Effectiveness analysis of traditional and mixed reality simulations in medical training: a methodological approach for the assessment of stress, cognitive load and performance

La simulazione nell'educazione in medicina è considerata un metodo di formazione in grado di migliorare le competenze cliniche e il comportamento degli operatori sanitari e, di conseguenza, la qualità dell'assistenza per il paziente. Inoltre, l'utilizzo di nuove tecnologie come la Realtà Aumentata, offre ai discenti l'opportunità di esercitarsi in un ambiente immersivo. L'opportunità di sperimentare questo innovativo metodo didattico è efficace non solo nel ridurre il rischio di errori e approcci sbagliati ma anche nel provare ansia e stress simili a quelli avvertiti nella pratica reale. La sfida sta nel trovare il giusto equilibrio. I discenti devono infatti provare lo stesso stress che avvertirebbero lavorando ad un vero caso clinico ma, allo stesso tempo, devono essere controllati ed evitati possibili disturbi da stress post-traumatico, verificabili soprattutto nel campo della gestione delle emergenze (pronto soccorso). Inoltre, è fondamentale anche ottenere alte prestazioni e un apprendimento adeguato, evitando sovraccarichi cognitivi che influenzerebbero negativamente l’apprendimento. Tuttavia, ad oggi mancano ancora studi approfonditi sull'impatto che le simulazioni mediche hanno su stress, frustrazione, carico cognitivo e apprendimento dei discenti. Per questo motivo, l'obiettivo principale di questo studio è valutare l'efficacia del training tramite simulazione, analizzando prestazioni, ansia, stress e carico cognitivo durante simulazioni cliniche tradizionali (con manichino) ed avanzate (in realtà mista). A questo scopo, è stato sviluppato un approccio metodologico strutturato e completo per valutare le prestazioni, le condizioni emotive e cognitive degli studenti. Questo comprende l'acquisizione e l'analisi di parametri psicologici (valutazione soggettiva), segnali biometrici (valutazione oggettiva) e prestazioni. Questa indagine consente di evidenziare i punti deboli delle simulazioni e offre l'opportunità di definire utili linee guida per la riprogettazione e l'ottimizzazione delle stesse. La metodologia è stata applicata su tre casi studio: il primo si riferisce a simulazioni ad alta fedeltà per la gestione del paziente in pronto soccorso, il secondo si riferisce a simulazioni a bassa fedeltà per la pratica della rachicentesi. Per il terzo caso studio, è stato progettato e sviluppato un prototipo di simulatore in realtà mista per la rachicentesi, con l'obiettivo di migliorare il senso di realismo e immersione della simulazione a bassa fedeltà. 148 studenti sono stati coinvolti nei primi due casi studio osservazionali, mentre soltanto 36 studenti hanno preso parte allo studio pilota sulla simulazione in realtà mista. In tutti i casi di studio sono state effettuate analisi descrittive delle prestazioni, degli stati cognitivi ed emotivi. Per le simulazioni ad alta e bassa fedeltà, le analisi di regressione statistica hanno evidenziato quali variabili influenzano le prestazioni, lo stress e il carico cognitivo degli studenti. Per lo studio pilota sulla realtà mista, l'analisi della user experience ha sottolineato i limiti tecnici della nuova tecnologia.Simulation in medical education is considered a training method capable of improving clinical competence and practitioners’ behaviour, and, consequently quality of care and patient’s outcome. Moreover, the use of new technologies, such as augmented reality, offers to the learners the opportunity to engage themselves in an immersive environment. The opportunity to experiment with this innovative instructional method is effective not only in reducing the risk of errors and wrong approaches but also in experiencing anxiety and stress as in real practice. The challenge is to find the right stress balance: learners have to feel as if they were practicing in the real stressful clinical case, and, at the same time, post-traumatic stress disorders, verifiable especially in the emergency field, must be controlled and avoided. Moreover, it is fundamental also to obtain high performance and learning, thus avoiding cognitive overloads. However, extensive researches about the impact of medical simulations on students’ stress, frustration, cognitive load, and learning are still lacking. For this reason, the main objective of this study is to assess simulation training effectiveness by analysing performance, anxiety, stress, and cognitive load during traditional (with manikin) and advanced (with augmented reality) clinical simulations. A structured and comprehensive methodological approach to assess performance, emotional and cognitive conditions of students has been developed. It includes the acquisition and analysis of psychological parameters (subjective assessment), biometric signals (objective assessment), and task performance. This investigation allows to point out simulations’ weaknesses and offers the opportunity to define useful optimisation guidelines. The methodology has been applied to three case studies: the first one refers to high-fidelity simulations, for the patient management in the emergency room, the second one refers to low-fidelity simulation for rachicentesis. For the third case study, a prototype of a mixed reality simulator for the rachicentesis practice has been designed and developed aiming at improving the sense of realism and immersion of the low-fidelity simulation. While 148 students have been enrolled in the first two case studies, only 36 students have taken part in the pilot study about mixed reality simulation. Descriptive analysis about performance, cognitive and emotional states have been done in all the case studies. For the high-fidelity and low-fidelity simulations, the statistical regression analysis has pointed out which variables affect students’ performance, stress, and cognitive load. For the pilot study about mixed reality, the user experience analysis highlighted the technical limitations of the new technology

Developtment of a software tool for the analysis and verification of emergency operating procedures through the integrated simulation of plant and operators actions

Probabilistic safety assessment (PSA) includes operator actions as elements in the set of the considered protection performances during accident sequences. Nevertheless, its impact throughout a sequence is not usually analyzed dynamically. In this sense, it is convenient to make a more detailed analysis about its importance in the dynamics of the sequences, allowing for sensitivity studies with respect to human reliability and response times. For this reason, new developments in simulation software must be able to incorporate operator actions in conventional thermalhydraulic simulations. In this paper, we present one of these new tools, the TRETA/TIZONA–COPMA III coupled codes, which can be used for evaluating the impact in the final plant state of the execution by operators of procedures and the evaluation of the available times for the manual actions of the operators. This software tool consists of a closed-loop plant/operator simulator: a thermalhydraulic code for simulating the plant transient (TRETA for PWR NPPs and TIZONA for BWR NPPs) and the procedures processor (COPMA III) to simulate the operator actions requested by the procedures, both coupled by a data communication system which allows the information exchange (SWBus). The first pilot cases have been performed in order to analyze sequences initiated by secondary side breaks leading to loss of heat sink sequences in a PWR plant. These tests have been carried out using the real plant EOPs for COPMA-III and a PWR plant model for TRETA code. The results of these simulations are presented in this paper

Modeling Decision Making In Trauma Centers From The Standpoint Of Complex Adaptive Systems

This research examines complex clinical decision-making processes in trauma center units of hospitals in terms of the impact of complexity on the medical team involved in the trauma event. The science of complex adaptive systems together with human judgment theories provide important concepts and tools for responding to health care challenges in this century and beyond. Clinical decision-makers in trauma centers are placed in urgent and anxious situations that are increasingly complex, making decision-making and problem-solving processes multifaceted. Under stressful circumstances, physicians must derive their decision-making schemas (―internal models‖ or ―mental models‖) without the benefits of judicious identification, evaluation, and/or application of relevant medical information, and always using fragmentary data. This research developed a model of decision-making processes in trauma events that uses a Bayesian Classifier model jointly with Convolution and Deconvolution operators to study real-time observed trauma data for decision-making processes under stress. The objective was to explore and explain physicians‘ decision-making processes during actual trauma events while under the stress of time constraints and lack of data. The research addresses important operations that describe the behavior of a dynamic system resulting from stress placed on the physician‘s rational decision making processes by the conditions of the environment. Deconvolution, that is, determining the impulse response of the system, is used to understand how physicians clear out extraneous environmental noise in order to have a clearer picture of their mental models and reach a diagnosis or diagnostic course of action

Distributions of air traffic control students’ attitudes towards workload

Mental workload is a well-known concept with a long development history. It can be used to examine students’ attitudes at the end of the educational process and compare them in groups or separately. However, building a continuous workload profile across the range of task complexity increase is still an urgent issue. All four groups of methods used to define mental workload have such flaws for the workload profile construction process as significant time requirements, single value processing and post-processing of the received results. Only one of them can be used without modifications to construct the operator’s attitude chart (profile) regarding the workload range and it doesn’t operate with more reliable absolute values. To resolve this problem, a special workload assessment grid was developed, considering the advantages of a subjective group of methods and seven core characteristics. The reasoning for grid axes choice, threshold values, and question formulation were provided. Statistics were calculated for the full sample, different grades, and educational institutions. Comparison of the received responses with referential values, cross-comparison between institutions and different grades were performed. The results contribute to such important aspects of workload, as redlines, workload profiling, and operator’s comparison

Effects of Acute Stress on Aircrew Performance: Literature Review and Analysis of Operational Aspects

Situational stress can adversely affect the cognition and skilled performance of pilots, as well as experts in other domains. Emergencies and other threatening situations require pilots to execute infrequently practiced procedures correctly and to use their skills and judgment to select an appropriate course of action, often under high workload, time pressure, and ambiguous indications, all of which can be stressful. Our current study, consited of three parts, starting with a critical review of the research literature on the effects of stress on skilled performance, going back to World War II and continuing to recent and more sophisticated studies of the cognitive effects of anxiety. In the second part we analyzed the specific ways stress may have impaired the performance of airline crews in twelve major accidents, selected for diversity of the situations the crews encountered. The third part examined the operational significance and practical implications of the findings from the first two parts, suggested specific ways to reduce the harmful effects of stress on flight crews, and identified aspects requiring further research. Even thought this study focused on flight crews, the findings apply to the effects of stress on the skilled performance of experts in almost any domain

What and Why of Technostress: Technology Antecedents and Implications

The Bureau of Labor Statistics (2002) reports that, on average, individuals worked seven hours per week from home in addition to regular work hours. This is made possible by advances in information and communication technologies (ICTs). While the increasing workload is not unusual, it has been related to stress, including the relatively new phenomenon of stress induced by technologies (technostress). Academic literature, popular press and anecdotal evidence suggest that ICTs are responsible for increased stress levels in individuals. However, it is not very clear as to how or why ICTs create stress. Prior research on technostress has been largely descriptive. As ICTs become ubiquitous, their stressful impact can be felt at all levels of an organization. Stress related health costs are increasing dramatically and there is evidence of decreased productivity in stressed individuals (Chilton et al., 2005; Cooper et al., 2001; Jex, 1998). So, organizations have incentives to better understand stressful situations at workplace. Based on the literature from management information systems, psychology, organizational behavior, and occupational stress, a model of technostress is developed to address the question of \u27how and why information and communication technologies enable stress in individuals\u27. Person-Environment fit model (Edwards, 1996) is used as a theoretical lens to explain technostress. The research model proposes that certain technology characteristics exacerbate stressors identified in occupational stress literature leading to the manifestation of stress, referred to as strain. Specifically, technology characteristics - usability (usefulness, complexity, and reliability), intrusive (presenteeism, anonymity), and dynamic (pace of change) are proposed to be related to stressors (work overload, role ambiguity, invasion of privacy, work-home conflict, and job insecurity). Survey design methodology is used to test the proposed research model. Field data for 692 working professionals was obtained from a market research firm (Zoomerang®). In general, the results from structural equation modeling supported the hypotheses from the model. The results suggest that technostress is prevalent (and a significant predictor of overall job strain). Specifically, work overload and role ambiguity are found to be the two most dominant stressors, whereas intrusive technology characteristics are found to be the dominant predictors of stressors. The results from this study have implications for both research and practice. It opens up new avenues for research by showing that ICTs are a source of stress - thereby addressing calls to understand the stressful impacts of ICTs (Nelson, 1990; Weber, 2004). To our knowledge, it is the first empirical study to address the phenomenon of technostress that is theoretically grounded in stress research. The implications of present research to other research streams such as resistance to technologies, value of technology investments are also highlighted. Based on research findings, this research proposes certain recommendations that can influence managerial action. Foremost among these, it brings attention to presence of technostress in organizations and also provides a framework which can be used to assess the extent to which technostress is prevalent

FROM ORGANIZATIONAL WELFARE TO BUSINESS SUCCESS: HIGHER PERFORMANCE IN HEALTHY ORGANIZATIONAL ENVIRONMENTS

This e-book provides insight into the link between employee health and productivity/performance, with a focus on how individuals, groups, or organizations can intervene in this relationship to improve both well-being and performance-related outcomes. Given the continuous changes that organizations and employees face, such as the aging workforce and continued economic turbulence, it is not surprising that studies are increasingly finding that employee health is related to job conditions. The papers in this e-book emphasize that organizations make a critical difference when it comes to employees' health and well-being. In turn, healthy employees help their organizations to flourish. Such findings are in line with the recent emphasis by both the International Labour Organization (ILO) and the United Nations (UN) on the importance of work for individual well-being and the importance of individual well-being for productive and sustainable economic growth (see e.g., ILO, 1985; World Health Organisation, 2007; UN, 2015). Overall, the papers report findings from a cumulative sample of nearly 19,000 workers and perspectives from 68 authors. They suggest that performance cannot be successfully achieved at the cost of health and well-being, and provide various perspectives and tools to guide future research and practice

Establishing knowledge and skill in a novel system-supervisory task: an application to automated mail sorting

This thesis aims to establish methods for identifying and training the knowledge and skills of operating a novel automated system still undergoing final design and construction. The absence of operating experience requires the characteristics of the system to be examined so that the future tasks of supervisors can be anticipated in order to address human factors design. This work is carried out in the context of an 'Integrated Mail Processor' (IMP)—a highly automated letter sorting machine being developed by Royal Mail. [Continues.

Evaluation of the use of engineering judgements applied to analytical human reliablity analysis methods (HRA)

Due to the scarcity of Human Reliability Analysis (HRA) data, one of the key elements of any HRA analysis is use of engineering judgment. The Electric Power Research Institute (EPRI) HRA Calculator guides the user through the steps of any HRA analysis and allows the user to choose among analytical HRA methods. It applies Accident Sequence Evaluation Program (ASEP), Technique for Human Error Rate Prediction (THERP), the HCR/ORE Correlation, and the Caused Based Decision Tree Method (CBDTM). This program is intended to produce consistent results among different analysts provided that the initial information is similar. Even with this analytical approach, an HRA analyst must still render several judgments. The objective of this study was to evaluate the use of engineering judgment applied to the quantification of post-initiator actions using the HRA Calculator. The Comanche Peak Steam Electric Station (CPSES) Level 1 Probabilistic Risk Assessment (PRA) HRA was used as a database for examples and numerical comparison. Engineering judgments were evaluated in the following ways: 1) Survey of HRA experts. Two surveys were completed, and the participants provided a range of different perspectives on how they individually apply engineering judgment. 2) Numerical comparison among the three methods. 3) Review of CPSES HRA and identification of judgments and the effects on the overall results of the database. The results of this study identified thirteen areas in which an HRA analyst must interpret and render judgments on how to quantify a Human Error Probability (HEP) and recommendations are provided on how current industry practitioners render these same judgments. The areas are: identification and definition of actions to be modeled, identification and definition of actions to be modeled, definition of critical actions, definition of cognitive portion of the action, choice of methodology, stress level, rule-, skill- or knowledge-based designation, timing information, training, procedures, human interactions with hardware, recoveries and dependencies within an action, and review of final HEP