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The research catalogue is an archive of ESRC-funded grants and outputs. Links, files and other content will no longer be maintained or updated after April 2014.

'Bilateral (Hong Kong):' Gaze strategies of laparoscopy surgeons: Observational learning, implicit knowledge and performance in demanding conditions

Grant reference: RES-000-22-3016

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Journal article details

Development and validation of a surgical workload measure : the surgery task load index (SURG-TLX)
The purpose of the present study was to develop and validate a multidimensional, surgery-specific workload measure, and to determine its utility in providing diagnostic information about the impact of various sources of stress on the perceived demands of trained surgical operators. As a wide range of stressors have been identified for surgeons in the operating room, the current approach of considering stress as a unidimensional construct may not only limit the degree to which underlying mechanisms may be understood but also the degree to which training interventions may be successfully matched to particular sources of stress. The dimensions of the SURG-TLX were based on two current multidimensional workload measures and developed via focus group discussion. The six dimensions were defined as mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. Thirty novices were trained on the Fundamentals of Laparoscopic Surgery peg transfer task and then completed the task under various conditions designed to manipulate the degree and source of stress experienced: task novelty, physical fatigue, time pressure, evaluation apprehension, multitasking, and distraction. The results were supportive of the discriminant sensitivity of the SURG-TLX to different sources of stress. The sub-factors loaded on the relevant stressors as hypothesized, although the evaluation pressure manipulation was not strong enough to cause a significant rise in situational stress. The present study provides support for the validity of the SURG-TLX instrument and also highlights the importance of considering how different stressors may load surgeons. Implications for categorizing the difficulty of certain procedures, the implementation of new technology in the operating room, and the targeting of stress training strategies to the sources of demand are discussed. Modifications to the scale to enhance clinical utility are also suggested.

Primary contributor

Author Mark Wilson

Additional contributors

Co-author Jamie M. Poolton
Co-author Neha Malhotra
Co-author Karen Ngo
Co-author Elizabeth Bright
Co-author Rich S.W. Masters

Additional details

01 September 2011
New York, NY
World journal of surgery


Wilson_development.pdf (.pdf / 318kb)

Cite this outcome


Wilson, Mark et al (2011) Development and validation of a surgical workload measure : the surgery task load index (SURG-TLX). World journal of surgery. 35 (9), pp. 1961-1969 New York, NY: Springer.


Wilson Mark et al. Development and validation of a surgical workload measure : the surgery task load index (SURG-TLX). World journal of surgery 2011; 35 (9): 1961-1969.