Chilvers Nicholas J S, Evans Zachariah M, Clark Alexander W, Mydin Muhammad I, Clark Stephen C
Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
JHLT Open. 2024 Apr 30;5:100102. doi: 10.1016/j.jhlto.2024.100102. eCollection 2024 Aug.
Sequential lung transplantation is a complex procedure. The traditional training model continues to center 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, multidimensional 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.
We 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).
The overall weighted rating was significantly lower for the surgeons undertaking the case themselves rather than training ( < 0.001). Cases were comparable in terms of case type, donor ischemic time, and peri-operative characteristics. Mental and temporal demands were greater throughout training cases ( < 0.001, < 0.05). There was less effect on frustration, physical demand, and effort. Perceived performance showed no significant difference between the groups.
The NASA task load index can be used to inform the effects of training in 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 provide them with a mechanism to reflect on their own training performance.
Interpersonal and communication skills.Practice-based learning and improvement.
序贯肺移植是一项复杂的手术。传统的培训模式仍然以手术经验为核心，逐步增加手术各阶段的授权。然而，关于这对手术培训者的影响，几乎没有证据。NASA-TLX是一种主观的多维评估工具，用于评估感知工作量。我们试图将其作为一种评估肺移植培训对培训者影响的方法。
我们前瞻性地收集了60例接受双侧序贯肺移植患者的NASA-TLX数据。在30例手术中，手术完全由植入双肺的资深外科医生（SS）完成。在另外30例手术中，资深外科医生植入右肺（SSR）并监督一名实习生植入左肺（TL）。
亲自实施手术的外科医生的总体加权评分显著低于培训时（<0.001）。病例在病例类型、供体缺血时间和围手术期特征方面具有可比性。在整个培训过程中，心理和时间需求更大（<0.001，<0.05）。对挫折感、体力需求和努力的影响较小。两组之间的感知表现没有显著差异。
NASA任务负荷指数可用于了解肺移植培训对培训者的影响。培训导致更大的心理和时间需求，对其他因素的影响较小。至关重要的是，感知表现没有显著差异。随着该专业继续面临各种挑战，本研究应让未来培训移植外科医生的人充满信心，并为他们提供一种反思自己培训表现的机制。
人际和沟通技能。基于实践的学习与改进。
