Relationship between intraoperative teaching skills and surgeons’ cognitive load

Purpose The operating room (OR) has the potential to be a high-stress environment due to the multiple tasks that surgeons must complete. Surgeons in a training environment must balance the tasks of teaching and operating, which may impose a high cognitive load. It is not known how a surgeon's cognitive load is related to intraoperative teaching. The aim of this study was to investigate the relationship between surgeons’ cognitive load and intraoperative teaching skills. Methods We conducted a mixed methods study at an urban academic hospital from February to October 2022. Following each operation, attending surgeons were asked to complete a quantitative survey instrument, the Surgeons’ Task Load Index (range 0–100), to report cognitive load during the operation. Surgical residents were asked to complete a four-item (5-point Likert Scale) questionnaire to report their perception of surgeons’ intraoperative teaching skills (setting learning goals, intraoperative teaching, autonomy, and continuous feedback). Spearman’s correlation was used to calculate the association between surgeons’ cognitive load scores and intraoperative teaching skills. Qualitative data were collected through non-participant observations and comments from the open-ended questions from the surgeons’ intraoperative teaching skills. Qualitative data were analyzed thematically with inductive and deductive logic. Results We enrolled 45 surgeons in the study. Correlation coefficients revealed that preoperatively setting learning goals were negatively correlated with surgeon cognitive load ( r = – 0.54, p = 0.005) and positively correlated with autonomy ( r = 0.71, p < 0.001) and intraoperative teaching ( r = 0.72, p < 0.001). Intraoperative teaching ( r = – 0.61, p = 0.001) and autonomy ( r = – 0.52, p = 0.007) were negatively correlated with surgeons’ cognitive load. Continuous feedback ( r = – 0.53, p = 0.006) was negatively correlated with surgeons’ cognitive load and positively correlated with autonomy ( r = 0.8, p < 0.001). Qualitative data analysis identified that: (1) attending surgeons demonstrated effective and ineffective teaching behaviors, and (2) attending surgeons applied various strategies to decrease the cognitive load. Conclusions Surgeons’ cognitive load negatively correlated with their intraoperative teaching skills. There is an opportunity to develop strategies and interventions to improve intraoperative teaching that support the need for surgeons to manage intraoperative workload.