Human factors in the development of complications of airway management: preliminary evaluation of an interview tool.

The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) analysed reports of serious events arising from airway management during anaesthesia, intensive care and the emergency department. We conducted supplementary telephone interviews with 12 anaesthetists who had reported to NAP4, aiming to identify causal factors using a method based on the Human Factors Investigation Tool (HFIT). We identified contributing human factors in all cases (median [range] 4.5 [1-10] per case). The most frequent related to: situation awareness (failures to anticipate, wrong decision) (nine cases); job factors (e.g. task difficulty; staffing, time pressure) (eight cases); and person factors (e.g. tiredness, hunger, stress) (six cases). Protective factors, such as teamwork and communication, were also revealed. The post-report HFIT interview method identified relevant human factors and this approach merits further testing as part of the investigation of anaesthetic incidents.

Cognitive adaptation: spatial memory or attentional processing. a comment on Furley and Memmert (2010).

This commentary considers the paper by Furley and Memmert (2010) who sought to test the respective validities of the specific processing and cognitive adaptation hypotheses. That they found no evidence of a difference between experienced basketball players and nonathletes on the Corsi block task, a measure of spatial memory, led them to infer support for the specific processing hypothesis, namely that differences between experts and novices manifest themselves only in processes related specifically to the domain of expertise. An alternative interpretation is offered, indicating possible confounds and referring to recent research that suggests Corsi block and dynamic spatial tasks depend upon different neuronal networks.

Beyond monitoring: distributed situation awareness in anaesthesia.

Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia. Distributed SA in anaesthetic practice provides the foundation for further research that may in turn influence the teaching and assessment of this important non-technical skill.

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.

Verbalization and problem solving: insight and spatial factors.

Two groups of participants attempted eight examples of each of four different problem types formed by combining insight versus non-insight and verbal versus spatial factors. The groups were given different verbalization instructions viz., Silent (N=40) or Direct Concurrent (N=40). There were significant differences between insight and non-insight tasks and between spatial and verbal tasks in terms of solution rates and latencies. Significant interactions between the verbal versus spatial factor and verbalization condition on solution rates and latencies reflected a greater (negative) effect of verbalizing on spatial as against verbal problems. However, no significant interactions of the insight versus non-insight factor with verbalization condition on solution rates or latencies were found. These results favoured the 'business as usual' view of insight problem solving as against the 'special process' view which predicted larger effects of verbalization for insight problems as against non-insight problems.

Divergent thinking: strategies and executive involvement in generating novel uses for familiar objects.

Although the Alternative Uses divergent thinking task has been widely used in psychometric and experimental studies of creativity, the cognitive processes underlying this task have not been examined in detail before the two studies are reported here. In Experiment 1, a verbal protocol analysis study of the Alternative Uses task was carried out with a Think aloud group (N=40) and a Silent control group (N=64). The groups did not differ in fluency or novelty of idea production indicating no verbal overshadowing. Analysis of protocols from the Think aloud group suggested that initial responses were based on a strategy of Retrieval from long-term memory of pre-known uses. Later responses tended to be based on a small number of other strategies: property-use generation, imagined Disassembly of the target object into components and scanning of Broad Use categories for possible uses of the target item. Novelty of uses was particularly associated with the Disassembly strategy. Experiment 2 (N=103) addressed the role of executive processes in generating new and previously known uses by examining individual differences in category fluency, letter fluency and divergent task performance. After completing the task, participants were asked to indicate which of their responses were new for them. It was predicted and found in regression analyses that letter fluency (an executively loading task) was related to production of 'new' uses and category fluency was related to production of 'old' uses but not vice versa.