Quantifying the Effects of Training in Lung Transplantation: Lessons from NASA

Purpose Sequential lung transplantation is a complex procedure and is challenging to teach to inexperienced surgeons in training. In-theatre training and delegation of parts of the surgery has remained the traditional model for knowledge and skill transfer. However, there is little evidence on the effects this has on surgical trainers. The NASA Task Load Index (NASA-TLX) is a subjective, multidimensional assessment tool that rates perceived workload in order to assess a task, system or other aspects of performance. Methods Total workload is divided into six subjective subscales including mental, physical and temporal demand together with performance, effort and frustration. TLX creates an individual sub scale weighting by letting the subject compare them pairwise based on their perceived importance. We prospectively collected NASA-TLX data after bilateral sequential lung transplantation by the surgeon only and from the senior surgeon where he implanted the right lung and a surgical trainee implanted the left lung under supervision in the same recipient to assess the effects of training on the trainer. 60 patients were studied. In 30 the operation was performed entirely by the senior surgeon (SS). In 30 operations the senior surgeon implanted the right lung (SSR) and a trainee the left lung (TL). Immediately after surgery the surgeon made a subjective assessment of the NASA-TLX. Results The overall weighted rating was significantly lower for the surgeon undertaking the case themselves rather than training (SSmean 32.3:SSRmean 95;TLmean 68.8 p Conclusion The NASA task load index demonstrates the effect of training in lung transplantation. Training leads to greater mental and temporal demands but had less effect on physical demand, effort and performance. Frustration scores are greater when training. As the transplant surgical workforce continues to face challenges in the future, this data should provide senior surgeons with confidence to train and teach and reflect and improve on their training performance.