Analysis of Anaesthesiology Activities: A Work-Psychological Contribution to Increased Professionalism in Complex Work Systems
Deutschland (Tübingen) und Schweiz (Bern, Zürich, Basel)
Since the end of the 1980s, so-called patient simulators have increasingly been used in anaesthesiology for training and research. The concrete design of simulator settings for teaching, learning or research-oriented use has many levels of freedom. Also due to this complexity, many (functional) relationships are still unclear when using the simulator. Until this project was carried out (2001-2003), there were no systematic studies in anaesthesiology with a comparison of the simulator with the simulated work area (operating room, intensive care unit, emergency room, etc.) in terms of fundamental research. This project was initiated in order to systematically explore the field of action of simulator setting for occupational and organizational psychological research.
The aim was therefore to check whether an analytical concept developed in preliminary studies to describe anesthesiological courses of action in the operating room (OR) is also suitable for the analysis of courses of action in the simulator and whether the two settings can be compared on the basis of the collected data. The activity structure should be described in particular, taking into account the handling of unexpected events. From the comparative analysis of both settings, the ecological validity of simulator settings was to be analysed by means of various data sources - observation and interviews. In addition to the fundamental research-oriented comparison of the two settings, design recommendations for simulator settings should also be deduced.
For the observations, the observation system developed was used to describe the anesthesiological activity and enabled differentiated observations of courses of action in the operating room and in the simulator in comparable laparoscopic operations. The comparison was based on the analysis of the structural composition of the course of action from seven partial actions (communication, observation, measures, documentation, additional activities, miscellaneous, anaesthetist leaves surgery) differentiated according to the anaesthetic phase (initiation of the anaesthetic, middle phase, recovery from the anaesthetic), the setting or type of case (surgical case, routine simulator case, simulator incident) and finally the expertise of the persons involved (interns; assistant doctors).
For the analysis of the ecological validity, in addition to the assessment of the "behavioral realsim" on the basis of the observation data, the experience of the situation by the study participants through semi-structured interviews was collected and the current practice of the use of the simulator through semi-structured interviews with simulator operators was collected.
Beyond the comparison of the views and actions of the participants in relation to simulator setting, it is important for an ecologically valid design of training and research conditions to maintain the close relationship between the simulated work area and simulation. In this project, this was done by means of socio-technical system analyses in a Swiss hospital. The results could be compared with the results of previous examinations in a German hospital.
The research project presented here therefore deals with the possibilities of describing anesthesiological courses of action, both in the operating room and in simulator setting, as well as the comparison of simulator and simulated work area against the background of work practice in the simulated work area. The analyses are used to develop design proposals for simulator setting.
Da keines der meist branchen- bzw. tätigkeitsspezifischen arbeitspsychologischen Analyseverfahren für das Anwendungsfeld des Operationssaals oder gar spezifisch für die Anästhesie konzipiert ist, besteht ein methodisches und theoretisches Interesse an einer dem Gegenstandsbereich und damit dem anästhesiologischen Handeln angemessenen Analysestrategie und -methode.
Im Rahmen des skizzierten Forschungsvorhabens werden drei Analysestränge verfolgt:
a) Tätigkeits- bzw. Handlungsverlaufsanalysen,
b) prozessorientierte Systemanalysen und
c) eine Analyse der gegenwärtigen Praxis des Simulatoreinsatzes zu Trainingszwecken.
Erhebungsverfahren: Beobachtung teilnehmend, Gruppendiskussion, Qualitatives Interview
Erhebungseinheiten: Einzelfälle von Handlungsverläufen in der Narkoseführung
Anzahl Untersuchungseinheiten:30 Fälle
Untersuchungsdesign: Personen mit unterschiedlichem Ausbildungsstand in unterschiedlichen Settings sowie Fällen
Durchführung der Feldarbeit: Projektmitarbeiter sowie medizinische Kooperationspartner der jeweiligen Institution
|Start - End date||01.11.2001 - 28.05.2003|