Domhnall MacAuley: Mental rehearsal in medicine

Domhnall MacauleyLet’s try a few mental exercises. Can you tell me how many windows you would see if you stood at the front of your house, do the first three notes of three blind mice go up or down, or can you throw a tennis ball up in the air and catch it—in your mind? Not trick questions, just illustrations of how to use different parts of our imagination. When I heard Aiden Moran interviewed on the radio recently, these examples were used to illustrate the power of our imagination.

So, as a doctor, when was the last time you used your imagination at work? Indeed, when was the last time you heard imagination used in a medical context? Medical education tends to stifle our ability to think differently. There is often little opportunity to use any artistic or creative talent and, in our current educational system, a doctor finishing medical school might not have written an essay since the age of 16. Imagination is forgotten.

There is more imagination in sport than in medicine. Mental rehearsal is now an integral part of top sport with well validated evidence of its effectiveness in improving performance. Athletes mentally rehearse skills and techniques and visualise the different scenarios they might meet in their event. They can rehearse complex motor skills, see themselves perform entire routines, compete in their event time and time again. In addition, they can learn how to deal with the stress of competition, the noise of the crowd, the expectation of spectators, cope with early failure or a setback in their event and respond to a range of potential critical events.

Could imagination help medicine? What fascinated me even more than its application in sport was when I heard Aiden speak about using mental rehearsal to improve the performance of surgeons.  When you think about it, surgery is a technical skill that improves with training and surgeons also need to be able to cope with intense pressure and unexpected stress. Mental rehearsal might help.

Next time you find yourself watching a major sporting events and see athletes using mental rehearsal (most likely in technical events such as the high jump, pole vault, hurdles etc) you too might wonder about we could apply it to medicine.

Domhnall MacAuley is primary care editor, BMJ