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Studying Simulations with Distributed Cognition
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. (Centrum för forskning inom respons- och räddningssystem (CARER))
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Simulations are frequently used techniques for training, performance assessment, and prediction of future outcomes. In this thesis, the term “human-centered simulation” is used to refer to any simulation in which humans and human cognition are integral to the simulation’s function and purpose (e.g., simulation-based training). A general problem for human-centered simulations is to capture the cognitive processes and activities of the target situation (i.e., the real world task) and recreate them accurately in the simulation. The prevalent view within the simulation research community is that cognition is internal, decontextualized computational processes of individuals. However, contemporary theories of cognition emphasize the importance of the external environment, use of tools, as well as social and cultural factors in cognitive practice. Consequently, there is a need for research on how such contemporary perspectives can be used to describe human-centered simulations, re-interpret theoretical constructs of such simulations, and direct how simulations should be modeled, designed, and evaluated.

This thesis adopts distributed cognition as a framework for studying human-centered simulations. Training and assessment of emergency medical management in a Swedish context using the Emergo Train System (ETS) simulator was adopted as a case study. ETS simulations were studied and analyzed using the distributed cognition for teamwork (DiCoT) methodology with the goal of understanding, evaluating, and testing the validity of the ETS simulator. Moreover, to explore distributed cognition as a basis for simulator design, a digital re-design of ETS (DIGEMERGO) was developed based on the DiCoT analysis. The aim of the DIGEMERGO system was to retain core distributed cognitive features of ETS, to increase validity, outcome reliability, and to provide a digital platform for emergency medical studies. DIGEMERGO was evaluated in three separate studies; first, a usefulness, usability, and facevalidation study that involved subject-matter-experts; second, a comparative validation study using an expert-novice group comparison; and finally, a transfer of training study based on self-efficacy and management performance. Overall, the results showed that DIGEMERGO was perceived as a useful, immersive, and promising simulator – with mixed evidence for validity – that demonstrated increased general self-efficacy and management performance following simulation exercises.

This thesis demonstrates that distributed cognition, using DiCoT, is a useful framework for understanding, designing and evaluating simulated environments. In addition, the thesis conceptualizes and re-interprets central constructs of human-centered simulation in terms of distributed cognition. In doing so, the thesis shows how distributed cognitive processes relate to validity, fidelity, functionality, and usefulness of human-centered simulations. This thesis thus provides a new understanding of human-centered simulations that is grounded in distributed cognition theory.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. , p. 94
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1913
National Category
Human Computer Interaction
Identifiers
URN: urn:nbn:se:liu:diva-145307DOI: 10.3384/diss.diva-145307ISBN: 9789176853481 (print)OAI: oai:DiVA.org:liu-145307DiVA, id: diva2:1191736
Public defence
2018-04-19, Ada Lovelace, B-huset, Campus Valla, Linköping, 13:15 (English)
Opponent
Supervisors
Available from: 2018-03-20 Created: 2018-03-20 Last updated: 2018-03-21Bibliographically approved
List of papers
1. Exploring prehospital C2-work during a mass gathering event
Open this publication in new window or tab >>Exploring prehospital C2-work during a mass gathering event
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2015 (English)In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 4, no 2, p. 227-241Article in journal (Refereed) Published
Abstract [en]

Purpose– The purpose of this paper is to explore the workload and shared workload awareness in a staff performing command and control (C2) work during a planned major incident (MI) empirical case in Sweden. Design/methodology/approach– Data on workload and shared awareness were collected during live C2-work using qualitative observations and in-situ interviews mixed with quantitative questionnaires. Findings– A content analysis of the qualitative data revealed categories of workload sources. Quantified workload estimates showed changes in workload levels over time and staff roles, which were also contextualized using the results of the qualitative data. Data on shared awareness indicated that team workload awareness shifted over time according to common patterns. This study demonstrates a promising methodology to study C2-related factors during live EMS work. Research limitations/implications– The observed variations in workload imply that research that relies only on post-task measurements of workload may be inaccurate. Future research could use this method to investigate the connection between workload and performance during different types of MIs. Originality/value– The results can be used to inform future Göteborgsvarvet C2-teams in terms of when, why, and for whom task load changes, which would support predictive allocation of resources.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Keywords
Emergency response, Mixed methods, Command and control, Mass gathering, Mental workload, Shared awareness
National Category
Pedagogical Work
Identifiers
urn:nbn:se:liu:diva-126628 (URN)10.1108/IJES-04-2015-0016 (DOI)
Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-03-20Bibliographically approved
2. Studying distributed cognition of simulation-based team training with DiCoT.
Open this publication in new window or tab >>Studying distributed cognition of simulation-based team training with DiCoT.
2016 (English)In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 59, no 3, p. 423-434Article in journal (Refereed) Published
Abstract [en]

Health care organizations employ simulation-based team training (SBTT) to improve skill, communication and coordination in a broad range of critical care contexts. Quantitative approaches, such as team performance measurements, are predominantly used to measure SBTTs effectiveness. However, a practical evaluation method that examines how this approach supports cognition and teamwork is missing. We have applied Distributed Cognition for Teamwork (DiCoT), a method for analysing cognition and collaboration aspects of work settings, with the purpose of assessing the methodology's usefulness for evaluating SBTTs. In a case study, we observed and analysed four Emergo Train System® simulation exercises where medical professionals trained emergency response routines. The study suggests that DiCoT is an applicable and learnable tool for determining key distributed cognition attributes of SBTTs that are of importance for the simulation validity of training environments. Moreover, we discuss and exemplify how DiCoT supports design of SBTTs with a focus on transfer and validity characteristics. Practitioner Summary: In this study, we have evaluated a method to assess simulation-based team training environments from a cognitive ergonomics perspective. Using a case study, we analysed Distributed Cognition for Teamwork (DiCoT) by applying it to the Emergo Train System®. We conclude that DiCoT is useful for SBTT evaluation and simulator (re)design.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Simulation; distributed cognition; prehospital medicine, methodology; team training
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-126627 (URN)10.1080/00140139.2015.1074290 (DOI)000377692100008 ()26275026 (PubMedID)
Note

Funding agencies:  Swedish Civil Contingencies Agency; Swedish Governmental Agency for Innovation Systems (VINNOVA)

Available from: 2016-03-31 Created: 2016-03-31 Last updated: 2018-03-20Bibliographically approved
3. Designing a Digital Medical Management Training Simulator Using Distributed Cognition Theory
Open this publication in new window or tab >>Designing a Digital Medical Management Training Simulator Using Distributed Cognition Theory
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2017 (English)In: Journal Simulation & Gaming, ISSN 1046-8781, E-ISSN 1552-826X, Vol. 48, no 1, p. 131-152Article in journal (Refereed) Published
Abstract [en]

Background Training of medical professionals is important to improve care during mass-causality events. Therefore, it is essential to extend knowledge on how to design valid and usable simulation-based training environments.

Purpose This article investigates how distributed cognition and simulation theory concepts can guide design of simulation-based training environments. We present the design and user evaluation of DigEmergo, a simulator for training and assessing emergency medicine management.

Design approach A prior Distributed Cognition in Teamwork (DiCoT) analysis of the Emergo Train System (ETS) guided the design process. The design objective of DigEmergo was to be useful, usable, retain distributed cognition features of ETS, and strengthen validity and output reliability.

Evaluation Eight expert ETS instructors participated in a formative system evaluation. The Technology Assessment Model (TAM) questionnaire was used to measure usefulness and ease of use. Observations and post-test interviews were conducted to contextualize the measures.

Results The results showed that DigEmergo was perceived as somewhat to quite useful and somewhat easy to use. Overall, expert users considered DigEmergo promising and successful in retaining core ETS features.

Conclusions The study indicates that a design methodology based on distributed cognition and simulation theory can be successfully combined to guide simulator (re)design and strengthen simulator validity.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
distributed cognition, emergency medicine management training, simulation, simulator design, simulator user evaluation
National Category
Computer Systems
Identifiers
urn:nbn:se:liu:diva-132723 (URN)10.1177/1046878116676511 (DOI)2-s2.0-85011578887 (Scopus ID)
Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2018-05-02Bibliographically approved
4. Preliminary Validation Results of DigEmergo for Surge Capacity Management
Open this publication in new window or tab >>Preliminary Validation Results of DigEmergo for Surge Capacity Management
2016 (English)In: Proceedings of the 13th International Conference on Information Systems for Crisis Response and Management / [ed] Andrea H. Tapia, Pedro Antunes, Victor A. Bañuls, Kathleen Moore and João Porto de Albuquerque, ISCRAM , 2016Conference paper, Published paper (Refereed)
Abstract [en]

This paper presents preliminary analysis from a validation study of a novel emergency medicine command and control training and evaluation simulator: DIGEMERGO®. The simulated emergency scenario was a surge capacity event at a generic emergency department, in which the participants took on a management role as the emergency department’s coordinating head nurse. A between group validation design with medical expert and novice participants was used. Initial analysis examined three triage measures associated with surge capacity management performance: time to triage, amount of patients triaged, and triage accuracy. The results show that experts were significantly more accurate at triaging in-hospital patients, but not incoming trauma patients. No significant differences in time or number of patients triaged was found. These initial results partially indicate simulator validity, but trauma patient triage accuracy suffered from a confounding variable in the triage system used. Analysis of additional measures is undergoing to further investigate validity claims.

Place, publisher, year, edition, pages
ISCRAM, 2016
Series
Proceedings of the International ISCRAM Conference, ISSN 2411-3387 ; 2016
Keywords
Simulator validation, between group analysis, command and control, performance measures, emergency medicine, surge capacity
National Category
Computer Systems
Identifiers
urn:nbn:se:liu:diva-128700 (URN)9788460879848 (ISBN)
Conference
The 13th International Conference on Information Systems for Crisis Response and Management, Rio de Janeiro, Brazil, May 22-25, 2016
Available from: 2016-05-30 Created: 2016-05-30 Last updated: 2018-03-20Bibliographically approved
5. Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
Open this publication in new window or tab >>Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
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2017 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 55, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Introduction: Head nurses at emergency departments often assume responsibility for managing the initial response to a major incident, and to create surge capacity. Training is essential to enable these nurses to perform an effective disaster response. Evaluating the effects of such training is however complicated as real skill only can be demonstrated during a real major incident. Self-efficacy has been proposed as an alternative measure of training effectiveness. Purpose: The aim of this study was to examine if short, small-scale computer-based simulation exercises could improve head emergency nurses general and specific self-efficacy and initial incident management skills. Method: A within-group pretest-posttest design was used to examine 13 head nurses general and specific self efficacy before and after an intervention consisting of three short computer based simulation exercises during a 1-h session. Management skills were assessed using the computer simulation tool DigEmergo. Results: The exercises increased the head nurses general self-efficacy but not their specific self-efficacy. After completing the first two exercises they also exhibited improved management skills as indicated by shorter time to treatment for both trauma and in-hospital patients. Conclusion: This study indicates that short computer based simulation exercises provide opportunities for head nurses to improve management skills and increase their general self-efficacy.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE, 2017
Keywords
Management; Mass casualty incident; Nurses; Simulation training; Surge capacity
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-139548 (URN)10.1016/j.nedt.2017.04.020 (DOI)000404700900005 ()28505521 (PubMedID)
Note

Funding Agencies|Swedish Civil Contingencies Agency (MSB) [2011-4957]

Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2018-05-02

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Rybing, Jonas

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