Validation of the National Aeronautics and Space Administration-Task Load Index as a tool to evaluate the learning curve for endoscopy training Administration

BACKGROUND: Although workplace workload assessments exist in different fields, an endoscopy- specific workload assessment tool is lacking. Objective: To validate such a workload tool and use it to map the progression of novice trainees in gastroenterology in performing their first endoscopies. METHODS: The National Aeronautics and Space Administration Task Load Index ( NASA- TLX) workload assessment tool was completed by eight novice trainees in gastroenterology and 10 practicing gastroenterologists/surgeons. An exploratory factor analysis was performed to construct a streamlined endoscopy- specific task load index, which was subsequently validated. The 'Endoscopy Task Load Index' was used to monitor progression of trainee exertion and self- assessed performance over their first 40 procedures. RESULTS: From the factor analysis of the NASA- TLX, two principal components emerged: a measure of exertion and a measure of self-efficacy. These items became the components of the newly validated Endoscopy Task Load Index. There was a steady decline in self- perceived exertion over the training period, which was more rapid for gastroscopy than colonoscopy. The self- efficacy scores for gastroscopy rapidly increased over the first few procedures, reaching a plateau after this period of time. For colonoscopy, there was a progressive increase in reported self- efficacy over the first three quartiles of procedures, followed by a drop in self- efficacy scores over the final quartile. DISCUSSION: The present study validated an Endoscopy Task Load Index that can be completed in < 1 min. Practical implications of such a tool in endoscopy education include identifying periods of higher perceived exertion among novice endoscopists, facilitating appropriate levels of guidance from trainers.