Using Cognitive Load to Differentiate Experience Levels for Performing Endobronchial Ultrasound Bronchoscopy.

Authors

Dylan Wang, Jeffrey Thiboutot, Christopher M Kapp, A Christine Argento, Lonny Yarmus, Hans J Lee

Published in

CHEST pulmonary. Volume 4. Issue 1. Pages 100217. Epub Oct 09, 2025.

Abstract

Endobronchial ultrasound (EBUS) bronchoscopy is an indispensable tool for diagnosing lung cancer and pulmonary diseases. However, the cognitive load associated with learning and performing EBUS bronchoscopy has not been examined. This could be used to understand the critical components of performing the procedure. In this study, we attempt to characterize cognitive load using continuous pupillometry and the surgery task load index (SURG-TLX) with various experience levels to give weighted importance of various steps in EBUS bronchoscopy.
Can cognitive load measurements be used to differentiate experience levels and determine the relative importance of procedural steps in EBUS bronchoscopy?
In this controlled observational study, 8 bronchoscopists of varying experience performed EBUS in a cadaveric model. During the procedure, bronchoscopists wore eye-tracking glasses, which collected pupil dilation measurements. Immediately after each procedure, bronchoscopists completed a SURG-TLX assessment. The duration of each procedure was timed, and critical time points were recorded.
Participants' SURG-TLX scores revealed that greater experience level was associated with significantly lower components of the SURG-TLX, which included perceived total workload, task complexity, physical demand, and mental demand. However, no statistically significant differences were observed across experience levels for perceived distractions, situational stress, and temporal demand. Pupillometry data revealed that all bronchoscopists' pupils were most dilated during the image optimization portion of EBUS bronchoscopy. Furthermore, expert bronchoscopists spent a larger proportion of procedural time on image optimization than did intermediates or novices.
Both SURG-TLX assessments and pupillometry data were shown to provide valuable insight into weighted importance to various steps in EBUS bronchoscopy by examining cognitive load that distinguish experts from nonexperts.

PMID:
42548455
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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