Skip to main content

Table 2 Characteristics of included studies

From: A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education

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)

  1. ATLS Advanced Trauma Life Support, GRS Global Rating Scale, KP Knowledge of performance, KR Knowledge of results, MD Movement duration, MI Mental imagery, mMIQ modified Mental Imagery Questionnaire, MP Mental practice, PSRS Procedure Specific Rating Scale, PT Performance tests, VH Vaginal hysterectomy