Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Surgical Services Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2022 Apr;113(4):1370-1377. doi: 10.1016/j.athoracsur.2021.05.086. Epub 2021 Jun 29.
Methods to assess competency in cardiothoracic training are essential. Here, we report a system that allows us to better assess competency from the perspective of both the trainee and educator. We hypothesized that postprocedural cognitive burden measurement (by the trainee) with immediate feedback (from the educator) could aid in identifying barriers to the acquisition of skills and knowledge so that training curricula can be individualized.
The National Aeronautics and Space Administration Task Load Index (NASA-TLX), a validated instrument to measure cognitive load, was administered with an online platform after bronchoscopy, esophagogastroduodenoscopy, and video-assisted thoracoscopic surgery for 11 residents. Immediate postprocedure feedback and standardized debriefing occurred for each procedure.
Mean NASA-TLX scores were highest (indicating greater cognitive load) for esophagogastroduodenoscopy and video-assisted thoracoscopic surgery (P < .001). When comparing subscale measures, mental demand was significantly higher for video-assisted thoracoscopic surgery (P = .026) compared with the other procedures, whereas physical demand was highest for esophagogastroduodenoscopy (P = .018). Self-reported frustration was similar for all case types (P = .247). Cognitive burden decreased with a greater number of procedures for bronchoscopy (P = .027). Significant improvement was noted by the trainee at the end of the rotation in self-assessed procedural competency and preparedness for thoracic board topics (all P < .05). Postprocedure feedback by the attending surgeon correlated with more frequent completion of self-evaluations by the residents.
Longitudinal assessment of cognitive load in combination with postprocedural feedback identified barriers to skill acquisition for both residents and educators. This information allows for individualized rotation development as a step toward a competency-based curriculum.
评估心胸培训能力的方法至关重要。在这里，我们报告了一种系统，使我们能够从学员和教育者的角度更好地评估能力。我们假设，通过学员进行术后认知负担测量（由学员完成）并即时反馈（由教育者提供），可以帮助确定获取技能和知识的障碍，从而实现个体化培训课程。
使用国家航空航天局任务负荷指数（NASA-TLX）对 11 名住院医师进行支气管镜检查、食管胃十二指肠镜检查和电视辅助胸腔镜手术后进行在线评估。对每个手术过程均立即进行术后反馈和标准化的讨论。
平均 NASA-TLX 评分在食管胃十二指肠镜检查和电视辅助胸腔镜手术中最高（表明认知负担更大）（P<0.001）。当比较子量表测量值时，电视辅助胸腔镜手术的心理需求明显高于其他手术（P=0.026），而食管胃十二指肠镜检查的体力需求最高（P=0.018）。所有病例类型的自我报告挫折感相似（P=0.247）。支气管镜检查次数越多，认知负担越低（P=0.027）。学员在旋转结束时自我评估程序能力和准备胸腔板主题方面均有显著改善（所有 P<0.05）。主治外科医生的术后反馈与住院医师更频繁地进行自我评估相关。
结合术后反馈对认知负担进行纵向评估，确定了学员和教育者在技能获取方面的障碍。这些信息为个体化旋转发展提供了信息，是迈向基于能力的课程的一步。
