Massachusetts Chapter of the American College of Surgeons

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Team cognitive load and clinical performance during medical events in a spaceflight simulator
Sandra Park1,6, Mahdi Ebnali1,5, Steven Yule1,2,3,4, Roger Dias1,5
1STRATUS Center for Medical Simulation, Brigham and Womenís Hospital, Boston, MA, USA; 2Center for Surgery & Public Health, Brigham & Womenís Hospital, Boston, MA, USA; 3Department of Surgery, Brigham & Womenís Hospital/ Harvard Medical School, Boston, MA, USA; 4Department of Clinical Surgery, The University of Edinburgh, Scotland; 5Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; 6Harvard Medical School, Boston, MA, USA

Background: The success of long duration space missions depends on the health of crew members. Understanding performance variability is essential to optimizing mission success. Increase in cognitive load (CL) during emergencies can be detrimental to performance. Our aim was to determine the relationship between team cognitive load and clinical performance during simulated spaceflight emergencies.
Methods: This was a retrospective analysis of a dataset from a previous study. Astronaut-like participants underwent four simulated medical scenarios: cardiac arrest, pneumothorax, smoke inhalation, and eye injury. A wearable chest strap was used to measure heart rate variability (HRV) as an objective measure of CL. NASA-TLX was used to capture participants' self-reported CL. Clinical performance was measured using technical performance (% adherence to critical process of care), non-technical performance (SFRM-Med tool), and overall performance (1-100 analog visual scale).
Results: 59 participants completed four simulations. Bivariate correlation analysis showed NASA-TLX and HRV triangular index were associated with clinical performance. Stepwise regression analysis showed adding HRV triangular parameter to the NASA-TLX score in a model to predict overall performance increases the correlation coefficient from 0.381 to 0.577, p< 0.001. Regression model combining NASA-TLX and HRV triangular has a 31.1% accuracy to predict overall clinical performance (adjusted R-Square:0.31, F:15.25, p<0.001).
Conclusion: Team cognitive load is negatively correlated with performance. Mitigation measures that alleviate cognitive load, such as cognitive decision support systems, may improve team performance. Further studies are needed to determine which combinations of physiological parameters and self-report measures are optimal for understanding team cognitive load and optimizing performance.


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