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An attempt to estimate students' workload.

Following the recent introduction of the European Credit Transfer System (ECTS) into several European university programs, a new interest has developed in determining students' workload. ECTS credits are numerical values describing the student workload required to complete course units; ECTS has the potential to facilitate comparison and create transparency between institutional curricula. ECTS credits are frequently listed alongside institutional credits in course outlines and module summaries. Measuring student workload has been difficult; to a large extent, estimates are based only upon anecdotal and casual information. To gather more systematic information, we asked students at the Veterinary Faculty, University of Ljubljana, to estimate the actual total workload they committed to fulfill their coursework obligations for specific subjects in the veterinary degree program by reporting their attendance at defined contact hours and their estimated time for outside study, including the time required for examinations and other activities. Students also reported the final grades they received for these subjects. The results show that certain courses require much more work than others, independent of credit unit assignment. Generally, the courses with more contact hours tend also to demand more independent work; the best predictor of both actual student workload and student success is the amount of contact time in which they participate. The data failed to show any strong connection between students' total workload and grades they received; rather, they showed some evidence that regular presence at contact hours was the most positive influence on grades. Less frequent presence at lectures tended to indicate less time spent on independent study. It was also found that pre-clinical and clinical courses tended to require more work from students than other, more general subjects. While the present study does not provide conclusive evidence, it does indicate the need for further inquiry into the nature of the relationship between teaching and learning in higher education and for evaluation of the benefits (or otherwise) of more "self-directed" study.

Education, Veterinary↗

Faculty workload and collegial support related to proportion of part-time faculty composition.

Part-time faculty use has become more prevalent in higher education in response to enrollment shifts and budgetary constraints. This descriptive, exploratory study used a mailed survey to investigate whether full-time nursing faculty perceptions of workload and collegial support differ with changes in the proportion of part-time faculty in Comprehensive I baccalaureate nursing programs. Workload was measured by Dick's Workload Instrument. Collegial support was measured by the Survey of Collegial Communication, adapted by Beyer, which was based on Likert's organizational model. Schools were partitioned into three strata based on the proportion of part-time faculty employed (low, medium, and high). A 30% sample of schools were randomly selected from each stratum (10 schools from each). Within each selected school, six full-time undergraduate faculty were chosen by their respective deans to participate. The total response rate was 89.4%. The results of this study did not support assertions about part-time faculty use in the literature and existing accreditation standards. Findings indicated that there were significant differences in reported total faculty workload when varying proportions of part-time faculty are employed. Faculty in nursing programs with medium proportions of part-time faculty reported higher average total workloads per week than faculty in programs with low and high proportions of part-timers. Another finding demonstrated that full-time faculty in nursing programs with high proportions of part-time faculty spend fewer hours in direct clinical supervision of their students when compared with faculty in the other two strata. There were, however, no differences in perceived collegial support among full-time faculty participants. It was recommended that further research be conducted to investigate specific workload differences found in this study using more precise quantitative measures. Communication and collegiality between part-time and full-time faculty should be further developed and researched under more controlled conditions. Case studies of arrangements that make part-time faculty use beneficial are needed. Other variables such as leadership style, scholarly productivity, and morale and their relationship to the proportion of part-time faculty employed in the nursing program should be investigated.

Adult↗

Interest among occupational therapy managers in measuring workload for case costing.

OBJECTIVES: Interest in costing health care delivery on an individual case basis has increased in recent years as concern with overall health care costs has heightened. Costing exercises have been largely oriented around medical classification systems. Measures to incorporate the contributions of allied health activities such as occupational therapy are relatively recent. The objective of this study was to examine the attitudes and opinions of senior occupational therapy managers toward workload measurement on the basis of case mix. METHOD: A survey was sent to all 198 senior occupational therapy managers in accredited Canadian facilities, which was completed by 182 respondents for a response rate of 92%. The questionnaire asked about workload measurement system(s) currently used, satisfaction with the system(s), and needs and expectations of workload systems in general. RESULTS: The majority of respondents were using a time recording workload measurement system and expressed relatively low levels of satisfaction with it. Current systems were unable to provide costing data, which respondents ranked as very important for themselves as managers. The majority of respondents believed that it would be useful or very useful to be able to cost occupational therapy services by a diagnostic grouping system and to establish standard protocols per diagnosis, standard times per procedure per institution, and standard times per procedure for the profession. CONCLUSION: There is support for developing or expanding current methods of measuring workload. Senior occupational therapy managers would like to be able to predict their workload prospectively, a step that will accommodate the move toward case costing and program management.

Attitude of Health Personnel↗

The impact of nursing home patients on general practitioners' workload.

BACKGROUND: Although the number of people in nursing homes has risen substantially in recent years, the shift of responsibility into general practice has rarely been accompanied by extra resources. These patients may be associated with a higher general practitioner (GP) workload than others of similar age and sex. AIM: To assess the GP workload associated with nursing home residents and its associated costs. METHOD: All nursing home residents aged over 65 years and registered with nine Nottinghamshire practices during one year were matched with patients living in the community for general practice, age, and sex. Data were collected retrospectively for both groups on key workload measures. Costs for the workload measures were calculated using published estimates. RESULTS: Data were collected for 270 pairs of patients. Nursing home patients had more face-to-face contacts in normal surgery hours, telephone calls, and out-of-hours visits. The mean workload cost per month of a nursing home patient (assuming that one patient was seen per visit) was estimated to be 18.21 Pounds (10.49 Pounds higher than the cost of controls). A sensitivity analysis demonstrated that potential savings in visiting costs associated with increasing the numbers of patients seen per visit were 27% for one extra patient seen per visit and 44% for four extra patients. CONCLUSION: Nursing home residents were associated with higher workload for GPs than other patients of the same age and sex living in the community. Our costings provide a basis for negotiating suitable reimbursement of GPs for their additional work.

Aged↗

Comparison of histopathologists' workloads in two pathology departments in Croatia.

AIM: To calculate workloads of Departments of Pathology and staff histopathologists at two Croatian University Hospitals by means of the Suvarna and Kay's Kim Unit (KU) activity index. METHOD: The total number of specimens and KU activity/year were calculated to compare staff pathologists' workload in two Pathology Departments, one at Split and the other at Zagreb University Hospital. The individual specimen types were assigned a difficulty score on a scale of 1-5 units (KUs), depending on the time needed for specimen dissection and macroscopic description, number of sections and stains required, and time spent on microscopy of an "average case". KU activity was calculated for all pathologists individually in terms of histology (1-5 KUs), autopsy (10 KUs), supervision of residents, and outside consultations (2 KUs). RESULTS: According to calculated Kim Unit activity index, pathologists' workload in two investigated pathology departments was not equally spread. In the Split Department of Pathology the distribution of workload was more uniform than in the Zagreb Department of Pathology. The average workload of both institutions was 4,562 KUs. CONCLUSION: KU activity index is a very useful method for assessing average pathologists' workload. It may be also used in hospital administration for predicting changes in service and number of working pathologists.

Biopsy, Needle↗

[The assessment of nursing workload].

The measurement of nursing workload first began in the 1970s, because of the need for determining severity of illness and cost-effectiveness in the intensive care unit. In the following decades, the need for more specific tools for assessing nursing workload brought to the development of scoring systems more focused on nursing activities. We will briefly review the scoring systems validated since 1974. TISS-Therapeutic Intervention Scoring System elaborated by Cullen in 1974 is based on 57 therapeutic procedures and was designed to assess the severity of illness in the ICU. Each intervention scores 1 to 4. Patients are grouped in 5 classes. It was not sufficiently validated and was abandoned. However it first introduced the idea of "patient point managed per nurse". TISS update was elaborated by Keene in 1983. The therapeutic procedures were increased to 76. It was assumed that a single nurse can manage 40/50 points per day. Though not validated, it became the most used tool to assess complexity of treatment and nurse/patient ratio. However many of these items are obsolete and frequently related to the severity of illness rather than to specific nursing interventions. PRN-Project Research of Nursing was elaborated by EROS during 1980-1987. Points are assigned to each nursing activity according to their frequency, duration, need for more than one nurse, etc. It results quite time consuming, thus unsuitable for routine use. OMEGA elaborated in 1986 describes 86 therapeutic interventions, grouped in 3 categories, measured at the end of ICU stay, thus representing a measure of global workload and use of resources. TOSS-Time Oriented Score System was elaborated by GIRTI in 1991. This score was studied and tested in Italy. It represents a direct temporal evaluation of nursing workload. The score is expressed in minutes. It is reliable and relatively simple, and has been validated on over 2 700 ICU patients. TISS 28 was elaborated by Miranda in 1996. It represents a simplified and updated version of the original TISS, proposed to assess the nursing workload. The authors stated that a nurse can deal with 46 points over the 24 hours. NEMS-Nine Equivalents of nursing Manpower use Score was elaborated by Miranda in 1997. It was derived from TISS and TISS28. Only 9 items, related to specific organ support, nursing and diagnostic/therapeutic interventions inside or outside the ICU, are considered. These items were weighted by multivariate analysis, obtaining a score comparable to the TISS28 score. Each nurse can deal with 45/50 points per day. NAS-Nursing Activity Score was elaborated by Miranda in 2003. It was derived from TISS28, aiming at the description of nursing activities not necessarily correlated to the severity of illness. It describes 81% of the nursing time, compared to 43% of TISS 28. In conclusion, many scoring systems have been proposed to describe nursing workload, both directly (as with TOSS and PRN) or through severity and complexity of treatment (TISS, TISS 28, NAS and NEMS). These scores represent the instruments to assess the correct use of ICU resources.

Intensive Care Units↗

A comparison of heart rate, eye activity, EEG and subjective measures of pilot mental workload during flight.

BACKGROUND: Mental workload is a major consideration in the design and operation of modern aircraft systems. Objective measures of mental workload that are sensitive and diagnostic are required to meet the needs of both pilots and designers. Due to the multifaceted nature of these complex mental demands multiple measures are required. HYPOTHESIS: Psychophysiological and subjective measures provide unique information about mental workload during flight. METHODS: Cardiac, eye, brain and subjective data were collected during an actual flight scenario designed to provide tasks which required different piloting skills at several levels of mental workload. RESULTS: Heart rate was sensitive to the demands of flight but not diagnostic with regard to determining the cause of the workload. Heart rates increased during take offs and landings and to an intermediate level during instrument flight rules (IFR) segments. By showing sensitivity to only the visual demands of the various segments of flight eye activity was more diagnostic. The theta band of the EEG demonstrated increased power during those flight segments which required inflight mental calculations. The subjective measures showed trends suggesting different levels of mental demand but demonstrated few statistically significant differences. CONCLUSIONS: Multiple measures, especially psychophysiological measures, provide a comprehensive picture of the mental demands of flight. The measures used in this study were shown to provide unique, non-overlapping information. Because of the continuous nature of the psychophysiological data it may be possible to develop systems which provide on-line monitoring of mental workload that can provide feedback to the pilot and aircraft systems.

Adult↗

Effects of cognitive workload on speech production: acoustic analyses and perceptual consequences.

The present investigation examined the effects of cognitive workload on speech production. Workload was manipulated by having talkers perform a compensatory visual tracking task while speaking test sentences of the form "Say hVd again." Acoustic measurements were made to compare utterances produced under workload with the same utterances produced in a control condition. In the workload condition, some talkers produced utterances with increased amplitude and amplitude variability, decreased spectral tilt and F0 variability and increased speaking rate. No changes in F1, F2, or F3 were observed across conditions for any of the talkers. These findings indicate both laryngeal and sublaryngeal adjustments in articulation, as well as modifications in the absolute timing of articulatory gestures. The results of a perceptual identification experiment paralleled the acoustic measurements. Small but significant advantages in intelligibility were observed for utterances produced under workload for talkers who showed robust changes in speech production. Changes in amplitude and amplitude variability for utterances produced under workload appeared to be the major factor controlling intelligibility. The results of the present investigation support the assumptions of Lindblom's ["Explaining phonetic variation: A sketch of the H&H theory," in Speech Production and Speech Modeling (Klewer Academic, The Netherlands, 1990)] H&H model: Talkers adapt their speech to suit the demands of the environment and these modifications are designed to maximize intelligibility.

Adult↗

Inflight application of three pilot workload measurement techniques.

Three measures of workload were tested during 11 routine missions conducted by the NASA Kuiper Airborne Observatory: communications performance, subjective ratings, and heart rate. The activities that contributed to crewmember workload varied; the commander was responsible for aircraft control and navigation whereas the copilot handled communications with ATC and the astronomers. Ratings of workload, stress, and effort given by the two crewmembers were highly correlated and varied across flight segments, peaking during takeoff and landing. Since the pilots performed different tasks during each segment, their ratings appeared to reflect overall crew workload, rather than experiences specific to each pilot. Subjective fatigue increased significantly from takeoff to landing for all flights, although the increase was significantly greater as landing times shifted from 10:00 p.m. to 9:00 a.m. The type, source, number, and frequency of communications varied significantly across flight segments, providing an objective indicator of pilot workload. Heart rate was significantly higher for the aircraft commander than for the copilot. Although heart rate peaked for both positions during takeoff and landing, the amount of change was significantly greater for the aircraft commander. Subjective ratings of stress, workload, and mental effort were significantly correlated with heart rate and communications frequency but were unrelated to mission duration, rated fatigue, or pilot evaluation of performance.

Aerospace Medicine↗

Using a nursing-workload index to validate hospital pharmacy productivity.

The use of a nursing-workload-index indicator generated by the Medicus patient classification system was explored as a means of simplifying and validating a manual pharmacy-workload-reporting system. The pharmacy department of this 290-bed hospital monitors 14 activities in its productivity-measurement process. In an effort to validate this process, a 20-week study was conducted to evaluate the relationship between the nursing-workload-index data and the number of hours required to provide pharmaceutical services. Number of patient days and the nursing index were compared with respect to their reliability in predicting pharmacy workload. A significant correlation was found between the nursing index and the number of hours earned for pharmacy activities (with or without hours earned for processing admissions and discharges). Significant correlations were also found when the patient-days indicator was used, but those relationships were not as strong. The nursing-workload-index indicator studied was useful in validating the workload data generated by the pharmacy department.

Efficiency↗

The increasing workload of general surgery.

BACKGROUND: With the aging of the baby boomers, individuals aged 65 years and older make up the fastest-growing segment of the US population. This aging of the population will lead to new challenges for the US health care system because older individuals are the largest consumers of health care. HYPOTHESIS: The general surgery workload will increase dramatically by 2020 as a result of the aging population. DATA SOURCES: The National Hospital Discharge Survey, National Survey of Ambulatory Surgery, US Census Bureau, and Centers for Medicare and Medicaid Services. SETTING: A nationally representative random sample of inpatient and outpatient general surgical operations performed in 1996 in the United States. METHODS: Age- and procedure-specific rates of general surgery were obtained from the National Hospital Discharge Survey and National Survey of Ambulatory Surgery. Population projections were derived from the census bureau. We used relative-value units as a proxy for surgical work. By linking these 3 data sources, we predicted the future general surgery workload by analyzing the rates of surgery and modeling both the aging and expansion of the population. RESULTS: General surgery operations (n = 63) were classified into 5 procedure categories. Whereas the population will grow by 18% between 2000 and 2020, the workload of general surgeons will increase by 31.5%. The amount of growth (19.9%-40.3%) varies among different categories of operations. CONCLUSIONS: To our knowledge, this is one of the only studies to analyze the future workload of general surgery. We project a dramatic increase in workload in the next 20 years, largely as a result of the aging US population. Our baseline assumptions are relatively conservative, so this forecast may be an underestimation. Hence, the challenge for general surgeons is to develop strategies to address this problem while maintaining quality of care for our patients.

Adolescent↗

Construct and face validity and task workload for laparoscopic camera navigation: virtual reality versus videotrainer systems at the SAGES Learning Center.

BACKGROUND: Laparoscopic camera navigation (LCN) training on simulators has demonstrated transferability to actual operations, but no comparative data exist. The objective of this study was to compare the construct and face validity, as well as workload, of two previously validated virtual reality (VR) and videotrainer (VT) systems. METHODS: Attendees (n = 90) of the SAGES 2005 Learning Center performed two repetitions on both VR (EndoTower) and VT (Tulane Trainer) LCN systems using 30 degrees laparoscopes and completed a questionnaire regarding demographics, simulator characteristics, and task workload. Construct validity was determined by comparing the performance scores of subjects with various levels of experience according to five parameters and face validity according to eight. The validated NASA-TLX questionnaire that rates the mental, physical, and temporal demand of a task as well as the performance, effort, and frustration of the subject was used for workload measurement. RESULTS: Construct validity was demonstrated for both simulators according to the number of basic laparoscopic cases (p = 0.005), number of advanced cases (p < 0.001), and frequency of angled scope use (p < 0.001), and only for VT according to training level (p < 0.001) and fellowship training (p = 0.008). Face validity ratings on a 1-20 scale averaged 15.4 +/- 3 for VR vs. 16 +/- 2.6 for VT (p = 0.04). Ninety-six percent of participants rated both simulators as valid educational tools. The NASA-TLX overall workload score was 69.5 +/- 24 for VR vs. 68.8 +/- 20.5 for VT (p = 0.31). CONCLUSIONS: This is the largest study to date that compares two validated LCN simulators. While subtle differences exist, both VR and VT simulators demonstrated excellent construct validity, good face validity, and acceptable workload parameters. These systems thus represent useful training devices and should be widely used to improve surgical performance.

Adult↗

Variation in the treatment of cervical cancer patients and the effect of consultant workload on survival: a population-based study.

This population-based study aimed to investigate the extent of variation in the treatment of patients diagnosed with cervical cancer between 1995 and 2000, and the relationship between workload and survival, looking at managing consultants and clinical oncologists. Cases were identified from the Northern and Yorkshire Cancer Registry (n=1500) and divided into three groups according to their gynaecologists' or clinical oncologists' annual cervical cancer workload; 'low' (1-3 new patients), 'intermediate' (4-11 new patients) and 'high' (12+new patients). Over the study period, there was a decrease in the proportion of patients treated by low workload gynaecologists. After adjustment for age, stage and socioeconomic status, higher gynaecologist workload was associated with improved survival but this was not statistically significant. No such trend was found for clinical oncologist workload. During the 1990s, there were moves to establish more specialised care of gynaecological cancers, with referral to multidisciplinary teams. The trends observed in this study are consistent with the goals of policy.

Adult↗

The effect of cell phone type on drivers subjective workload during concurrent driving and conversing.

The effect of three types of cell phones (hand held, hands free with an external speaker and personal hands free) on total subjective workload (including its constituent components; mental demand, physical demand, temporal demand, performance, effort and frustration) and intelligibility was measured using the NASA-task load index (TLX) and the modified rhyme test (MRT), respectively in 13 experienced drivers (nine male, four female, age range 28-65 years), whilst driving on a rural highway. The drivers rated all components of workload for each type of cell phone to be significantly higher than for a control condition in which no cell phone was used. The mean (standard deviation) total workload was lowest for the personal hands free cell phone (7.1(3.65)) and highest for the hands free speaker phone (10.8 (3.63)) (P<0.001). The mean (standard deviation) intelligibility score was highest for the personal hands free cell phone (74.1 (7.9)) and lowest for the hands free speaker phone (55.0 (10.4)) (P<0.001). Frustration was significantly correlated with total workload (0.60, P<0.001) and intelligibility was significantly correlated with frustration (-0.35, P<0.05). Physical demand was not a high contributor to total workload. It is concluded that a personal hands free cell phone would interfere least with the cognitive demands of driving.

Adult↗

Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit.

BACKGROUND: Few studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. METHODS: We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustment of mortality risk by the APACHE II equation (n=1050). APACHE II data were validated by one observer. Measures of workload in each patient's stay included occupancy, total ICU nursing requirement as defined by the UK Intensive Care Society, and the ratio of occupied to appropriately staffed beds. Over the period, staffing was appropriate for between 4.1 and 5.3 occupied beds (1.3 nurses per patient). FINDINGS: There were 337 deaths, 49 more (95% CI 34-65) than predicted by the APACHE II equation. Median occupancy was 5.8 beds, and median nursing requirement was 1.6 per patient. On multiple logistic regression analysis, adjusted mortality was more than two times higher (odds ratio 3.1 [1.9-5.0]) in patients exposed to high than in those exposed to low ICU workload, defined by average nursing requirement per occupied bed and peak occupancy; the unadjusted odds ratio for this comparison was 4.0 (2.6-6.2). After exclusion of measures of nursing requirement, adjusted mortality increased with the ratio of occupied to appropriately staffed beds during each patient's stay. All logistic regression models fitted the data satisfactorily. INTERPRETATION: Variations in mortality may be partly explained by excess ICU workload. This methodology may have implications for planning and clinical governance.

APACHE↗

Electrophysiological, behavioral, and subjective indexes of workload when performing multiple tasks: manipulations of task difficulty and training.

This study examined whether alpha event-related desynchronization (ERD) and theta event-related synchronization (ERS) could successfully measure changes in cognitive workload and training while an operator was engaged in a continuous, interactive, control task(s). Alpha 1 (8-10 Hz) ERD, alpha 2 (10-12 Hz) ERD, and theta (3-7 Hz) ERS were determined for a communications event that occurred during multiple task workload conditions or as a single task. Other measures (alpha and theta EEG power, heart rate, respiration, eye blinks, behavioral performance, and subjective workload ratings) were also evaluated. Results showed that alpha 2 EEG, heart rate, behavioral, and subjective measures were sensitive to changes in workload in the multiple tasks. In addition, eye blink rate and behavioral measures were sensitive to training. Alpha ERD and theta ERS were not sensitive to workload and training in our interactive, multiple task environment. However, they were effective indexes of cognitive/behavioral demands within an interactive single task.

Adult↗

Variation in routine psychiatric workload: the role of financing source, managed care participation, and mental health workforce competition.

This study was conducted to examine the association between psychiatrists' demographic characteristics, payment source, and managed care participation and psychiatrists' practice workload, and between the supply of other mental health providers in a psychiatrist's county of practice and psychiatrists' practice workload. Data from the 1996 American Psychiatric Association National Survey of Psychiatric Practice were merged with national countywide measures of mental health workforce and environmental data from the 1996 Area Resource File. In comparison to male psychiatrists, female psychiatrists treat fewer patients per week, provide less total hours of weekly patient care, and obtain fewer new monthly referrals. An increase in psychiatrists' managed care participation was associated with only minor increases in the number of patients per week, weekly time spent in clinical care, and number of new monthly referrals. The supply of other mental health providers was not associated with variation in practice workload. Once psychiatrists participate in managed care plans, an increase in their participation rate does not significantly expand clinical practice workload. The supply of other mental health providers was not significantly associated with variation in psychiatrists' workload, which suggests that substitution effects may not be evident with this aspect of psychiatric practice.

Adult↗

Psychological workload and weight gain among women with and without familial obesity.

OBJECTIVE: High job demands and low job influence may be associated with subsequent weight gain. Predisposition to obesity may further modify such associations. The purpose of the study was to determine whether familial predisposition to obesity modified associations between psychological workload and 6-year weight changes among nurses. RESEARCH METHODS AND PROCEDURES: A total of 6404 Danish nurses 45 to 65 years old, who belonged to the workforce in both 1993 and 1999, answered a questionnaire on psychological workload, body weight, and familial obesity. Women were considered to be predisposed to obesity if they were overweight and had at least one obese parent. Parents' body shape was reported using pictograms. RESULTS: An increased psychological workload, reflected by high job demands and low influence in job, was associated with an increased body weight. This was particularly the case for nurses being predisposed to obesity, suggesting a synergy between familial obesity predisposition and the psychological workload environment. An interaction test among job demands, familial predisposition to obesity, and weight gain on adjusted data was made. The test showed p = 0.05. The adjusted interaction test among influence in job, familial predisposition to obesity, and weight gain showed p = 0.02. Predisposed nurses who were busy in their job gained 4.4 kg, whereas other nurses gained only 3.2 kg during the 6 years. Similarly, nurses predisposed to obesity with low influence in job had a higher body weight gain (5.4 vs. 3.2 kg) compared with other nurses. DISCUSSION: High psychological workload due to high job demands and low influence in job seems to predict weight gain in general and, in particular, among those nurses with a familial predisposition to obesity.

Causality↗