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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 3, Pages 155-160
Original Article

Validation of the National Aeronautics and Space Administration Task Load Index as a Tool to Evaluate-The Learning Curve for Endoscopy Training

Rachid Mohamed,1 Maitreyi Raman,1 John Anderson,2 Kevin McLaughlin,3 Alaa Rostom,1 and Sylvain Coderre1

1Department of Medicine (Division Gastroenterology), University of Calgary, Calgary, Alberta, Canada
2Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust Hospital, United Kingdom
3Office of Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada

Received 11 March 2013; Accepted 16 November 2013

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.