Estimating Cognitive Workload Using Task-Related Pupillary Responses in Simulated Drilling in Cochlear Implantation

Area of Science:

• Otorhinolaryngology
• Surgical Education
• Medical Simulation

Background:

• Temporal bone drilling is crucial for cochlear implant surgery, requiring complex psychomotor skills beyond technical proficiency.
• Understanding the impact of workload and psychomotor skills on surgical performance is essential for effective training.

Purpose of the Study:

• To investigate the relationship between workload, psychomotor skills, and performance during temporal bone drilling.
• To evaluate the utility of task-evoked pupillary responses (TEPR) as an objective measure of workload in surgical training.

Main Methods:

• 22 medical students performed transmastoid-posterior tympanotomy (TMPT) and round window niche drilling on 3D-printed temporal bone models.
• Task-evoked pupillary responses (TEPR) metrics, including Average Pupil Size (APS), Index of Pupil Activity (IPA), and Low/High Index of Pupillary Activity (LHIPA), were recorded.
• TEPR metrics and drilling times were correlated with performance in key surgical phases.

Main Results:

• TEPR measures showed significant differences across drilling phases, reflecting anticipated workload variations.
• Enlarging the facial recess was the longest drilling phase.
• IPA indicated increased workload during posterior canal wall thinning, while APS showed higher workload during bony overhang drilling.

Conclusions:

• TEPR metrics provide objective insights into workload and skill acquisition during temporal bone drilling.
• Continuous monitoring of psychomotor skills using TEPR can support competency-based medical residency programs.
• Findings aid in developing objective assessments for surgical expertise.