Investigating mental rehearsal’s applicability in guiding independent E-learning (IMAGINE) of eye examination skills during the pandemic

Abstract

Background

COVID-19’s infection control policies have hindered the Deliberate Practice of clinical examinations. Guided Mental Rehearsal (GMR) may overcome this obstacle by facilitating independent, repetitive practice. Underpinned by the ‘Motor Simulation Theory,’ GMR reinforces similar neuro-circuit activations during physical practice and was proven effective in surgical training.

Methods

This prospective, randomized controlled study evaluated the efficacy of GMR versus ‘peer-learning’ of Confrontational Visual Field Examination (CVFE). Third-year medical-students without clinical Ophthalmology experience were recruited. Controls (n = 40) watched an e-learning instructional video (8-min CVFE tutorial) followed by 6-min of ‘peer-learning.’ GMR-students (n = 40) had ‘peer-learning’ replaced by a 6-min GMR audio-recording (CVFE running commentary). Pre-test and post-test MCQs were administered to determine baseline knowledge and knowledge acquisition, respectively. 28 controls and 26 GMR-students performed CVFE on simulated patients with right homonymous hemianopia. Four Ophthalmologists graded their performances using a checklist-based marking scheme.

Results

Both groups did not exhibit a significant difference in pre-test scores (8.550 vs. 7.947, p = 0.266); outcome of sub-group analysis of CVFE-performing candidates was similar (8.214 vs. 7.833, p = 0.561). Post-test scores were significantly higher than pre-test in both groups (all p < .001), without inter-group difference (14.000 vs. 15.000, p = 0.715). GMR-group had significantly higher scores on CVFE performance than controls (85.354 vs. 73.679%, p = .001).

Conclusions

GMR improved psychomotor but not cognitive aspect of learning CVFE. This may be attributable to GMR’s theoretical resemblance with physical practice, with additional expert guidance. By enabling independent learning, GMR may also reduce the demand for teaching manpower and thus education cost in the future.

Keywords:

• Mental rehearsal
• COVID-19
• clinical examination
• E-learning

Acknowledgements

The IMAGINE study group will like to acknowledge Ms. Goh Pei Ling, Dr. Preman Rajalingam, and Mr. Lam Xiao Liang for facilitating the conduct of this study

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Guided Mental Rehearsal: Cognitive rehearsal of psychomotor skills without overt physical movements, under the guidance of an expert narrated audio.

Theory of Motor Simulation: Mental visualization of psychomotor tasks may activate similar neural pathways as the physical execution of actions.

Additional information

Notes on contributors

Jianbin Ding

Jianbin Ding, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore, and Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Andrew Shi-Jie Yap

Andrew Shi-Jie Yap, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore.

Zheng Xian Thng

Zheng Xian Thng, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Nicola Yi’an Gan

Nicola Yi’an Gan, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Johnson Choon-Hwai Tan

Johnson Choon-Hwai Tan, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Chee Chew Yip

Chee Chew Yip, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore.