Task Load Index Scores Research Articles

Intraoperative Image Guidance Improves Outcomes in Complex Orbital Reconstruction by Novice Surgeons

This study aims to describe the utility of surgical navigation in improving operative outcomes in complex orbital reconstruction by novice compared with experienced surgical trainees. A randomized, controlled cadaveric study was conducted at the University of Pittsburgh School of Medicine with otolaryngology and ophthalmology residents and fellows. Participants were divided into novice (postgraduate year 2-4 residents) and experienced (postgraduate year 5 residents and fellows) groups. Ten cadaveric specimens with pre-dissection computed tomography images underwent endoscopic resection of the orbital floor and lamina papyracea bilaterally. Participants performed reconstruction with or without the use of surgical navigation, randomized by laterality and order of the use of navigation. Post-dissection imaging was obtained after reconstruction and compared with pre-dissection imaging. The primary outcome was orbital volume; secondary outcomes included the participant's operative time and National Aeronautics and Space Administration Task Load Index score, a subjective workload assessment measure. Matched-pair t tests and 2-way analysis of variance were used for statistical analysis. Novice participants (n= 6) had improved outcomes with respect to orbital volume when using surgical navigation compared with experienced participants (n= 4). There were no differences in operative times or National Aeronautics and Space Administration Task Load Index scores when using surgical navigation. In a cadaveric setting, use of surgical navigation by novice surgeons improves post-dissection orbital volume in complex orbital reconstruction. Surgical navigation should be considered as an adjunct to surgical training and simulation curricula.

A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

ObjectiveTo verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.Materials and MethodsIn this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.ResultsThe navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.ConclusionThe self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute.

EUS-guided portal pressure measurement using a digital pressure wire with real-time remote display: a novel, minimally invasive technique for direct measurement in an animal model

Hepatic venous pressure gradient (HVPG) currently serves as a surrogate for portal pressure measurement but has many limitations. We developed a novel technique for rapid and direct portal pressure measurements using a digital pressure wire delivered through an EUS-guided 22-gauge FNA needle. Our aims were to evaluate (1) the short-term safety and technical feasibility, (2) procedural duration and subjective workload assessment, and (3) accuracy compared with a transjugular criterion standard approach. The subjects were Yorkshire pigs, weighing 40 to 55 kg. The portal vein was identified by using a linear array echoendoscope and accessed with a commercially available 22-gauge FNA needle preloaded with a digital pressure wire. Access was confirmed by portal venography. Mean digital pressure measurements were recorded over 30 to 60 seconds, and the National Aeronautics and Space Administration Task Load Index was scored. The control measurements were conventional transjugular catheterization with a balloon occlusion catheter to obtain free and wedged hepatic pressures, with subsequent HVPG calculation. The total time required for EUS identification and needle access of the portal vein, venography, and digital pressure measurement was less than 5 minutes in 5 of 5 pigs. The National Aeronautics and Space Administration Task Load Index scores revealed a low subjective workload. Baseline portal pressure measurements via EUS ranged from 5 mm Hg to 10 mm Hg (mean, 6.4 mm Hg). HVPG measurements were consistently ±1 mm Hg of portal pressure. This study is the first report of direct EUS-guided portal pressure measurements by using a digital pressure wire. This method is routinely performed in minutes and provides real-time pressure tracings via wireless transmission. This novel approach for direct portal pressure measurement has the potential to replace traditional indirect HVPG measurements.

How High is High? A Meta-Analysis of NASA-TLX Global Workload Scores

This paper presents a descriptive analysis of over 1000 global NASA Task Load Index (TLX; Hart & Staveland, 1988) scores from over 200 publications. This analysis is similar to that which was suggested by Hart (2006). The frequency distributions and measures of central tendency presented will aid practitioners in understanding global NASA-TLX scores observed in system tests.

Multimodal Intelligent Eye-Gaze Tracking System

This article presents a series of user studies to develop a new eye-gaze tracking–based pointing system. We developed a new target prediction model that works for different input modalities and combined the eye-gaze tracking–based pointing with a joystick controller that can reduce pointing and selection times. The system finds important applications in cockpit of combat aircraft and for computer novice users. User studies confirmed that users can perform significantly faster using this new eye-gaze tracking–based system for both military and everyday computing tasks compared to existing input devices. As part of the study it was also found that the amplitude of maximum power component obtained through Fourier Transform of pupil signal significantly correlates with selection times and perceived cognitive load of users in terms of Task Load Index scores.

A Randomized Controlled Study to Establish the Effect of Articulating Instruments on Performance in Single-Incision Laparoscopic Surgery

In single-incision laparoscopic surgery (SILS), operating through 1 incision presents ergonomic challenges. No consensus exists on whether articulating instruments (ARTs) may help. This study evaluated their effect on simulated SILS, hypothesizing that they would affect performance and workload. Surgeons were randomized to 2 straight instruments (STRs), 1 ART and 1 STR, or 2 ARTs. After baseline testing, 25 repetitions of the Fundamentals of Laparoscopic Surgery (FLS) peg-transfer (PEG) task and 5 repetitions of the short-hand for the FLS pattern-cutting task (CIRCLE) were performed. Primary outcomes were maximum FLS PEG scores, CIRCLE times and errors, and Imperial College Surgical Assessment Device hand motion analysis. National Aeronautics and Space Administration (NASA) Raw Task Load Index (RTLX) questionnaires evaluated a secondary outcome--workload. The trial took place in a simulated operating theater within the Academic Surgical Unit at St Mary's Hospital, London, UK. Eligible surgeons had completed at least 5 laparoscopic cases as a primary operator. Surgeons were stratified by laparoscopic experience into intermediate (less than 25 previous procedures as primary operator) or advanced (25 procedures or more). A total of 21 surgeons were recruited and randomized; 7 of them to each instrument combination group. All surgeons completed PEG, and 5 from each group completed CIRCLE. Groups' baseline PEG scores were similar (p = 0.625). STR-ART achieved higher maximum PEG scores than STR or ART did (median = 236 vs 198 vs 193, respectively, p = 0.002). Fastest CIRCLE times were similar (median = 190s vs 130s vs 186s, p = 0.129) as were minimum errors (median = 1 vs 2 vs 3, p = 0.101). For PEG, Imperial College Surgical Assessment Device demonstrated similar total path lengths (median = 12.3m vs 12.3m vs 16.0m, p = 0.545) and total numbers of movements (median = 89.6 vs 86.4 vs 171, p = 0.080). Groups' NASA Raw Task Load Index scores were similar (p = 0.708). Combining 1 STR and 1 ART improved SILS performance in the PEG task. Therefore, this may be the optimum instrument configuration for use within some clinical SILS applications.

Comparison of physiological and perceptual responses to a maximal exhaustive test performed on the SRM and the Cyclus2 ergometer

Background: No cycle ergometer perfectly replicates the physiological demands and movement patterns associated with real world cycling (Abbiss et al., 2009: International Journal of Sports Medicine, 30(2), 107-112). The purpose of this research was to compare physiological and perceptual responses during a standardized exercise test using the classical SRM ergometer (Schoberer Rad Messtechnik, GmbH, JA¼lich, Germany) and the Cyclus2 ergometer (RBM elektronik-automation GmbH, Leipzig, Germany) which allows the use of personal bikes and allows lateral movement. Methods: 13 moderately trained cyclists (mean ± SD: age 35 ± 7 years, body mass 74.1 ± 9.6 kg) performed two graded cycling tests to volitional exhaustion in a randomized order on the SRM and the Cyclus2 ergometer. Maximal aerobic capacity (VO2max), maximal aerobic power (MAP), blood lactate concentrations and heart rate responses were compared using a paired t-test. Participants were also required to fill in the NASA Task Load Index (TLX) questionnaire (Hart, 2006: NASA-Task Load Index, 50th Human Factors and Ergonomics Society Meeting, Santa Monica, USA) after each test to assess the perceived workload in an effort to understand if one ergometer is perceived to be more or less of a workload than its counterpart. In order to analyse the workload from each participant, individual TXL factors were summed for each ergometer TLX administration creating an overall workload score per ergometer. After conclusion of the experiment participants were asked to state their preference in ergometers. Lastly, a correlation was performed on the level of performance within the ergometer testing and the perceived performance. Results: Compared physiological responses and MAP (321 ± 44 W; SRM and 326 ± 41 W; Cyclus2) did not find any significant differences. A constructed ANOVA model which examined the difference of the overall workload scores between the two ergometers did not show any significant difference (F(1,12) = .025, p = .876). In order to examine if there were individual factor differences between the six TLX factors of each ergometer, a constructed repeated measure MANOVA did not reveal any significant differences between ergometers and within individual TLX scores (F(5,8) = .995, p = .477). Interestingly, the absolute VO2max performance score was significantly correlated on the Cyclus2 ergometer with the self-reported performance TLX factor (r = .560, p = .047) while the same score was not significant for the SRM ergometer (r = .247, p = .415). However, participants were highly positively correlated between perceived performance on each ergometer (r = .736, p = .004). Participants were asked to name which ergometer they felt they performed better on. Eight participants named the SRM Ergometer, while 5 named the Cyclus2. When asked which ergometer they preferred to use, 4 named the SRM Ergometer, while 9 named the Cyclus2. When asked which ergometer the participant would prefer to use if the test were to be run again, 5 named the SRM Ergometer, while 8 named the Cyclus2. Participants were lastly asked to think of how comfortable they were for each of the ergometers. A paired t-test examined the differences between the comfort ratings of revealed a significant difference (t = -2.803, p = .016), with this being driven by the higher favourable ratings of the Cyclus2 compared to the SRM (Figure 1). These differences can be accounted for by 6 participants stating that they preferred the Cyclus2 and increased comfort owning to the usage of their own bike. Those that preferred the SRM stated it was more solid and stable (n = 4). Discussion: Biomechanical factors can influence physiological responses, perception of exercise and efficiency of an individual riding a bicycle or ergometer at a given power output (Patterson and Moreno, 1990: Medicine & Science in Sports & Exercise, 22(4), 512-516. Whilst not demonstrating any differences in physiological variables and MAP, participants generally felt more comfortable on the ergometer, which allows the use of personal bikes and which appears to replicate real world cycling more closely.

Augmented real‐time navigation with critical structure proximity alerts for endoscopic skull base surgery

Image-guided surgery (IGS) systems are frequently utilized during cranial base surgery to aid in orientation and facilitate targeted surgery. We wished to assess the performance of our recently developed localized intraoperative virtual endoscopy (LIVE)-IGS prototype in a preclinical setting prior to deployment in the operating room. This system combines real-time ablative instrument tracking, critical structure proximity alerts, three-dimensional virtual endoscopic views, and intraoperative cone-beam computed tomographic image updates. Randomized-controlled trial plus qualitative analysis. Skull base procedures were performed on 14 cadaver specimens by seven fellowship-trained skull base surgeons. Each subject performed two endoscopic transclival approaches; one with LIVE-IGS and one using a conventional IGS system in random order. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were documented for each dissection, and a semistructured interview was recorded for qualitative assessment. The NASA-TLX scores for mental demand, effort, and frustration were significantly reduced with the LIVE-IGS system in comparison to conventional navigation (P < .05). The system interface was judged to be intuitive and most useful when there was a combination of high spatial demand, reduced or absent surface landmarks, and proximity to critical structures. The development of auditory icons for proximity alerts during the trial better informed the surgeon while limiting distraction. The LIVE-IGS system provided accurate, intuitive, and dynamic feedback to the operating surgeon. Further refinements to proximity alerts and visualization settings will enhance orientation while limiting distraction. The system is currently being deployed in a prospective clinical trial in skull base surgery.

Quantification of the impact of multifaceted initiatives intended to improve operational efficiency and the safety culture: A case study from an academic medical center radiation oncology department

PurposeWe have systematically been incorporating several operational efficiency and safety initiatives into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful, metrics. Methods and MaterialsThe data from 5 quality improvement initiatives, each focused on a specific safety/process concern in our clinic, are presented. Data was collected prospectively: operational metrics recorded before and after implementation of the initiative were compared using statistical analysis. Results from the Agency for Health Care Research and Quality (AHRQ) patient safety culture surveys administered during and after many of these initiatives were similarly compared. Results(1) Workload levels for nurses assisting with brachytherapy were high (National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores >55-60, suggesting, “overwork”). Changes in work flow and procedure room layout reduced workload to more acceptable levels (NASA-TLX <55; P < .01). (2) The rate of treatment therapists being interrupted was reduced from a mean of 4 (range, 1-11) times per patient treatment to a mean <1 (range, 0-3; P < .001) after implementing standards for electronic communication and placement of monitors informing patients and staff of the treatment machine status (ie, delayed, on time). (3) The rates of replans by dosimetrists was reduced from 11% to 6% (P < .01) through a more systematic pretreatment peer review process. (4) Standardizing nursing and resident functions reduced patient wait times by ≈ 45% (14 min; P < .01). (5) Standardizing presimulation instructions from the physician reduced the number of patients experiencing delays on the simulator (>50% to <10%; P < .01). To assess the overall changes in “patient safety culture,” we conducted a pre- and postanalysis using the AHRQ survey. Improvements in all measured dimensions were noted. ConclusionsQuality improvement initiatives can be successfully implemented in an academic radiation oncology department to yield measurable improvements in operations resulting in improvement in patient safety culture.

Quantification of physician workload for radiotherapy planning, and possible associations with performance.

245 Background: Workload is a hypothetical construct representing the overall human cost incurred during a task. Across disciplines, the NASA Task Load Index (TLX) has been used as a subjective measure of workload. It quantifies six dimensions of work (mental, physical, and temporal demands, frustration, effort, and performance) on a scale of 1-100 scale, with scores &gt;55 (i.e. overworked) associated with lesser performance. We herein quantify differences in physician workload for planning a relatively “simple” (palliative 2 field opposed lateral brain) versus relatively “complex” (curative 4 field pancreas) case. Further, we explore the association between workload and performance to define TLX levels where performance could be expected to decline. Methods: Nine physicians planned two cases, each case involving three tasks (i.e., task 1 - review written patient medical records; task 2 - review diagnostic images and design of treatment fields; and task 3 - review and approval of the treatment plan). After completing each case, TLX scores of each case/task was collected. Differences in workload between cases/tasks were assessed via ANOVA. The association between workload and performance (assessed using time-to-task completion and self-assessments) was assessed via Pearson’s correlation test. Results: 54 TLX workload and performance assessments were obtained. Workloads for the simple brain case/tasks averaged 41-48, versus 62-69 for the complex pancreas case/tasks (p&lt;0.001 via ANOVA). There were no differences between tasks for the individual cases (p&gt;0.1). There was a correlation between TLX scores and time-to-complete (r=0.54, p&lt;0.001), and with physician self-assessments (r=-0.74, p&lt;0.001). There was a trend towards reduced performance with TLX scores &gt; 55. Conclusions: Physician workload levels are markedly lower for “simple” versus “complex” cases, indicating that TLX is a reliable tool to quantify workload. Performance appears to decline at TLX levels &gt; 55, which is consistent with findings from other industries. Thus, we propose workload assessment (via TLX) to be considered as an independent quality measure to assess the quality assurance (QA) of processes used to deliver radiation therapy.

Quantification of the impact of multifaceted improvements in patient safety culture: A case study from academic medical center radiation oncology department.

205 Background: We have systematically been incorporating several safety initiatives (based on process-engineering and Lean methodologies) into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful metrics. Methods: The data from five quality improvement initiatives are presented. For each, data was collected prospectively: operational metrics recorded before and after implementation of the initiative were compared using descriptive statistics and unpaired student t-test. Each initiative focused on a specific safety/process concern in our clinic. Results: 1) Workload levels for nurses assisting with brachytherapy were too high (NASA task load index scores &gt;55-60, suggesting, “overwork”). Changes in work flow and procedure room layout reduced workload scores to more acceptable limits (&lt;55). 2) The rate of treatment therapists being interrupted was reduced from a mean of 4 (range 1-11) times per patient treatment to a mean &lt; 1 (range 0-3, p&lt;0.001) after implementing standards for electronic communication and placement of monitors informing patients and staff of the treatment machine status (e.g., delayed, on time). 3) The rates of replans by dosimetrists was reduced from 11% in 2010 to 6% in 2011 though a more systematic pre-treatment peer review process. 4) Standardizing nursing/resident functions reduced patient wait times by ≈ 45% (14 min). 5) Standardizing pre-simulation instructions from the physician within the EMR reduced the number of patients experiencing delays on the simulator (from approximatley &gt;50% to &lt;10%). Conclusions: Process engineering and Lean methodologies can be successfully applied in an academic radiation oncology department to yield measurable improvements in operations likely improving quality/safety.

Augmented Real-Time Navigation with Critical Structure Proximity Alerts for Endoscopic Skull Base Surgery

Objectives/Hypothesis Image-guided surgery (IGS) systems are frequently utilized during cranial base surgery to aid in orientation and facilitate targeted surgery. We wished to assess the performance of our recently developed localized intraoperative virtual endoscopy (LIVE)-IGS prototype in a preclinical setting prior to deployment in the operating room. This system combines real-time ablative instrument tracking, critical structure proximity alerts, three-dimensional virtual endoscopic views, and intraoperative cone-beam computed tomographic image updates. Study Design Randomized-controlled trial plus qualitative analysis. Methods Skull base procedures were performed on 14 cadaver specimens by seven fellowship-trained skull base surgeons. Each subject performed two endoscopic transclival approaches; one with LIVE-IGS and one using a conventional IGS system in random order. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores were documented for each dissection, and a semistructured interview was recorded for qualitative assessment. Results The NASA-TLX scores for mental demand, effort, and frustration were significantly reduced with the LIVE-IGS system in comparison to conventional navigation (P < .05). The system interface was judged to be intuitive and most useful when there was a combination of high spatial demand, reduced or absent surface landmarks, and proximity to critical structures. The development of auditory icons for proximity alerts during the trial better informed the surgeon while limiting distraction. Conclusions The LIVE-IGS system provided accurate, intuitive, and dynamic feedback to the operating surgeon. Further refinements to proximity alerts and visualization settings will enhance orientation while limiting distraction. The system is currently being deployed in a prospective clinical trial in skull base surgery. Laryngoscope, 124:853–859, 2014

Respiratory sinus arrhythmia as a measure of cognitive workload

The current standard for measuring cognitive workload is the NASA Task-load Index (TLX) questionnaire. Although this measure has a high degree of reliability, diagnosticity, and sensitivity, a reliable physiological measure of cognitive workload could provide a non-invasive, objective measure of workload that could be tracked in real or near real-time without interrupting the task. This study investigated changes in respiratory sinus arrhythmia (RSA) during seven different sub-sections of a proposed selection test for Navy aviation and compared them to changes reported on the NASA-TLX. 201 healthy participants performed the seven tasks of the Navy's Performance Based Measure. RSA was measured during each task and the NASA-TLX was administered after each task. Multi-level modeling revealed that RSA significantly predicted NASA-TLX scores. A moderate within-subject correlation was also found between RSA and NASA TLX scores. The findings support the potential development of RSA as a real-time measure of cognitive workload.

Health Literacy and Task Environment Influence Parents' Burden for Data Entry on Child-Specific Health Information: Randomized Controlled Trial

Background Health care systems increasingly rely on patients’ data entry efforts to organize and assist in care delivery through health information exchange. Objectives We sought to determine (1) the variation in burden imposed on parents by data entry efforts across paper-based and computer-based environments, and (2) the impact, if any, of parents’ health literacy on the task burden.Methods We completed a randomized controlled trial of parent-completed data entry tasks. Parents of children with attention deficit hyperactivity disorder (ADHD) were randomized based on the Test of Functional Health Literacy in Adults (TOFHLA) to either a paper-based or computer-based environment for entry of health information on their children. The primary outcome was the National Aeronautics and Space Administration Task Load Index (TLX) total weighted score.Results We screened 271 parents: 194 (71.6%) were eligible, and 180 of these (92.8%) constituted the study cohort. We analyzed 90 participants from each arm. Parents who completed information tasks on paper reported a higher task burden than those who worked in the computer environment: mean (SD) TLX scores were 22.8 (20.6) for paper and 16.3 (16.1) for computer. Assignment to the paper environment conferred a significant risk of higher task burden (F1,178 = 4.05, P = .046). Adequate literacy was associated with lower task burden (decrease in burden score of 1.15 SD, P = .003). After adjusting for relevant child and parent factors, parents’ TOFHLA score (beta = -.02, P = .02) and task environment (beta = .31, P = .03) remained significantly associated with task burden.Conclusions A tailored computer-based environment provided an improved task experience for data entry compared to the same tasks completed on paper. Health literacy was inversely related to task burden. Trial registration Clinicaltrials.gov NCT00543257; http://www.clinicaltrials.gov/ct2/show/NCT00543257 (Archived by WebCite at http://www.webcitation.org/5vUVH2DYR)

Surgeons' Stress From Surgery and Night Duty

To examine the stress experienced by surgeons in response to surgery and night duty. Analyses were done by subjective questionnaires and an objective urine analysis. One university hospital and 15 community/public hospitals in Kitakyushu City, Japan. Sixty-six Japanese surgeons. Scores on the NASA Task Load Index and Stress Arousal Checklist and urine biopyrin levels. The Task Load Index score significantly increased in association with the duration of surgery and the amount of surgical blood loss. Urine biopyrin levels significantly increased with the duration of surgery. Night duty significantly decreased sleep time and significantly increased urine biopyrin levels. Stress Arousal Checklist Arousal Scale scores significantly decreased the morning after night duty and the evening after the end of the following day shift. Surgery was associated with stress on surgeons and night duty influenced the arousal of the surgeons during the day shift following night duty.

High-intensity stress elicits robust cortisol increases, and impairs working memory and visuo-spatial declarative memory in Special Forces candidates: A field experiment

While running a selection procedure, 27 male Belgian Special Forces candidates, with a mean age of 27.4 years (SD = 5.1), were randomly assigned to a no-stress control (n = 14) or a high-intensity stress group (n = 13). Participants in the latter group were exposed to an extremely strenuous mock prisoner of war (POW) exercise. Immediately after stress or control treatment, working memory and visuo-spatial declarative memory performances were measured by the digit span (DS) test and the Rey–Osterrieth complex figure (ROCF), respectively. Concurrently, stress levels were assessed by obtaining salivary cortisol measurements and subjectively by the NASA Task Load Index (TLX). As expected, exposure to high-intensity stress led to both robust cortisol increases and significant differences in TLX scores. Stress induction also significantly impaired DS and ROCF performances. Moreover, delta cortisol increases and ROCF performance in the POW stress group showed a significant negative correlation, while DS performances followed the same tendency. Summarizing, the current findings complement and extend previous work on hormonal stress effects, and the subsequent performance deterioration on two memory tests in a unique high-intensity stress environment.

Physiological Self-Regulation and Adaptive Automation

Adaptive automation has been proposed as a solution to current problems of human-automation interaction. Past research has shown the potential of this advanced form of automation to enhance pilot engagement and lower cognitive workload. However, there have been concerns voiced regarding issues, such as automation surprises, associated with the use of adaptive automation. This study examined the use of psychophysiological self-regulation training with adaptive automation that may help pilots deal with these problems through the enhancement of cognitive resource management skills. Eighteen participants were assigned to 3 groups (self-regulation training, false feedback, and control) and performed resource management, monitoring, and tracking tasks from the Multiple Attribute Task Battery. The tracking task was cycled between 3 levels of task difficulty (automatic, adaptive aiding, manual) on the basis of the electroencephalogram-derived engagement index. The other two tasks remained in automatic mode that had a single automation failure. Those participants who had received self-regulation training performed significantly better and reported lower National Aeronautics and Space Administration Task Load Index scores than participants in the false feedback and control groups. The theoretical and practical implications of these results for adaptive automation are discussed.