Lin John C, Paul Alfred A, Greenberg Paul B
Program in Liberal Medical Education, Brown University, Providence, Rhode Island; Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island.
Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island; Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island.
J Surg Educ. 2020 Nov-Dec;77(6):1377-1391. doi: 10.1016/j.jsurg.2020.05.028. Epub 2020 Aug 6.
Mental skills training (MST) in surgical education varies greatly in quality and outcomes. This systematic review assessed the effectiveness of MST on surgical trainee performance in simulated and operating room (OR) settings.
We searched PubMed/MEDLINE, EMBASE, and PsycINFO for randomized controlled trials using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Peer-reviewed studies published in the English language between January 1, 2000 and March 1, 2020 were considered for inclusion. Articles that did not study surgical residents, assess surgical performance as an outcome, or report findings were excluded. Study characteristics, methodologies, and outcomes were qualitatively analyzed. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to measure the quality of the studies, and the Oxford quality scoring system for risk of bias ratings.
Seven randomized controlled trials met study inclusion criteria; interventions were mental practice, relaxation exercises, action observation, and Mindfulness-Based Stress Reduction. Targeted interventions based on mental practice, relaxation exercises, and MBSR significantly improved surgical performance in four (57%) studies. Risk of bias was low for all included studies, and quality of evidence was moderate for both simulated and OR performance.
Mental practice, relaxation, and mindfulness training improved simulation and OR performance for surgical residents. There was insufficient evidence to support other MST interventions or the intermediate- and long-term efficacy of MST.
外科教育中的心理技能训练（MST）在质量和效果方面差异很大。本系统评价评估了MST在模拟环境和手术室（OR）环境中对外科实习生表现的有效性。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed/MEDLINE、EMBASE和PsycINFO中检索随机对照试验。纳入2000年1月1日至2020年3月1日期间以英文发表的同行评审研究。未研究外科住院医师、未将手术表现作为结果进行评估或未报告研究结果的文章被排除。对研究特征、方法和结果进行定性分析。使用推荐分级、评估、制定与评价（GRADE）来衡量研究质量，并采用牛津质量评分系统进行偏倚风险评级。
七项随机对照试验符合研究纳入标准；干预措施包括心理练习、放松练习、动作观察和基于正念的减压法。在四项（57%）研究中，基于心理练习、放松练习和正念减压法的针对性干预显著提高了手术表现。所有纳入研究的偏倚风险较低，模拟环境和手术室表现的证据质量均为中等。
心理练习、放松和正念训练提高了外科住院医师在模拟环境和手术室中的表现。没有足够的证据支持其他MST干预措施或MST的中长期疗效。
