Effective coordination in medical emergency teams: The moderating role of task type

Coordination in health care action teams is an important factor in clinical performance and patient safety. Implementing a high-fidelity in situ simulation study, we investigated the performance-relevant effects of task distribution, provide information without request (PIWR) and closed-loop communication (CLC) in 68 medical emergency teams (METs) composed of fully qualified clinicians. We differentiated between two task types: algorithm-driven and knowledge-driven tasks. We assigned two different emergency tasks to each task type. We proposed not only a direct relationship between the three coordination behaviours and clinical performance, but also a moderating role for the type of task. Only CLC was related to performance and also moderated by task type. There was no relationship between the coordination behaviours task distribution and PIWR and performance. We discuss the differential effects of the three coordination behaviours on performance and emphasize the importance of the task in team research. In particular, we highlight theoretical and practical implications.     

The stability of aspect-based career preferences and of the recommended list of occupations derived from them

Career-related preferences (e.g., team work, independence, length of training, income), which are an elaboration and extension of vocational interests, are one of the cornerstones that guide individuals to promising occupations recommended for further exploration. These preferences are informative and can serve individuals and their career counselors only if they are reliable and stable. Study 1 tested the two-week reliability of 31 career-related preferences of 213 freshman students and the two-year stability of the preferences of 132 of these students. Both the within-aspect preferred levels (e.g., only indoors most preferred, but mostly indoors also acceptable) and the importance of the aspects were elicited. The median within-participant two-week reliability was .85 for preferred levels and .64 for aspect importance; the median two-year stabilities were .75 and .51, respectively. In Study 2, the preferences elicited in Study 1 were used to derive a list of recommended occupations compatible with each participant's preferences at Time 1, Time 2 (2 weeks later), and Time 3 (2 years later), using a compensatory-model-based fit index. The percentage of identical occupations in the lists of the top ten recommended occupations was quite high — 62% for Time 1 and Time 2, and 54% for Time 1 and Time 3. The theoretical and practical implications of the reliability and stability of recommendations based on aspect-based career preferences are discussed.     

Development and Initial Validation of a Scale Measuring the Beliefs of Educators Regarding Response to Intervention

This article presents information on the development and initial validation of the 16-item Response to Intervention (RTI) Beliefs Scale. The scale is designed to measure the extent to which educators working in schools hold beliefs consistent with the tenets of RTI. The authors administered the instrument to 2,430 educators in 62 elementary schools in the fall of 2007 and 2,443 educators in 68 elementary schools in the spring of 2008. Exploratory, single-level confirmatory, and multilevel confirmatory factor analysis procedures were used to examine construct validity. Results supported a correlated 3-factor model (Academic Abilities and Performance of Students with Disabilities, Data-Based Decision Making, and Functions of Core and Supplemental Instruction) at both the school and educator levels of analysis. Furthermore, the factor scores derived from the model demonstrated significant, positive relations to RTI implementation. Reliability estimates for two of the three factor scores exceeded.70. Implications for research on educator beliefs and implementation of RTI as well as implications for school psychologists supporting RTI implementation are discussed.     

医务人员对医患共同决策辅助工具的态度研究

循证医学实践要求在临床决策中整合最佳临床研究证据、医者经验、患者自身价值取向与所处具体临床情境。使用决策辅助工具进行医患共同决策可作为一种实践模式,有必要了解来自临床一线医务人员的态度。采用多阶段分层抽样方法,于国内11省及3个直辖市共32个城市的51所二级和三级医院发放问卷,探究使用决策辅助工具促进共同决策实施的可能性。对1 212份问卷的分析显示,73.2%的医务人员认可患者是高质量临床决策的参与主体;支持患者获知诊疗决策依据、认同患者决策辅助工具的积极效果与高学历等正相关。     

医患共享决策的价值意蕴、影响因素及辅助工具

当今社会,受消费行为和人权意识的影响,患者愈发渴望参与到医疗决策的过程之中。医患共享决策体现了对患者自主权的尊重,并有助于提高医疗服务品质。然而我国的医患共享决策起步较晚,面对的困难复杂且多样,需要克服来自患方、医方,以及医疗决策过程本身等方面的因素。患者与医生的有效沟通,是提高患者的就医体验,真正实现以患者为中心的使然。在其他国家的实践经验中,决策辅助工具为实现共享决策提供了有益的参考,但现有的决策辅助工具尚不完善,尤其缺乏适合我国国情的决策工具。     

Make‐or‐Break: Chasing Risky Goals or Settling for Safe Rewards?

Humans regularly pursue activities characterized by dramatic success or failure outcomes where, critically, the chances of success depend on the time invested working toward it. How should people allocate time between such make‐or‐break challenges and safe alternatives, where rewards are more predictable (e.g., linear) functions of performance? We present a formal framework for studying time allocation between these two types of activities, and we explore optimal behavior in both one‐shot and dynamic versions of the problem. In the one‐shot version, we illustrate striking discontinuities in the optimal time allocation policy as we gradually change the parameters of the decision‐making problem. In the dynamic version, we formulate the optimal strategy—defined by a giving‐up threshold—which adaptively dictates when people should stop pursuing the make‐or‐break goal. We then show that this strategy is computationally inaccessible for humans, and we explore boundedly rational alternatives. We compare the performance of the optimal model against (a) a myopic giving‐up threshold that is easier to compute, and even simpler heuristic strategies that either (b) only decide whether or not to start pursuing the goal and never give up or (c) consider giving up at a fixed number of control points. Comparing strategies across environments, we investigate the cost and behavioral implications of sidestepping the computational burden of full rationality.     

Measuring information demand of a dynamic in-vehicle display while driving – A study evaluating the MARS (Masking Action Relevant Stimuli) method

The MARS (Masking Action Relevant Stimuli) method assesses information demand for dynamic stimuli while driving. An action relevant stimulus is masked and the driver presses a button to unmask the stimulus for a limited period. We interpreted button presses as information demand. Following our previous research (Rittger, Kiesel, Schmidt, & Maag, 2014), the current study further evaluates the method. We applied the MARS method to a dynamic in-vehicle display containing recommendations from a traffic light assistant. In a driving simulator, drivers approached intersections with different traffic light phasing. The display either presented simple or complex information. In half of the drives, the participants used the MARS method. The study had a full within subjects design and fixations were recorded in all conditions. The results showed that the information demand varied according to the information in the display and the traffic light phase. A comparison of button presses with fixations showed that one unmasking interval came along with one fixation on the display. As a conclusion, the MARS method can distinguish between conditions with high and low information demand for the display. Button presses relate to fixations on the display. Hence, the MARS method is a promising tool to assess the information demand in dynamic environments and can be applied as an extension or alternative for eye tracking.     

团队决策及其影响因素

随着组织结构的变化,团队决策为越来越多的组织所采用。该文将团队决策的研究范式概括为以下四类：社会决策图式（social decision scheme, SDS）、信息取样模型（information sampling model）、项目排序任务（ranking item task）团队以及组织中以安全优先的团队（safety priority team）;并从影响团队决策的因素,提高团队决策质量的策略等角度分别对四类团队决策的研究进行探讨,在此基础上本文对未来研究进行了展望