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. 2018 Apr;105(5):491-501.
doi: 10.1002/bjs.10795. Epub 2018 Feb 21.

Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload

R D Dias  1   2 , M C Ngo-Howard  3   4 , M T Boskovski  5   2 , M A Zenati  2   4 , S J Yule  1   6   5   2
Affiliations

Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload

R D Dias et al. Br J Surg. 2018 Apr.

Abstract

Background: Surgeons in the operating theatre deal constantly with high-demand tasks that require simultaneous processing of a large amount of information. In certain situations, high cognitive load occurs, which may impact negatively on a surgeon's performance. This systematic review aims to provide a comprehensive understanding of the different methods used to assess surgeons' cognitive load, and a critique of the reliability and validity of current assessment metrics.

Methods: A search strategy encompassing MEDLINE, Embase, Web of Science, PsycINFO, ACM Digital Library, IEEE Xplore, PROSPERO and the Cochrane database was developed to identify peer-reviewed articles published from inception to November 2016. Quality was assessed by using the Medical Education Research Study Quality Instrument (MERSQI). A summary table was created to describe study design, setting, specialty, participants, cognitive load measures and MERSQI score.

Results: Of 391 articles retrieved, 84 met the inclusion criteria, totalling 2053 unique participants. Most studies were carried out in a simulated setting (59 studies, 70 per cent). Sixty studies (71 per cent) used self-reporting methods, of which the NASA Task Load Index (NASA-TLX) was the most commonly applied tool (44 studies, 52 per cent). Heart rate variability analysis was the most used real-time method (11 studies, 13 per cent).

Conclusion: Self-report instruments are valuable when the aim is to assess the overall cognitive load in different surgical procedures and assess learning curves within competence-based surgical education. When the aim is to assess cognitive load related to specific operative stages, real-time tools should be used, as they allow capture of cognitive load fluctuation. A combination of both subjective and objective methods might provide optimal measurement of surgeons' cognition.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the review
Fig. 2
Fig. 2
Distribution of the studies according to surgical specialties
Fig. 3
Fig. 3
Distribution of the studies according to surgical procedures. MIS, minimally invasive surgery
None
See this image and copyright information in PMC

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