Abstract
Simulation-based education is an important tool for anesthesiology educators given the work hour restrictions and limited exposure of anesthesiology residents to high acuity cardiac cases. Cognitive load is key to learning, performance, and resilience. When working with new and complicated information in an environment prone to changes and distractions, working memory has a limited capacity, duration, and is diminished by excessive cognitive workload. When this capacity is surpassed, learning and performance are impaired. Wecreated cardiac anesthesia-based high fidelity simulation scenarios to determine how to bestmeasure cognitive load by administering the NASA Task Load Index(NASA-TLX). We recreated a cardiac operating room by mimicking a complex learning environment that places high demand on the novice learners. Fourteen anesthesiology residents participated in this study for determination of cognitive load using NASA-TLX. This scale measures effort, frustration, performance, mental demand, physical demand, and temporal demand. The residents perceived mental demand as the most challenging, with a mean of 15.21 ± 1.86; followed by effort, demand with a mean of 14.32±2.49. We determined that using the NASA-TLX Scale to measure and report cognitive load provides an opportunity to effectively evaluate cognitive distress during the acquisition of new skills and enhance physician resilience.
Highlights
High fidelity simulation (HFS) provides a unique opportunity for the teaching and evaluation of knowledge, clinical reasoning, decision-making, and teamwork in a realistic and safe environment
The mental demand of the NASA-TLX Scale was the most challenging according to the residents with a mean of 15.21 ± 1.86
The aim in our research was to determine the efficacy of the NASA-TLX scale to measure cognitive load on the residents during cardiac anesthesia scenarios
Summary
High fidelity simulation (HFS) provides a unique opportunity for the teaching and evaluation of knowledge, clinical reasoning, decision-making, and teamwork in a realistic and safe environment. In the high-acuity cardiac anesthesia setting for example, teaching residents while simultaneously caring for an anesthetized patient can be very challenging. The practice of cardiac anesthesiology requires a distinct clinical and procedural skill set: interpretation of transesophageal echocardiography and complex hemodynamic monitoring, management of mechanical circulatory support devices such as intra-aortic balloon pumps and ventricular assist devices, and use of multiple pharmacological measures to support the heart. HFS provides an excellent educational environment to introduce some of these difficult topics without compromising patient safety. While providing learning through various clinical scenarios, instructors should always be attuned to an individual’s cognitive load, as well as that of the team. Measurement of cognitive workload is a crucial aspect to the future of medical training, team interaction and professionalism
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