Institute of Human Performance, University of Hong Kong, Hong Kong, SAR, People's Republic of China.
World J Surg. 2011 Sep;35(9):1961-9. doi: 10.1007/s00268-011-1141-4.
The purpose of the present study was to develop and validate a multidimensional, surgery-specific workload measure (the SURG-TLX), and to determine its utility in providing diagnostic information about the impact of various sources of stress on the perceived demands of trained surgical operators. As a wide range of stressors have been identified for surgeons in the operating room, the current approach of considering stress as a unidimensional construct may not only limit the degree to which underlying mechanisms may be understood but also the degree to which training interventions may be successfully matched to particular sources of stress.
The dimensions of the SURG-TLX were based on two current multidimensional workload measures and developed via focus group discussion. The six dimensions were defined as mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. Thirty novices were trained on the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task and then completed the task under various conditions designed to manipulate the degree and source of stress experienced: task novelty, physical fatigue, time pressure, evaluation apprehension, multitasking, and distraction.
The results were supportive of the discriminant sensitivity of the SURG-TLX to different sources of stress. The sub-factors loaded on the relevant stressors as hypothesized, although the evaluation pressure manipulation was not strong enough to cause a significant rise in situational stress.
The present study provides support for the validity of the SURG-TLX instrument and also highlights the importance of considering how different stressors may load surgeons. Implications for categorizing the difficulty of certain procedures, the implementation of new technology in the operating room (man-machine interface issues), and the targeting of stress training strategies to the sources of demand are discussed. Modifications to the scale to enhance clinical utility are also suggested.
本研究旨在开发和验证多维、特定于手术的工作量测量工具（SURG-TLX），并确定其在提供有关各种压力源对经过训练的外科操作人员感知需求的影响的诊断信息方面的效用。由于已经确定了手术室内外科医生面临的一系列压力源，因此目前将压力视为单维结构的方法不仅可能限制对潜在机制的理解程度，还可能限制培训干预措施与特定压力源的匹配程度。
SURG-TLX 的维度基于两种现有的多维工作量测量工具，并通过焦点小组讨论进行了开发。六个维度分别定义为心理需求、生理需求、时间需求、任务复杂性、情境压力和干扰。30 名新手接受了腹腔镜手术基础（FLS）钉转移任务的培训，然后在各种旨在操纵所经历的压力程度和压力源的条件下完成任务：任务新颖性、身体疲劳、时间压力、评估焦虑、多任务处理和干扰。
结果支持 SURG-TLX 对不同压力源的区分敏感性。子因素按照假设加载到相关的压力源上，尽管评估压力的操作不够强，无法引起情境压力的显著上升。
本研究为 SURG-TLX 仪器的有效性提供了支持，同时也强调了考虑不同压力源如何影响外科医生的重要性。讨论了对某些手术难度进行分类、在手术室实施新技术（人机界面问题）以及将压力培训策略针对需求源的重要性。还提出了对量表进行修改以增强临床实用性的建议。
