Development and validation of a mental practice tool for laparoscopic salpingectomy

Objective Laparoscopic training in gynaecology is impacted by the working time directive, non-surgical management options and concerns around safety and efficiency. One method of enhancing the available opportunities is to adopt mental practice (MP), or the cognitive rehearsal of a task in the absence of overt physical movement. The primary objective of the study was to develop and validate a MP script for laparoscopic salpingectomy (LS). Design Prospective cohort study. Method Three expert gynaecologic surgeons performed a guided task description for a LS. Each interview was transcribed and coded for visual, cognitive, and kinaesthetic cues by two independent assessors, before being merged into a single script based on common elements. For validation, a sample of 22 trainees ( 50 LS) were recruited from three teaching hospitals. The novices formed two equal groups-a faceto-face group, and a virtual group. All groups participated in a standardized validation process. Each participant underwent pre-and post-MP assessment using a previously validated mental imagery questionnaire (MIQ) to evaluate the impact of the imagery script on motivation, confidence, preparedness and quality of imagery. Scores were compared within each group by the Wilcoxon signed-rank test, and between groups with the Mann-Whitney U test (significance set at P < 0.05). Results Both novice groups significantly improved their MIQ scores for each element and the global score following the MP session. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, inferring non-inferiority of the virtual platform. Significant improvement in global MIQ scores after MP was demonstrated in all three groups. The median global scores for the face-to-face novice group were 27 preand 43 post-MP (P = 0.001), for the virtual novice group 23 and 41 (P = 0.001), and for the expert group 54 and 56 (P = 0.004). Reliability testing of the MIQ indicated a high degree of internal consistency (Cronbach a coefficient: pre-MP 0.957;post-MP 0.965). There was also a high degree of correlation between interview coders (total cues per interview;K-alpha = 0.861). Conclusions A MP script has been developed and validated for LS. The virtual platform was demonstrated to be non-inferior to the face-to-face approach, which is an important consideration in the current COVID era. Further research is needed to evaluate the impact in clinical practice.