Figure - uploaded by Sune Vork Steffensen
Content may be subject to copyright.
Source publication
While the past decade has witnessed a proliferation of work in the intersection between phenomenology and empirical studies of cognition, the multitude of possible methodological connections between the two remains largely uncharted. In line with recent developments in enactivist ethnography, this article contributes to the methodological multitude...
Similar publications
Epistemic engineering arises as systems and their parts develop functionality that is construed as valid knowledge. By hypothesis, epistemic engineering is a basic evolutionary principle. It ensures that not only living systems identify the differences that make differences but also ensure that distributed control enables them to construct epistemi...
Citations
... In analyzing the ethnographic data, we rely on the phenomenological-hermeneutic tradition 82 and thematic analysis, used in traditional ethnography. 83,84 In the analysis of videodata we rely both on multimodal interaction analysis 81,85 and on cognitive event analysis (CEA) used in CE 86,87 to capture the real-time unfolding of events, as well as the changes and transitions that emerge around learning. 80 CEA is a qualitative and cognitive method for analyzing video recordings, particularly used for investigating how humans adapt to and modify their environment in order to get things done. ...
... The methodological procedure of CEA is described in Steffensen et al and Lebahn-Hadidi et al and consists of 5 steps spanning from event identification to interpretation. 87,89 In analyzing the video data, we looked more specifically at how the communication trajectory of the HCPs exposed to intervention changed over time. The purpose was to determine how and to what extent the HCPs applied the communicative skills introduced through e-learning modules in their clinical practice, and to identify any significant changes in the HCPs' behavior over time: What worked well, and what were the challenges. ...
OBJECTIVES
The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change.
METHODS
The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals’ implementation and individual competency development, and support the design of in-situ simulation training scenarios.
RESULTS
Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance.
CONCLUSION
We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.
... e.g. Hollan, Hutchins, and Kirsh 2000;Hutchins 1995;Lebahn-Hadidi et al. 2023;Luff et al. 2018;Orlikowski 2007;Wilson 2014;Wilson et al. 2007). ...
... There is an identified need to study how work is done from a cognitive distributed systems perspective (cf. Hollan, Hutchins, and Kirsh 2000;Hollnagel, Wears, and Braithwaite 2015;Hutchins 1995;Lebahn-Hadidi et al. 2023;Leveson 2020). Aligned with this perspective, it is emphasised that the workers are situated within a distributed socio-technical system where the system has to be designed in ways that allow for the workers to act in a flexible way to handle unexpected events, addressing the acquired implicit and embodied knowledge of the workers within the organisation. ...
... Aligned with this perspective, it is emphasised that the workers are situated within a distributed socio-technical system where the system has to be designed in ways that allow for the workers to act in a flexible way to handle unexpected events, addressing the acquired implicit and embodied knowledge of the workers within the organisation. Most reports on incident handling generally tend to stress what should have been done rather than what was actually done and attended to by the professional workers in situ (Lebahn-Hadidi et al. 2023). We, therefore, report on how an incident of a torn down electric overhead wire, that resulted in large disruptions of the train traffic, was handled remotely from the control room as the situation unfolded in situ. ...
... One can wonder why this interruption readiness skill is not a focus when introducing or training newly educated healthcare personnel. The results show how the healthcare personnel, through SBT, become aware of the importance of HFS competencies to cope with interruptions in their everyday clinical practice [45]. Data indicate a change in the personnel's awareness, talk and considerations about interruptions. ...
Increasingly more resources are being used internationally in training and educating qualified healthcare personnel due to high personnel flow and rapid development within technology, care and treatment. Consequently, transferring learning from simulation-based training to competency in clinical practice is an essential question for healthcare faculty and management. Nevertheless, there is no established method for assessing if transfer occurs. This article aims to demonstrate how a hybrid method can explore transfer of learning from a simulation-based course to competency in clinical practice.
... Nevertheless, the results also show that qualified teams mostly train situations where life is at stake. However, adverse events not only happens in highly acute situations but also in slow situations such as medication administration [131], receiving and transferring patients [132,133] and development of sepsis [134]-all situations where teams interact. If healthcare teams are trained in everyday care, it might reflect everyday clinical practice and prevent or reduce future adverse events. ...
Background
Simulation-based training used to train healthcare teams’ skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams’ human factor skills.
Method
A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies.
Results
The search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result.
Conclusion
Simulation-based training is a successful learning tool to improve qualified healthcare teams’ human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety.
... Nevertheless, the results also show that qualified teams mostly train situations where life is at stake. However, adverse events not only happens in highly acute situations but also in slow situations such as medication administration [131], receiving and transferring patients [132,133] and development of sepsis [134]-all situations where teams interact. If healthcare teams are trained in everyday care, it might reflect everyday clinical practice and prevent or reduce future adverse events. ...
Abstract
Background: Simulation-based training used to train healthcare teams’ skills and improve clinical practice has
evolved in recent decades. While it is evident that technical skills training is benefcial, the potential of human factor
training has not been described to the same extent. Research on human factor training has been limited to marginal
and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the efective‑
ness of simulation-based training in improving in-hospital qualifed healthcare teams’ human factor skills.
Method: A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the
systematic search was conducted on September 28th, 2021, in eight major scientifc databases. Three independent
reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used
to evaluate the evidence from the included studies.
Results: The search yielded 19,767 studies, of which 72 were included. The included studies were published between
2004 and 2021 and covered research from seven diferent in-hospital medical specialisms. Studies applied a wide
range of assessment tools, which made it challenging to compare the efectiveness of human factor skills training
across studies. The content analysis identifed evidence for the efectiveness. Four recurring themes were identifed:
(1) Training human factor skills in qualifed healthcare teams; (2) assessment of human factor skills; (3) combined
teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assess‑
ments are variable in the literature, afecting the power of the result.
Conclusion: Simulation-based training is a successful learning tool to improve qualifed healthcare teams’ human
factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the fnd‑
ings of this review. Moreover, research on retention and transfer is insufcient. Further, research on the retention and
transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the
efect on patient safety.
Keywords: Systematic review, Simulation-based training, Medical simulation, Human factor skills, Non-technical skills
(NTS), Adverse events, Teamwork, Crisis resource management (CRM), Qualifed healthcare team, In-hospital
This article explores the application of perturbation training to individuals, extending concepts originally developed for team training within dynamic systems theory. Drawing on enaction theory, we propose that perturbations—adverse or unforeseen events—can disrupt an individual’s structural coupling with their environment, fostering cognitive adaptation. Using a qualitative naturalistic case study in a gas plant crisis simulation, we document an experienced operator’s behavioral and cognitive responses to an unprecedented event. The findings reveal a three-phase adaptation cycle: a collapse of sensemaking, enactment of negative capability to tolerate uncertainty, and abductive reasoning to generate novel situational understanding and actions. This cycle enabled the individual to recover operational performance in a high-stakes scenario. The study highlights the potential of perturbation training for developing sensemaking, resilience, and adaptive thinking in individuals facing complex and uncertain conditions. We conclude with theoretical, methodological, and practical implications for crisis management training and future research.
This article aims to sketch a new integrative perspective on what I call change-ability. I define change-ability as skilled ways of coordinating with a rapidly changing world. Many urgent societal challenges – from climate change to obesity, from the mass extinction of species to fraying social cohesion – require people to collectively change everyday patterns of behaviour they take for granted. The key insight I start from is that to durably change undesirable patterns of behaviour, we could start by changing the affordances the environment offers – the possibilities for action offered to us by the living environment. The aim of this article is to sketch an integrative conceptual framework for understanding change-ability in terms in terms of a dynamical ‘brain ↔ body ↔ community ↔ landscape of affordances’ system. This Change-Ability Conceptual Framework starts from the idea that individuals and communities are situated in the same rich landscape of affordances and suggests that making communities more change-able entails transforming the material ‘grooves’ that have formed in this landscape of affordances.
This thesis investigates the influences of direct others on a human cognitive agent, and specifically how these influences pertain in and are re-evoked by the human cognitive agent. I propose to call the human activity of re-evoking an absent other as presencing. The principle aim of this dissertation is to draw attention to presencing as an observable phenomenon.
Rather than focusing on ‘the other,’ I argue for greater attention to be given to the human cognitive agent and how they re-evoke a direct absent other. While this research originally set out to investigate alternative approaches to the notion of ‘social Presence,’ which roughly can be translated to the ‘sense of being with another in a medium,’ the active engagement with the data led me to see that presence has to be treated as activity. That is, how a person brings about what is absent. For this reason, I pursue in this dissertation to conceptualise the activity of re-evoking an absent other as presencing. Denying that this re-evoking, or what some might call ‘imagining,’ takes place solely in the ‘head,’ I pursue to sketch a conceptualisation of presencing without representations. This bears great theoretical and methodological challenges if one sets out to investigate how a person reacts to and acts upon what is not directly perceivable in the environment.
I, therefore, propose a theoretical and methodological framing that illuminates the role of the presencing person. While assigning great value to the ‘body,’ I propose the need for a framework that allows to investigate cognition not only beyond the brain but also beyond the body as, so I argue, re-evoking an absent other cannot solely be reduced to sensing an Other’s body (i.e. being able to ‘see’ or ‘hear’ the Other). Drawing on the processual philosophies of Heidegger and Lefebvre, I propose a framework that combines systemic views of cognition with the languaging perspective. The proposed framework originates from the two main tenets from radical embodied cognitive science: (a) that cognition is non-representational and (b) depends on close organism-environment couplings. Acknowledging the need to account for the impact of history, I propose to extend the radical embodied cognitive view with insights from the languaging perspective and a person-oriented systemic view of cognition.
Informed by the distributed perspective, I combine cognitive ethnography with multimodal video analysis. In so doing, I focus on one case study of a group of students at an American university and investigate how, in the course of the term, they work together in a project. The data set that forms the case study under scrutiny consists of longitudinal real-time video recordings of classroom engagement, interview data (individual and group), digital communication data, and field notes. Following research questions inform the empirical work:
1. How do people use their lived bodies to bring about presencing?
2. How does the system-in-the-person enable and give rise to presencing?
