Browsing by Author "Anton, Nicholas E."
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Item Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps(Liebert, 2017-05) Anton, Nicholas E.; Bean, Eric A.; Hammonds, Samuel C.; Stefanidis, Dimitrios; Surgery, School of MedicineIntroduction: Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. Materials and Methods: A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. Results: Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. Conclusions: Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training.Item Association between Medical Student Grit and United States Medical Licensing Examination Performance(2020-03-06) Anton, Nicholas E.; Huffman, Elizabeth; Choi, JenniferItem Attentional selectivity, automaticity, and self-efficacy predict simulator-acquired skill transfer to the clinical environment(Elsevier, 2019-02) Anton, Nicholas E.; Mizota, Tomoko; Timsina, Lava R.; Whiteside, Jake A.; Myers, Erinn M.; Stefanidis, Dimitrios; Surgery, School of MedicineIntroduction Several studies demonstrated that simulator-acquired skill transfer to the operating room is incomplete. Our objective was to identify trainee characteristics that predict the transfer of simulator-acquired skill to the operating room. Methods Trainees completed baseline assessments including intracorporeal suturing (IS) performance, attentional selectivity, self-reported use of mental skills, and self-reported prior clinical and simulated laparoscopic experience and confidence. Residents then followed proficiency-based laparoscopic skills training, and their skill transfer was assessed on a live-anesthetized porcine model. Predictive characteristics for transfer test performance were assessed using multiple linear regression. Results Thirty-eight residents completed the study. Automaticity, attentional selectivity, resident perceived ability with laparoscopy and simulators, and post-training IS performance were predictive of IS performance during the transfer test. Conclusions Promoting automaticity, self-efficacy, and attention selectivity may help improve the transfer of simulator-acquired skill. Mental skills training and training to automaticity may therefore be valuable interventions to achieve this goal.Item Augmenting mental imagery for robotic surgery using neurofeedback: results of a randomized controlled trial(Springer Nature, 2023) Anton, Nicholas E.; Ziliak, Meredith C.; Stefanidis, Dimitrios; Surgery, School of MedicineBackground: Mental imagery (MI) can enhance surgical skills. Research has shown that through brain-computer interface (BCI), it is possible to provide feedback on MI strength. We hypothesized that adding BCI to MI training would enhance robotic skill acquisition compared with controls. Methods: Surgical novices were recruited. At baseline, participants completed the Mental Imagery Questionnaire (MIQ) and the Vandenburg Mental Rotation Test (MRT). Students also performed several tasks on a robotic simulator. Participants were stratified based on MIQ and robotic skill and randomized into three groups: controls, MI, and MI and BCI training. All participants completed five 2-h training sessions. One hour was devoted to practicing robotic skill on the simulator. Additionally, controls completed crosswords for one hour, the MI group completed MI training and crosswords for one hour, and the MI + BCI group completed MI training and MI-related BCI training. Following training, participants completed the same baseline assessments. A Kruskal-Wallis test was used to determine differences between groups. Mann-Whitney U tests were performed to determine specific differences between groups. Results: Twenty-seven undergraduates participated. There were post-test differences on the MRT and knot tying task. Sub-analyses revealed that the MI + BCI group significantly outperformed the other groups on knot tying. There were no appreciable differences between the control and MI groups on any measures. Conclusions: Augmenting MI training with BCI led to significantly enhanced MI and robotic skill acquisition than traditional MI or robotic training methods. To optimize surgical skill acquisition in robotic and other surgical skills curricula, educators should consider utilizing MI with BCI training.Item A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents’ Operative Performance and Decreases Skill Variability: Cohort Study(Wolters Kluwer, 2022-12) Huffman, Elizabeth M.; Choi, Jennifer N.; Martin, John R.; Anton, Nicholas E.; Nickel, Brianne L.; Monfared, Sara; Timsina, Lava R.; Dunnington, Gary L.; Stefanidis, Dimitrios; Surgery, School of MedicineObjective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill. Summary of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability. Methods: PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group’s performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant. Results: Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance (P = 0.04). Conclusions: Completion of a CBE rotation led to significant improvements in PGY-2 residents’ LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training.Item Effectiveness of a comprehensive mental skills curriculum in enhancing surgical performance: Results of a randomized controlled trial(Elsevier, 2017-02) Stefanidis, Dimitrios; Anton, Nicholas E.; Howley, Lisa D.; Bean, Eric; Yurco, Ashley; Pimentel, Manuel E.; Davis, Cameron K.; Surgery, School of MedicineINTRODUCTION: We hypothesized that the implementation of a novel mental skills curriculum (MSC) during laparoscopic simulator training would improve mental skills and performance, and decrease stress. METHODS: Sixty volunteer novices were randomized into intervention and control groups. All participants received FLS training while the intervention group also participated in the MSC. Skill transfer and retention were assessed on a live porcine model after training and 2 months later, respectively. Performance was assessed using the Test of Performance Strategies-2 (TOPS-2) for mental skills, FLS metrics for laparoscopic performance, and the State Trait Anxiety Inventory (STAI-6) and heart rate (HR) for stress. RESULTS: Fifty-five participants (92%) completed training and the transfer test, and 46 (77%) the retention test. There were no significant differences between groups at baseline. Compared to controls the intervention group significantly improved their mental skill use, demonstrated higher laparoscopic skill improvement during retention, and reported less stress during the transfer test. CONCLUSIONS: The MSC implemented in this study effectively enhanced participants' mental skill use, reduced cognitive stress in the operating room with a small impact on laparoscopic performance.Item Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership(Elsevier, 2022-09) Greenberg, Anya L.; Sullins, Veronica F.; Donahue, Timothy R.; Sundaram, Varuna M.; Saldinger, Pierre F.; Divino, Celia M.; Anton, Nicholas E.; Stefanidis, Dimitrios; Reilly, Linda M.; Egan, Richard J.; Beals, Col Kristen J.; Riall, Taylor S.; Duh, Quan-Yang; Mukhtar, Rita A.; Hirose, Kenzo; Lebares, Carter C.; Surgery, School of MedicineEmotional regulation is increasingly gaining acceptance as a means to improve well-being, performance, and leadership across high-stakes professions, representing innovation in thinking within the field of surgical education. As one part of a broader cognitive skill set that can be trained and honed, emotional regulation has a strong evidence base in high-stress, high-performance fields. Nevertheless, even as Program Directors and surgical educators have become increasingly aware of this data, with emerging evidence in the surgical education literature supporting efficacy, hurdles to sustainable implementation exist. In this white paper, we present evidence supporting the value of emotional regulation training in surgery and share case studies in order to illustrate practical steps for the development, adaptation, and implementation of emotional regulation curricula in three key developmental contexts: basic cognitive skills training, technical skills acquisition and performance, and preparation for independence. We focus on the practical aspects of each case to elucidate the challenges and opportunities of introducing and adopting a curricular innovation into surgical education. We propose an integrated curriculum consisting of all three applied contexts for emotional regulation skills and advocate for the dissemination of such a longitudinal curriculum on a national level.Item How resilient is your team? Exploring healthcare providers’ well-being during the COVID-19 pandemic(Elsevier, 2020-09-11) Huffman, Elizabeth M.; Athanasiadis, Dimitrios I.; Anton, Nicholas E.; Haskett, Lindsay A.; Doster, Dominique L.; Stefanidis, Dimitrios; Lee, Nicole K.; Surgery, School of MedicineBackground: The global COVID-19 pandemic has placed tremendous physical and mental strain on the US healthcare system. Studies examining the effects of outbreaks have demonstrated both an increased prevalence and long-term development of Post-Traumatic Stress Disorder (PTSD) symptoms in healthcare providers. We sought to assess the impact of the COVID-19 pandemic on the psychological well-being of medical providers, medical trainees, and administrators at a large academic center to identify stressors and moderators to guide future mental health and hospital-system interventions. Methods: A 42-item survey examining specific stressors, grit, and resilience was widely distributed to physicians, residents, fellows, and administrators a large academic institution for departmental distribution. Survey results were analyzed using descriptive statistics, ANOVA, and multivariate linear regressions. A p-value <0.05 was considered statistically significant. Results: A total of 785 participants completed the survey. The majority of respondents rated their stress to be significantly increased during the pandemic. Respondents’ fear of transmitting the virus to their family members was a significant stressor. Higher resilience was associated with lower stress, anxiety, fatigue, and sleep disturbances. Overall, respondents felt supported by their departments and institution and felt contingency plans and personal protective equipment were adequate. Conclusions: Healthcare workers have increased resilience in the face of heightened stress during a pandemic. Higher resilience and grit were protective factors in managing personal and system-level stressors at the peak of the COVID-19 pandemic in our institution. Implementing an intervention designed to enhance healthcare workers’ resilience in response to the COVID-19 pandemic is warranted.Item Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life(Elsevier, 2021-07) Anton, Nicholas E.; Lebares, Carter C.; Karipidis, Theoklitos; Stefanidis, Dimitrios; Surgery, School of MedicineMental skills and emotional regulation training are gaining acceptance in surgical education as vital elements of surgeon development. These skills can effectively enhance technical skill development, improve well-being, and promote career longevity. There is evidence emerging in the surgical education literature to support the incorporation of mental skills and emotional regulation training curricula in residency training. In this study, we present the existing evidence supporting the use of this training with high performers to reduce stress and optimize well-being and performance. We also consider the recent research emerging in surgical education that offers validity evidence for use of mental skills training with surgeons. Finally, we provide a framework to guide the incorporation of these skills throughout the career of a surgeon and suggest methods to promote the development of mental skills training efforts nationally.Item Measurement of Nontechnical Skills During Robotic-Assisted Surgery Using Sensor-Based Communication and Proximity Metrics(American Medical Association, 2021-11-01) Cha, Jackie S.; Athanasiadis, Dimitrios; Anton, Nicholas E.; Stefanidis, Dimitrios; Yu, Denny; Surgery, School of MedicineThis cohort study uses sensor-based communication and proximity metrics to assess surgeon nontechnical skills during robotic-assisted surgery.