Investigating Mental Rehearsal's Applicability in Guiding Independent E-learning of Eye Examination Skills During the Pandemic – Part II (IMAGINE-II)

Background Guided Mental Rehearsal (GMR), underpinned by the Theory of Motor Simulation, supports the learning of psychomotor skills. We hypothesized that (a) GMR would be comparable to Guided Physical Practice (GPP) for learning Pupillary Examination (PE), and (b) Mental Imagery (MI) ability would improve with GMR practice. Methods This assessor-blinded, randomized 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. Practices (GMR or GPP) were conducted at weeks 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 the GMR and GPP groups at months 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, 1 month, and 2 months (Kinaesthetic Visualization Score: 22.00 [8.00] vs. 23.00 [7.00] vs. 24.00 [6.00], p < 0.01; External Visualization Score: 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. Conclusions Repeated GMR was found to be non-inferior to GPP for learning PE, and MI ability improved with deliberate GMR practice. GMR may serve as a cost-effective, resource-independent adjunct for acquiring clinical examination skills.