Embedding mental rehearsal in surgery: a comprehensive review of the evidence

BackgroundMental rehearsal (MR), the deliberate practice of skills specific to a procedure, has been successfully used in sports and music training for decades, but has not been adopted in surgery. This narrative review explores MR's role in surgical training and clinical practice, evaluating i...

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Main Authors: Josephine Walshaw, Bright Huo, Paul Barach, Philippa Banks, Adam McClean, Florent Lebon, Faisal Mushtaq, David Jayne, Danilo Miskovic, Marina Yiasemidou
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Surgery
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Online Access:https://www.frontiersin.org/articles/10.3389/fsurg.2025.1524468/full
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author Josephine Walshaw
Bright Huo
Paul Barach
Paul Barach
Paul Barach
Philippa Banks
Adam McClean
Florent Lebon
Faisal Mushtaq
David Jayne
Danilo Miskovic
Marina Yiasemidou
Marina Yiasemidou
author_facet Josephine Walshaw
Bright Huo
Paul Barach
Paul Barach
Paul Barach
Philippa Banks
Adam McClean
Florent Lebon
Faisal Mushtaq
David Jayne
Danilo Miskovic
Marina Yiasemidou
Marina Yiasemidou
author_sort Josephine Walshaw
collection DOAJ
description BackgroundMental rehearsal (MR), the deliberate practice of skills specific to a procedure, has been successfully used in sports and music training for decades, but has not been adopted in surgery. This narrative review explores MR's role in surgical training and clinical practice, evaluating its effectiveness in motor skill acquisition, technical and non-technical skill development, and real world clinical implementation. Our aim was to assess MR's impact on both surgical education and clinical performance, while identifying the barriers to its routine adoption in surgical training.MethodsWe searched for relevant studies on the topic and impacts of MR in surgery using the Medline database up to December 2024. A range of studies were included covering mental rehearsal, surgical education, surgical training, and surgical outcomes. The primary outcomes were to provide insights into the mechanisms and implementation of MR in surgery and to assess the potential impact of MR on surgical outcomes.ResultsThe narrative review provides scientific insights into the mechanisms of MR in surgery and describes in detail the implementation methodology. The majority of evidence demonstrates that MR is beneficial when used as an adjunct approach to other forms of training. Moreover, there is evidence to support MR as a low-cost and valuable learning technique. Many questions remain regarding training schedules including the optimal duration and nature of the MR sessions, accommodating the surgeon's prior experience, optimal number of repetitions, and addressing the abilities of the participants to perform mental imagery. Most studies have heterogenous methods, diffuse aims and poor descriptions of the specific intervention components. Several studies applied MR in demanding real-life surgical environments and demonstrated feasibility in surgery.ConclusionsThe preliminary findings suggest that MR may improve the performance of operators and operating teams as an efficient adjuvant to traditional surgical skills training methods. More work is needed to better understand how MR interventions can best be implemented to improve training, practice, and outcomes in routine surgical practice.
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spelling doaj-art-c9e367fe98064fff9fe1dcd05097f4752025-08-20T03:46:33ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-06-011210.3389/fsurg.2025.15244681524468Embedding mental rehearsal in surgery: a comprehensive review of the evidenceJosephine Walshaw0Bright Huo1Paul Barach2Paul Barach3Paul Barach4Philippa Banks5Adam McClean6Florent Lebon7Faisal Mushtaq8David Jayne9Danilo Miskovic10Marina Yiasemidou11Marina Yiasemidou12Leeds Institute of Medical Research, St James’s University Hospital, University of Leeds, Leeds, United KingdomMedical School, Dalhousie University, Halifax, NS, CanadaThomas Jefferson University, Philadelphia, PA, United StatesFaculty of Medicine, Imperial College London, London, United KingdomSheps Health Services, Research Center, University of North Carolina, Chapel Hill, NC, United StatesDepartment of General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United KingdomDepartment of General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United KingdomDepartment of Psychology, Université de Bourgogne, Dijon, FranceSchool of Psychology, University of Leeds, Leeds, United KingdomLeeds Institute of Medical Research, St James’s University Hospital, University of Leeds, Leeds, United KingdomSt Mark’s Hospital, London North West University Healthcare NHS Trust, London, United Kingdom0The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom1Department of Health Research, University of York, York, United KingdomBackgroundMental rehearsal (MR), the deliberate practice of skills specific to a procedure, has been successfully used in sports and music training for decades, but has not been adopted in surgery. This narrative review explores MR's role in surgical training and clinical practice, evaluating its effectiveness in motor skill acquisition, technical and non-technical skill development, and real world clinical implementation. Our aim was to assess MR's impact on both surgical education and clinical performance, while identifying the barriers to its routine adoption in surgical training.MethodsWe searched for relevant studies on the topic and impacts of MR in surgery using the Medline database up to December 2024. A range of studies were included covering mental rehearsal, surgical education, surgical training, and surgical outcomes. The primary outcomes were to provide insights into the mechanisms and implementation of MR in surgery and to assess the potential impact of MR on surgical outcomes.ResultsThe narrative review provides scientific insights into the mechanisms of MR in surgery and describes in detail the implementation methodology. The majority of evidence demonstrates that MR is beneficial when used as an adjunct approach to other forms of training. Moreover, there is evidence to support MR as a low-cost and valuable learning technique. Many questions remain regarding training schedules including the optimal duration and nature of the MR sessions, accommodating the surgeon's prior experience, optimal number of repetitions, and addressing the abilities of the participants to perform mental imagery. Most studies have heterogenous methods, diffuse aims and poor descriptions of the specific intervention components. Several studies applied MR in demanding real-life surgical environments and demonstrated feasibility in surgery.ConclusionsThe preliminary findings suggest that MR may improve the performance of operators and operating teams as an efficient adjuvant to traditional surgical skills training methods. More work is needed to better understand how MR interventions can best be implemented to improve training, practice, and outcomes in routine surgical practice.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1524468/fulleducationsurgerysimulationmental rehearsal (MR)training
spellingShingle Josephine Walshaw
Bright Huo
Paul Barach
Paul Barach
Paul Barach
Philippa Banks
Adam McClean
Florent Lebon
Faisal Mushtaq
David Jayne
Danilo Miskovic
Marina Yiasemidou
Marina Yiasemidou
Embedding mental rehearsal in surgery: a comprehensive review of the evidence
Frontiers in Surgery
education
surgery
simulation
mental rehearsal (MR)
training
title Embedding mental rehearsal in surgery: a comprehensive review of the evidence
title_full Embedding mental rehearsal in surgery: a comprehensive review of the evidence
title_fullStr Embedding mental rehearsal in surgery: a comprehensive review of the evidence
title_full_unstemmed Embedding mental rehearsal in surgery: a comprehensive review of the evidence
title_short Embedding mental rehearsal in surgery: a comprehensive review of the evidence
title_sort embedding mental rehearsal in surgery a comprehensive review of the evidence
topic education
surgery
simulation
mental rehearsal (MR)
training
url https://www.frontiersin.org/articles/10.3389/fsurg.2025.1524468/full
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