COVID-19 pandemic has caused drastic changes in personal and educational lives of medical students, who hold a unique position between being a student and a part of the health care workforce (1). The role of senior medical students who are on the brink of becoming licenced physicians, in particular, have been discussed thoroughly by experts from the perspective of safety, education and the need for skilled workforce. As the discussions continue, medical students got to stay home – as it should be, in my opinion – at least in most countries. Remote learning became the primary training modality all in a sudden.
Remote learning, even though the safest option, is not free of problems. Studying from home and continuing daily routine require a strong determination, especially when people have a lot on their minds. But most of all, clinical and procedural skills are hard, if not impossible, to translate into online learning. Medical students need alternative methods to physical practice of clinical and procedural skills, other than reading instructions and watching procedural videos. Mental practice may offer a solution for medical students who want to sharpen or at least retain procedural skills at home.
What is Mental Practice?
Mental practice refers to the introspective rehearsal or visualisation of psychomotor skills (2). It has been called many names including ‘‘imaginary practice,’’ ‘‘covert rehearsal,’’ ‘‘conceptualization,’’ or ‘‘mental imagery rehearsal’.’ It has been researched extensively in sports literature and is shown to provide both cognitive and motivational benefits (3). Can it do the same trick for medical training, though? At this point, being sceptical is perfectly normal. Let’s look into the literature.
The History of Mental Practice
Surprisingly, even as early as the 1900s, the scientists were discussing the effect of ideational elements in motor learning (4). In the 1930s, pioneer researchers had already experimented on rats that were deprived of kinesthetic impulses by sectioning of the cervical cord and discovered that even they could not run the maze as perfectly as normal rats in terms of motor skills, they still learned it (5, 6, 7). They asserted that kinesthetic impulses were neither sufficient nor necessary in learning of the motor skill. A few years later in 1940, researchers observed ideational clues helped human subjects to learn basic motor skills making fewer attempts, committing fewer errors, and spending less time (8). Subsequent studies tested mental practice against the physical in basketball free throws, dart games, and ring toss (9, 10). All reached the same conclusion: Mental practice was effective, even about as effective as physical practice in learning of motor skills.
What About Medical Training?
Experiments on the use of mental practice in the area of medical training started a few decades later. One of the first studies examined the use of mental practice in the pelvic examination. The students who did 5-minute audio-guided mental practices before and after the physical practice on a model performed significantly better at skill examination (11). Research in this area has gained momentum recently. Mental practice was shown to facilitate medical students’ learning of suturing, venipuncture, cricothyroidotomy, and lumbar puncture (12-15). In some studies, it performed as effective as physical practice, and superior to studying text (12, 16).
The evidence shows that mental practice can be a strong and free learning tool. It can serve as a satisfactory substitute for physical practice in the days of the pandemic, which forces medical students to stay at home. But, let’s not get ahead of ourselves. Mental practice does not provide all of the answers. Remember the rats: They still needed motor practice to run perfectly and as fast as normal rats (7). In other words, you still need the train your muscles to operate smoothly what you have learned. Even after years of mental practice, one could never score a free throw if he or she is lacking the muscle strength to make the ball reach the basket. Admittedly, most medical procedures do not require large motor skills or much strength, but they still demand well-trained small muscles. However, until the world figures out how to put a medical student and a simulator together in the same room safely, the mental practice seems like a solid way of learning new procedures.
- Miller, D. G., Pierson, L., & Doernberg, S. (2020). The role of medical students during the COVID-19 pandemic. Annals of Internal Medicine.
- Oxendine, J.B. (1968). Psychology of motor learning. Englewood Cliffs, New York: Prentice-Hall.
- Rogers, R. G. (2006). Mental practice and acquisition of motor skills: examples from sports training and surgical education. Obstetrics and Gynecology Clinics, 33(2), 297-304.
- Watson, J. B. (1907). Kinæsthetic and organic sensations: Their role in the reactions of the white rat to the maze. The Psychological Review: Monograph Supplements, 8(2), i.
- Lashley, K. S., & Ball, J. (1929). Spinal conduction and kinesthetic sensitivity in the maze habit. Journal of Comparative Psychology, 9(1), 71.
- Ingebritsen, O. C. (1932). Maze learning after lesion in the cervical cord. Journal of Comparative Psychology, 14(2), 279.
- Honzik, C. H. (1936). The role of kinesthesis in maze learning. Science, 84(2182), 373-373.
- Buegel, H. F. (1940). The effects of introducing ideational elements in perceptual-motor learning. Journal of Experimental Psychology, 27(2), 111.
- Vandell, R. A., Davis, R. A., & Clugston, H. A. (1943). The function of mental practice in the acquisition of motor skills. The Journal of General Psychology, 29(2), 243-250.
- Twining, W. E. (1949). Mental practice and physical practice in learning a motor skill. Research Quarterly. American Association for Health, Physical Education and Recreation, 20(4), 432-435.
- Rakestraw, P. G., Irby, D. M., & Vontver, L. A. (1983). The use of mental practice in pelvic examination instruction. Journal of Medical Education, 58(4), 335.
- Sanders, C. W., Sadoski, M., Bramson, R., Wiprud, R., & Van Walsum, K. (2004). Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. American journal of obstetrics and gynecology, 191(5), 1811-1814.
- Sanders, C. W., Sadoski, M., Wasserman, R. M., Wiprud, R., English, M., & Bramson, R. (2007). Comparing the effects of physical practice and mental imagery rehearsal on learning basic venipuncture by medical students. Imagination, Cognition and Personality, 27(2), 117-127.
- Bathalon, S., Martin, M., & Dorion, D. (2004). Cognitive task analysis, kinesiology and mental imagery: Challenging surgical attrition. Journal of the American College of Surgeons, 199(3), 73.
- Bramson, R., Sanders, C. W., Sadoski, M., West, C., Wiprud, R., English, M., … & Xenakis, A. (2011). Comparing the effects of mental imagery rehearsal and physical practice on learning lumbar puncture by medical students. Annals of Behavioral Science and Medical Education, 17(2), 3-6.
- Sanders, C. W., Sadoski, M., van Walsum, K., Bramson, R., Wiprud, R., & Fossum, T. W. (2008). Learning basic surgical skills with mental imagery: using the simulation centre in the mind. Medical Education, 42(6), 607-612.