The Effects of Reflective Pauses on Performance in Simulation Training

Introduction: The reflective pause, taking a pause during performance to reflect, is an important practice in simulation-based learning. However, for novice learners, it is a highly complex self-regulatory skill that cannot stand alone without guidance. Using educational theories, we propose how to design cognitive and metacognitive aids to guide learners with the reflective pause and investigate its effects on performance in a simulation training environment. Methods: These effects are examined in four aspects of performance: cognitive load, primary performance, secondary performance, and encapsulation. Medical students (N = 72) performed tasks in simulation training for emergency medicine, under 2 conditions: reflection condition (n = 36) where reflection was prompted and guided, and control condition (n = 36) without such reflection. Results: The effects of reflective pauses emerged for 2 aspects of performance: cognitive load decreased and secondary performance improved. However, primary performance and encapsulation did not show significant difference. Conclusions: The results demonstrate that reflective pauses with cognitive and metacognitive aids implemented can enhance some aspects of performance. We suggest that to secure these effects, feedback during reflection and an adaptation period should be provided.</p

The Effects of Reflective Pauses on Performance in Simulation Training

Introduction: The reflective pause, taking a pause during performance to reflect, is an important practice in simulation-based learning. However, for novice learners, it is a highly complex self-regulatory skill that cannot stand alone without guidance. Using educational theories, we propose how to design cognitive and metacognitive aids to guide learners with the reflective pause and investigate its effects on performance in a simulation training environment. Methods: These effects are examined in four aspects of performance: cognitive load, primary performance, secondary performance, and encapsulation. Medical students (N = 72) performed tasks in simulation training for emergency medicine, under 2 conditions: reflection condition (n = 36) where reflection was prompted and guided, and control condition (n = 36) without such reflection. Results: The effects of reflective pauses emerged for 2 aspects of performance: cognitive load decreased and secondary performance improved. However, primary performance and encapsulation did not show significant difference. Conclusions: The results demonstrate that reflective pauses with cognitive and metacognitive aids implemented can enhance some aspects of performance. We suggest that to secure these effects, feedback during reflection and an adaptation period should be provided.</p

DOES THE ANESTHESIOLOGIST SLEP SOUNDLY?

Rad u smjenama i noćni rad utječu na zdravlje, raspoloženje i kognitivne funkcije. Specijalizanti i specijalisti anesteziologije rade u dugim smjenama i noću. Promjena kognitivnih funkcija može smanjiti kvalitetu rada anesteziologa, povećati broj grešaka u radu i ugroziti bolesnika. Promjena bioloških ritmova može ugroziti i zdravlje anesteziologa. Zabilježene su promjene cirkulacije, metabolizma, memorije, fine motorike, raspoloženja i pažnje. Nakon noćnog rada raste vjerojatnost prometnih nezgoda. Negativne učinke noćnog rada se pokušalo smanjiti tako da je skraćena ukupna dužina radnog tjedna. Rasprave o učinkovitnosti toga poteza živahne su i trajne. Osobito su zanimljive u tom smislu sljedeće sastavnice: kvaliteta izobrazbe liječnika na specijalizaciji, učestalost grešaka u radu i kvaliteta skrbi o bolesniku. Nakon skraćenja radnog tjedna nema jasnih pokazatelja u navedenim smjerovima koji bi sa sigurnošću potvrdili učinkovitost takve odluke. Skraćenje radnog tjedna uklapa se u “kulturu sigurnosti” u anesteziologiji.Working in night shifts influences human health, mood, and cognitive functions. Anesthesia residents and consultants work in long shifts that include the night. Changes of cognitive functions may diminish the quality of anesthesiologist’s work, increase the number of errors, and endanger the patient. Changes of biological rhythms can influence health of the anesthesiologist himself. The alterations in circulation, metabolism, memory, fine motor control, mood and attention have been recorded. After night work, the possibility of car accident for an anesthesiologist is higher. Attempts have been made to reduce negative influences of night work by shortening the number of working hours during the week. The debate about this step is vivid and still present. From this viewpoint, the most interesting aspects are the quality of educational process, the number of errors in practical work, and the quality of health care. After shortening of working hours, there are no clear indicators of the positive effects in any of these fields. Shortening of the working week is part of ‘the culture of safety’ in anesthesiology

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

The medical pause in simulation training

The medical pause, stopping current performance for a short time for additional cognitive activities, can potentially advance patient safety and learning in medicine. Yet, to date, we do not have a theoretical understanding of why pausing skills should be taught as a professional skill, nor empirical evidence of how pausing affects performance and learning. To address this gap, this thesis investigates the effects of pausing in medical training theoretically and empirically. For the empirical investigation, a computer-based simulation was used for the task environment, and eye-tracking and log data to assess performance

Latent gaze information in highly dynamic decision-tasks

Die Digitalisierung durchdringt immer mehr Lebensbereiche. Aufgaben werden zunehmend digital erledigt und damit schneller, effizienter, aber auch zielorientierter und erfolgreicher erfüllt. Die rasante Entwicklung im Bereich der künstlichen Intelligenz in den letzten Jahren hat dabei eine große Rolle gespielt, denn sie hat viele hilfreiche Ansätze hervorgebracht, auf die immer weiter aufgebaut werden kann. Gleichzeitig werden die Augen, ihre Bewegungen und die Bedeutung dieser Bewegungen immer weiter erforscht. Die Verknüpfung dieser Entwicklungen hat zu spannenden Ansätzen in der Wissenschaft geführt. In dieser Dissertation stelle ich einige der Ansätze vor, an denen ich während meiner Promotion gearbeitet habe. Zunächst gebe ich einen Einblick in die Entwicklung von Modellen, die mit Hilfe künstlicher Intelligenz Verbindungen zwischen Augenbewegungsdaten und visueller Expertise herstellen. Dies wird anhand zwei verschiedener Bereiche, genauer gesagt zwei verschiedener Personengruppen, demonstriert: Sportler bei Entscheidungsfindungen und Chirurgen bei arthroskopischen Eingriffen. Die daraus resultierenden Modelle können als digitale Diagnosemodelle für die automatische Erkennung von visueller Expertise betrachtet werden. Darüber hinaus stelle ich Ansätze vor, die die Übertragbarkeit von Augenbewegungsmustern auf verschiedene Kompetenzbereiche untersuchen sowie wichtige Aspekte von Techniken zur Generalisierung. Schließlich befasse ich mich mit der zeitlichen Erkennung von Verwirrung auf der Grundlage von Augenbewegungsdaten. Die Ergebnisse legen eine Nutzung der Modelle als Zeitgeber für mögliche digitale Assistenzoptionen in der Ausbildung von Berufsanfängern nahe. Eine Besonderheit meiner Untersuchungen besteht darin, dass ich auf sehr wervolle Daten von DFB-Jugendkaderathleten sowie von langjährigen Experten in der Arthroskopie zurückgreifen konnte. Insbesondere die Arbeit mit den DFB-Daten stieß auf das Interesse von Radiound Printmedien, genauer, DeutschlandFunk Nova und SWR DasDing. Alle hier vorgestellten Beiträge wurden in international renommierten Fachzeitschriften oder auf Konferenzen veröffentlicht.Digitization is penetrating more and more areas of life. Tasks are increasingly being completed digitally, and are therefore not only fulfilled faster, more efficiently but also more purposefully and successfully. The rapid developments in the field of artificial intelligence in recent years have played a major role in this, as they brought up many helpful approaches to build on. At the same time, the eyes, their movements, and the meaning of these movements are being progressively researched. The combination of these developments has led to exciting approaches. In this dissertation, I present some of these approaches which I worked on during my Ph.D. First, I provide insight into the development of models that use artificial intelligence to connect eye movements with visual expertise. This is demonstrated for two domains or rather groups of people: athletes in decision-making actions and surgeons in arthroscopic procedures. The resulting models can be considered as digital diagnostic models for automatic expertise recognition. Furthermore, I show approaches that investigate the transferability of eye movement patterns to different expertise domains and subsequently, important aspects of techniques for generalization. Finally, I address the temporal detection of confusion based on eye movement data. The results suggest the use of the resulting model as a clock signal for possible digital assistance options in the training of young professionals. An interesting aspect of my research is that I was able to draw on very valuable data from DFB youth elite athletes as well as on long-standing experts in arthroscopy. In particular, the work with the DFB data attracted the interest of radio and print media, namely DeutschlandFunk Nova and SWR DasDing. All resulting articles presented here have been published in internationally renowned journals or at conferences