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Mental practice: a simple tool to enhance team-based trauma resuscitation

  • Gianni R. Lorello (a1), Christopher M. Hicks (a2), Sana-Ara Ahmed (a1), Zoe Unger (a1), Deven Chandra (a1) and Megan A. Hayter (a3)...
Abstract Introduction

Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated.


We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences.


Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01.


MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.

Résumé Introduction

La réanimation efficace des traumatisés exige la coordination des efforts d’une équipe interdisciplinaire. La visualisation mentale (VM) se définit comme la répétition mentale d’une action, sans mouvement musculaire visible, et il a été démontré que ce type d’exercice mental améliorait l’acquisition de compétences techniques et opératoires. Toutefois, le rôle de la VM visant à faciliter l’acquisition de compétences non techniques, réalisées en équipe, dans la prestation des soins aux traumatisés reste à étudier.


Après répartition aléatoire, des résidents en anesthésiologie, en médecine d’urgence et en chirurgie ont été divisés en équipes de deux membres, elles-mêmes dirigées au hasard vers le groupe de VM ou vers le groupe témoin. Le groupe de VM s’est concentré sur une VM de 20 minutes, tandis que le groupe témoin a reçu une formation de 20 minutes sur les principes des soins avancés de réanimation traumatologique (Advanced Trauma Life Support© [ATLS]). Par la suite, toutes les équipes ont participé à une simulation réaliste de réanimation chez des adultes traumatisés, après quoi elles ont reçu un compte rendu sur la communication, le pouvoir d’influence et le travail d’équipe. Deux examinateurs tenus dans l’ignorance des faits ont évalué, chacun de leur côté, les enregistrements vidéo des réanimations simulées, et ce, à l’aide de la Mayo High Performance Teamwork Scale (MHPTS), une échelle validée d'évaluation du comportement en équipe. Le test U de Mann-Whitney a servi à évaluer les écarts entre groupes.


Soixante-dix-huit résidents ont donné, par écrit, leur consentement éclairé, puis ont été retenus pour l’étude. Le groupe de VM a obtenu des résultats significativement meilleurs que le groupe témoin en ce qui concerne le comportement en équipe, d’après la Mayo Team Scale (MHPTS: r=0,67; p<0,01).


La VM a permis d’améliorer les compétences liées au travail d’équipe comparativement à la formation classique, fondée sur la simulation, sur les soins à donner aux traumatisés. Les auteurs sont d’avis que la VM pourrait s’avérer un outil utile et économique, qui permettrait d’améliorer l’efficacité de la formation sur les compétences non techniques, dans la prestation des soins en équipe, en traumatologie.

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Corresponding author
Correspondence to: Dr. Christopher Hicks, Department of Emergency Medicine, St. Michael’s Hospital, 30 Bond Street, 1-008e Shuter Wing, Toronto, ON M5B 1W8; Email:
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2. JE Driskell , C Copper , A Moran . Does mental practice enhance performance? J Appl Psychol 1994;79:481-492.

4. CW Sanders , M Sadoski , R Bramson , et al. Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. Am J Obstet Gynecol 2004;191(5):1811-1814.

5. S Arora , R Aggarwal , N Sevdalis , et al. Development and validation of mental practice as a training strategy for laparoscopic surgery. Surg Endosc 2010;24(1):179-187.

6. Y Komesu , R Urwitz-Lane , B Ozel , et al. Does mental imagery prior to cystoscopy make a difference? A randomized controlled trial. Am J Obstet Gynecol 2009;201(2):218.e1-9.

7. M Immenroth , T Bürger , J Brenner , et al. Mental training in surgical education: a randomized controlled trial. Ann Surg 2007;245(3):385-391.

8. S Arora , R Aggarwal , P Sirimanna , et al. Mental practice enhances surgical technical skills: a randomized controlled study. Ann Surg 2011;253(2):265-270.

9. JF Malec , LC Torsher , WF Dunn , et al. The mayo high performance teamwork scale: reliability and validity for evaluating key crew resource management skills. Simul Healthc: J Soc Simul Healthc 2007;2(1):4-10.

11. MA Hayter , MD Bould , M Afsari , et al. Does warm-up using mental practice improve crisis resource management performance? A simulation study. Br J Anaesth 2013;110(2):299-304.

12. J Cohen . A power primer. Psychol Bull 1992;112(1):155-159.

13. J Cohen . Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968;70(4):213-220.

14. JL Fleiss . The equivalence of the weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 1973;33(3):613-619.

15. D Calatayud , S Arora , R Aggarwal , et al. Warm-up in a virtual reality environment improves performance in the operating room. Ann Surg 2010;251(6):1181-1185.

16. J Driskell . Group decision making under stress. J Appl Psychol 1991;76:473-478.

17. J Driskell , E Salas , J Johnston . Does stress lead to a loss of team perspective? Group Dyn-Theor Res 1999;3(4):291-302.

18. JE Mathieu , TS Heffner , GF Goodwin , et al. The influence of shared mental models on team process and performance. J Appl Psychol 2000;85(2):273-283.

19. JR Landis , GG Koch . The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159-174.

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Canadian Journal of Emergency Medicine
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  • EISSN: 1481-8035
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Type Description Title
Supplementary Materials

Lorello supplementary material
Appendix 2

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Supplementary Materials

Lorello supplementary material
Appendix 3

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Supplementary Materials

Lorello supplementary material
Appendix 1a and 1b

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