Comparison of ‘Mental training’ and physical practice in the mediation of a structured facial examination: a quasi randomized, blinded and controlled study

Nelskamp et al. BMC Medical Education (2021) 21:178 https://doi.org/10.1186/s12909-021-02603-0 RESEARCH ARTICLE Open Access Comparison of ‘Mental training’ and physical practice in the mediation of a structured facial examination: a quasi randomized, blinded and controlled study Arne Nelskamp1, Benedikt Schnurr1, Alexandra Germanyuk2, Jasmina Sterz3, Jonas Lorenz1, Robert Sader1, Miriam Rüsseler3 and Lukas B. Seifert1* Abstract Background: The correct performance of a structured facial examination presents a fundamental clinical skill to detect facial pathologies. However, many students are not adequately prepared in this basic clinical skill. Many argue that the traditional ‘See One, Do One’ approach is not sufficient to fully master a clinical skill. ‘Mental Training’ has successfully been used to train psychomotor and technical skills in sports and other surgical fields, but its use in Oral and Maxillofacial Surgery is not described. We conducted a quasi-experimental to determine if ‘Mental Training’ was effective in teaching a structured facial examination. Methods: Sixty-seven students were randomly assigned to a ‘Mental Training’ and ‘See One, Do One’ group. Both groups received standardized video instruction on how to perform a structured facial examination. The ‘See One, Do One’ group then received 60 min of guided physical practice while the ‘Mental Training’ group actively developed a detailed, stepwise sequence of the performance of a structured facial examination and visualized this sequence subvocally before practicing the skill. Student performance was measured shortly after (T1) and five to 10 weeks (T2) after the training by two blinded examiners (E1 and E2) using a validated checklist. Results: Groups did not differ in gender, age or in experience. The ‘Mental Training’ group averaged significantly more points in T1 (pE1 = 0.00012; pE2 = 0.004; dE1 = 0.86; dE2 = 0.66) and T2 (pE1 = 0.04; pE2 = 0.008, dE1 = 0.37; dE2 = 0.64) than the ‘See One, Do One’ group. The intragroup comparison showed a significant (pE1 = 0.0002; pE2 = 0.06, dE1 = 1.07; dE2 = 0.50) increase in clinical examination skills in the ‘See One, Do One’ group, while the ‘Mental Training’ group maintained an already high level of clinical examination skills between T1 and T2. Discussion: ‘Mental Training’ is an efficient tool to teach and maintain basic clinical skills. In this study ‘Mental Training’ was shown to be superior to the commonly used ‘See One, Do One’ approach in learning how to perform a structured facial examination and should therefore be considered more often to teach physical examination skills. * Correspondence: 1 Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Nelskamp et al. BMC Medical Education (2021) 21:178 Background Practical skills must be learned by every medical student regardless of her or his future specialization [1]. However, studies show that students consider the training of practical skills in the context of their medical education as insufficient [2] and there are still shortcomings in the training of basic clinical skills such as the physical examination in undergraduate medical education [3–5]. Although, many authors have demonstrated deficits in the training of clinical skills, the methodological approaches in teaching methods to impart competencies in those skills are not completely elaborate. Therefore, it is necessary to find effective educational strategies for each clinical skill. In medical education, clinical skills are traditionally taught using the ‘See One, Do One’ method. In 1889, Halsted introduced a system in which medical students completed a university-sponsored, hospital-based surgical training program [6]. Halsted’s model of ‘See One, Do One, Teach One’ is based on acquiring increasing amounts of responsibility that culminate in near independence. Halsted was not only interested in developing a system to train surgeons, but also in creating teachers and role models [7]. Today this approach is labelled as the main component of clinical-bedside teaching. Students learn by watching an expert explaining and demonstrating a skill. This is followed by the first independent performance of the skill, which is mostly with a patient [7]. Although this method has been obviously proven to be effective, reality is forcing us to establish new teaching methods. The enormous workload including reduced lengths of stay in hospital combined with increasing case numbers, growing multimorbidity and increased complexity of treatments leads to significantly reduced chances for bedside teaching [8]. Often, the important last step ‘Teach one’ is often omitted or is undertaken without supervision in everyday clinical practice. Further, the health care system is facing increased economic pressure and scarcity of resources [9]. Thus, it would be optimal to establish a teaching method that does not involve many resources. Recently there has been a growing understanding that cognitive abilities, such as problem solving and movementplanning, play a crucial role in learning practical skills [10, 11]. This has resulted in a shift away from training methods that exclusively focus on the acquisition of motor skills but rather target the actual thought process when performing a clinical skill. This way of cognitive or mentally training in a certain skill has long been established in sports [12, 13] and has also been shown to be beneficial in the retrieval of motor abilities in rehabilitative medicine [14]. A reason discussed for its effectiveness resides in Janerod’s simulation theory [15] which hypotheses that the motor system is also part of a bigger Page 2 of 8 cognitive network which includes various psychological activities. During (...truncated)