part task practice (random) | a) Number of hand movements | Post-acquisition test (5 min after training) | PT: Similar performance between groups | ||||||
Group 3: Part task practice (blocked) | b) Total time on task Videotape (expert evaluation): | Transfer test (1 week after the acquisition phase on an artificial radius) | MD: In favour of part practice (not significant) | ||||||
a) Global rating scale (operative performance) | Transfer test: | ||||||||
b) 15-item checklist (operation-specific procedures) | PT: Infavour of part practice (not significant) | ||||||||
c) Final product analysis | MD: In favour of part practice (not significant) | ||||||||
Dubrowski et al. [62] | RCT (3 arms)/Canada | N = 28 medical students (1st and 2nd year), | Novice learners | Orthopaedic surgical task (bone plating task on artificial ulna bones, with five separate skills) | Group 1: Whole task practice (“functional- order-practice”) (3× 20 min sessions) | a) Checklist (operation-specific measurements) | Pre-test | Post-acquisition-test: | |
b) Final product analysis | Post-acquisition test (immediately after acquisition phase) | PT: In favour of whole practice (significant) | |||||||
Group 2: Part practice (random) (3× 20 min. sessions) | c) Global rating scale (general operative performance) | ||||||||
Group 3: Part practice (blocked) (5× 12 min. sessions) | d) Duration of the drilling skill | Retention test (after 30 min rest period) | |||||||
All participants practiced each skill 3 times for 2 min and 10 sec | |||||||||
Willaert et al. [63] | RCT/UK | N = 20 junior medical residents (surgery, radiology and cardiology) | Prior experience as an operator but not with this procedure | Carotid stenting procedure (virtual reality simulation) | Group 1: Part task rehearsal; 30 min of repeated catheterisations | a) Simulator derived dexterity metrics (procedure time, fluoroscopy time, contrast volume and number of roadmaps) | Post-acquisition test immediately after the training on a “real” patient | Post-acquisition-test: | |
Group 2: Whole task rehearsal (N = 10); one full task rehearsal (~30 min) | b) Video recordings of hand movements (evaluated with a GRS and a PSRS) | PT: Similar performance between groups | |||||||
c) Non Technical Skills for Surgeons Rating Scale | MD: Similar performance between groups | ||||||||
d) Self-assessment | |||||||||
Random practice-Blocked practice | Brydges et al. [9] | See above | See above | See above | See above | See above | See above | Pre-test | Post-acquisition-test: |
Post-acquisition test (5 min after training) | PT: In favour of random practice (not significant) | ||||||||
Transfer test (1 week after the acquisition phase on an artificial radius) | MD: In favour of random practice (not significant) | ||||||||
Transfer test: | |||||||||
PT: In favour of blocked practice (not significant) | |||||||||
MD: In favour of random practice (not significant) | |||||||||
Dubrowski et al. [62] | See above | See above | See above | See above | See above | See above | Pre-test | Post-acquisition-test: | |
Post-acquisition test (immediately after acquisition phase) | PT: In favour of random practice (not significant) | ||||||||
Retention test (after 30 min rest period) | |||||||||
Mental practice | Arora et al. [64] | RCT/UK | N = 18 (surgeons) | Novices to laparoscopic surgery | Laparoscopic chole-cystectomies (simulation) | Group 1: Had an additional mental practice session before the simulation (30 min) | a) GRS of technical skills | Pre-test | Post-acquisition-test: |
Group 2: Had no additional training | b) Mental Imagery Questionnaire | Post-acquisition test | PT: In favour of mental practice (significant) | ||||||
Learning curve (all 5 practice sessions were measured) | |||||||||
Bathalon et al. [65] | RCT (3 arms)/Canada | N = 44 medical students (1st year) | Novices | Cricothyrotomy (simulation) | Group 1: Kinesiology practice (cognitive task analysis). The procedure was divided in 8 specific steps. All steps were discussed and practiced separately | OSCE examination: | Retention test (2 weeks after the teaching event) | Retention test: | |
a) Knowledge of needed steps | MD: In favour of no mental practice (not significant) | ||||||||
Group 2: Kinesiology and mental imagery. Same practice as group 1. With additional 5 min of mental imagery | b) Time and fluidity of intervention | ||||||||
Group 3: Standard educational ATLS approach | |||||||||
Geoffrion et al. [66] | Multi-centre RCT/8 centres across Canada and the USA | N = 50 junior gynaecology residents | All participants were at the start of their learning curve | Vaginal hysterectomies | Group 1: Mental Practice. The MP script enumerated the procedure steps based on a reference textbook. The participants performed the MP with an expert educator. MP was continued individually until the participant felt comfortable with the procedure. Group 2: Participants were encouraged to read a textbook describing the procedure. | a) GRS of surgical skill | Pre-test | Post-acquisition-test: | |
b) Procedure-specific score | Post-acquisition test (immediately after the intervention) | PT: In favour of mental practice (non significant) | |||||||
c) Self-assessment (GRS) | |||||||||
d) Self-confidence | MD: In favour of mental practice (not significant) | ||||||||
e) Time in operating theatre | |||||||||
f) Attending surgeons evaluations (e.g. blood loss and complications) | |||||||||
Jungmann et al. [67] | RCT/Germany | N = 40 medical students | Novice learners | Laparoscopic exercises: | All participants followed 2 sessions on a simulator with three tasks. | Performance measures: | Pre-test (parameters of the 1st training session) | Post-acquisition-test: | |
a) Grasping movements | Between the 2 sessions: | a) Time | |||||||
b) Tissue manipulation | Group 1: Additional mental practice (at least 4 times and not less than 3 min) | b) Tip trajectory | |||||||
c) Surgeons’ Knot | Group 2: No additional training | c) Time of the instrument collision | Post-acquisition test (parameters of the 2nd training session) | MD: In favour of no mental practice (not significant) | |||||
Visual-spatial ability: | |||||||||
a) Cube test | |||||||||
Komesu et al. [68] | Multi-centre RCT/6 academic centres in the USA | N = 68 gynaecology residents | Some prior experience with the procedure | Cystoscopy | Group 1: Mental practice 24-48 h prior to a scheduled cystoscopy. Session lasted < 20 min | a) Global Scale of Operative Performance | 1st Post-acquisition test (Evaluation of the 1st procedure) | Post-acquisition-test: | |
b) Time required for cystoscopy | PT: In favour for mental practice (significant) | ||||||||
Group 2: Students were encouraged to read a standard text 24-48 h prior to a scheduled cystoscopy. | c) Competence to perform the procedure | ||||||||
d) Preparedness for the procedure | 2nd Post-acquisition test (Evaluation of the 2nd procedure) | MD: In favour of no mental practice (not significant) | |||||||
Rakestraw et al. [69] | RCT/USA | N = 160 medical students (2nd year) | Novice learners | Pelvic examination | Group 1 (control group): 1 student practiced the task and two students observed the performance | Knowledge of attainment | 1st post-acquisition test (after practice on models) | Study not included into the meta-analysis | |
a) Memory list of relevant steps | |||||||||
Group 2: Mental practice before the task (pre-motor). | b) Patient record | ||||||||
Group 3: Mental practice after the task (post-motor) | Performance measures: | Retention test (immediately before the evaluation on a simulated patients) | |||||||
a) Behavioural checklist | |||||||||
Group 4: Mental practice before and after the task. | |||||||||
Transfer test (simulated -patients) | |||||||||
Sanders et al. [70] | RCT (3arms)/USA | N = 65 medical students (2nd year) | Unclear experience | Cutting and suturing a pig’s foots | Group 1: 3 sessions of physical practice | a) 7-item GRS | Post-acquisition-test (During the 1st training session) | Post-acquisition-test: | |
Group 2: 2 sessions of physical practice and 1 session of mental practice (relaxation exercises and imagery exercises) | b) Surgical skills attitude questionnaire (Confidence) | PT: In favour of mental practice (not significant) | |||||||
Transfer test (10 days after the last session) | Transfer test: | ||||||||
Group 3: 1 session of physical practice and 2 sessions of mental practice (relaxation exercises and imagery Tr test: exercises) | PT: In favour of no mental practice (not significant) | ||||||||
Sanders et al. [71] | RCT/USA | N = 64 medical students (2nd year) | Unclear experience | Cutting and suturing a pig’s foot | Group 1: Mental practice for ~30 min (1st part relaxation exercises and 2nd part imagery exercises) (2 sessions) | Surgical performance: | Pre-test (confounding) | Post-acquisition-test: | |
a) 15 item checklist (surgical behaviour) | |||||||||
b) 6 specific rating scales | |||||||||
Group 2: Textbook study for 30 min (using a verbal method) (2 sessions) | Measurement of confounding: | Post-acquisition test (after the 1st intervention period) | PT: In favour of no mental practice (not significant) | ||||||
Afterwards: All participants received 1 h practice under supervision (together) | a) Self-confidence | 1st retention test (after the 1 h practice session) | Transfer test: | ||||||
b) Prior learning | PT: In favour of mental practice (not significant) | ||||||||
c) Anxiety | 2nd retention test (10 days after the last intervention) | ||||||||
d) Visual-spatial ability | |||||||||
Terminal Feedback-Concurrent Feedback | Chang et al. [72] | RCT (3arms)/Taiwan | N = 36 undergraduate physical therapist students | Limited exposure to peripheral joint mobilisa-tion | Joint mobilization (simulation) | Group 1: Received concurrent graphical feedback on their performance during three 25 trials blocks | Accuracy of performance: | Pre-test | Post-acquisition-test: |
a) Deviation of the grading force | Acquisition phase test | PT: In favour of terminal feedback (not significant) | |||||||
Group 2: Received terminal feedback on their performance after each trial block | Post-acquisition test (10 min after the acquisition phase) | ||||||||
Retention test: | |||||||||
Group 3: Received no feedback | Retention test (5 days after the acquisition phase) | PT: In favour of concurrent feedback (not significant) | |||||||
The skill acquisition phase lasted ~40 min for all groups | |||||||||
Gofton et al. [73] | RCT (3 arms)/Canada | N = 45 surgical residents (1st or 2nd year) or senior medical students | Some prior experience with the procedure | Acetabular cup placement (simulation) | Group 1: Conventional training | Performance measures: | Pre-test | Post-acquisition-test: | |
Group 2: Received concurrent feedback during each trial | a) Acetabular position | Post-acquisition test & transfer test | PT: In favour of terminal feedback (not significant) | ||||||
b) Time required to determine optimal position | |||||||||
Group 3: Received terminal feedback after every trial | Visual-spatial ability | (10 min after the skill acquisition) | Retention test: | ||||||
a) Mental Rotations Test Part A | Retention- & transfer test (6 weeks after the skill acquisition) | PT: In favour of concurrent feedback (not significant) | |||||||
O’Connor et al. [74] | RCT (3 arms)/USA | N = 9 medical students (1st and 2nd year) | Unclear experience | Laparoscopic knot-tying and suturing (simulation) | Group 1: Received no feedback during the 4 weeks | Measurement of performance: | Measurement points during all practice sessions | Post-acquisition-test: | |
a) Time | PT: In favour of concurrent feedback (not significant) | ||||||||
Group 2: Received KR at the end of each practice session | b) Instrument path length | ||||||||
c) Smoothness of instruments | |||||||||
Group 3: Received KR and KP during and at the end of each practice session | d) Examination of each knot | ||||||||
f) Error scale | |||||||||
Walsh et al. [75] | RCT/Canada | N = 30 medical students (1st and 2nd year) | Novice learners | Colonoscopy (simulation) | Group 1: Received concurrent feedback (KP) | Performance measures: | Pre-test | Post-acquisition-test: | |
a) Execution time | Post-acquisition test (immediately after the practice) | PT: In favour of concurrent feedback (not significant) | |||||||
Group 2: Received terminal feedback (KR) | b) 5-item Checklist (endoscopic performance) | ||||||||
MD: In favour of concurrent feedback (not significant) | |||||||||
c) GRS | 2nd retention test (1 week after the intervention) | ||||||||
Retention test: | |||||||||
Transfer test (1 week after the intervention) | PT: In favour of concurrent feedback (not significant) | ||||||||
MD: In favour of concurrent feedback (not significant) | |||||||||
Transfer test: | |||||||||
PT: In favour of terminal feedback (significant) | |||||||||
MD: In favour of terminal feedback (significant) |