Cynthia Dominguez’s research while affiliated with MITRE and other places

Study objectives: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear. Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under two conditions, Post-Call (defined as >2 hours of nighttime clinical duties) and Non-Post-Call. Results: Each surgeon contributed up to five surgical procedures post-call and non-post-call yielding 362 cases total (150 Post-Call and 210 Non-Post-Call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less Post-Call (4.98 ± 1.41) vs. Non-Post-Call (6.68 ± 0.88, p<0.01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons (NOTSS) ratings demonstrated poorer performance while Post-Call for Situational Awareness, Decision Making and Communication/Teamwork. Fewer hours of sleep also was related to lower ratings for Situational Awareness and Decision Making. Decreased self-reported alertness was observed to be associated with increased procedure time. Conclusions: Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on non-technical surgical skills were adversely affected by sleep deficiency.

Background: Sleep deficiency can adversely affect the performance of resident physicians resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons is less clear. Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under two conditions, Post-Call (defined as >2 hours of nighttime clinical duties) and Non-Post-Call. Results: Each surgeon contributed up to five surgical procedures post-call and non-post-call yielding 362 cases total (150 Post-Call and 210 Non-Post-Call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less Post-Call (4.98 ± 1.41) vs. Non-Post-Call (6.68 ± 0.88, p<0.01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons (NOTSS) ratings demonstrated poorer performance while Post-Call for Situational Awareness, Decision Making and Communication/Teamwork. Fewer hours of sleep also was related to lower ratings for Situational Awareness and Decision Making. Decreased self-reported alertness was observed to be associated with increased procedure time. Conclusions: Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on non-technical surgical skills were adversely affected by sleep deficiency.

Ensuring that unmanned aerial systems' (UAS) control stations include a tight coupling of systems engineering with human factors, cognitive analysis, and design is key to their success. We describe a combined cognitive task analysis (CTA) and design thinking effort to develop interfaces for an operator controlling an autonomous helicopter, a prototype system that the Office of Naval Research is developing. We first conducted CTA interviews with subject-matter experts having expertise in UAS flight operations, helicopter resupply, military ground forces, and marine airspace control. Data informed the development of analysis products, including human-system interface requirements, which drove the creation of design concepts through ideation sessions using design thinking methods. We validated and refined the design concepts with UAS pilots. We provide an overview of our process, illustrated by details of a timeline display development. Significant aspects of our work include close integration of CTA and design thinking efforts, designing for an "Üenvisioned world" of interaction with highly autonomous helicopter systems, and the importance of knowledge elicitation early in system design. This effort represents a successful demonstration of an innovative design process in developing UAS interfaces.

This paper reports on a research project that combined cognitive task analysis (CTA) methods with innovative design processes to develop a handheld device application enabling a non-aviator to interact with a highly autonomous resupply helicopter. In recent military operations, unmanned helicopters have been used to resupply U.S. Marines at remote forward operating bases (FOBs) and combat outposts (COPs). This use of unmanned systems saves lives by eliminating the need to drive through high-risk areas for routine resupply. The U.S. Navy is investing in research to improve the autonomy of these systems and the design of interfaces to enable a non-aviator Marine to safely and successfully interact with an incoming resupply helicopter using a simple, intuitive handheld device application. In this research, we collected data from multiple stakeholders to develop requirements, use cases, and design storyboards that have been implemented and demonstrated during flight tests in early 2014.

Sensitivity to patient needs makes clinicians the primary source of adaptive capacity, or resilience, in the intensive care unit (ICU). Work setting complexities and contingencies make cognitive work in this setting particularly challenging. A IT-based system to support individual and team decisions and communication would increase clinicians' capacity to adapt. We report on a 3-year project now underway to develop such a system. During the first year, our research team used Cognitive Systems Engineering (CSE) methods to reveal characteristics of the work setting, goals, barriers, and individual and team initiatives to overcome barriers. Our data analyses identified requirements for the IT system that were embodied in use cases, as well as in first draft prototypes of the system architecture and user interface. Our team is currently evaluating the interface prototype for face validity and refining details prior to starting programming. Interactive prototypes will be evaluated against criteria identified in field research to ensure validity. The resulting system is expected to improve staff decision making ability and communications with an expected improvement in unit adaptability. Shared decisions based on better information about procedures and resources are expected to improve staff efficiency and decrease missteps, lapses, delays in care, and the occurrence of morbidities including wrong medication/dose, infections, and unanticipated emergencies such as cardiac arrest.

Cognitive Engineering methods were developed to enable human factors practitioners to understand and systematically support the cognitive work of people working “at the sharp end of the spear.” Military members for whom DoD acquisition organizations develop systems are the quintessential “sharp end of the spear.” This panel is proposed to share present-day experience from military and industry reflecting how pervasively Cognitive Engineering is contributing to research and development for the highly complex military systems being operated under conditions of stress, time pressure, and uncertainty today. The implications for human factors practitioners will be highlighted, both in terms of practices to continue and areas for improvement.

While military command and control (C2) systems are intended to support operator cognitive work, current US Navy system engineering processes only capture behavioral-level tasks. Deployed forces in high threat settings need support for cognitive and macrocognitive work including planning, replanning, sensemaking and situation awareness. We describe a project on behalf of the Navy Expeditionary Combat Command (NECC) to create an approach to system development that reveals and supports cognitive work. Cognitive systems engineering methods, including cognitive task analysis (CTA), have been used to capture operational requirements and translate them into decision and display requirements. Quality critieria for accomplishing this work are presented. The project team has produced initial prototype displays that are suited to two of eleven NECC commands, those with the highest operations tempo and tactical mission requirements.