cognitive load

Healthcare Simulation: Cognitive Load in the Control Room Pt2

Healthcare Simulation: Cognitive Load in the Control Room Pt2 1500 1001 Level 3 Healthcare

I invite you to read Part 1 before you begin reading this section. Part 1 is an introduction to the challenge for the simulationist in regard to cognitive load. Part 2 begins a discussion on the types of technologies that will help address these challenges. 

Part 1 assumes that you as the reader even has experience with the typical control room. The reality is that each simulation program may have the control room layout designed differently. Allow me to provide a little more context for those of you who don’t have a control room.

Facility Design Challenges

A control room will have at least one control “station” and may even have half a dozen or more. Some simulation programs have distributed control rooms that are placed in proximity to one or more simulation training rooms. A central control room that hosts all the control stations has a huge benefit in terms of facility infrastructure design (easy access to power, network, collaboration, support). However, some prefer having a one-way glass placed between the control room and the simulation training rooms so that even without an AV solution, the operator/facilitator can see what is happening in the training room. However, the reliance on glass (one way or otherwise) to see into the room also creates new challenges. If the light is too bright in the control room, learners/participants can see movement, and sometimes see clearly those in the control room, thus creating some distraction to learners and consequently to staff. Other simulation facilities with this setup struggle to see past reflections and glares on the glass. To reduce glare, or transparency, some have decided to turn lights off in the control room altogether, with no light except for the light from the computer monitors. Collaboration, note taking, and even control may be sacrificed or hampered without appropriate lighting.

So, what does facility design have to do with “cognitive load”? In part one, I made it pretty clear the types of distractions and load that a facilitator/operator has to face, and this did not even take into consideration the environment in which the simulator and AV system is being controlled. Removal of distractions in the environment are important, if not critical.

 

Distractions and Solutions:

  • Clutter: The control room and consequently, each control station should be free of clutter. Clutter could include loose papers, notes (not being used), unmanaged cables (network, power, USB, etc.)
    • Solution: each operator/facilitator should pick up after themselves and leave their station clean at the end of each session. Cables should be managed so that feet do not get tangled in them, or that counter/desktops stay neat and tidy.
  • Complex station design where multiple keyboards, pointing devices (mouse, touchpad, etc.), inconsistency between one control station and another, requiring operators to learn the uniqueness of each station, operating system, application location, etc.
    • Solution 1: standardize each control station as much as possible. Use same branding monitors and computers and input devices (keyboard, mouse, microphone, etc.). The operator/facilitator should not have to relearn how to use the hardware (and software,if possible) just by changing to a different station. Each station is typically dedicated to a single simulation training space, but different manikin models and brands may be swapped out between each one. As much as it is possible, each control station can operate any manikin owned in any of these spaces.
    • Solution 2: When multiple computers are required for a control station, reduce multiple keyboards and mice to a single keyboard and mouse by using a KM switch. Switching control between computers can be as easy as moving your mouse pointer from one monitor screen to an adjacent monitor. Adder and Avocent both offer a command and control type KM (where KM = Keyboard, Mouse) switch. These switches can support up to four computers. Avocent has a switch that is smaller where only two computers are needed, and that will save some money.
    • Solution 3: As much as possible, each computer should have the same version of operating system (Windows 10.*, MacOS, etc.) and the computer should only have software related to simulation control. I’ve seen staff members use control station computers to do their office work and sometimes install software, or plugins for the browser. This has a strong potential to create instability with the simulation control and AV software. Control Stations should only be used for control.
  • Speakers from different control stations being used where sound is blaring from one scenario and distracting other operators/facilitators in the control room.
    • Solution 1: Use headphones when other operators are in the same room and more than one scenario is being controlled. When entering the control room be discreet and considerate that your activity does not add to the cognitive load already bearing down on the facilitator/operator.
    • Solution 2: If still designing your center, and the layout of your facility supports it, use a distributed control room model, where each simulation training room has one control station in its own control room. These are smaller rooms, but you will have greater freedom to control what is happening in the space if it isn’t shared with other facilitators like a central control room. However, this does create challenges as well. There are advantages to both distributed and central control room facility design. Consider how you will use the space.

 

Next time, I will talk about how standardized scenarios through programming and design can reduce cognitive load by automating many of the physiological processes that would otherwise have to be manipulated manually.

Do you have a challenge you would like me to address? Reach out to me anytime at myoung@l3hc.com. Do you have a solution to address cognitive load?

Share with me and I will give you credit for the suggestion in a future blog article.

Healthcare Simulation: Cognitive Load in the Control Room Pt1

Healthcare Simulation: Cognitive Load in the Control Room Pt1 1500 1001 Level 3 Healthcare

The Stage:

Let’s face it, simulation control rooms could use a huge makeover; so many distractions can overwhelm most simulationists. Cognitive load refers to the total amount of mental effort being used to accomplish a set of tasks, or just one task. The human brain can only do so much before errors become a part of the effort. So, when a typical OB simulation room has both the mother and newborn simulators, a fetal heart monitor and the mother’s vitals, it requires a means for the simulator operator/facilitator to control the progress and outcome of the scenario; this requires a lot of infrastructure at the simulation control station. In the case of an OB scenario, one person (sometimes two) is (are) required to operate a computer to control the OB simulator, another computer to control the newborn simulator, and a third computer to manage the audiovisual solution that allows the operator to see into the room from multiple angles. On top of this, some configurations may have at least one other computer that is displaying vitals in the patient room, which to some degree must be managed as well.

Behind the Curtain:

For the operator to guide the scenario, they need to be able to see and hear what learners are doing so that appropriate physiological and vocal responses can be managed. Pan-Tilt-Zoom (PTZ) cameras may need to target another view of the room, getting another glimpse into the minds of the learners. “How many liters of oxygen did they administer to the patient?” Zoom the camera in to see what the gauge says, but oops, while the operator was doing that, the learners were doing something else in the space, but the operator missed it.

With so many computers, the operator may have to switch between several keyboards and pointing devices (mouse or touch pad). Each computer may have a different operating system, so the operator is having to migrate their attention away from assessing learners constantly, as they navigate between multiple platforms. The operator can also be the voice of the patient, or directing someone else to be the voice of the patient. A male operator uses falsetto to approximate a female patient’s higher voice. The learners giggle as they are not convinced. The learners ask the “patient” several questions, and the operator shuffles through some notes to find the correct response.

I’ve been there. It is overwhelming and at the end of the scenario, I am emotionally and physically spent. Therefore, some simulation programs utilize a subject matter expert (facilitator/educator) to help assess the learners and guide the operator, and in some cases, portray the voice of the patient. Even with two people, there is a lot to coordinate, communicate and monitor.

Scene Changes:

For those of you reading this that have facilitated a scenario using simulators, you know what it means to experience cognitive overload. Operating the scenario is only part of the cognitive load that a typical operations specialist must facilitate. Once the scenario is complete, the simulation space must be setup for the next group of learners. The simulator must be reset, and perhaps calibrated appropriately. What if a simulator has a technical issue? What if the network goes down? What if? Each interval between each scenario are as critical as the scenario itself. Are the props in place? Are supplies present and in the right quantity? This can be a logistical nightmare, as the setting must be complete and ready by the time the learners step into the scenario environment.

Any Solutions?

This post serves as introduction to a series of forth-coming posts that will attempt to address critical factors in reducing cognitive load for the operations specialist. Keep in mind that a faculty member or a simulation educator may not have the “luxury” of having a simulation technician, or operations specialist, so must function as such. This only adds another layer of distraction (cognitive load) as these professionals must think beyond the moment and consider how a scenario might fit into the overall curriculum, and how learner performance should be addressed in a safe environment during debriefing. Join me next time as we begin to address technological and operational solutions to cognitive overload. Have questions? Fill out the form below and I will get back to you.