Expert, intermediate and novice performance during simulated pre-flight decision-making

The Role of Cue-Based Strategies in Skilled Diagnosis Among Pathologists

OBJECTIVE

This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task.

BACKGROUND

Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information.

METHOD

Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills.

RESULTS

Behavioral indicators of higher or lower cue utilization were based on the participants' performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases.

CONCLUSION

This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists.

APPLICATION

Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases.

Explaining emergency physicians' capacity to recover from interruptions

OBJECTIVE

To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption.

BACKGROUND

Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions.

METHOD

Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients.

RESULTS

Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028).

CONCLUSION

The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load.

APPLICATION

Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

Mind the gap: Distributed practice enhances performance in a MOBA game

Understanding how humans master complex skills has the potential for wide-reaching societal benefit. Research has shown that one important aspect of effective skill learning is the temporal distribution of practice episodes (i.e., distributed practice). Using a large observational sample of players (n = 162,417) drawn from a competitive and popular online game (League of Legends), we analysed the relationship between practice distribution and performance through time. We compared groups of players who exhibited different play schedules using data slicing and machine learning techniques, to show that players who cluster gameplay into shorter time frames ultimately achieve lower performance levels than those who space their games across longer time windows. Additionally, we found that the timing of intensive play periods does not affect final performance-it is the overall amount of spacing that matters. These results extend some of the key findings in the literature on practice and learning to an ecologically valid environment with huge n. We discuss our work in relation to recent studies that have examined practice effects using Big Data and suggest solutions for salient confounds.

Cue utilisation reduces the impact of response bias in histopathology

Histopathologists make diagnostic decisions that are thought to be based on pattern recognition, likely informed by cue-based associations formed in memory, a process known as cue utilisation. Typically, the cases presented to the histopathologist have already been classified as 'abnormal' by clinical examination and/or other diagnostic tests. This results in a high disease prevalence, the potential for 'abnormality priming', and a response bias leading to false positives on normal cases. This study investigated whether higher cue utilisation is associated with a reduction in positive response bias in the diagnostic decisions of histopathologists. Data were collected from eighty-two histopathologists who completed a series of demographic and experience-related questions and the histopathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioural indicators of context-related cue utilisation. They also completed a separate, diagnostic task comprising breast histopathology images where the frequency of abnormality was manipulated to create a high disease prevalence context for diagnostic decisions relating to normal tissue. Participants were assigned to higher or lower cue utilisation groups based on their performance on EXPERTise 2.0. When the effects of experience were controlled, higher cue utilisation was specifically associated with a greater accuracy classifying normal images, recording a lower positive response bias. This study suggests that cue utilisation may play a protective role against response biases in histopathology settings.

Differentiating Experience From Cue Utilization in Radiological Assessments

OBJECTIVE

This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology.

BACKGROUND

Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance.

METHOD

Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance.

RESULTS

Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization (p = .01).

CONCLUSION

This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task.

APPLICATION

Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature-event relationships and internalize these associations in the form of cues in memory.

Drivers' Cue Utilization Predicts Cognitive Resource Consumption During a Simulated Driving Scenario

OBJECTIVE

This study was designed to examine whether cue utilization differentiates drivers' consumption of cognitive resources during a simulated driving task.

BACKGROUND

Outcomes from previous research have demonstrated that a general capacity for cue utilization differentiates cognitive load during novel process control tasks. However, it was previously unclear whether similar results would be demonstrated during familiar operational tasks.

METHOD

Based on an assessment of cue utilization within a driving context, participants were classified into higher or lower cue utilization typologies. During a simulated driving task, cognitive load was assessed through changes against baseline in cerebral oxygenation in the prefrontal cortex, through eye behavior metrics (fixation rates and fixation dispersion), and through driving performance (frequency of missed traffic signals and speed exceedances).

RESULTS

Drivers with higher cue utilization recorded smaller mean fixation dispersions, smaller increases in cerebral oxygenation, and fewer missed traffic signals compared with drivers with lower cue utilization. These results suggest that compared with drivers with lower cue utilization, drivers with higher cue utilization experienced lower cognitive load during the simulated driving task while maintaining a higher level of performance.

CONCLUSION

The results provide support for the assertion that, among qualified operators, a greater capacity for cue utilization is associated with lower cognitive load during operational tasks.

APPLICATION

Cue-based assessments of driving may be beneficial in predicting performance and assisting in targeted training for recently qualified and/or older drivers.

Cue Utilization Differentiates Performance in the Management of Interruptions

OBJECTIVE

To examine the role of cue utilization in the management of interruptions during a high workload, rail control simulation.

BACKGROUND

High-risk, high-consequence environments are characterized by cognitively demanding, time-critical activities, in which operators are required to manage frequent interruptions under conditions of high workload. Interruptions are deleterious to performance as they impose excessive cognitive demand on limited working memory resources, thereby depleting residual resources for the primary task. Cue utilization may enable superior performance in managing interruptions through efficiencies gained by the application of implicit patterns stored in long-term memory.

METHOD

Two experiments were conducted. In Experiment 1, 46 university students undertook an assessment of cue utilization and subsequently engaged in a high workload, simulated rail control task while managing multiple interruptive tasks. Experiment 2 replicated and extended Experiment 1, wherein 52 university students completed a measure of cue utilization and engaged in a high workload, simulated rail control task while managing multiple interruptions and breaks.

RESULTS

The analyses revealed that participants who demonstrated a greater capacity for cue utilization also demonstrated a reduced loss of performance following interruptions.

CONCLUSION

The outcomes suggest a relationship between a greater capacity for cue utilization and superior performance in the management of interruptions in high workload conditions.

APPLICATION

Assessments of cue utilization may assist in the selection and training of operators in high-consequence, high-risk environments, to ensure efficient and accurate performance during the management of interruptions.

Cue utilisation predicts control room operators' performance in a sustained visual search task

This research was designed to determine whether qualified practitioners' cue utilisation is predictive of their performance during a sustained visual search task in an operational context. Australian Distribution Network Service Provider (DNSP) operators were recruited for two experiments, and were classified with either higher or lower cue utilisation based on an assessment of cue utilisation within the context of power distribution. Operators' performance was assessed using a domain-related sustained visual search task. In both experiments, power distribution operators with higher cue utilisation demonstrated shorter mean response latencies during the sustained visual search task, compared to operators with lower cue utilisation. Further, no differences in accuracy based on cue utilisation were observed during the sustained visual search task. The results are consistent with the proposition that power operators with higher cue utilisation have a greater capacity to sustain visual search during domain-related tasks, compared to operators with lower cue utilisation. Practitioner summary: Power distribution system operators' cue utilisation was used to predict performance during a domain-related sustained visual search task. Power distribution operators with higher cue utilisation demonstrated shorter mean response latencies during the sustained visual search task, but no differences in accuracy, compared to operators with lower cue utilisation. Abbreviations: DNSP: distribution network service provider; EXPERTise 2.0: EXPERT intensive skills evaluation; FAT: feature association task; FDT: feature discrimination task; FIT: feature identification task; fNIRS: functional near infrared spectroscopy; FPT: feature prioritisation task; FRT: feature recognition task; SCADA: supervisory control and data acquisition.

Control Room Operators' Cue Utilization Predicts Cognitive Resource Consumption During Regular Operational Tasks

This study was designed to examine whether qualified practitioners’ cue utilization is predictive of their sustained attention performance during regular operational tasks. Simulated laboratory studies have demonstrated that cue utilization differentiates cognitive load during process control tasks. However, it was previously unclear whether similar results would be demonstrated with qualified practitioners during familiar operational tasks. Australian distribution network service provider (DNSP) operators were classified with either higher or lower cue utilization based on an assessment of cue utilization within the context of electrical power distribution. During two, 20-min periods of operators’ regular workdays, physiological measures of workload were assessed through changes in cerebral oxygenation in the prefrontal cortex compared to baseline, and through eye behavior metrics (fixation rates, saccade amplitude, and fixation dispersion). The results indicated that there were no statistically significant differences in eye behavior metrics, based on levels of cue utilization. However, as hypothesized, during both sessions, operators with higher cue utilization demonstrated smaller increases in cerebral oxygenation in the prefrontal cortex from baseline, compared to operators with lower cue utilization. The results are consistent with the proposition that operators with higher cue utilization experience lower cognitive load during periods of regular activity during their workday, compared to operators with lower cue utilization. Assessments of cue utilization could help identify operators who are better able to sustain attention during regular operational tasks, as well as those who may benefit from cue-based training interventions.

The Potential Role of Context-Related Exposure in Explaining Differences in Water Safety Cue Utilization

OBJECTIVE

To examine whether differences in water safety-related cue utilization might be associated with differences in exposure to water-related recreational contexts.

BACKGROUND

A disproportionate number of incidents of drowning were attributable to recent visitors to New South Wales in the 2016-2017 summer swimming season. This was due to their assumed lack of exposure to the water-related recreational settings in which Australians engage and therefore, the absence of cues that are associated with danger.

METHOD

In Study 1, the water safety cue utilization of 101 Australian residents and 328 recent visitors to the country was compared using the Expert Intensive Skills Evaluation (EXPERTise 2.0) program. Accounting for differences between the samples, Australian residents demonstrated significantly superior water safety cue utilization. In Study 2, the water safety cue utilization of a sample of 219 Australian residents was examined, the outcomes of which indicated that those participants who learned to swim before the age of 11 years demonstrated superior water safety cue utilization to participants who learned to swim at a later age.

RESULTS

Overall, the results suggest that there are individual differences in water safety cue utilization that are explained, in part, by differences in country of residence and the age at which participants first learned to swim.

CONCLUSION

Water safety cue utilization is likely to be dependent upon exposure to water-related activities. Identifying individual differences enables the development of more targeted, drowning-prevention strategies.

The role of cue utilisation in reducing the workload in a train control task

Skilled performance has been characterised, in part, by the capacity to accurately identify and respond to patterns as cues in the environment. The outcome is a reduction in cognitive load and a greater residual capacity to undertake concurrent tasks. The present study was designed to examine the relationship between cue utilisation and temporal pattern recognition in the context of a simulated, rail control task. Sixty-one university students undertook an assessment of cue utilisation and engaged in a rail control simulation. The appearance and movement of trains followed a consistent but implicit (undisclosed) pattern. Throughout the second half of the rail task, a secondary task was included. The results indicated that participants with relatively higher cue utilisation were more likely to identify the implicit pattern of rail movements, were more accurate and responded more rapidly under increased workload conditions. The results suggest that a propensity to identify patterns as cues may provide an opportunity to reduce cognitive demands, thereby facilitating performance in a novel task. Implications for selection and system design are discussed. Practitioner Summary: This study was designed to explain differences in the way in which people learn, particularly when tasks involve recurring patterns. Using simulated rail control, the results indicated that participants who display behaviour that is indicative of the utilisation of cues also recognise patterns in the movement of simulated trains. This enables them to manage trains more effectively, even while undertaking other tasks.

Cue Utilization and Cognitive Load in Novel Task Performance

This study was designed to examine whether differences in cue utilization were associated with differences in performance during a novel, simulated rail control task, and whether these differences reflected a reduction in cognitive load. Two experiments were conducted, the first of which involved the completion of a 20-min rail control simulation that required participants to re-route trains that periodically required a diversion. Participants with a greater level of cue utilization recorded a consistently greater response latency, consistent with a strategy that maintained accuracy, but reduced the demands on cognitive resources. In the second experiment, participants completed the rail task, during which a concurrent, secondary task was introduced. The results revealed an interaction, whereby participants with lesser levels of cue utilization recorded an increase in response latency that exceeded the response latency recorded for participants with greater levels of cue utilization. The relative consistency of response latencies for participants with greater levels of cue utilization, across all blocks, despite the imposition of a secondary task, suggested that those participants with greater levels of cue utilization had adopted a strategy that was effectively minimizing the impact of additional sources of cognitive load on their performance.

"There are risks to be taken and some just push it too far": how farmers perceive quad-bike incident risk

OBJECTIVE

To qualitatively explore how farmers perceive personal risk of an occupational quad-bike incident and develop a model of the factors that modify this perception.

METHODS

Grounded theory methods were used to inform data collection and analysis. Semi-structured interviews were undertaken with eight New Zealand livestock farmers. Interviews were inductively analysed to derive categories that helped explain the processes involved in quad-bike incident risk perception.

RESULTS

Farmers perceived personal risk of experiencing a quad-bike incident could be modelled on a sliding scale from low to high. Four core categories encapsulated risk perception: the impact of previous quad-bike incidents; personal attributes; getting the job done; and being familiar with the performance of the quad bike, the terrain and task(s) being undertaken. An exploratory model was developed to elucidate the temporal gap between farmers' reflections on their perceived risk and reported real-time risk management.

CONCLUSIONS

These findings have implications for planning quad-bike safety interventions, which may benefit from incorporating both 'reflective' contemplation of risks and skills for coping with things suddenly going wrong 'in the moment'.

Measuring Diagnostic Skills through the Utilization of Cues

The aim of this paper is to outline a theoretical and empirical case for the role of cue utilization in the cognitive process of diagnosis. Drawing on theories of skill acquisition, the case is made that the utilization of cues represents a critical precursor to the progression toward expertise but that the acquisition and utilization of cues is dependent upon a repertoire of cases and exemplars that have been acquired during the progression from novice to competence. Cases and exemplars form the basis of a mental model from which cues, in the form or feature-event or feature-object relationships, can be identified and retained in memory. The implications of a more sophisticated understanding of the role of cue utilization in skill acquisition will provide the foundation for more effective and more efficient industrial training systems in the future.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills

OBJECTIVE

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of

BACKGROUND

Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance.

METHOD

Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training.

RESULTS

The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues.

CONCLUSION

It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance.

APPLICATION

Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

An objective approach to identifying diagnostic expertise among power system controllers

OBJECTIVE

The present study investigated whether performance across a range of cue-based cognitive tasks differentiated the diagnostic performance of power control operators into three distinct groups, characteristic of novice, competence, and expertise.

BACKGROUND

Despite its increasing importance in the contemporary workplace, there is little understanding of the cognitive processes that distinguish novice, competent, and expert performance in the context of remote diagnosis. However, recent evidence suggests that cue acquisition and utilization may represent a mechanism by which the transition from novice to expertise occurs.

METHOD

The study involved the application of four distinct cue-based tasks within the context of power system control. A total of 65 controllers, encompassing a range of industry experience, completed the tasks as part of an in-service training program.

RESULTS

Using a cluster analysis, it was possible to extract three distinct groups of operators on the basis of their performance in the cue-based tasks, and these groups corresponded to differences in diagnostic performance.

CONCLUSION

The results indicate assessments of the capacity to extract and utilize cues were able to distinguish expert from competent practitioners in the context of power control.

APPLICATION

Assessments of the capacity to extract and utilize cues may be used in the future to distinguish expert from nonexpert practitioners, particularly in the context of remote diagnosis.

The capability of static and dynamic features to distinguish competent from genuinely expert practitioners in pediatric diagnosis

OBJECTIVE

The authors describe the development of a new, more objective method of distinguishing experienced competent nonexpert from expert practitioners within pediatric intensive care.

BACKGROUND

Expert performance involves the acquisition and use of refined feature-event associations (cues) in the operational environment. Competent non-experts, although experienced, possess rudimentary cue associations in memory. Thus, they cannot respond as efficiently or as reliably as their expert counterparts, particularly when key diagnostic information is unavailable, such as that provided by dynamic cues.

METHOD

This study involved the application of four distinct tasks in which the use of relevant cues could be expected to increase both the accuracy and the efficiency of diagnostic performance. These tasks included both static and dynamic stimuli that were varied systematically. A total of 50 experienced pediatric intensive staff took part in the study.

RESULTS

The sample clustered into two levels across the tasks: Participants who performed at a consistently high level throughout the four tasks were labeled experts, and participants who performed at a lower level throughout the tasks were labeled competent nonexperts. The groups differed in their responses to the diagnostic scenarios presented in two of the tasks and their ability to maintain performance in the absence of dynamic features.

CONCLUSION

Experienced pediatricians can be decomposed into two groups on the basis of their capacity to acquire and use cues; these groups differ in their diagnostic accuracy and in their ability to maintain performance in the absence of dynamic features.

APPLICATION

The tasks may be used to identify practitioners who are failing to acquire expertise at a rate consistent with their experience, position, or training. This information may be used to guide targeted training efforts.

Cue Generation amongst Firefighters: Competent vs. Expert Differences

Empirical investigations of cognitive skill acquisition have generally focused on differences between novice and expert operators. The result is a neglect of the intermediate stage of skill acquisition in which operators progress through competence towards expert performance. This study investigated the qualitative and quantitative differences in the cognitive cues generated by competent and expert firefighters. Participants first read a written, firefighting-related decision scenario before listing the cues that they considered relevant in formulating a decision. The results revealed that experts generated significantly more cues than competent operators. Further, the types of cues generated by competent and expert operators differed, with experts reporting significantly more safety-related cues than competent operators. These outcomes suggest that differences exist between the cues that are employed by expert and competent operators during decision-making, and that these differences reflect a qualitative change in information processing that occurs during the transition from competence to expertise.