Preliminary findings of a multimodal sensor system for measuring surgeon cognitive workload

Abstract

The operating room represents a high-risk environment centred around the safe and efficient delivery of patient care. It is a complex ecosystem that encompasses many factors including communication within the multidisciplinary surgical team often led by the operating surgeon as well as execution of precise technical surgical skill. These factors are associated with the mental or cognitive workload (CWL) of the surgeon. CWL, also described as the mental effort exerted while undertaking a task, is a construct derived from the cognitive load theory first described in the eighties during problem solving exercises [1]. There has been a growing emphasis on the measurement of CWL since then on individuals working in high-stake environments such as aviation [2]. Measurement of CWL in surgery is moving from solitary traditional subjective measures such as the Surgical Task Load Index (SURG-TLX) to objective measurement of physiological parameters secondary to changes in the CWL of the surgeon which are less exposed to subjective bias [3]. These have included heart rate variability (HRV), pupil metrics, electromyography (EMG), electroencephalography (EEG), skin conductance and functional near-infrared spectroscopy (fNIRS). More recently, there is increasing evidence to demonstrate the use of multiple sensors, or a multimodal sensor system designed to measure CWL with greater accuracy [4]. The aim of this paper is to demonstrate the use of a pilot synchronised system of multiple sensors to measure the real-time cognitive workload of surgeons in a simulated setting to demonstrate a proof of concept and to discuss the early findings.