title: Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool.
abstract: BACKGROUND
  Increased workload during task performance may increase fatigue and facilitate errors. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a previously validated tool for workload self-assessment. We assessed the relationship of workload and performance during simulator training on a complex laparoscopic task.
  
  
  METHODS
  NASA-TLX workload data from three separate trials were analyzed. All participants were novices (n = 28), followed the same curriculum on the fundamentals of laparoscopic surgery suturing model, and were tested in the animal operating room (OR) on a Nissen fundoplication model after training. Performance and workload scores were recorded at baseline, after proficiency achievement, and during the test. Performance, NASA-TLX scores, and inadvertent injuries during the test were analyzed and compared.
  
  
  RESULTS
  Workload scores declined during training and mirrored performance changes. NASA-TLX scores correlated significantly with performance scores (r = -0.5, P < 0.001). Participants with higher workload scores caused more inadvertent injuries to adjacent structures in the OR (r = 0.38, P < 0.05). Increased mental and physical workload scores at baseline correlated with higher workload scores in the OR (r = 0.52-0.82; P < 0.05) and more inadvertent injuries (r = 0.52, P < 0.01).
  
  
  CONCLUSIONS
  Increased workload is associated with inferior task performance and higher likelihood of errors. The NASA-TLX questionnaire accurately reflects workload changes during simulator training and may identify individuals more likely to experience high workload and more prone to errors during skill transfer to the clinical environment.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Yuliya Y
authors.initials: YY
authors.lastname: Yurko
authors.forename: Mark W
authors.initials: MW
authors.lastname: Scerbo
authors.forename: Ajita S
authors.initials: AS
authors.lastname: Prabhu
authors.forename: Christina E
authors.initials: CE
authors.lastname: Acker
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
mesh_terms: D000818:Animals; D002983:Clinical Competence; D003071:Cognition; D003479:Curriculum; D004521:Educational Measurement; D005260:Female; D018662:Fundoplication / Q000193:education* / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods; D008297:Male; D023421:Models, Animal; D009657:North Carolina; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013552:Swine; D013647:Task Performance and Analysis; D014481:United States; D018557:United States National Aeronautics and Space Administration; D014768:Virginia; D016526:Workload; D055815:Young Adult