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

Objectives Training of temporal bone drilling requires more than mastering technical skills with the drill. Skills such as visual imagery, bimanual dexterity, and stress management need to be mastered along with precise knowledge of anatomy. In otorhinolaryngology, these psychomotor skills underlie performance in the drilling of the temporal bone for access to the inner ear in cochlear implant surgery. However, little is known about how psychomotor skills and workload management impact the practitioners' continuous and overall performance. Methods To understand how the practitioner's workload and performance unfolds over time, we examine task‐evoked pupillary responses (TEPR) of 22 medical students who performed transmastoid‐posterior tympanotomy (TMPT) and removal of the bony overhang of the round window niche in a 3D‐printed model of the temporal bone. We investigate how students' TEPR metrics (Average Pupil Size [APS], Index of Pupil Activity [IPA], and Low/High Index of Pupillary Activity [LHIPA]) and time spent in drilling phases correspond to the performance in key drilling phases. Results All TEPR measures revealed significant differences between key drilling phases that corresponded to the anticipated workload. Enlarging the facial recess lasted significantly longer than other phases. IPA captured significant increase of workload in thinning of the posterior canal wall, while APS revealed increased workload during the drilling of the bony overhang. Conclusion Our findings contribute to the contemporary competency‐based medical residency programs where objective and continuous monitoring of participants' progress allows to track progress in expertise acquisition. Laryngoscope, 134:5087–5095, 2024 To advance temporal bone drilling, psychomotor skills need to be trained along with technical prowess. We examined workload fluctuations using pupillary responses and reported on significant differences in key drilling phases. Our findings contribute to continuous monitoring in medical residency programs.