Quantifying the effects of training in lung transplantation: Lessons from NASA

Abstract

IntroductionSequential lung transplantation is a complex procedure. The traditional training model continues to centre around operative experience with progressively increasing delegation of stages of the procedure. However, little evidence exists on the effects this has on surgical trainers. The NASA-TLX is a subjective, multi-dimensional assessment tool that rates perceived workload. We sought to employ this as a means of assessing the impact that training in lung transplantation has on trainers. MethodsWe prospectively collected the NASA-TLX data for 60 patients undergoing bilateral sequential lung transplantation. In 30 cases the operation was performed entirely by the senior surgeon (SS) who implanted both lungs. In 30 operations the senior surgeon implanted the right lung (SSR) and supervised a trainee implanting the left lung (TL). ResultsThe overall weighted rating was significantly lower for the surgeon undertaking the case themselves rather than training (p <0.001). Cases were comparable in terms of case type, donor ischaemic time and peri-operative characteristics. Mental and temporal demand were greater throughout training cases (p<0.001, p<0.05). There was less effect on frustration, physical demand and effort. Perceived performance showed no significant difference between the groups. ConclusionThe NASA task load index can be used to inform the effects of training lung transplantation on trainers. Training leads to greater mental and temporal demands with less effect on other factors. Crucially, there was no significant difference in perceived performance. As the specialty continues to be confronted with diverse challenges, this study should give confidence to those training the transplant surgeons of the future, as well as providing them with a mechanism to reflect on their own training performance. ACGME CompetenciesInterpersonal and communication skillsPractice-based learning and improvement