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date: 22 October 2017

Surgical Performance from a Psychological Perspective

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Psychology. Please check back later for the full article.

There are close parallels between surgical performance and performance in competitive sports. For example, both require significant gross and fine motor ability and effective concentration skills, and both are routinely performed in dynamic environments under significant time constraints. Given such parallels, it is not surprising that there has been an upsurge of research interest in the psychological processes that underlie expertise in surgical performance. Of these processes, perhaps the most frequently studied in recent years is that of motor imagery (MI; also known as “mental practice” or MP), the cognitive simulation skill that enables us to “see” and “feel” actions in our imagination without engaging in the physical movements involved. Current research interest in the role of motor (or “feeling oriented”) imagery in surgical performance is attributable to a combination of theoretical and practical factors. Specifically, at a theoretical level, hundreds of experimental studies in psychology have demonstrated the efficacy of MI/MP in improving skill learning and skilled performance in a variety of fields such as sport and music. The most widely accepted explanation of these effects comes from simulation theory, which postulates that executed and imagined actions share some common neural circuits and cognitive mechanisms. Put simply, imagining a skill activates some of the brain areas that are involved in its actual execution. Accordingly, systematic engagement in MI/MP appears to “prime” the brain for optimal skilled performance. Turning to the practical level, as surgical instruction has moved largely from an apprenticeship model (the so-called, “see one, do one, teach one” approach) to a model based on simulation technology (e.g., the use of virtual reality equipment), there has been a steady growth of interest in the potential of cognitive training techniques (e.g., MI/MP) to improve surgical skills and performance. Although these cognitive training techniques suffer both from certain conceptual confusion (e.g., with regard to the clarity of key terms) and inadequate empirical validation, they offer considerable promise in the quest for a cost-effective supplementary training tool in surgical education. Against this background, it is important for researchers and practitioners alike to evaluate progress in understanding the cognitive psychological factors (such as motor imagery) that underlie surgical skill learning and performance.