Abstract

Despite preventive measures such as safety checklists, “time-outs” with the entire theatre team and marking the correct side for surgery, more than four thousand preventable surgical errors occur every year. Lack of attention to detail, the hierarchical culture within the National Health Service, stress and fatigue, increasing pressures to start and finish surgical procedures and even unusual anatomical characteristics, have been identified as potential reasons for adverse surgical events. However, the underlying cognitive mechanisms which lead to surgical error are not fully understood. Could cognitive preparation prior to surgery be the key to preventing surgical error?

Mental practice has been assessed in simulated surgical environments. Some of the outcome measures included surgical errors. Nevertheless, a simulated environment is considered by many as a relatively “stress free environment”, hence eliminating one of the factors that may precipitate surgical error. Assessment of the technique in a clinical (surgical) environment through high quality studies is urgently needed.

Further, patient characteristics are linked with increased technical difficulty and surgical error, however, mental practice is a generic method which remains the same for each type of surgery. Also its success is reliant on the individual ability to perform mental imagery, which may vary form surgeon to surgeon. These are factors that should be taken into consideration in future research.

Another factor that should be evaluated is the experience of the surgeon. Studies showed that more experienced individuals perform cognitive preparation in a more effective manner. Is mental practice relevant for consultants or is it a method that should be employed by trainee surgeons only? Studies to date have not explored the potential impact of mental practice in expert performance.

Current research undertaken in our department aims to answer these questions and prove or dismiss the impact of mental practice in preventing surgical error and overall improving surgical performance.

Additional Information

This presentation was given at the one day symposium, Current Approaches to Understanding Surgical Error, University of Leeds, Leeds, UK, on 9 December 2016.

Conflicts of interest: none declared.