Use of Cognitive Task Analysis and Simulators for After Action Review of Medical Events in Iraq

摘要

Prior attempts to use standard 'self report' or interview protocols to extract After Action Review (AAR) descriptions of emergency event decision making and problem solving strategies generated by participants are problematical. Cognitive psychological studies suggest that the resulting information often contains significant errors and omissions (Glaser et al., 1985; Besnard, 2000). These errors are not often recognized by participants who solved important problems in emergency situations and wish to give accurate reports on their solutions because the knowledge they are describing is largely automated and unconscious (Wheatley & Wegner, 2001). The problem is further complicated by the fact that experienced medical personnel mistakenly believe that their reports are complete and accurate and that they solved the problems they are describing in a conscious, willful, deliberate manner (Wegner, 2002). These reporting errors most likely increase in number and severity under time- pressure battlefield situations (Hunt & Joslyn, 2000). This research attempts to improve medical AAR with a novel combination of Cognitive Task Analysis (CTA) conducted while interviewees moulage simulators (Clark and Estes, 2002; Clark & Estes, 1996; Velmahos et al, 2002). Nine trauma surgeons, who have used Argyle-type shunts to repair femoral artery damage, were interviewed, in which they simply described (no CTA) the procedure. A full CTA was conducted with a tenth trauma surgeon with similar experience in the procedure. The interviews were coded and compared with a gold standard protocol. It was hypothesized that our protocol which employed a novel combination of medical Cognitive Task Analysis combined with the moulage of instruments and depictions of the femoral artery will more accurately capture the mix of automated and conscious decisions used to solve critical medical problems faced in battlefield situations.