Operating at a Distance-How a Teleoperated Surgical Robot Reconfigures Teamwork in the Operating Room

This paper investigates how a teleoperated surgical robot reconfigures teamwork in the operating room by spatially redistributing team members. We report on findings from two years of fieldwork at two hospitals, including interviews and video data. We find that while in non-robotic cases team members huddle together, physically touching, introduction of a surgical robot increases physical and sensory distance between team members. This spatial rearrangement has implications for both cognitive and affective dimensions of collaborative surgical work. Cognitive distance is increased, necessitating new efforts to maintain situation awareness and common ground. Moreover, affective distance is introduced, decreasing sensitivity to shared and non-shared affective states and leading to new practices aimed at restoring affective connection within the team. We describe new forms of physical, cognitive, and affective distance associated with teleoperated robotic surgery, and the effects these have on power distribution, practice, and collaborative experience within the surgical team

Intense Collaboration In Globally Distributed Teams: Evolving Patterns Of Dependencies And Coordination

As multi-national firms and major offshore outsourcing companies develop experience with global work, their globally distributed teams face the challenge of collaborating intensely without the common interaction advantages associated with collocated work. This chapter analyzes the sources of intense collaboration. It then introduces strategies that organizations have developed to reduce the intensity of collaboration (sequentializing work, using mediating artifacts, modularity), or to enable intense teamwork (real time contact, boundary spanners). Strategy properties and deployment opportunities and constraints are indicated in order to equip managers and researchers with a framework for handling or analyzing globally distributed teamwork

The Transformative Role of Telemedicine on Coordination: A Practice Approach

Delivering coordinated care at a distance challenges work practices and interprofessional collaboration. Using a case study methodology, we analyzed how three occupational groups, pathologists, technologists, and surgeons, coordinate work during the deployment of a major telepathology network in Eastern Canada. The aim of this study is to determine the extent to which and how telemedicine modifies coordination practices. \ \ Transformations emerged from our in-depth case analysis around three aspects of coordination: predictability, common understanding and accountability. First, predictability relied on routines in traditional settings, but shifted to a reliance on plans and rules in a telemedicine setting. Second, common understanding of the task shifted from relying on familiarity between stakeholders to an emphasis on standards. Third, accountability became less collective and more individual and contractual in a telemedicine setting, resulting in more marked boundaries between professional groups. Finally, proximity remained a determinant of accountability in telemedicine contexts, regardless of organizational arrangements. Implications for research and practice are discussed

How Does Robotic Surgery Influence Communication, Leadership, and Team Outcomes? A Multimethod Examination.

The practice of delivering surgical care has evolved to be less invasive to the patients undergoing surgery. Minimally-invasive surgery can be practiced through traditional laparoscopic methods as well as with robotic technology that displaces the surgeon from the operating table. Robotic surgery has been cited to be safer and more effective than traditional laparoscopic surgery; however, little research has endeavored to investigate the role of surgical modality upon aspects of teamwork. This dissertation contributes to the human factors and teamwork literature by evaluating how surgical modality may influence communication, shared leadership, and team outcomes. Multiple methods were employed to study robotic and non-robotic (i.e., open and laparoscopic) surgical teams. Teams were evaluated through video analysis of surgical procedures as well as questionnaire methods. The results of this research revealed very few modality-specific differences which may represent the adaptive nature of teams and individuals. Robotic surgical team members did not perceive a statistically significant difference in communication quality which may indicate that the impact of the closed console design may be relatively benign in this regard. While there were no statistically significant differences between the degree to which robotic and non-robotic teams shared or perceived shared leadership, there were interesting role and leadership behavior type differences. For instance, the assists conducted significantly more leadership in robotic surgery than in laparoscopic surgery. In the video data, sharing leadership to a greater extent led to shorter operative durations. In the survey data, higher perceptions of communication quality and communication behavior significantly predicted higher perceptions of team effectiveness, indicating a strong positive relationship between perceived communication and perceived effectiveness. As robotic surgical systems and practices continue to inevitably advance in the coming years, developers should be keenly aware of the interdependencies between all aspects of the sociotechnical system including the providers and recipients of care, the environment and organization, and the tools and technologies

Losing Touch:An embodiment perspective on coordination in robotic surgery

Because new technologies allow new performances, mediations, representations, and information flows, they are often associated with changes in how coordination is achieved. Current coordination research emphasizes its situated and emergent nature, but seldom accounts for the role of embodied action. Building on a 25-month field study of the da Vinci robot, an endoscopic system for minimally invasive surgery, we bring to the fore the role of the body in how coordination was reconfigured in response to a change in technological mediation. Using the robot, surgeons experienced both an augmentation and a reduction of what they can do with their bodies in terms of haptic, visual, and auditory perception and manipulative dexterity. These bodily augmentations and reductions affected joint task performance and led to coordinative adaptations (e.g., spatial relocating, redistributing tasks, accommodating novel perceptual dependencies, and mounting novel responses) that, over time, resulted in reconfiguration of roles, including expanded occupational knowledge, emergence of new specializations, and shifts in status and boundaries. By emphasizing the importance of the body in coordination, this paper suggests that an embodiment perspective is important for explaining how and why coordination evolves following the introduction of a new technology

Patient triage by topic modelling of referral letters: Feasibility study

Background: Musculoskeletal conditions are managed within primary care but patients can be referred to secondary care if a specialist opinion is required. The ever increasing demand of healthcare resources emphasizes the need to streamline care pathways with the ultimate aim of ensuring that patients receive timely and optimal care. Information contained in referral letters underpins the referral decision-making process but is yet to be explored systematically for the purposes of treatment prioritization for musculoskeletal conditions. Objective: This study aims to explore the feasibility of using natural language processing and machine learning to automate triage of patients with musculoskeletal conditions by analyzing information from referral letters. Specifically, we aim to determine whether referral letters can be automatically assorted into latent topics that are clinically relevant, i.e. considered relevant when prescribing treatments. Here, clinical relevance is assessed by posing two research questions. Can latent topics be used to automatically predict the treatment? Can clinicians interpret latent topics as cohorts of patients who share common characteristics or experience such as medical history, demographics and possible treatments? Methods: We used latent Dirichlet allocation to model each referral letter as a finite mixture over an underlying set of topics and model each topic as an infinite mixture over an underlying set of topic probabilities. The topic model was evaluated in the context of automating patient triage. Given a set of treatment outcomes, a binary classifier was trained for each outcome using previously extracted topics as the input features of the machine learning algorithm. In addition, qualitative evaluation was performed to assess human interpretability of topics. Results: The prediction accuracy of binary classifiers outperformed the stratified random classifier by a large margin giving an indication that topic modelling could be used to predict the treatment thus effectively supporting patient triage. Qualitative evaluation confirmed high clinical interpretability of the topic model. Conclusions: The results established the feasibility of using natural language processing and machine learning to automate triage of patients with knee and/or hip pain by analyzing information from their referral letters

英語症例報告の語彙的・テキスト的特徴 : 予備調査の結果から

本稿では英文の症例報告108本を対象としたコーパス分析の結果を報告する。まず，筆者らによる医学英語カリキュラム開発のこれまでの取り組みを概観し，次に3本の症例報告を対象とした談話分析，および108本すべてのコーパスを対象とした予備的分析の結果を報告する。最後に，本研究の教育的示唆を考察する。 本稿のリサーチクエスチョンは以下の2点である。 1. 症例報告にはどのようなテキスト的特徴が見られるか。 2. 症例報告の小規模な初期コーパスから，主要な語彙項目や定型的言語表現の特定は可能か。 分析結果によれば，症例報告で用いられる医学用語は難解なものもあるが，全体的な構成や展開は極めてシンプルで，3つの主要セクション（緒言，症例提示，考察）および抄録と参考文献で構成されている。緒言では当該疾患についての概要を述べ，新しい症例の導入説明を行う。症例提示では症例の顕著な特徴を記述し，考察では関連文献を引用しつつ，その症例が興味深い理由を論述し，最後は示唆で締め括る。詳細なコーパス分析により，症例報告において広範囲かつ高頻度で出現する用語や表現の特定が可能である。例えば，非定型的症例の導入説明には，“We report a case…” のような表現が用いられる。また，考察で著者の示唆が記述される部分では，‘may’ や ‘can’ のような法助動詞とbe動詞のコロケーションが頻出する。 本稿の教育的示唆として，症例報告を読むことと実際に書くことの違いを考察する。症例報告の読解と分析は医学教育の比較的初期から開始できるが，症例報告を書くことは，学部3年生の段階では難易度が高すぎると思われる。しかしそうした学生であっても，まずは模擬患者の情報を用い，ごく一般的な症例について書く指導から始めることで，症例報告における症例提示の技能を効果的に伸長できるだろう。さらに次の段階では，実際の症例報告を書くために，研究者が自分のニーズにあった小規模コーパスの構築を行えるよう，基本的なコーパス分析の訓練を行う方法について考察する。In this article, we present our findings on an analysis of a corpus of 108 medical case reports in English. We first summarize the history of our involvement with medical English curriculum development, then present our findings from a discourse analysis of three case reports and a preliminary corpus analysis of the entire collection of articles. We conclude with a consideration of the pedagogical implications. The following research questions are addressed: 1. What textual features of medical case reports can be identified? 2. From a small initial corpus of case reports, is it possible to identify key lexical items and formulaic sequences? The results of the analyses show that although the medical terminology of case reports may be challenging, their overall organization and structure is quite simple, comprising three main sections (introduction, case presentation/report, and discussion) plus an abstract and references. The introduction describes the key area and introduces the new case. The case presentation/report narrates the salient features of the case, and the discussion involves an explanation of why the case is interesting or unusual, usually citing other literature in the area, and concluding with some suggestions. From the detailed corpus analysis a variety of terms and expressions that occur frequently and in a wide range of case reports can be identified. For example, phrases such as “We report a case . . .” are used to introduce the atypical case described in the study, and the modal verbs ‘may’ and ‘can’ often collocate with ‘be’ in the suggestions made by the authors in the discussion. In the section on pedagogical implications, we discuss the difference between reading case reports and actually writing them. While reading and analyzing case reports can start relatively early in students’ medical studies, we argue that writing case reports is too big a challenge for third-year undergraduates. However, these students could be taught first to write up usual rather than rare cases by using simulated patient information, effectively developing skills for the presentation section of a case report. For the writing of actual case reports, we consider how training in basic corpus analysis could be provided, enabling researchers to build small corpora relevant to their needs

Identifying common problems in the acquisition and deployment of large-scale software projects in the US and UK healthcare systems

Public and private organizations are investing increasing amounts into the development of healthcare information technology. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardised procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the problems that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail on electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of Healthcare Information Systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems