**6. Discussion**

In this chapter we have explored the theoretical basis for surgical psychomotor skill development. We describe a model based on the educational theories and a tool to facilitate production of instructional resources and activities for this. We describe a study to evaluate the product created from the tool for its effectiveness in developing skills in a group of novices. It has shown that using a Design and Development Research approach and using the ADDIE model, subject matter experts can design and develop authentic and validated learning materials for motor skills training. We document the methodology to produce evidencebased instructional videos for surgery. This chapter elaborates on the processes involved in the creation of these learning resources, the use of specific protocols to understand the key components of a psychomotor skill from the experts; the use of the verbal protocol, and the hierarchical task analysis and its use to create a mental script to aid in the acquisition of surgical skills by the trainees. The findings of this study demonstrate the need for a new medium of instructional materials to be developed in the key and index clinical procedures in all the medical specialties requiring procedural skills. Incorporating detailed mental scripts for the surgical procedures and the methodologies to produce them need to be developed among faculty members. Most faculty members should be able to produce short, high-quality educational videos using the process described in this study. This will allow for motor imagery and mental practice to be practised by all surgical trainees to facilitate mastery in the current environment of reduced practice and motor skill learning opportunities. Deliberate practice is now universally accepted as one of the strategies for the expert performance of motor skills and has been proven effective in surgical training.

Faculty members need to be familiar with the methodology of creating mental scripts and the use of instructional design models to create multimedia instructional materials inclusive of the instructional videos by experts. The implication is for medical educators to apply instructional design and technology models to guide education curricula development. As the model described in this research and the process of creating the instructional materials and activities are translatable to other health professional education that requires the acquisition of motor skills, the findings of this research can therefore be adapted for use in other disciplines. The recommended strategy should incorporate mental skills training, i.e., the motor imagery and mental practice for the learners, and the faculty development programme for all health professionals. The faculty must be trained in the design and development of instructional videos and mental scripts. Every index procedure in surgical skill training should have the following:


Though the model needs further external validation, this model and its methodology and approach to developing the individual scripts for motor imagery and mental practice will redefine surgical training. Considering the constraints of obtaining the opportunity to observe, practice, and perform in a work environment and the universal lack of accessibility to the alternative high-technology medical simulators, the trainee needs a model that will allow for deliberate practice anywhere at any time.
