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

Abstract

Introduction: Guided Mental Rehearsal (GMR), underpinned by the Theory of Motor Simulation, supports the learning of psychomotor skills. We hypothesised that (a) GMR is comparable to Guided Physical Practice (GPP) for learning Pupillary Examination (PE), and (b) Mental Imagery (MI) ability improves GMR practice. Methods: This assessor-blinded, randomised controlled study included 53 pre-clinical students (GMR n=26, GPP n=27), with sample size calculated from pilot data (n=46, power=0.81, alpha=0.05). On day 1, baseline MI ability was assessed, followed by PE instruction. Subjects were practiced at week 1 and 3. PE performance and MI ability were reassessed using a checklist score sheet (month-1) and the Movement Imagery Questionnaire-3 (month-2). Results: Data is presented as median with interquartile range. The Mann-Whitney U test showed no significant differences in PE performance between GMR and GPP at month-1 (35.00 [14.00] vs. 33.25 [12.00], p=0.91) and 2 (40.00 [10.50] vs. 36.42 [12.00], p=0.50). In the GMR group, PE scores improved from month-1 to 2 (35.00 [14.00] vs. 40.00 [10.50], p=0.02, Wilcoxon Signed-Rank test). The Friedman test, followed by a post-hoc Wilcoxon Signed-Rank test with Bonferroni adjustment, indicated improved MI ability across baseline, month-1, and month-2 (Kinaesthetic Visualisation: 22.00 [8.00] vs. 23.00 [7.00] vs. 24.00 [6.00], p<0.01; External Visualisation: 24.00 [5.00] vs. 25.00 [6.00] vs. 26.00 [4.00], p=0.36), which was not observed in the GPP group. Conclusion: Repeated GMR and GPP had no significantly different teaching outcomes, and MI ability improved with deliberate GMR practice. GMR may confer potential cost advantages with its hypothesised operational efficacy gains as an adjunct for teaching clinical examination skills.