Park Sandra Hyunsoo, Goldberg Scott A, Al-Ballaa Abdulrahman, Tayeb Baraa, Basurrah Mohammed, Abahuje Egide, Miccile Chrisitian, Pozner Charles N, Yule Steven, Dias Roger Daglius
STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2022 Nov;279:361-367. doi: 10.1016/j.jss.2022.06.023. Epub 2022 Jul 8.
Literature has shown cognitive overload which can negatively impact learning and clinical performance in surgery. We investigated learners' cognitive load during simulation-based trauma team training using an objective digital biomarker.
A cross-sectional study was carried out in a simulation center where a 3-h simulation-based interprofessional trauma team training program was conducted. A session included three scenarios each followed by a debriefing session. One scenario involved multiple patients. Learners wore a heart rate sensor that detects interbeat intervals in real-time. Low-frequency/high-frequency (LF/HF) ratio was used as a validated proxy for cognitive load. Learners' LF/HF ratio was tracked through different phases of simulation.
Ten subjects participated in 12 simulations. LF/HF ratios during scenario versus debriefing were compared for each simulation. These were 3.75 versus 2.40, P < 0.001 for scenario 1; 4.18 versus 2.77, P < 0.001 for scenario 2; and 4.79 versus 2.68, P < 0.001 for scenario 3. Compared to single-patient scenarios, multiple-patient scenarios posed a higher cognitive load, with LF/HF ratios of 3.88 and 4.79, P < 0.001, respectively.
LF/HF ratio, a proxy for cognitive load, was increased during all three scenarios compared to debriefings and reached the highest levels in a multiple-patient scenario. Using heart rate variability as an objective marker of cognitive load is feasible and this metric is able to detect cognitive load fluctuations during different simulation phases and varying scenario difficulties.
文献表明，认知过载会对手术学习和临床操作产生负面影响。我们使用一种客观的数字生物标志物，研究了基于模拟的创伤团队培训期间学习者的认知负荷。
在一个模拟中心开展了一项横断面研究，进行了一个3小时的基于模拟的跨专业创伤团队培训项目。一次培训包括三个场景，每个场景之后都有一次总结讨论。其中一个场景涉及多名患者。学习者佩戴心率传感器，实时检测心跳间期。低频/高频（LF/HF）比值被用作认知负荷的有效替代指标。在模拟的不同阶段跟踪学习者的LF/HF比值。
10名受试者参与了12次模拟。对每次模拟的场景阶段与总结讨论阶段的LF/HF比值进行了比较。场景1中分别为3.75和2.40，P<0.001；场景2中为4.18和2.77，P<0.001；场景3中为4.79和2.68，P<0.001。与单患者场景相比，多患者场景带来更高的认知负荷，LF/HF比值分别为3.88和4.79，P<0.001。
与总结讨论阶段相比，在所有三个场景中，作为认知负荷替代指标的LF/HF比值均升高，且在多患者场景中达到最高水平。使用心率变异性作为认知负荷的客观指标是可行的，该指标能够检测不同模拟阶段和不同场景难度下的认知负荷波动。
