Modeling motivation using goal competition in mental fatigue studies

Motivation can counteract the effects of mental fatigue. However, the underlying mechanism by which motivation affects performance in mentally fatiguing tasks is obscure. In this paper, we propose goal competition as a paradigm to understand the role of motivation and built three models of mental fatigue studies to demonstrate the mechanism in a cognitive architecture named PRIMs. Each of these studies explored the impact of reward and mental fatigue on performance. Overall, performance decreased in nonreward conditions but remained stable in reward conditions. The comparisons between our models and empirical data showed that our models were able to capture human performance. We managed to model changes in performance levels by adjusting the value of the main task goals, which controls the competition with distractions. In all the tasks modeled, the best model fits were obtained by a linear decrease in goal activation, suggesting this is a general pattern. We discuss possible mechanisms for activation decrease, and the potential of goal competition to model motivation

The effects of intrinsic motivation on mental fatigue

There have been many studies attempting to disentangle the relation between motivation and mental fatigue. Mental fatigue occurs after performing a demanding task for a prolonged time, and many studies have suggested that motivation can counteract the negative effects of mental fatigue on task performance. To complicate matters, most mental fatigue studies looked exclusively at the effects of extrinsic motivation but not intrinsic motivation. Individuals are said to be extrinsically motivated when they perform a task to attain rewards and avoid punishments, while they are said to be intrinsically motivated when they do for the pleasure of doing the activity. To assess whether intrinsic motivation has similar effects as extrinsic motivation, we conducted an experiment using subjective, performance, and physiological measures (heart rate variability and pupillometry). In this experiment, 28 participants solved Sudoku puzzles on a computer for three hours, with a cat video playing in the corner of the screen. The experiment consisted of 14 blocks with two alternating conditions: low intrinsic motivation and high intrinsic motivation. The main results showed that irrespective of condition, participants reported becoming fatigued over time. They performed better, invested more mental effort physiologically, and were less distracted in high-level than in low-level motivation blocks. The results suggest that similarly to extrinsic motivation, time-on-task effects are modulated by the level of intrinsic motivation: With high intrinsic motivation, people can maintain their performance over time as they seem willing to invest more effort as time progresses than in low intrinsic motivation

Qualitative development and content validation of the "SPART" model:a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process

Abstract Background Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process

Heart rate variability as a measure of mental stress in surgery:A systematic review

PURPOSE: There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed. RESULTS: 24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place. CONCLUSIONS: HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery

The Effects of Mental Fatigue on Surgical Performance:A Systematic Review

Introduction: The effect of mental fatigue and sleep deprivation on surgeons has been questioned for decades. While other high-stake professions such as aviation and military have already established guidelines to restrict work hours, this trend has yet to reach the surgical profession. This study aimed to give a complete and up-to-date overview of the existing literature regarding the impact of mental fatigue on surgical performance, in order to facilitate further research and the development of guidelines. Methods: A systematic review was performed searching Medline and Embase. 31 studies regarding the relation between fatigue and surgical performance, using both real-life surgery and simulator studies, were included. Articles based on patients as well as on surgeons and surgical residents were included. Articles based on stress, muscle fatigue, learning, work hour restrictions or regulations were excluded from analysis, as were studies on medical students and non-surgical professions. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. The studies were analyzed using descriptive statistics. Results: None of the studies on real-life surgery found a correlation between fatigue and surgical performance, but 45% of simulator studies found a negative correlation between fatigue and surgical performance, and 22% of simulator studies found a positive correlation. 8% of surgeon-based studies found a negative correlation, while 44,5% of intern-based studies did. Conclusion: In simulator studies, the effects of fatigue were mixed, but in real-life surgery, fatigue appears not to affect surgical performance. An explanation for this difference between simulator and real-life studies may lie in the fact that in real-life operations the stakes are higher and surgeons put in more effort to protect their performance against the detrimental effects of fatigue. However, surgical performance measures in real life operations were found to be rather crude, so it is unclear whether these measures were sufficiently sensitive to detect effects of fatigue if they do exist. We argue for more fine-grained performance measures in future research. Disclosure: Nothing to disclos

The Effects of Expert and Augmented Feedback on Learning a Complex Medical Skill

Many medical skills are complex due to their requirements for integration of declarative (biomedical) knowledge with perceptual–motor and perceptual–cognitive proficiency. While feedback generally helps learners guide their actions, it is unclear how feedback supports the integration of declarative knowledge with skills. Thus, we investigated the effect of expert and augmented feedback on acquisition and retention of a complex medical skill (acquiring a transthoracic echocardiogram) in a simulation study. We randomly assigned 36 medical undergraduate students to one of three feedback sources: Expert (EF), Augmented visual (HS), and Expert plus Help Screen (EF + HS). Participants practiced until reaching proficiency. Outcome measures (knowledge test and practical skill ratings on a 5-point scale), were gathered at initial acquisition and at retention after 11 days, the time needed to obtain the images and the quality of images obtained. We divided the knowledge test into three topics: names of the images, manipulation of the probe, and anatomy of the heart. At acquisition, immediately after training, EF group participants were faster at obtaining images than participants in the two other groups. On the retention test, there were no group differences for speed of obtaining images, but the EF + HS group scored significantly higher than the other two groups on image quality. Thus, expert feedback best assisted initial acquisition and combined augmented and expert feedback best assisted retention of this complex medical task. Expert assistance reduced learners’ cognitive load during initial practice, helping learners integrate declarative knowledge with physical skills

Fingerprints of Teaching Interactions:Capturing and Quantifying How Supervisor Regulate Autonomy of Residents in the Operating Room

Objective: Supervisors and residents agree that entrusted autonomy is central to learning in the Operating Room (OR), but supervisors and residents hold different opinions about entrustment: residents regularly experience that they receive insufficient autonomy while supervisors feel their guiding is not appreciated as teaching. These opinions are commonly grounded on general experiences and perceptions, instead of real-time supervisors’ regulatory behaviors as procedures unfold. To close that gap, we captured and analyzed when and to what level supervisors award or restrain autonomy during procedures. Furthermore, we constructed fingerprints, an instrument to visualize entrustment of autonomy by supervisors in the OR that allows us to reflect on regulation of autonomy and discuss teaching interactions. Design: All interactions between supervisors and residents were captured by video and transcribed. Subsequently a multistage analysis was performed: (1) the procedure was broken down into 10 steps, (2) for each step, type and frequency of strategies by supervisors to regulate autonomy were scored, (3) the scores for each step were plotted into fingerprints, and (4) fingerprints were analyzed and compared. Setting: University Medical Centre Groningen (the Netherlands). Participants: Six different supervisor-resident dyads. Results: No fingerprint was alike: timing, frequency, and type of strategy that supervisors used to regulate autonomy varied within and between procedures. Comparing fingerprints revealed that supervisors B and D displayed more overall control over their program-year 5 residents than supervisors C and E over their program-year 4 residents. Furthermore, each supervisor restrained autonomy during steps 4 to 6 but with different intensities. Conclusions: Fingerprints show a high definition view on the unique dynamics of real-time autonomy regulation in the OR. One fingerprint functions as a snapshot and serves a purpose in one-off teaching and learning. Multiple snapshots of one resident quantify autonomy development over time, while multiple snapshots of supervisors may capture best teaching practices to feed train-the-trainer programs

Reasons to Engage in and Learning Experiences From Different Play Strategies in a Web-Based Serious Game on Delirium for Medical Students:Mixed Methods Design

BACKGROUND: Although many studies have recently been published on the value of serious games for medical education, little attention has been given to the role of dark play (choosing unacceptable actions in games). OBJECTIVE: This study aimed to investigate potential differences in the characteristics of medical students who have the opportunity to choose normal or dark play in a serious game. This study also aimed to compare their reasons for choosing a play strategy and their perceptions of what they learned from their game play. METHODS: We asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game was collected using an open-ended question and self-reported knowledge on delirium. RESULTS: This study had 160 participants (89 normal play, 71 dark play). Male students (26/160, 56.5%) chose dark play significantly more often than female students (45/160, 39.5%; P=.049). We did not find significant differences in student characteristics or measurement outcomes between play strategies. Participants' main reason for choosing normal play was to learn how to provide care to delirious patients, and the main reason for dark play was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge. CONCLUSIONS: When medical students have the opportunity to choose dark play in a serious game, half of them will probably choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy

Machine learning in anesthesiology:Detecting adverse events in clinical practice

The credibility of threshold-based alarms in anesthesia monitors is low and most of the warnings they produce are not informative. This study aims to show that Machine Learning techniques have a potential to generate meaningful alarms during general anesthesia without putting constraints on the type of procedure. Two distinct approaches were tested - Complication Detection and Anomaly Detection. The former is a generic supervised learning problem and for this a simple feed-forward Neural Network performed best. For the latter, we used an Encoder-Decoder Long Short-Term Memory architecture that does not require a large manually-labeled dataset. We show this approach to be more flexible and in the spirit of Explainable Artificial Intelligence, offering greater potential for future improvement