The Use of Cognitive Task Analysis and Simulators for After Action Review of Medical Events in Iraq

Abstract : Prior attempts to use standard interview protocols to extract After Action Review (AAR) descriptions of emergency event decision making and problem solving strategies generated by participants are problematical. Cognitive psychological studies suggest that the resulting information often contains significant errors and omissions (Glaser et al., 1985; Besnard, 2000). These errors are often not recognized by participants who have solved important problems in emergency situations because the knowledge they are describing is largely automated and unconscious (Wheatley & Wegner, 2001). The problem is further complicated because experienced medical personnel mistakenly believe that their reports are complete and accurate and that they have solved the problems they are describing in a conscious, willful, and deliberate manner (Wegner, 2002). These reporting errors most likely increase in number and severity under time pressure battlefield situations (Hunt & Joslyn, 2000). This research attempts to improve medical AAR with a novel combination of Cognitive Task Analysis (CTA) conducted while interviewees moulage simulators (Clark & Estes, 2002; Clark & Estes, 1996; Velmahos et al., 2002). In this study, three medical experts who have experienced and solved the same type of medical problem in Iraq will be interviewed separately and together. It is hypothesized that interview protocols employing a novel combination of medical CTA combined with the moulage of simulators will more accurately capture the mix of automated and conscious decisions used to solve critical medical problems on the battlefield in Iraq. Each expert will be interviewed separately and, after reviewing the results, the other two experts will be asked to correct and improve on the information gathered from the "other" experts. This process has been found to identify and eliminate errors as well as provide accurate and efficient descriptions of medical decisions and actions that solved battlefield problems.