Ronnie Glavin

Rating non-technical skills: developing a behavioural marker system for use in anaesthesia

Studies of performance in medicine are often based on observation. Videotape provides a valuable tool for recording events from both real environments and simulators. When analysing observational data it is important that robust tools are used, particularly when investigating non-technical (cognitive and social) skills. This paper describes the method used to identify the key non-technical skills required in anaesthesia and to develop a behavioural marker system for their measurement. A prototype taxonomy was designed on the basis of a literature review; an examination of existing marker systems; cognitive task analysis interviews; an iterative development process involving workshops; and cross-checking in theatre. The resulting anaesthetists’ non-technical skills (ANTS) system comprises four skill categories (task management, team working, situation awareness, and decision making) that divide into 15 elements, each with example behaviours. Preliminary evaluation using ratings of videotaped scenarios indicated that the skills were observable and could be rated with reasonable agreement.

No simple fix for fixation errors: cognitive processes and their clinical applications

Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use ‘insight problems’ in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice.

Review article: The influence of psychology and human factors on education in anesthesiology

PurposeWe look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm.Principle findingsResearch in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world.ConclusionsThere is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists.RésuméObjectifNous examinons la nature changeante de la formation médicale dans les pays développés en nous concentrant particulièrement sur les structures des nouveaux programmes d’études qui ont intégré des thèmes tirés du monde de la psychologie.Constatations principalesLa recherche dans la branche de la psychologie s’intéressant aux facteurs humains a permis de créer un corpus utile de connaissances pratiques qui s’appliquent à d’autres domaines dans lesquels l’homme interagit avec les systèmes complexes dans lequel il évolue. Certaines découvertes sont d’ores et déjà appliquées à quelques-unes des facettes de la performance en anesthésie, notamment la prise de conscience de la situation, l’efficacité du travail en équipe, les contre-mesures pour pallier les erreurs actives et les pathogènes latents, et les limites de la performance humaine. Toutefois, les leçons et pratiques existantes tirées de la recherche dans les domaines de l’industrie et de l’armée pourraient ne pas se traduire directement en stratégies efficaces pour les anesthésiologistes. Des études collaboratives réalisées par des psychologues et des cliniciens continuent d’être réalisées. Leur objectif est de fournir au programme de formation en anesthésie un corpus efficace de connaissances concernant chacun des rôles de l’anesthésiologiste. Bien que certains anesthésiologistes aient apporté d’importantes contributions dans ce domaine, celles-ci n’ont pas été intégrées de façon formelle aux programmes suivis par les anesthésiologistes dans les pays développés.ConclusionIl existe un fossé entre les facteurs humains que les psychologues connaissent actuellement et les facteurs humains que les anesthésiologistes ont besoin de connaître. Au fur et à mesure que ce fossé se comblera, les anesthésiologistes pourraient être amenés à penser davantage comme des psychologues des facteurs humains et comme des scientifiques biomédicaux.

No simple fix for fixation errors: cognitive processes and their clinical applications: No simple fix for fixation errors

Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use ‘insight problems’ in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice.

Beyond monitors: distributed situation awareness in anaesthesia management

ABSTRACT In this study, the construct and the role of distributed situation awareness (DSA) on the anaesthetic management of challenging major obstetric haemorrhage (MOH) cases is explored, specifically the anaesthetists perception of the operating theatre elements, the understanding of their meaning and the anticipation of their progress in interaction with other people and artefacts. Eighteen anaesthetists from four Scottish Hospitals were asked to discuss a challenging MOH case from their experience, prompted by questions emanating from a critical decision method protocol. The majority of the described DSA references were attributed to gathering information and in interaction with external artefacts, including monitors, suction containers, the whiteboard and even swabs. For understanding and anticipating, the majority of DSA references emerged in interaction with other team members within and outside the operating theatre. Methods for improving practice and training in MOH should address the interactive nature of DSA, by going beyond monitoring anaesthetic displays.

The influence of psychology and human factors on education in anesthesiology

PurposeWe look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm.Principle findingsResearch in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world.ConclusionsThere is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists.RésuméObjectifNous examinons la nature changeante de la formation médicale dans les pays développés en nous concentrant particulièrement sur les structures des nouveaux programmes d’études qui ont intégré des thèmes tirés du monde de la psychologie.Constatations principalesLa recherche dans la branche de la psychologie s’intéressant aux facteurs humains a permis de créer un corpus utile de connaissances pratiques qui s’appliquent à d’autres domaines dans lesquels l’homme interagit avec les systèmes complexes dans lequel il évolue. Certaines découvertes sont d’ores et déjà appliquées à quelques-unes des facettes de la performance en anesthésie, notamment la prise de conscience de la situation, l’efficacité du travail en équipe, les contre-mesures pour pallier les erreurs actives et les pathogènes latents, et les limites de la performance humaine. Toutefois, les leçons et pratiques existantes tirées de la recherche dans les domaines de l’industrie et de l’armée pourraient ne pas se traduire directement en stratégies efficaces pour les anesthésiologistes. Des études collaboratives réalisées par des psychologues et des cliniciens continuent d’être réalisées. Leur objectif est de fournir au programme de formation en anesthésie un corpus efficace de connaissances concernant chacun des rôles de l’anesthésiologiste. Bien que certains anesthésiologistes aient apporté d’importantes contributions dans ce domaine, celles-ci n’ont pas été intégrées de façon formelle aux programmes suivis par les anesthésiologistes dans les pays développés.ConclusionIl existe un fossé entre les facteurs humains que les psychologues connaissent actuellement et les facteurs humains que les anesthésiologistes ont besoin de connaître. Au fur et à mesure que ce fossé se comblera, les anesthésiologistes pourraient être amenés à penser davantage comme des psychologues des facteurs humains et comme des scientifiques biomédicaux.

Review article: The influence of psychology and human factors on education in anesthesiology Article de synthese: L'influence de la psychologie et des facteurs humains sur la formation en anesthesiologie

PurposeWe look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm.Principle findingsResearch in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world.ConclusionsThere is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists.RésuméObjectifNous examinons la nature changeante de la formation médicale dans les pays développés en nous concentrant particulièrement sur les structures des nouveaux programmes d’études qui ont intégré des thèmes tirés du monde de la psychologie.Constatations principalesLa recherche dans la branche de la psychologie s’intéressant aux facteurs humains a permis de créer un corpus utile de connaissances pratiques qui s’appliquent à d’autres domaines dans lesquels l’homme interagit avec les systèmes complexes dans lequel il évolue. Certaines découvertes sont d’ores et déjà appliquées à quelques-unes des facettes de la performance en anesthésie, notamment la prise de conscience de la situation, l’efficacité du travail en équipe, les contre-mesures pour pallier les erreurs actives et les pathogènes latents, et les limites de la performance humaine. Toutefois, les leçons et pratiques existantes tirées de la recherche dans les domaines de l’industrie et de l’armée pourraient ne pas se traduire directement en stratégies efficaces pour les anesthésiologistes. Des études collaboratives réalisées par des psychologues et des cliniciens continuent d’être réalisées. Leur objectif est de fournir au programme de formation en anesthésie un corpus efficace de connaissances concernant chacun des rôles de l’anesthésiologiste. Bien que certains anesthésiologistes aient apporté d’importantes contributions dans ce domaine, celles-ci n’ont pas été intégrées de façon formelle aux programmes suivis par les anesthésiologistes dans les pays développés.ConclusionIl existe un fossé entre les facteurs humains que les psychologues connaissent actuellement et les facteurs humains que les anesthésiologistes ont besoin de connaître. Au fur et à mesure que ce fossé se comblera, les anesthésiologistes pourraient être amenés à penser davantage comme des psychologues des facteurs humains et comme des scientifiques biomédicaux.

A reply: Correspondence

and its accompanying editorial make clear [3]. The issue is whether the countermeasures to fixation, that proved largely ineffective in Fioratou’s study group, may actually have worked for a group of anaesthetists. This is important because our knowledge of what works and what does not with regards to overcoming fixation will influence our behaviour as anaesthetists, and will also influence anaesthetic training in the future. I would be interested to hear the authors’ views.

No simple fix for fixation errors

Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use ‘insight problems’ in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice.