High-Fidelity Simulation to Assess Task Load Index and Performance: A Prospective Observational Study

Objective: The NASA Task Load Index is a questionnaire widely used in aviation. This index might help for attesting the quality of a scenario in high-fidelity simulation in healthcare. The main purpose of this study was to observe whether NASA Task Load Index for critical care-simulated scenarios, designed for residents, was consistent with the literature. The second purpose was to describe relationships between NASA Task Load Index, performance and generated stress during high-fidelity simulation. Methods: All residents in anaesthesia and intensive care undergoing high-fidelity simulation were included. The primary endpoint was the task load generated by each scenario assessed by NASA Task Load Index. Based on the literature, the NASA Task Load Index scores between 39 and 61 were considered an acceptable level. Stress level (Visual Analogue Scale) and specific technical and non-technical skills performances (Team Emergency Assessment Measure) were also assessed. Results: Totally 53 residents actively participated in 1 of 10 different scenarios, between June and December 2017. The median NASA Task Load Index score of scenarios was 61 [48-65]. Five scenarios generated acceptable task load levels. There was no association between the NASA Task Load Index score and technical or non-technical skills performance scores, but an association between NASA Task Load Index and the stress level (rho = 4.7, P = .001) was observed. Conclusion: Simulation scenarios generate different task loads for residents; the task load was deemed acceptable for half of the scenarios. The NASA Task Load Index could be considered as a tool to assess the pedagogic adequacy of scenarios. Scenario and generated stress level, but not task load, can modify residents' performance during simulation. This should be considered when planning normative simulation.