Arthroscopic surgery of the knee and shoulder involves inserting a pencil-thin lens and lighting system though a small incision in the human body to view injured connective tissue. Joint repair is then performed with specialized instruments inserted through separate small incisions.
Although orthopedic residents learn to perform this precise surgery on arthroscopy simulators, it is often hard for trainees to retain a high level of proficiency. In part, this is because surgical performance is negatively impacted by factors such as operating room distractions and the surgeon’s mental state.
Li et al. [Arthroscopy] tested whether a mindfulness meditation app could improve orthopedic residents’ performance during arthroscopic surgical simulation as well as reduce stress and distraction.
The researchers randomly assigned 43 male meditation-naïve and arthroscopically-naive orthopedic residents in Guangzhou, China (average age = 26 years) to one of three training conditions. On the first day of the study, all residents attended a didactic lecture on knee arthroscopic surgery and performed practice surgery using an arthroscopic simulator. Residents continued simulator practice until they attained two consecutive perfect scores on a set of surgical tasks.
Performance scoring was calculated by a pre-programmed simulator algorithm using a scoring system developed by the Arthoscopy Association of North America. It included measures like procedure time, camera path length, and degree of simulated cartilage injury.
After that initial arthroscopic training, two of the groups meditated 10-minutes a day for a total of 10 days using the Tide smartphone app. The app included guided audio meditations focusing on topics such as acceptance, calmness, and bodily and emotional awareness.
On day 11, residents were re-evaluated on the arthroscopic simulator performance. One-half of the meditation-trained residents meditated for 10 minutes immediately prior to the evaluation, and the other half did not. Residents reported their stress and mindfulness (Cognitive and Affective Mindfulness Scale-Revised) on day 1 and day 11 of the study.
The results showed that meditation-trained residents who meditated immediately before the simulator evaluation performed significantly better than meditation-trained residents who did not meditate immediately before the evaluation. This improvement was noted on several measures including total simulator score, surgery completion time, and injury to cartilage.
In addition, meditation-trained residents who did not meditate immediately prior to the evaluation showed significantly less skill deterioration over the course of the eleven days than residents in the non-meditation control.
Both groups of meditators showed significantly reduced stress over time compared to the non-meditators who reported increased stress levels (partial η2=0.67). Mindfulness scores improved for both mindfulness groups and declined for non-meditating controls (partial η2=0.50).
The study shows meditation app use can reduce the normal deterioration in arthroscopic surgical skills over time, and that meditating immediately before a surgical evaluation can improve surgical performance by orthopedic residents. Meditation may accomplish this by reducing stress and improving attentional skills during a surgical task.
The study’s generalizability is limited by its reliance on a male-only sample and a simulated rather than real-life surgical outcome, and by the absence of an active control group.
Li, W., Meng, X., Zhang, K.-J., Yang, Z., Feng, Z., Tong, K., & Tian, J. (2022). Meditation Using a Mobile App Improves Surgery Trainee Performance: A Simulation-Based Randomized Controlled Trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery.
Link to study