Aug 9, 2010 - Woods et al., 1991). The first step is for the practitioner to recognize, out of all the potentially changing ... by Earl Wiener to refer to automation.
NASA-CR-19B027
STATE
f
Grounding Explanations in Evolving, Diagnostic Situations
UNIVERSITY
Leila
J. Johannesen,
Cognitive
Systems
Richard
I. Cook,
Engineering
and David
D. Woods
Laboratory
N95-25335 (NASA-CR-198027) _XPLANATTONS OIAGNOSTIC (Ohio
GROUNOING IN EVCLVINGt SITUATIONS Final
State
Univ.)
85
Report unclas
p 63163
NASA-Johnson Houston,
Grant
Space
Texas
No.
Center
77058
NAG9-390
Final Report RF Project
December,
No.
760678/727376
1994
0065760
GROUNDING
EXPLANATIONS DIAGNOSTIC
Leila
J. Johannesen,
Cognitive
Richard
EVOLVING,
SITUATIONS
I. Cook,
and
David
Systems Engineering Laboratory The Ohio State University Columbus, OH 43210
CSEL
REPORT December,
Sponsored
IN
1994-TR-03 1994
by NASA Johnson Space under Grant NAG9-390
Center
D. Woods
TABLE
OF CONTENTS
CHAPTER
I°
PAGE
INTRODUCTION
AND
Introduction An
OVERVIEW
Illustrative
Clumsy Feedback
Example
.................................................................
2
of Artificial
Intelligence
4 6
......................................
7
Overview of Approach and Scope ............................................... Contributions ....................................................................................
10 10
Overview
12
FRAMEWORK
of the FOR
The
Rest
Cooperative
Grounding
Nature
Problem
STRATEGY Goals
in Dynamic
...................... ....................
........................................... Solving
Fault
.............................
Management
................
................................................................................ and
Control
Cognitive Field
Activities
...................
Relationships ........................................... Issues ....................................................
Issues
Activity
Study
of Anesthesiologists
............................................................. and
Information
Exchanges
Questions
Analysis ............................................................................. Data Sources ........................................................................
Episodes
15 15 16 17 18
19 21 21 21
..............
.................................................................................
Data
Transcription
14
19
Guiding and
13
.............................
Communication
in Cooperative
Supervisory The
Explanations
for Explanation Grounding
Practitioner Roles and General Communication Joint
of Causal
Affecting
Grounding
13
.......................................................
in Human-Human
Grounding
.............................................
................................................................
Knowledge
Factors
General
Report
Communication Mutual
RESEARCH
of the
ANALYSIS
Cooperative
III.
1 1
Explanation ........................................................................ .............................................................................................
Characteristics
II.
........................................................
......................................................................................
............................................................................
23 24 25 25 25
.....................................................................................
26
...............................................................................................
27
Updates
.................................................................................
28
Management and Diagnosis ............................................ Assumptions and Limitations ........................................................
28 29
The Normative Assumption .......................................... Omissions ............................................................................
29 29
Representations
of the ii
Findings
.....................................................
29
Key to Transcription Symbols ......................................... 30 IV.
FINDINGS OF THE
FIELD
Explanations
STUDY
in Dynamic
Joint
Fault
Interpretations Episode:
Unprompted
Management
about
Process
Anomalous
Blood
31
............................ State
.......................
Pressure
.................
31 31 31
Episode: Evaluating of Interventions
the Effects ..................................................
33
Episode:
of Management
34
The
Explanations
State
for Interpretations
Communications
Information
and
.................... Actions
..............
.....................................................
Exchanges
Highlighting of Concern
about
Activities
.......................
Anomalies, Events and Parameters .......................................................................
39 42 42 44
Information Through Noticing ..................................................... Shared Tools .......................................................................................
45 47
Queries
50
and
Updating Returns
Informative
DISCUSSION
Responses
.............................................
the Common Ground when a Team Member ............................................................................................ Overview
of Episode
Anomaly
Detection,
Investigation Update and V.
..............................................................
......................................................... Corrective
Action
Invest
in the
Implications
for
Agents In the Common Future
Directions
Common
Ground?
Human-IS
Cooperative
......................................... Interaction
of Reference
for Research
52 54 60
................
vs. Tools ................................................................... Context of the Monitored Process ........................ Frame
52
and
..................................................................... Joint Problem Solving .................................
.....................................................................................................
Why
52
..........................................
.......................................................
61 62 64 65 66 68
APPENDIX List of Cases BIBLIOGRAPHY
.........................................................................................
............................................................................................................
iii
69 70
LIST OF FIGURES FIGURES
o
PAGE
Model
of disturbance
2.
Clumsy
3.
Basic
5.
Supervisory
management
explanation logic
of research control
(from
Woods
et al.,
1991) .................
5
..........................................................................................
6
....................................................................................... mapping
11
........................................................................
22
6.
Types
7.
Logic of the analysis Episode: Anomalous
.......................................................................................... blood pressure ............................................................
27 32
the
35
8. 9.
of joint
cognitive
activity
Episode:
Evaluating
10
Episode:
The
11. 12.
Episode:
Evaluating
a course
Episode:
Deferring
explanation
13a.
state
of interventions
of management
record record
information
exchanges
...............................................................
of action
38
...................................................................
14.
Different
15.
Context for bradycardia update ...................................................................... Bradycardia update ........................................................................................... Common frame of reference ..........................................................................
40
......................................................................... ............................................................................. elaborations
iv
for
the
same
question
24
36
.........................................................
13b.
context-sensitive
................
.......................................
Page Page
16. 17.
1 of anesthesia 2 of anesthesia
effects
and
48 49 ............
51 53 56 67
ACKNOWLEDGMENTS
TX.
This research was sponsored by NASA Johnson Space Our deep appreciation goes to Dr. Jane Malin, technical
interest
and
support
Collection in part
by grants
Mandalfino acknowledge Departments University, possible.
in our
and
of the operating
the
Anesthesia
Fund
of the
Patient Ohio
the generous assistance of Anesthesiology and without
whose
Houston, for her
work.
analysis
from
Research
Center, monitor,
State
room
data was
Safety
Foundation
University.
of the faculty Neurosurgery
cooperation
V
the
study
made and
The
not
the
authors
and residents of the Ohio would
possible
of the State
have
been
also
EXECUTIVE
This
research
was
SUMMARY
motivated
by the
on how artificial intelligence (AI) systems practitioners engaged in fault management standard
approach
for
but
these
explanations, management.
Such
diagnostic are
explanations
and result in data overload. dynamic fault management neurosurgical effective
diagnostic
guided
communication, "common
The maintaining keep
track
providing by
of influences
on
reports
informative
interpretations
(in
on that
that
are
The
general
from
to gain
that
The
conceptual on
are typically
cooperation
one
in on
another
helping
they
do
one
this
activities
go beyond
rather to another.
into
analysis
assist by
ways
members
insight
research
on
the
are
in another
are by the
answering
and diagnosis show are better described
team
of work
in one
activity.
process
relevant
fault
flow
conversation
members
Two
of their
both
from
of the
responses
found
of dynamic in the
coordinative
the process.
attaining a mutual interpretation), given from one team member activities
work team
of management team members which
members.
drew
during
indicate
unprompted
in order
team
interpretations
Episodes among
One
retrospective
demands
as interruptions
study
particularly
findings
providing
questions. explanations
field
maintained
accurate
to the
undertaken
among
the
and
ground"
is to provide
suited
occur
was
support
that
understanding
A field study of human practitioners application (anesthesiologists during
operations)
framework
well
to further
may effectively support in dynamic situations.
assistance
not
desire
process
explicitly
and posed
that causal as joint
involved
in the
process
of
than as retrospective explanations Explanations of assessments and
brief
and
embedded
in the
flow
of
activity. intended systems assessments. displayed distracting
to support should
not But,
human
they partners
the focus information
to)
dynamic
in the
the
design
in dynamic boards"
effort
vi
are
activities
sophisticated system
to maintain
that
such
and capabilities
design
should be on providing intelligent about activities in the context process.
systems
management their
of the
intelligent in an
of intelligent
fault
concerning
lack many
communication,
ground. Instead, assessments and events
for
practitioners be "dark because
in human their
implications
the
must
avoid
common
system of (i.e., relative
I
CHAPTER INTRODUCTION
AND
OVERVIEW
Introduction Certain
fields
of practice
involve
the management
complex dynamic systems. These include flight commercial aviation, control of space systems, during
surgery
or chemical
dynamic systems and in conjunction Some include:
demands
need
to form
all the data
interpretations these
as data
out more
(AI)
and
and
comes
the
about
possible
to prevent faults,
is increasingly
control
of the
need
complex
and
Woods, used
between joint
humans One
and
intelligent
system
with
is a lack
standard
(Roth, more
in problems
for
Bennett
the and
cooperative
practitioner
1We refer distinguish
to act based
Artificial
in the
to the dynamic it from other
or on
or to intelligence
practitioners
common
who
role
for
AI
and as intelligent
process, but (or support for
the
supervised paradigm)
success
of assistance
between
situations between
in managing
in dynamic
to
of the fault
AI explanations
and
problem's
automated
Woods, intelligent process
process possible
solution 1987;
have
Billings,
systems-of problem
that is monitored processes.
the
(Malin et al., 1991). Poor design of automation and human have been resources
and
in failures
1991; Norman, 1990). In particular, forms of interaction out of the problem solving loop, while still leaving the
responsible
data
these
consequences
diagnoses function
(IS) is critical
forms
of coordination
demands of evolving, diagnostic the interaction and coordination
(Billings, human
need
1994). One
faulty
system.
problem
management
implicated
the
of these 1 on-line
process
update
dire
agents taking actions on the monitored by humans. The nature of the interaction
human-intelligent
with
to assist
systems.
systems is to function as advisors, presenting recommendations. In addition they may also subordinate some extent
situation
possible
e.g.,
of
diagnosis process
to continuously
being
dynamic
Fault
in a dynamic
in or is changed,
(in order
automation
manage
control.
the monitored integrity.
management
interpretations
are available,
interpretations
find
of fault
control
deck operations in anesthetic management
process
generally must occur with with maintaining system
of the
the
before
or nuclear
and
been
1991). systems
solving
and managed
shown There that
and
that take person
to be ineffective is a need
assist decision
as the "monitored
the
to create human
making,
process"
rather
in order
to
the
than simply 1994). 2
providing
This
research
intelligent
system
dynamic
diagnosis the
how
and
comparing
in which
Illustrative
with
expert
provides
system
model
diagnoses
of the
of decisions"
form
following
example.
process
other
an AI system was
in keeping
to study
aware
process
person's
respectively.
surgery.
is dynamic,
assistance,
of
and
hand,
3 This
the
typically
of
diagnosis
it is usually underlying
is generally
AI
accompanied
The
a causal cause(s).
The
a description
of
Tanner and of the world"
distinction
(or simply, explanations). of the problems with the explanation
Though
cognitive
be chemical,
solving
Chandrasekaran, as "explanations
for dynamic
the
example
and cognitive implications Malin et al., 1991; Woods,
Imagine that you managing some process.
undergoing
fault
will
and
be relevant
We will often refer to the first as interpretations which has a connotation of completeness), and
of diagnostic
characteristics Woods, 1988;
it might
with
or recommendation.
on the
explanations of interpretations To motivate discussion
to the
in complex,
and
concern
monitored
is also a type of explanation; observed symptoms to some
diagnosis,
throughout this report. (rather than diagnoses,
the
another
of the
an
human
situation
recommendations,
diagnosis
system arrived at the diagnosis. (1989) refer to this distinction
"explanations
system
one
state
for
dynamic process: investigation focused
Of particular
for problem
and/or
for the
provided by the system, explanation that relates explanation
the
it means
in management
to the
support
et al.,
player"
to study
cooperate
interaction
concerning process.
was
of a complex, operations. The
explanations.
practitioners
an explanation
how the Josephson
this
what
or as a "team
taken
members
and
detail
Layton
Example
In the system
approach
team
diagnoses
relevant information the problem solving An
cooperatively,
The
(e.g.,
in more
engaged in the management during neurosurgical
provides ways
or recommendation
to understand
to function
understanding
that
seeks
environments.
practitioners anesthesiologists on
a solution
nuclear,
What
or even
The important that
2The term practitioner is used as working within a field of practice,
it is important
the
of the
to avoid
systems
process situation
certain
really like
states,
and
access matter:
a patient
are that
to "operator" or "user" in order to emphasize fi6t simply interacting with a machine.
opposed
use
(see
at work on will also have
is, doesn't
a physiological
aspects
we
the
on actual
process
expert
management,
is hypothetical,
are based 1994).
are able to observe a practitioner For illustrative purposes, you activities.
standard
fault
the that
the person's
the
role as
3There are many distinctions among explanations that one could make. For example, Chandmsekaran et al. (1989) distinguish the latter class into 1)explaining why certain decision were or were not made, 2) justifying system's compiled knowledge by linking it to deepknowledge from which it was derived, and 3) explaining control behavior and proble_n solving sfrategy. -
--
3
process cannot the state of the values. process, The
There and
expert
be taken off-line while diagnosis process is available via a monitor
is also provides system's
an expert system, assessments on
which another
main
three
display
status messages, diagnoses the following hypothetical The
practitioner
notices
an unexpected
anomaly anomaly.
thinking
windows
on From
picture
of what
glances
over
Shifting
should
the
back
on
leads
at once.
data
diagnostic
screen He
He more
He back
the
action
on the
process.
and
turns
diagnostic
to investigate patterns, to do
It is one
wonders dire,
He begins things
are
When
of the
the
whether
possibility.
lower
current the He
expert looks
to understand at its diagnosis. to read
progressing,
it, but
then
ones values has
at the
4Note that the male pronoun is used only for simplicity's 5Actions to place the system in a "safe" configuration.
turns
to the
to determine
sake.
set
an
its
of
anomalous
the expert as he finds the
away
posted
from
he initially
taken
process
into
explanation
account
the
the
window
the reasoning scrolls beyond
process what
the
in the
in the
the data used and The explanation
and
Seeing to call up
he notices
been
system back
process
with more severe to him. He searches
priority
parameter
to the
another
he looks
has
gives
he needs
this,
he does,
hypothesis
initially
and
value.
more information. Suddenly a note to look at it as soon
for.
He
the
display
window.
to gather He makes
re-checks
the ES display to try followed in arriving on how
system
He
to see what
window.
considered.
that
action.
As he begins
a
is blank.
he notices
command
practitioner
together
to mind.
safing
to see potential
he is looking
data
parameter
he pieces
the
the
other
He also notices that another the sating actions 5 that
expert
therapeutic
the
a few
window
hypothesis springs to mind--one than the two that initially occurred
the interface display beeps.
process
display,
to the
the for
up
jump
he
he 4 begins
relevant
hypotheses
its trend. considers
back
both
In order
windows
trend; another consequences
relevant
goes
some windows
its diagnosis
process
subsystem
has
process
values.
several
then
to evaluate action
the
parameter
window.
to the
two but
is continuing He quickly
automated
sating
on--
system
for it to execute in order
The
through system
be going
when
account
he calls
contain
different
consider
Because
could
situation,
that
in the
display
is unexpected,
or faults
the
display
expert
and
fault
Now,
parameter.
the
provide:
diagnoses.
condition)
assess
data
may
be taken,
display
other,
raw
to the
instructions
display.
process
the
parameter is anomalous.
retrieves
what
that
process
in a process
a standard
about
attention
anomalous parameter
the
monitoring
data directly from to the practitioner.
windows
been
to better
the
values.
main of the
from
In order
receives monitor
and explanations scenario. anomaly
(deviation
diagnosis--
effect
has
has
proceeds. Information about that displays raw parameter
display next
on the
to check
--
4
management new
action
event
system?
He
there
messages
back
this
he looks
due
to the
expert
system
He
searches
one
process
that
might
display
are
at the
to an action
explain
raw
by
to check and the
data,
taken
the
This
example
attempts
in managing
disturbance
messages;
among
the
pattern.
Meanwhile,
changing...
to give
which
to cognitive
activity
responses
in Figure
to execute.
to cope
When
one
with
these
of cognitive
Woods
out of all the
Recognizing
how
flow
of the cognitive
1 (from
to recognize,
are anomalies. about
of the
6 A model
is shown
is for the practitioner
indications,
a sense
disturbances.
management
step
the
or more
are taken,
diagnostic
cognitive
of reasoning
practitioner
activity concern
in the example
perform
fault
diagnosis
is triggered. developing needs
system."
The first
to cope
in parallel
The example illustrates that can exist between
solving
problem
When
i.e.,
with
(Woods,
the
1988;
practitioner
to do with
the
time
and are,
Note
consequences
in multiple
evaluating fault(s),
hypotheses, planning
interventions, those
due
attention
and direction
reasoning
and
people
as a potential
may
include
a new
event
or monitoring
to differentiate
actions.
behavior
with
actions
attempting
the way
occurs
which
dealing
corrective
to corrective
interruptibility message
activities
The expert
with
the
the
activities
do (Pavard interruption
period
during
several or the
which
of the
does
of others
to be
consequences
not
the
following:
the effects
influences
et al., 1989). to these
and
for joint problem and an "intelligent
for
system
the
of faults
expert system's diagnosis and explanation arrives. A retrospective explanation typically comes at a time when the practitioner is likely engaged
the
how
1994).
a lack of coordination a human practitioner
has
leads
what
is reached,
responses.
The
changing
anomalies the
a diagnosis
corrective
in
et al., 1991).
potentially
disturbance(s),
actions
activities
activities
needs to monitor to see if the responses have occurred as expected whether they are having the desired effect. If unexpected anomalies lines
a
automated
status
scrolls
current
he realizes
the
Explanation
involved
sating
be. As
Was
list of messages.
to find
on the
"Clumsy"
first
turns
is a long
data
should
occurred.
of the
of
due
to faults
coordinate
its
by judging In effect,
on-going
the system's
lines
of
monitoring.
6 Disturbances are abnormal conditions particular operating context.
in which process
state deviates
from the desired
function for the
and
--
5
Data Channels
I
I
© 1991 Woods, Potter, Johannesen and Holloway
Figure
1.
Model
of anomaly-driven
information
processing
in dynamic
fault
management. A second
problem
concerns
diagnosis/explanation.
A long
attention
system
to the expert
to follow required
the
for some
the reasoning. In addition, such as scrolling, in order
searching
among
other
windows
to both from
it means
the explanation it means that
that
establishing
time,
for relevant
of the because
of data
requires
present
in the
the practitioner
demanding
information
of the above
the
process
relationships
needs to be undertaken examining the diagnosis
from
This
among
as extra tasks and explanation
resources may be or such
in order
results
views.
to pay
cognitive
interface management tasks to read the complete message,
understand the explanation. A problem that relates diagnosis/explanation
amount
explanation
the
as
to
a dissociation
is a problem process
data
and
by the practitioner. will take the
Also,
practitioner away from what is currently going on in the process, possibly resulting in missed events. In general, the dynamics and form of this expert system's based
explanation on "clumsy
automation creates new
make
it a "clumsy"
automation,"
a phrase
type coined
form
of interaction.
by Earl Wiener
This to refer
that provides its benefits during low workload periods, burdens during high workload periods (Wiener, 1989).
term to
but A clumsy
is
6
explanation
style
is one
periods.
It is a form
time
creates
and
that
creates
of data
extra
extra
overload;
tasks
and
workload
during
it interrupts
cognitive
the
burdens.
high
tempo
practitioner
Figure
at a busy
2 illustrates
this
concept.
I time
I
I ,
,_
,,llll
'l disturbance begins
Figure
2. "Clumsy
Explanation."
Feedback In the about
illustrative
whether
Effective
the
feedback
example
intelligent on
the
management many different
applications influences
actions
taken
by
among
humans
1981;
other and
Norman,
system
in the
1989;
in anticipating and occurred. Ineffective the
demands
on
system
had
the
taken
practitioner
an action
activities
agents
(Woods,
indicate knowing feedback
are
et al., that
1994). not
1991).
"Strong,
team Studies
inadequate
to remember
of the
functions (Sarter and Woods, 1992; 1994). Inadequate automation's activities also contributes to outcome factor in aviation incidents. 7
process.
types,
flight
Manos,
management
can lead
how
the to
both
and
to difficulties
mode changes workload by about
fault
disentangling may be due
(Foushee
feedback
information
the
unsure
in dynamic
silent"
players
when uncommanded can increase cognitive
was
on
is critical
because diagnosis may involve on the process, some of which
Malin
pilots
earlier,
automation's
automation
cockpit
used
the
feedback on failures; it has
have increasing system been
a
7As an example, consider the China Airlines 747 incident: the autopilot silently compensated for an engine's loss of power until it reached its limits, whereupon the unaware crew was forced to deal with the situation.
7
Some Characteristics Directions Recent
AI research
typical expert developments
(e.g., (e.g.,
to some
and
of the problems
Cawsey,
developing
Clancey
Explanations
New associated
Many of these criticisms and have been inspired by studies
et al., 1982;
concerns
Hasling,
System
has pointed
Pollack
in explanation
systems
Expert
system explanations. in the research labs
explanations work
of Typical
and
1992;
better
Rennels,
Paris,
1988).
explanations
1984;
Much
have 1) the
significant
important underlying
factor.
investigates
It is worth
what
management
to impact
cognitive
support
the
1989)
Below
cognitive
and
impact
them from process and 2) time is not a
to be no research in dynamic
characteristics hence
the
we
nature
that
fault
of the
to impact
in this work
(e.g., task
task
the
nature
are concerned of effective
of a
with
AI
we
summarize
some
problematic for dynamic that has also indicated
of the
characteristics
of typical
explanations
fault management. We also point the limitations of these characteristics
to AI for
domains.
given
at the Jones,
engaged of their
end
These
problem authors
in collaborative
Expert solving
point
problem
diagnosis
situations
that
available
evolution
stabilization. process, that al., 1991).
went
taking
This
management
or with
of the
suggests
is, with
uncertain
process
that
into an uncontrolled
there
they
explanations (Cawsey,
by
when
to provide solving. often cannot
actions;
are typically
Galliers,
contrast,
tend
corrective
though
Reece
people
are
justifications wait the
for a
picture
of
clearer with time, the ability to recover with time (Perrow, 1984). Hence, some actions data.
is needed
hypothesis
that,
of the problem practitioners
fault(s) may become will tend to decrease
demand
becomes
before
system
activity
out
solving,
beliefs or reasoning as part In dynamic fault management,
the underlying safe the system
The plane aircraft.
as Retrospective.
of some
1992).
full-fledged
and
the
functioning control
seems
explanations
expect
In particular,
of process
• Explanation and
can
there
or
support.
that are research other
that
effective We
system.
demands
diagnostic
noting
constitutes
applications.
demands how
characteristics that distinguish system is static and unchanging,
of the
for diagnostic
Chandrasekaran,
better explanations for how some device works for tutoring purposes Cawsey, 1992, Feiner and McKeown, 1990; Suthers et al., 1992). These domains control:
with
subsequent of human
be taken Some
in order should
revision
roll and lost thousands
before
understanding to move
the
be collaboration
and
refinement
of feet in altitude
all the
in the over
before
data
of the situation time
the crew
or
state towards
diagnosis (Malin,
recovered
et
the
8
In addition, process
of the
taking
the
time
keeping
aspect
Mastaglio provide
long
and
Reeves,
1991). explainee
then,
is involved
Recent
research
interactive Cornell,
explanation attempt
and
into and
the
guarantee
present,
man
out
draw
the
summaries
and
in which
the
for some
in some
process
(Malin et al., "spontaneous" providing
question not
(what
know
that
information). in which
in which
only
only
when
• Explanation typical explanations on what is being
given explained
"how..?"
they
is particularly
as given
and puts
of system
that
a command.
be asking may
in data overload; information, and there. time
is
is
constraints can
are
be severe.
of (at least
"why...?").
This
is taken
or explanations
requested
by the
operator
provide unprompted or 1992). A problem with people
seek), for relevant
be involved
it there
This
can be thought
is that
This
evolve
Unix
actions
explicitly
should
can
Woolf
type
about
interpretations
queried
information
agents
the
in which
people often and Falzon,
they
several
situations
when
(e.g.,
provide
1991, vol 2). By contrast, explanations (Karsenty to ask
even
some
situations
disturbances
1982).
approach
this
is even
of erroneous
query that
Suthers,
to know
needs
Explanations
to some
explanations
user
consequences
systems
et al.,
one-shot by
the
explanation
with
results relevant
of practice
as Response.
as a response
literally
want
Cawsey,
in which
(Pollack
the
oL for
or tailored explanations--providing and Reeves, 1990; Grice, 1975).
the
in domains
1990;
1990;
provided might
"minimal" (Mastaglio
information
that
people
consisting
machine
a parallel
A
in "one
process,
Swartout,
mean
1991,
of how
Swartout,
explanation
and
a user
and
to make
point
They
page
problematic
implicitly)
and
(1990)
provide needed
• Explanation
need
Moore
everything
that
particularly
what
of the how
The man page approach to explanation the user to search for and extract the
forces
may
1991;
Reeves
By contrast people just the information
quite
shaping
provided Cawsey,
studies
(Moore
include
to Explainee.
a dialogue
is a negotiation
an explanation.
to provide
empirical requires
it will
at an inappropriate
are
1989;
or elaborations
Cawsey,
Mastaglio
they
interpretation
its soundness.
Explainer
an explanation in the
the because
process
Swartout,
it often
on
to evaluate
is that
and
loop
workload
from
By contrast, that
directions
(e.g., 1992).
too much
no
1990).
clarifications In a sense
and
Process
(Moore
show
of the
monitored
AI explanations
chunk
explanations
example,
the
explanation
as a One-Shot
of typical
or as one
out
in a higher
from
a long
• Explanation shot"
result
away
to read
operator
may
practitioner
in order
related
the
AI system
may
or in the
not
know
extreme
case,
an explanation in complex in managing
quite
(that
they
dynamic the
process
quickly.
by Expert
to Novice.
by expert systems is that and provides the person
A premise
behind
the
the system is the authority with a final answer. This
9
perspective is inappropriate for supporting which and
practitioners are
many
active
are believe
levels
a more
• Explanation an explanation has
and
than
the
management
monitored for
interaction
Bennett and collaborating
expertise,
fault
substituting
appropriate
(Roth, studying
of experience
about
Rather
that
practitioner expertise may be gained from
different expertise.
knowledgeable
in its management.
researchers
support Insight
highly
cooperative
Woods, team
and
who
process
expertise, paradigm
is to
1987; Billings, members with
have
explanatory
as Context-Independent. Traditionally, been seen as context-independent, i.e.,
coherence
Cornell, the
1992)
goals
or testability,
in philosophy 1991, Cawsey, indicates
and
that
information
Another independent
sense is that
it is common
window,
fail to highlight causal) among among
the goodness of that there is a valid,
the
management
are
Remington analysis
and systems
basic
attempted and data interpret demands monitored
reason.
Work
need
AI explanations
dissociated
from
the
and
monitored these events
process (Potter
IS assessments
and
systems
with likely
the
to lead
Shafto,
1990).
developed
to take
into
process
views.
explanations
the
For
process
et al., 1991).
Message
relationships 1991). This
(e.g. lack of
view
imposes
nuclear The
points
management
industry did
actual
that
in the
not
that et al.,
was
1991;
disturbance 1980's,
incorporate
result
have
fault
(Malin out
the
simply
for dynamic
interactions
(1989)
systems
diagnoses.
fault
example,
in a separate
(Malin
events and and Woods,
dynamic
to "clumsy"
these
account
are context-
characteristics
Woods
in the
Though
to automate
for
above
on
explainee.
practitioners. In such cases, practitioners system (Remington and Shafto, 1990).
support
explanations
typical
brevity.
in this as
1990) and more recently in 1990; Suthers, Woolf and
explanations
of the
i.e., a list of text messages
integration task on the ignored the intelligent Diagnostic
and
(Hilton, Swartout,
IS interpretations
lists often temporal,
same
are
to present
list"
coordination
effective needs
they
completeness,
psychology Moore and
in which
"message
provide
and 1991;
1991).
overlapping
best explanation for some event (Leake, 1991). Leake points out that approach, determining an explanation relies on certain criteria such explanation AI (Leake,
in
failed
AI,
clumsy
for
the
they explanation
overload-operators had to sort through the diagnostic information, it, and integrate it with other sources, all at the same time that the for
monitoring,
process
assessing
were
technology purported burdens during critical
the
and
highest.
to aid practitioners and high tempo
responding
Similarly in fact portions
to events other created of the
studies
in the have
found
that
new cognitive task (Woods, 1993a).
10
Overview
of Approach
The research practitioners support one
in one
one
Scope fault
human-human
see Coombs
experienced
and
to the
and
Alty,
human-intelligent
described
in this
The study
system
report
performed
the performance
higher
is a field
of practitioners
study
of field
one
particular
anothers'
study
The basic
aspect--
situation
how
because
we
fault
are
of the
observed
and
without
analyzed
taking
any
field study" as Xiao, 1994 for this
described
cooperate
in dynamic
that
logic
work,
The study
practitioners
assessment
the
of this
3.
in actual
of anesthesiologists).
is
is that by examining
interventions. The study is what might be called a "focused opposed to a cognitive task analysis of anesthesiology (see kind
to aid
principles
in Figure
engaged
approach
example
level
case.
is shown
general
insight
another
The assumption
form
of how
(anesthesiology)
The
to provide (For
1980). can
domain
diagnosis.
interaction
one
investigation
management
interaction.
practitioners,
applicable research
an empirical
in management
of human-computer
approach
was
dynamic
another
of studying
design
and
undertaken
herein
in supporting
focuses
on
one
management.
Contributions This
research
practitioners provided
on
information and
the
episodes
dynamic
fault
that
seen
in these team
constraints
understanding
in dynamic
of explanations
management,
human and
to fill a gap in our another
seen
during
a new members of current
among
among
is possible. the
of the The
nature ground.
practitioners
the
of the in and
indicates
implications
is
diagnosis
members
study
common
to support
and and
framework team
AI technology,
the design of intelligent systems intended players" in dynamic fault management.
Data
practitioners
of management
interpretation maintain
of how
management.
the conceptual
exchanges
applications
fault
episodes
By applying
to information
of explanations study
kinds
of updating.
ground
the
one
exchanges
common
ways
begins
support
function some
Based
on
are drawn as "team
for
11
Typical expert system form of diagnostic support, which involves automated diagnosis and explanations, is problematic for dynamic fault management. What are some important ways team members support one another in dynamic fault management?
Field study of human practitioners engaged in a particular dynamic fault management application: anesthetic management during surgery Conceptual framework that guides study: • coo erative rinci P le in conversation anaPexplanation • common ground Select episodes: * management and diagnosis • updating
• Extract empirical patterns about how team players cboperate and support one another in one dynamic fault management domain.
• Implications for cooperative syst/_m design in dynamic fault management
Figure
3. Basic
Logic
of the Research.
12
Overview
of the Rest
Chapter analyze
the
cooperative explanations research discusses
of the
2 presents raw
data.
This
Report
the
concept
framework
base
consists
nature of communication, i.e., and the notion of a "common
strategy of the study. these findings.
Chapter
(or conceptual
framework)
highlight
the the
the findings
that
to
the context sensitivity of ground." Chapter 3 presents
4 presents
of concepts
used
and
Chapter
5
13
CHAPTER II FRAMEWORK FOR ANALYSIS The challenge of from
the
field studies of complex behavioral
study
analytic
process
involves
taking
a description
transcript),
which
converting and which
it to a description that can generalize to other
have
The
et al.,
problems
with
capabilities
problems.
and
communication
the
and
conversation
and
ground"
that
explicit
some
and
Cooperative
during seem
cooperation
the
to
concepts
used
of
and
as communication
for
relating
major
support
generally,
the
field
study
draws
to effective
concepts
as a cooperative
that
guides
of diagnostic
of, very areas
The
(raw
and
and domain-independent to do this, one needs
that
framework
explanation.
performance
1993b).
forms
different
is maintained
actual
context-dependent
glass"
Woods,
standard
explanation
concepts
communication
looking
be thought
from
of the
highly
conceptual
theory
valid, generalizable patterns (Woods, 1993b). The basic
is concept-specific domains. In order
1981;
the can
Therefore,
research
and
or "conceptual
(Hollnagel
explanation on
is concept-free
a framework
importance
is to extract situations
of the
endeavor
communication.
framework
and
This
the
are:
"common
framework
to be relevant
to understanding
in distributed
problem
makes
solving.
Communication
Grice
(1975)
interlocutors
pointed
out
to recognize
the
that
conversation
intentions
utterances, speakers need to adhere referred to these as maxims of: • manner:
speak
• quantity:
as clearly
provide
• quality:
speak
true
• relation:
make
your
to certain
as possible,
as much
is cooperative.
(illocutionary principles
avoid
information
acts)
In order
for
behind
or maxims.
Grice
ambiguity.
as needed
in a context
but not
more
information contribution
relevant
to the
context
in which
you
are
speaking Adhering account
to these
information
maxims
about
their
tailor needs
their communications of their listeners (e.g.,
allow
Grice's maxims, one to anticipate
how
they
(e.g.,
"Error
clearly several
apply code:
what the different
are cognitive
implies listeners
that
speakers
when
need
formulating
to what they perceive to be the Krauss and Fussell, 1991).
when applied to human-computer problems in interaction. Woods
to alarm 22345")
systems. violate
For example, the maxim
messages.
of violating
the
maxims
People
information
alarm they
messages
do not
problem is. Group alarms, in which the same alarm underlying problems, violate the maxim of quantity.
consequences
into
communication, (1992a) illustrates
inscrutable of manner;
to take
of cooperative
express indicates There
14
communication; need to seek has
actually
The
occurred
Cooperative Any
There
perhaps
Nature
during
of Causal
are potentially
many
contributing
as if there multiple
was
a single
necessary
select built
question
them did
on.
remain
valid
necessary
but only We
but we are selecting
Which
of these
often
one
multiple
have
1990).
an assumed
For
contains
unarticulated.
contrast
example,
some The
case,
an explanation
counterfactual complete
to the
contrast
question,
case,
will
depending than target the
on the
explaining case
cause
and
not
in some
sense
a gap
they
i.e.,
explains
why
generally
depends
relevant explanation from the questioner's backgrounded conditions
is one point
contrast are taken
explanation explainee
itself needs
(Hilton,
1990).
knowledge
focuses
Studies gap
indicate
in someone's
explanations shared
they
among
for an overview).
on
(Hilton,
is taken (Mackie, other
To be relevant, concerning
to be 1965).
forms
of
explanations
the
issue
in
(mere conditions) of the explanation,
of the
Another
depending and
So if explainer
that
explainee.
The
explainer
is needed
explainee
believes
that
that
knowledge
contributing factor x, then factor y which was explainer thinks the explainee does not know,
the
to satisfy
explanations
explainee and
to say it is that some whereas
the
of an explanation
furthermore
on the the
the
goodness
provide and
way
knowledge, that
the
information
that people
give
1990).
the factor(s)
knowledge
themselves
Rather
in the
of (cooperative)
are background to the purposes
or common
Therefore, the
case.
that "refers to the factor that makes the difference of view between the target event and the
case"
to know.
What case
rules
needs
vary
occurs
are like
general
x rather that are
contrast
event
case.
explanations
the information
as shared
on whether it provides (Leake, 1991). the
on
the
contrast
to the
question (TurnbuU, 1986). Some conditions and some are foreground (causes) relative which
on the
contrast
causal
adhere
explainee's
as causal
adopted,
counterfactual
maxims
in the
are viewed
counterfactual (1990)
that
or Gricean
close
se, one
causal
to Hilton
in the
conversation,
per
on the
According
that
of reference
an event
depends
dialogue must
frame
those
even
if articulated,
seen
and
of the
a "rather
"why factors
conditions
speak
contributors
could be one of several, such as: "why x rather than not x?', than the default value for x?" or "why x rather than y?" The as mere
ways.
of our inquiry.
always
(Hilton,
each
and
that is to be explained.
for the event,
x occur?"
the person will event in fact
period.
in different
factors--
event
on the purposes
into
it may
"explained"
to focus
explanations
"why
though
cause
factors
depends
Causal
be
the
tempo
alarm, what
Explanations
may
to produce
of the group to understand
a high
event
sufficient
than"
in the case information
particular
jointly
we
for example, the missing
out
(see
they
share
some
attempt will
that they Turnball
depends
and
knowledge
goal to close
change
perceive
the to be
Slugoski,
1988
of some
also involved but which the will be emphasized. These
15
results
are
with
interpreted
Gricean
Mutual
when
Knowledge
explainees
verification
about
advisory
interactions,
requests
are
eliciting
the
observed
a good
resolution
of the
assurance
that
1974).
the
For
(e.g.,
wants
to know
gone).
Also,
explainee's
why
way
mutual
collaborative 1969;
and
explanations, mutual shared
just
offer
that
Grounding
BILL
causal
and
go
to the
like
"why
isn't
that
John
should
out
have
store?"
means
This
yet?"
conveys
home
contrast
case
participants
an explanation
is mutually
in general
(Searle,
mutual
goals
and
a collaborative
and
and
conversation. During the course establish whether their utterances current
purposes.
An
This
expectations.
activity
presuppositions
that
relies each
on
of the have
utterance
has been
studied
precisely
assumes
and common
mainly
conversation, participants been understood well
or, more
a "common
participant
functions
to the when
1992).
perceived or inferred task provides a shared
ground
their
(Lewis,
in giving
relevant environment"-
take to be their mutual knowledge Clark and Schaeffer, 1989). How
its role
in
known is used
are held by both, i.e., what they mutual beliefs (Stalnaker, 1978; up,
the
Communication
being
set of beliefs
about
have
engaged
can be built up by having undergone some or taking stock of what is in the "cognitive
informs
requester could
for
knowledge
of being on some
Clark,
already.
People
of what
in conversations
background for by
the
who
been
mutual
that
some
also
and
people
expectations.
models
1988).
implies
and
to gain are
(Haviland
home
have
implicit
and
mental
in Human-Human
is built
definition
be foregrounded
to other John
the
goals
can
for
et al. (1982) in order
Linguistic
found
idea
in the
background
as opposed
as it is used
Communication, ground'-the
Pollack
information,
-the facts and assumptions that are capable (Sperber and Wilson, 1986). Collaborating experience
(1987)
"is this
participate
all facts.
of an utterance
Slugoski,
knowledge experience,
ask
Similarly,
in their
Carroll
understanding
and
to figure
activity
to know and
one's
part
knowledge,
Turnball
need
intentions, goals One way is that
effectively
case
did
a sentence
Another
used
Bill went
expectation
is to use
complying
what should be taken as foreground and explainee's question can be used as a cue
some
"Why
they
actively
may
has
contrast
example,
emphasis
they
advisor
level.
advice
problem;
the
that
and
seeking
available for conveying for an explanation. The determining
cooperatively,
Aaronson
to communicate
type
people
what
(utterances way
explanation
that
act
about the knowledge, to the explanation?
information
In studying
correct...")
explainers
explain.
explainer know may be relevant
provide
queries.
that
they
for Explanation
How does the explainee that
of the
that
to mean
maxims
in
attempt enough for
its meaning,
common ground if it is accepted. Acceptance of an utterance interlocutors provide evidence of understanding; some ways
to
is added occurs people
do
--
16
this in
conversation
are
nodding,
and
turn,
an appropriate
i.e.,
understood part
the
been
Participants intonation for
the
been
(e.g.,
followed
by
confirmation
understood,
One
a pause
that
conversations,
attention, positive
this is done and
the
repair
is almost
for
leads
always
has all
or
of understanding
is via
the
try
1979).
of an utterance
opportunity
of an utterance
next
a participant
4) demonstrating
evidence Schegloff,
part
a relevant
that
and
way (Sacks
or
verbatim.
seek
a particular
or allow
Non-acceptance
evidence
or repeating
actively
1991).
as "uh-huh"
2) supplying
gives
3) continued
may
such
"really"),
which
understood
Brennan,
acknowledgments
"gosh,"
response
utterance,
has
and
1) using
assessments
of what
(Clark
by:
marker,
Try
a rising
markers
allow
or reference
has
correction.
to repair.
initiated
In everyday
on the
spot
and
is completed
quickly. Factors
Affecting Grounding
Groundin_ is affected
communication grounding
(Clark may
Task-oriented higher.
dialogues
For
example,
to be imparted, her partner (Clark and The For
medium
example,
(Clark
(1986), is, they
lead
to the
present
speaker Brennan,
to use
should least
operate
as little
ground collaborative
For
expecting each
via
his
or
to ground.
to face the
needs
installment
required
or telephone
full
so as not
start-up
duplex
to interrupt
fault
example,
(of new
(utterance
delay
costs
the
the Principle those
of Least
effort
8 Some
aspects
high are and
Collaborative
as possible.
techniques
available of the
discourse),
mistakes), are
media, e.g., long pauses occur. According to Clark
effort.
be
for using this kind of acknowledgment of the costs of grounding include:
combined
with
grounding
after
in face
it precisely
conversation.
of information
effort
(e.g.,
display,
1991).
via
verbatim
understanding,
and simultaneous or forgetting may
people try
to time
change,
for
it in installments,
is easy
for
of the
piece
the
of
techniques
purposes
affects
is higher Some
medium
criterion
repeat
it is difficult
reception,
the
Different the the
"okay"
and
face or cotemporal in various ways,
people
may
and
complicated
communication
production,
asynchrony,
that
that
in keyboard
facility)
repair
That
require
important,
speaker
Hence, the cost communications.
delay,
Gibbs
on
acknowledgment
but
other typist. in keyboard formation,
1991).
depending
of communication
the
'talk'
TM
Brennan,
may if an
the
purposes
to respond or sometimes Schaeffer, 1989).
conversations, Unix
and
be required
by the
Their
and in face-to-
interpreted WilkesEffort. prediction
in a medium
is that
situation
8A study by Cohen (1984) demonstrates the way the medium affects groundingin a way that is consistent with this principle. In his study, tutors explained to a partner (student) in another room, how to put together a pump. Thb tutor, but not the student, had t-he instructions. When communicating over the ohone the tutors tended to get their students to first identify an object and only when they had confirmed its identification did they ask tlie student to do something with it. In contrast, in keyboard conversations, tutors would identify an object and instruct students on what to do with it all in a single turn. This result is interpreted as being due to the different grounding costs in the two media; repairs are more costly over keyboard.
17
(constraints) people,
that
A and
affect
B, are
• copresence
the
(A and
• visibility
(A and
• audibility
Clark
B can
produces it), • simultaneity (A and the same time), • sequentiality intrusions),
(A and
• reviewability
(B can
same
each
and
are
review
receive
not
A's
at the
varies
because
example,
reference
visibility,
where
the
media
is less
costly
cost
time
as A
communications by
at
external
communications),
vary
on
required
these
in media
is measured
same
de-sequenced
• revisability (A can revise B's messages). In this theoretical framework, the work media
environment),
other),
send
B's turns
two
other),
a communication
B can
between
1991):
physical
to each
hear
in conversations
Brennan,
the
visible
(B receives
process
and
B share
B are
(A and
• cotemporality
grounding
(from
that
in terms
to ground
grounding allow
such
in different
constraints.
For
for copresence
as production,
and reception
and
understanding. Grounding
in Cooperative
Not
only
activity
among
ground
(Clark
this work effective
is how
requires
Brennan, team
common
Findings
by Grosz
grounding
ground (1981)
theoretical
that
the
actually
can have
lacked
Grounding which
a shared was
solutions
McCarthy,
ground
and
field
have
et al. (1991)
to solve
visual
established a problem
space,
better
among
and
arguments
they
Monk
previous
and seen. 9 The authors postulate mechanisms, such as "the value
for
common found
that
(concerning
these
who
had
solutions
of for
visibility
in
some
(1991), field,
task.
showing
are consistent
section.
for an expert
experienced
participants
and
visual
in the
common
necessary
of performing
Miles
visual
of the
for the purposes
of copresence
context
of a shared
outlined
updating
task led to confusions about that one way misunderstandings they
text
role
all coordinative
interest
common
the
absence
McCarthy
via
the
of a shared
think
not.
communicated and
establish
framework
absence
engaged in a disassembly Grosz (1981) points out participants
and
to moment
Of particular
within
in the
for conversation;
moment 1991).
members
difficulties
the
found
agents and
Solving
necessary
joint problem solving. Some work has investigated
establishing
with
Problem
is grounding
Grosz
and
(1981)
apprentice
common referents. arise is that ground
when
they
participants
the
layout
grounding a shared could
when
who
of a bank)
difficulties. report
be jointly
space
in
posted
that the effect could be due to several of the public report as a shared memory
aid;
9Grounding difficulty was measured by the disagreement in recalling the solutions and arguments between the two members of the problem solving team. Grounding of the arguments, not solutions, was what suffered in the private report space condition.
18
the
communication
reference,
i.e.,
constraining
efficiencies
pointing]; the
This
range
work
interactions afforded
grounding.
In the
what
actions
displays
others
used
in team the task
take
in the
on
the
in dynamic
In dynamic process date
being common
fault
fault
ground
to suppress
there
are
typically
processed (monitored
only the
must state
team
several
may
about
monitored
is that data
data; raw data may process displays),
assessments) ground
difference
the
process
members
their
important knowing
in order to be able what to do depends
expected
and
what
is planned
order to know members also
what need
because
can potentially
these
is an
about
out
some
the
activities
their degrade
team
external
For
and
ability
to
by
maintain
solving,
fault
which
an
they
knowing
the
may
also
about
levels
the
of
displays (in the form
Maintaining the
relevant
impact
process. data
applications
different
systems." and
about
activities
up-to-
must
management
provide
"intelligent solving
the
state of the monitored directly, but only via
in dynamic sources
reference:
members
of problem
the changing be observed etc.
of problem
requires
because
point
they allow and to see
be available from computer-based and processed or integrated data
be provided state
hand,
This disrupts which can the crew.
(or
1990). The particular affect the nature of et al. (1992)
other
cues
there
maintain common ground about Many monitored processes cannot derived from sensors, transducers, Another
the
of open
management
Not about
(p. 212).
importance
Hughes
On
management
managed.
action
may inhibit the ability to ground. out that multifunction controls and
intent of the other human crew member. maintain a common situation assessment, communication and coordination across Grounding
the
allow for open interactions-see the state of the system
system.
tend
of [deitic
relevant
(Hutchins, and tools
operations,
environments (1994) point
cockpit
task
about
performance environment
of ATC
use
to an utterance."
findings
used (e.g., flight strips) participants to easily
characteristics of work example, Woods et al.
increased
attributable
with
domain
the
of a partner's
of meanings
by
by
visibility
is consistent
observable) interactions that the tools all the relevant
the
afforded
state
common
of the
activities process.
of other This
is
to manage the process effectively (because in part on knowing what has been done, for).
It is also
may be the causes(s) to be grounded about affect
clearly
important
and
plans.
what
for diagnosis
of an anomaly). Furthermore, relevant assessments of others
expectations
of
is (in
team
--
19
CHAPTER RESEARCH The
goal
of this
human
team
members
another.
An
important
situations
and
reason, high
for
engaged the actual
study
was
are
1994).
the
Rather,
range
General the
health
divided
safety
From into
the
the patient
for anesthesia,
catheters
basic and
critical
maintenance,
1Insertion aspiration
the
Particularly and
the patient. practitioner drugs
of an endotracheal of gastric contents.
getting
generally,
by anesthesiologists
one
to create point
using
(Xiao,
the
on the
issues
to investigate
that
below,
but
does.
to maintain
surgical
the
operation
is
induction, involves
establishing
preparation
intravenous
of
access, monitoring etc. During
intubated 1 and artificially ventilated. the surgeon makes an incision, is a busy must
monitors
drugs
tube in order
are
appropriate
of view,
preinduction,
includes
delivery
fluids
an operation
Preinduction
they
In some is involved and
the
management goal was not to
operating table, placement of the blood pressure, pulse oximetry,
that
(for
this offered
an anesthesiologist
and phases:
which
equipment patient
parameters),
intubating than one
this
complexity
more
expand
during
recovery.
anesthesiologists;
in the
and
goals
induction, the patient is put to sleep, Thus, the beginning of .a case, before as attaching
For
of Anesthesiologists
placement of the patient on the sensors for the electrocardiogram,
for the
allows
of what
main
the following emergence
because
issues
We
anesthesiologist's
maintenance,
period
one
in varied
study.
pressure,
taken
above
room
of the patient
the
studied
activities
overview
and Activities
and
of time
as a vehicle.
anesthesiologist's
conditions.
to a simulator
how
support
behavior
within a dynamic fault out that the field study's
operating
a brief
Goals The
about
by practitioners.
of explanation
to investigate
in the
present
were
issues
in practice
anesthesiology we
faced
as opposed
of cognitive
it was
anesthesiologists first
more
management
to observe
the constraints
and communication It should be pointed
characterize
was
in practice
to investigate
cooperation application.
fault
of failure.
Anesthesiologists opportunity
to understand
constraints
done,
this domain
consequences
was
in dynamic
consideration
under
a field
relevant
investigation
III
STRATEGY
undertake the
of drugs ready,
patient's and
fluids
administering
settings, especially in many of these are administered
to provide
several
a clear airway
vital and drugs
activities signs,
placing
for monitoring to patient,
teaching hospitals, tasks. During
to keep
and protect
the
such
more
patient
the patient's
lungs
against
20
anesthetized
for
physiological emergence, drugs
the
duration
function when
the
and
Anesthesiologists and
anesthesiologists must blood loss, respiratory function,
neuromuscular
functions
depending sugar,
palpation,
electrolytes,
indications monitors
as well
of these functions used include:
• electrocardiogram • pulse
(ECG)
oximeter
• arterial used
to sample
pressure
arterial
of oxygen
• automated
signs.
cardiac oxygen
the
during
is sent
other
the signs signs that
system
of the (e.g.,
patient
(e.g.,
inspection,
are
used
important
to provide
devices
and
rhythm,
saturation
which
and
arterial to a lab
dioxide
in the
(i.e.,
inflatable
sphygmomanometer
managing
circulatory function, gases, renal
health
means
Some
measures
carbon
for
instruments
which
blood
and
of
and
or the
Clinical
blood
or "A-line",
administration
anomalies
temperature
as several
to monitor
to measure
cannula
body
and
During
is extubated.
of anesthesia, and anesthetic
of surgery
hemoglobin.)
auscultation)
loss).
the patient's physiological The major functions and
are: depth respiratory
the type
the
responsible
need to monitor and surgery.
normal
blood
and
unexpected
function, on
is finished,
physicians
monitor function,
to maintain
to replace
is awakened
diagnosing
operation. To do this they and the effects of anesthesia
blood
procedure the
and
fluid
the patient are
process
operation
intravenous
surgical
is discontinued
physiological
of the
(e.g.,
pulse
blood
rate,
pressure,
for analysis
and
is
of partial
blood, cuff
for
measuring
blood
pressure), • central
venous
together and
hence
other
blood
to fluid
to measure
spectrometer
which
rate
and
provides urine
an indication,
output,
of blood
volume
replacement,
airway
to measure
concentration and
of carbon
distinguish
the
to monitor body temperature, catheter for measuring pulmonary
pressure and cardiac Data from many
output. of these
computerized display monitor). While some others
require not
catheter, pulse
dioxide,
concentration
of various
gases,
• thermistors • Swan-Ganz
rate)
(CVP)
pressure,
a guide
• capnograph * mass
pressure
with
are
some
all data
available
explicit
requires
drawing
the
anesthesiologist.
at intervals
activity
the
are
receiving such
blood
For lab the
capillary
available
on
as the vital available
(e.g.,
example, and
and
pressure)
practitioner
in a remote
and actions,
process effects
by
(cuff
available.
analysis sample
Management taken on the actions, side
measurements
(which we refer to in the text of these data are continuously
is immediately
sample
artery
ten
cardiac
blood
types
as administering
of drugs
the
may
elapse
heart
others Also, gas between
results. drugs,
blood,
depending on its state. Many drugs, each and contraindications, are available to the
Some
still output).
an arterial minutes
an integrated signs (e.g.,
and
wedge
that
are
typically
used
or fluids, with
during
specific the
are
_
21
maintenance
phase
of the
maintaining
unconsciousness),
hypotensive
agents,
Practitioner
narcotic
vasopressors
Roles
and
The operations involved
at least
simply
inhalation musde
anesthetics
attendings
relaxants,
vasodilators.
took
responsible always
and
one
observed
or two
here
during
of the
relatively
the
routine
case
years
after
junior
several
operations phase
he may
only
(usually
as assist
in his second
in intubation
Communication Present
is a senior In all cases
which
means
The
attending
that
He
they
or she
and
is
typically
the
during
gaining
case
for a
induction.
practical
throughout
alone;
of
experience
the case,
and
for four
in general
year).
Occasionally,
a medical
student
he was not involved in the management of the or resident might have him do some things, or in the
domain
among
agents
areas and levels of expertise. communicate and coordinate
placement
of a catheter.)
are general
issues
managing
some
of coordination process
and
and having
different
The attending and resident(s) must with one another, as well as with other
such as surgeons and nurses who have different tasks, and who same high-level goal of preserving the integrity of the physiological
process, although their lower level goals may be quite different even conflict in some situations; see Woods et al., 1994). Supervisory
had
is
Issues
in this
communication
team
(or
position.
operation,
to handle
be present
is present
also present, but typically (although the attending
personnel, have the
attending
concurrently. of the
and
the case. The attending adapts his schedule about how the case will go and on competence
school,
hospital
case. He is typically a senior resident (in his third or fourth year The operations with two residents had a senior resident and a
resident
General
Cook
anesthesiologist
a faculty
board-certified,
an anesthesiologist
medical
manages the of residency).
The
holds
induction
resident's
The resident,
see
teaching
in anesthesiology.
returns periodically throughout visits depending on expectations assessments
residents. who
were
examination
at a large
an attending
staff,
for overseeing
present
place
anesthesiologists:
a special
(for
Relationships
of the anesthesiology
completed
such
are:
analgesics,
and
observed
two
"attending")
member
was case
observed
For more on the cognitive activities of anesthesiologists and McDonald (1991) and Xiao (1994).
Woods
the
operations
Control
general
strategy
and
defers
to the
resident
monitor
and
may
Issues
The attending is the more member. He or she oversees
resident
(and
specifying attending take
actions
experienced, the process certain in these
actions
generally and the and
decisions.
on the process,
more resident,
or decision Both
knowledgeable, setting the choices.
attending
but the resident
The
and is present
22
during time
the
whole
(since
operation,
he supervises
operation,
he needs
events have will typically
while other
the
cases
to update
his
attending as well).
situation
occurred, how certain vital assist him in this process.
In these
characteristics
the
each
subordinates
take
with
assessments
to the
resident-attending the operations among them the the
senior senior
local
control
signs
resident resident's
scopes
supervisor.
Figure and
the
between
a junior attending
while
the
subordinates
to the the
resident and
resident the
intelligent provide
similarities
among
control
the
relationship.
resident, the and resident junior
what
control, computer
may
supervisory
of the
determine
These
and the
some
attending
In supervisory and intelligent
5 shows
a senior and to that of an
directs strategy decisions.
(e.g.,
proceeding);
process,
the
only
he returns
of responsibility.
on
relationship
Intelligent
are
relationship
actions
involving was similar
When
assessment
resembles a supervisory control relationship. human supervisor oversees some process subordinates,
is present
In
relationship in the sense
resident
typically
that
defers
to
Supervisor
• typically manages process
• oversees intelligent • has
process systems
wide
span
and
of
• updates supervisor • defers
control • can set general strategy
to
supervisor decisions, if any
• generally more knowledgeable Attending
Resident(s)
Figure
5.
Supervisory
The
supervisory
applications such
as NASA
is to add span
control
more
space
effectively
how
of interaction must
(Woods
to complex
may
relationships, provide
supervisors;
they can function as effective Studying interactions among into
attending
and
resident.
is important
be managed
et al., 1991).
systems,
The
giving
the
in
and
monitored,
technological human
trend
a wider
to monitor.
of these
support
among
process
applications
automation
anesthesiologists
form
a complex
of subordinates Because
relationship
control
in which
experienced,
an intelligent
the
a model or in the
interactions
of how
among
intelligent
language
of the
the
subordinates
can
introduction,
how
"team players" in supporting a team leader. the resident and attending can provide insight
subordinate:
23
• receives
and
implements
• provides feedback • offers assessments, • updates Types
the
of Joint
supervisor
when
Cognitive
perform
the high
courses
level
of action, in the
illustrates
these
their feed
support
role into
and
goals
keep
of what
in serving management
and
manage
and
These seen
among
activity
diagnosis.
The figure
events
though
that
it is driven
the past in another interventions. Practitioners what actions
about
incorporated Xiao,
anticipate them
into
1994).
problems
because
the they
members.
Figure
past,
current
state informs
concerns
Team
past the
arrows that
and
as monitored another about
members
to evaluate
that equipped may
to arise
actions
(Cook,
exchanges
about
may
arise,
and
to deal
with
be unlikely, are would
high
but
the
and
future
events, also
effects
talk about of their
them
McDonald,
reflect
to prepare
courses
(i.e.,
the
prepare
coping
with
to
of action for these
and
1991;
need
contingency
practitioners
or because
be too
Woods,
6
exchanges)
establish expectations about the future of the process should be taken; these expectations and plans 2 are
consequences tend
order
are
and diagnosis. The cognitive activities
depicts
his absence,
of the present. way--in
the present
problems
or be better
during
goals
important
Information
of these when
occurred by the
plan
past
information
future views into the process, i.e., patient's physiological via vital signs. Updating, in which one team member relevant
future,
activities
team
(and
the goals of management and diagnosis indicate
and
the
evaluate
cognitive
to
effectively,
about and
patient's
In order
diagnosis
expectations
cognitive
process.
the
anomalies.
has occurred,
exchanges
of joint
management
form
to the
Exchanges
unexpected
interventions.
information types
Information
of management must
track and
returns
monitor
diagnose
domain
actions
reflected and that
and
in this
management
attention
continually
process
practitioners
his
Activity
Anesthesiologists physiological
instructions,
on actions,
to avoid
plans).
Some
them
either
problems
resource-consuming.
2It should be noted that plans for courses of actions can be formulated to the contingencies of the current situation (Suchman, 1987).
at varying
levels of detail and subject
--
24
process
iiiiiill ilili !iliiiiiiliiiiii!iii r Ti...... actions & interpretations management & diagnosis _
evaluations
as!influences,
* ex_a_ons
V1Or
knowledge)
Figure
6. Different
Tutorial observed the
interactions
in the
purpose
They The
are
Types
data.
Field
Activity
are
another
type
are
exchanges
These
of instructing not
of Joint
critical
a less
to the
and
moment-to-moment
knowledge,
given
for
(or would-be-practitioner). management
and
diagnosis.
Study
Ten
neurosurgery
operations,
along
with
anesthesiology
5 attendings
and
author
is also
who
organization.
exchange
domain
practitioner
operations
were
observed
and
videotaped.
neurosurgeries involved one of the following: dipping aneurysm 3, removal of a brain tumor, or a laminectomy. potential
Relationships.
of information
about
expert
their
some staff
5 residents.
5 The
particulars, involved The
collection
in these
practitioners
an anaesthesiologist data
is given
working was
part
in the
Appendix.
operations were
was
recruited
within
of a larger
The
of a cerebral 4 A list of these
the study
The comprised
by
the
of
second
same of physician
3An abnormal bulge in the wall of an artery in the brain, which could rupture and result in fatal hemorrhage. 4 Rem o val of bone from the spinal column. 5Data collection procedures were approved by the university human subjects research committee; informed consent was obtained from physicfans and patients prior to data gathering.
--
25
interaction told that
with computers this was a study
resident
agreed
to participate
A transcription behavior
was
activities,
and
knowledge, procedures, (Woods, 1993b). 6 Note
that
the
this
of interest,
Guiding
Questions
prepared
(a) other
study
does
which
not
take
videotapes.
patient
state,
analyzed
are provided
along Hence,
do
human
team
dynamic We
with
can
further
refine
is the
the latter
the
for their
assessments?
in joint
problem
solving
fault
management
taken
important
or will
problem
take
keep
informed
Data Data
and Analysis Sources
of situation aware
Hence about
The data or those
that
anesthesiologists,
the
machines,
any
relied by
may
the have
such adjustments
impact
on in the
6It was research
to the analysis
that an anesthesiologist
kinds
about
of explanations
assessment? that
dynamic others
or the state
is: How
have
of
do team
members
of others?
analysis
are: 1) verbal and
overheard at the
to drugs
or drugs given, 3) actions with the anesthesiologists,
between
the process
anesthesiologists
as: looking
in
communicate provide
actions
question
how
explanations?
in distributed
relevant
actions
been
two
are: support
of their
situation
awareness
guiding
how taken), interacting
critical team.
are these
of the
may
the relevant
made
the
these another
sources
communications others,
aspect because
solving.
How
fault
management
members members
or in establishing
is keeping
the conventional or recommendations
investigation
function
do team do team
define
conceptual
by distinguishing
How How
used
and
and
domain
approach.
for dynamic
in this
diagnostic nature
question,
explanations: assessments?
explanations An
addressed
provide
What
and and
explanations
questions
members
situations?
interpretations interpretations
retrospective
the
on
which
given
verbal
protocol
testing
questions
not
(b) physician
a behavioral
The impetus for this study was the problem with approach to AI diagnostic assistance, in which diagnoses management.
The
based
a hypothesis
guiding are
that they were All but one
practitioners
to form
posing
in turn,
the
about
of the
practices
involves
from
data
intentions
typical
approach
episodes framework.
study.
was
with
(c) goals
expertise. Note or explanation.
in the
of each
integrated
and
Rather,
and physician of communication
by
those them,
monitor,
or objects,
directed 2) actions
any
to them taken
by
interactions
any samples
taken
with (and
taken by other personnel when 4) behavior of the dynamic process
who
also
worked
in the organization
by
was part
as
of the
26
indicated the
by the
various
data
Three sources.
and
displays.
and
in front
time.
record and
kept
during
the
and
a record
machines,
operation,
and
of vital
as displayed
by
signs.
cameras were placed in the operating room so as to capture One camera was focused on the various anesthesia machines Another of
Finally,
actions
patient
monitors
focused
the
on the
area
machines,
where
the
camera
focused
on
another
taken
on
the
at the
head
of the
anesthesiologists the
operating
spend
patient,
which
these
table
most
of their
captured
close-up
patient.
Transcription The guiding
questions
drive
as the transcription process about data acquisition and transcribing, with
some
certain
Jordan
data
analysis
omissions,
and
impossible
to include
in practice,
the
increasingly
(1994)
reflects
capturing
and there
out,
that
detailing
the
aspects
the analyst
data
certain
is no ideal
as well
is transcribed
behaviors.
transcript--
As
"..it
of an interaction,
as an iteratively
categories
for analysis,
be misleading to speak separate; during the
sense
relevant
emerges
the
selected
in the
point
all potentially
transcript
episodes
occurs
while
Henderson
the
to some extent. It would data analysis as completely
modified
has found
so that,
document
relevant
is that
to her
or his
analysis." The videotapes of transcribing
were
transcribed
all verbalizations
in two
made
verbalizations made by other team members only verbalizations omitted were those that social Note
activities that
or gossip.
although
we
is not a linguistic information
one
were
various
interactions with the drugs or other fluids. The episodes initial
pass
one
to look
events the
next (which
may
back
The generalize al., 1981; performance
taken
the
or other
once these
to fill in more
of field
studies
(episode
in raw
the
fairly
were about
situations involves transcript),
the analysis how Also
including
to identify
other
engineering
of particular
transcripts
is identified, episodes,
reviewed activities
it allows activity
on video and
in the
vital
which
to verify
is to be able
is concept-free
it to a description In order to arrive
domain-independent
one
needs
to have
and
or
signs. to
in different domains (Hollnagel taking a description of the actual
context-dependent and converting specific and domain independent. description,
transcript.
management.
detailed
episode
to see what detail
The about
or administration
transcript
an interesting episodes
consisted
it concerns
fault
equipment,
in cognitive
findings to similar Woods, 1993b). This
in this study, Rather,
dynamic
Having
transcript
in the
by the anesthesiologists,
reviewing
Then
and
goal
to support
because
be related.
transcription
behavior is used).
below.)
pass and
as such
language
function
involved
within
summarized
activities
are explained
The first
to the anesthesiologists. were obviously chatting
on verbal
how
machines,
stage
is useful
were
focused (i.e.,
exchanges
recorded
These
passes.
by the anesthesiologists
et
highly
that is more conceptat a concept-specific and a framework
or
27
"conceptual
looking
presented analysis.
The
contained episode terms.
glass"
in Chapter
that
Two.
concept-specific
within
the
guides
Figure
these
7 shows
description
text.
This
of the
description
in domain-independent
concepts.
terms
This
an overview episodes
is aided and,
logic
was of the
of interest
by
in some
framework
of the
is
a representation
cases,
of the
in problem
solving
! !
* Guiding
!
I
questions
• Theoretical
!
framework
I f I T Transcript
._
Episodes
_
Patterns & higher conce _ts
level
t_J
|_| I
Figure
I
7. Basic
Logic
of the
Analysis.
Episodes Some
of the
episodes
interaction-driven. interest:
The
of interest
are
situation-driven
situation-driven
episodes
are
and those
some
are
of a priori
* Updates: situation in which the attending returns to the operation and is informed ("updated") of what has occurred in his absence, and • Management/Diagnosis: engaged
situation
in managing
the
process. The interaction-driven information task
exchanges
performance.
activities, is being
interpretations, communicated.
is an interpretation; either more
episodes relating
These
are
call
and/or are
team
members
diagnosing
some
faults
episodes
that
are in the
contain
to situation
assessment,
decision
making
utterances
in which
information
about
explanations We
this
any
in which
process
them
can be a causal
or any
information
informs
for
explanations
case it is an interpretation of process causes). For example, stating "pressure
short.
about One
or an
type
the
and
process
of inform
assessment.
data (e.g., relating data to one is low" is not a restatement
In or of
28
the
data
low
(e.g.,
blood
depends
patient
on
in this
refer
pressure the
is 90) but a form
context--
circumstance.
to explanations
interpretation
low for
our
7 Explanations
are
of interpretations,
is held.
of interpretation
goals
i.e.,
and
because
expectations
another
type
explanations
being
given
this
of inform;
for
why
these
some
s
Updates Updating member and/or found
episodes
(typically
crew room
while on-line operations.)
Updates supervisor
means cases, Effective
(e.g.,
relevant
beyond
is updated
about
having
monitors
will
the
been
beginning
in which the state
on
away cases.
the progress are
episodes
the
process
an episode
are
not
topic
control
situations
they are over to
power
plant
in which
subordinates.
two
and/or
defined
that
and
attending
The
state
but
the
of the
patient.
some
team
members The
or otherwise
are
9There is another kind of update found resident. This will typically be another
typically
event
engaged and
generally
attains
7Note, however, that one cannot say that an utterance such as "blood pressure of data. In some contexts such a statement can be intended and can communicate words
may
may
associated
leave
update
has
Of particular
beginning
However,
then
at
Particularly
critical
continually.
detection.
interpretation or event (i.e., that it is low). 8These explanations may not occur with the telltale "because '_, "the reason is..." etc.)
it.
is present
resident
with a focus of attention on some is arrived at and/or management resolved
with
attending
intubation)
after
a priori.
In some has
to cope
the
returns,
occur
or more
a
for such an intelligent subordinate. comes back into the operating room
induction the
case,
subordinate
time. 9 Recall
(during
in anomaly
is dropped,
nuclear
intelligent
Diagnosis and management
well
process
because be turned
control,
intelligent
interactions/updates
in which and/or
of the
team
to monitor interacting subprocesses and intelligent subordinates. This
capability attending
some
When
kind of episode will begin end when an interpretation the
several
of the
for
of the
those
Management and Monitoring are
traffic
a returning
may be coming into "advanced" situations. have to be called into a situation which
ability
of a case other
interesting occurred.
air
in supervisory
updating is a desirable Updates occur when the
to oversee
and
situations
trend is for fewer people use of increased automation
that supervisors the supervisor
escalated
him
are
periodically
technological through the
the
attending)
are
of problem solving. Updates are selected for study in many fields of practice in which a process must
another control
after
the
("updates")
some
interest
in managing end
points
for
speaking,
this
anomaly, action
and is taken
closure.
is 90" is always a statement to someone else an with
an explanation
in the data; this occurs when a team member comes to relieve resident or a CRNA (certified registered nurse anesthetist).
(i.e., the
29
Not all of the cases yielded episodes cases, such as 3 and 6, were routine
Some
simulator
studies
questions virtue
of interest, of this
researchers devise
might
Field out
not
of which
have
can
very
offer
can
design
provide
unique
thought
are discussed in the relatively uneventful. the
scenarios
serendipitous
conditions
of time,
an enormous
amount
to address
opportunities.
and
of ahead
findings. Unlike
situations
the The
that
or could
not
possibly
study.
they
generate
generate
little
interesting
researcher studies
they
studies what
the
field
is that
in a simulator
precisely, seem
where
that and
may
at the
of "data."
is a lot of observations, end
outset,
up
being
may
turn
notes,
relevant out
to the
to be simply
More
and
transcriptions
study.
What
a piece
may
of a larger
concept of interest. Though it is important to have a conceptual framework and episodes of interest to guide the observation, analytic insights arise in the course
of observation.
observations;
The
there
process
is a cycle
and Trigg (1991) point through of the primary
this
way
analysis
and
categories
familiarity. lead
arise
to return
Normative The
good
relevant.
video
in turn,
the
Video
occurred
captured
these level.
imply
we
may
may
have
materials
and
careful arise. In of themes
are
renews
and
themes
to gather
practitioners this
that
constantly extends
and
new
the nature
did
the
not
capture
in a naive
for example, were
one's
categories
can
materials."
performance
is flawless
team
that
have
it all," but Also,
members all utterances
or incomprehensible. possible,
except
been
this is not
team not
level
interaction.
may
among
of sight).
are not
of
at an appropriate
to "get
exchanges
of line
as exemplars
of effective
attempt
inaudible,
assessments
that seen
everything
some
or out
some
studied
mean
as revealing
quantitative
exchanges
not
the patterns
off-camera,
of the
does
were
that
be used
study,
Understanding understanding
As
Articulations
of new
or workplace
assume
on tape;
Representations these
identification
among
recording
In this
pressure episode
the
be taken
possible.
how
with This,
However,
can
were
design.
materials. field
construction.
Assumption
Rather,
The
iterative
with
Limitations
performance.
of analysis Omissions
like
iterates
is precisely in the repeated that theoretical insights
familiarity
interactions
or optimal.
out, "...it materials
in data
theory
from
to the
and
and
those
Furthermore,
one
Assumptions The
is something
against
patterns
of observation
Suchman working
reevaluated
of finding
Both
of
at a gross
Findings the
information
support domain
now is informative) (i.e., what relevant
exchanges
dynamic
particulars and events
fault (e.g.,
among
management to know
why
team relies
members both
mentioning
on understanding the context occurred prior to the episode).
and
on blood
for the Just as an
30
utterance
may
meaning
or significance
knowing
their
parameters The a segment assist the Also,
on
any
context
have main
of several
of many (e.g.,
been type
to assist
what
in the
analysis,
contain
additional
purposes
of the
is contained
code
different
aspects
of speech
episode.
and
level
the
in
Where
code
that For
suffices. if they
indicates
could my
be
used,
purposes,
Aspects of prosody were deemed relevant
analysis.
•
incomprehensible Italics indicates
• •
Words in parenthesis express some uncertainty R = resident (used in cases where there is only
° • °
RS = senior resident, A = Attending M = Medical student
• •
S = Surgeon, N = Nurse that
for
utterances. The
dialogue.
Ellipsis Ellipsis
v.s.
conceptual
as follows:
schemes
given below transcription,
contain a third are short and do
are not timestamped because the dialogues
• •
•
The
is provided
text.
time,
transcription
however, a rather simple scheme were captured in the second pass to the
each
transcript
footnotes to details.
is significant
transcripts videotapes)
before
to Transcription Symbols There are several different capturing
transcript.
episode the
what
description
long pauses between these are noted.
the
case,
diagnosis also Some episodes
the
within
is used
case the episode occurs in and [case Ihour: minutes: seconds].
each
in the
the
expectations are.) Findings section provides
to an episode) with of the domain-dependent
the
presented from the
the episodes typically do not have relatively longer pauses are found, identifying
without
previously
beyond
i.e., why
The utterances in the (though this data is available
An
its context,
practitioner used in the
Episodes that involve of problem solving.
episode,
study,
on
be understood
a domain-independent
columns
of each
depending
cannot
occurred
of concern, what of representation
the transcript. indicating phase
description
Key
meanings
episodes
of the transcript (corresponding reader in understanding some
alongside column, not
take
indicates missing, inaudible or incomprehensible in parenthesis indicates approximate number
monitor displays
words actions
SA=
represented
RJ = junior
assistant
= vital all the
signs patient's
by
the
text. of
dots about the actual one resident)
words.
resident
surgeon monitor, vital
an integrated signs.
monitoring
system
the
--
31
CHAPTER FINDINGS The timing
introduction
How
This
do
We
team
important factors that play a role team members in this domain. Explanations [oint
in Dynamic
Interpretations Episodes might be
that
important are
about
of the
Episode:
the
to take
a management
nature
of the
Though
the
senior
by
simply The
attending when she
provide
junior
to establishing one,
providing
by
be,
is the
a directive
that
the
for
team
of among
members
interpretation.
but
also
concern cuff
one.
corrective
action,
along
exact
are engaged in the to its development.
process
("they
of investigation The
that his
the
junior
resident and
evidence
of
understanding
verification
and rather
with with
resident
senior
assessments
implies
must've and
provide
measurement, ends
the
simply
actions
further phase
on
whether is not
involved.
she
pressure This
depends
sense
states
and
determining
interpretation
are in the
comments
exchanges artifactual
the
of interactions to capture three
interpretation
a period
members
directives,
subsequent
are
support
in which
This
an initial
resident,
resident's
which
to an investigation
episode,
it should
anomaly.
and comprehending. For example, points out corroborating evidence.
The arterial
what the
team
senior
in
these are one type of Then we examine the
of an
8. In this
proposes
both
diagnosis?
engaged
pressure
and for
the
and are
reveal instances term attempts
acceptance
it is followed
in which
not
relate
action
resident
involved
reasons.
mutual
in Figure
interpretation
investigation:
State
it is a process
blood
something''),
verification does
Process
to the
episode
and
to diagnostic
the
of diagnostic
from one agent to another. Rather, both at the interpretation and both contribute
stimulated is kept
the
Anomalous
Consider
transferred of arriving
nature
form
Management
interaction:
in coming
that
lead
of management and diagnosis termed joint interpretation. This
aspects
involved
Fault
for
or actions,
findings
in the
approach
members
for interpretations These
the
in management team
of the process state. Recall in dynamic fault management.
to AI justifications.
with
question
in which
of explanations
counterparts
both
system
guiding
collaborate
episodes
STUDY
problems expert
the
members
forming interpretations explanation relevant
the
standard
defines
by examining
characteristics
out
in the
problem
human
begin
OF THE FIELD
pointed
of explanations
assistance.
IV
the the
senior
testing than
that
the
resident
statement
"I think
it's a true directive.
pressure" which can be considered an explanation or reason for the But, in this context it functions more as a confirmation of the
mutually
held
on
the
interpretation,
information
that
because has
been
understanding
gained
through
the the
joint
statement
depends
interpretation.
32
TRANSCRIPT
DOMAIN
INDEPENDENT
PHASE
DESCRIPTION [1014:22:38] (R2 looks at R2: [R]
v.s. monl R2 draws attention
to anomaly
R: yes? R2: his pressure's now reading 177 {R2 hits b.p. button to start cuff measurement} R: They must've just stimulated something. {R2 adjusts anesthetic agent, gets syringe} R: Don't give him anything yet, see what the cuff pressure is 1. It's a lot better waveform than we were having, so I think it's probably true, they stimulated something {both looking at v.s. monitor}
R suggests
hypothesis suggested
interpretation
R tells R2 to wait to take management action she was about to take, saying they should check another parameter (because anomalous data may be artifactual). But also comments on qualitative characteristic of data suggesting accuracy of reading R2 calls attention to a related
R2: yeah, his heart rate picked up 5 points {indicates to monitor} R: yeah, you'll see that when they're doing cervical, especially anterior, posterior not so much, but the anterior, you'll definitely see, you gotta be looking for vagal stimulation, you got the vagus...you got the carotid (body), and you gotta be
anomaly identifed
parameter that suggests anomaly is not artifactual
verification /testing hypothesis
corroborating evidence pointed
out
R mentions conditions under which flucuations in parameter would be expected
watching for all those things, it's just a real touchy surgery.this is not abnormal at all [continued] 1 Blood pressure is measured by two sensors; from an arm cuff and from the arterial line. The arterial line displays blood pressure continuously as a waveform. The cuff pressure, in contrast, is a discrete value measured intermittently. When an arterial line is present, cuff pressures are measured typically every 15 to 30 minutes.
Figure
8. Episode:
Anomalous
blood
pressure.
33
Figure
8 (continued),
DOMAIN INDEPENDENT
TRANSCRIPT
PHASE
DESCRIPTION [continued] R2: his blood pressure cuff is making me crazy
R2 comments on second sensor value
R: they correlated well until we started surgery and now neither one of them R2: yeah R: ..(probably cause his arterial) pressure's changing so rapidly, plus they're leaning on his arms ....
R calls attention to data indicating why second sensor value is artifactual
R2: {R2 looks back} right there
R2 corroborates latter hypothesis
R: {hits b.p. button} gonna drop his cuff, it's just complaining too much.
Evaluating
following
the
episode
part of joint interpretations the evaluation of the effects his break, The
senior
evaluative back down ("turning This Notice
the
the
junior
resident
corrective action directed and taken
R cancels the second sensor measurement (which has been deemed artifactual)
1A narcotic which blunts the response
The
testing
R directs R2 to take a specific management action consistent with the interpretation, provides explanation
R: cuff can't read his pressure well. Give him another 50 mics of fentanyl. 1 I think it's a true pressure {R2 administers}
Episode:
uerification/
statement. He on the nitro"),
effects
of interventions
captured
in Figure
in this domain: of interventions.
resident relates
to stimulation.
informs these
him
results
9, highlights
keeping When of the
one another involved in the senior returns from
values
to previous
of some
interventions
data
items.
in an
also suggests taking another intervention ("coming which is then evaluated aloud when he returns
down the nitro was a good thing .... "). episode also illustrates an interplay between relationship
an important
between
the
junior
resident's
data calling
and
evaluation.
attention
to
34
particular evaluating
data values and the senior resident's cognitive activity in response: possible management actions, developing further management
actions,
or verifying
resident
about
states
the
low
(e.g.,
when
temperature,
the junior the
senior
resident
queries
resident
engages
behavior --to see that the blood warmer is on). So, far from senior resident, the junior resident draws attention to data forming voicing the
an interpretation of his assessments,
state
of the
conceptual
and
framework,
management,
they
The
The next
episode
senior
in checking
distracting that assists
the in
of the process. Through the senior resident's both team members can become calibrated
process
Episode:
the
state
add
or, in the language
to the
common
about
of the
ground.
of management (see
Figure
10) illustrates
how
team
members
keep
one another aware of the state of management activities. with the resident informing the attending of an intended
The episode begins action. Team
members
this
do
this
relatively
often.
Depending
on context,
serves
several
possible functions: it allows for confirmation that the action is an appropriate action at the current time or alternatively, it allows the other team member halt or modify team
the
member
appropriately. explicit to do.
proposed
knows
The joint
particular The
physical
or anticipations, how the attending management
about
management
perceived
discussion
are
Figure
11b has
attending
sees
Figure and
evaluate These
and
"two
among
talking
So even
another,
(see
an example
of the
the resident
action
as soon
a course
makes what
occur
within
practitioners
team
example,
For example, level as he
members
they
may
notice is talking
are also
talking
talk
about
present.
section
on
latter;
Information
towards
is writing
down
attending is able to look data as soon as it comes
11 provides
case
about
always
to one
other
also plays an important role in facilitating on Contexts for Communication) and in the
of interactions that
in this
in thinking
members
the
expectations
context. This physical context with talk about evaluations
though
for
in the
ground--
modify
strategy
heads"
team
while
evaluation,
occurring
episodes
can
comments about events and data. makes reference to the urine output
over the phone. The and read the relevant management
engages
Even
This physical context communication (See section observability
common
hence
the changing physical exchanges --interspersed
activities.
events
to the
and
of management
and
context.
It adds
be done
exchanges
can continue to monitor affects the information
about
will
concerns
information
a dynamic
action.
what
to
the
through
end
of the
the lab results over the resident's in (i.e., to be able
Noticing). episode
the
as he gets
them
shoulder to take the
as possible.)
another
example
of management illustrate
the
taken "on-going
in which
team
earlier
in the
case.
about
the
talk"
members
discuss
monitored
process and problem solving state that team members engage in. This is a way team members can keep one another calibrated in the moment-to-moment interpretation
and
management
of the
case.
35
DOMAIN
TRANSCRIPT
INDEPENDENT
DESCRIPTION [212:15:00] RJ: I did another output 1 and it was five four, something like that RS: So she likes the dobutamine 2
RJ informs about result of test
RS evaluates result
RJ: Her SVR 3 came down (8 point 2)
RJ informs of relevant parameter, provides reference and value
RS: So she he likes-that's-we
RS suggests management action
could come
back down on the nitro 4, come down about a half if you want device}
{RJ turns it down on infusion
RJ takes suggested action
RS: I'm gonna get some more gloves. I'll be right back {RJ steps away} {2 minutes later RS returns} RJ: {paints at temperature indication monitor}: .. cold..hypothermia ....
on v.s.
RS provides possible explanation involving an intervention he took
RS: I think the problem was I dumped
all
that mannitol 5 in, boom {chuckles} ...well it's just-her blood warmer is on right? RJ: yeah, I checked
RJ queries about parameter value
RS queries about relevant equipment state
RJ responds: already checked
that
[ omitted utterances about blood warmer] RS: Turning down the nitro was a good thing to do, she's starting to get ..... I think the dobutamine's finally done its job. Took it a while.
RS evaluates previous intervention on process
RJ concurs RJ: ...right back where she was 1Test of cardiac output. 2Generally recommended in cases of increased SVR,normal heart rate and low cardiac output. 3Systemic vascular resistance, which is blood pressure divided by cardiac output. 4Nitroglycerin, a vasodilator, for controlled hypotension, useful in patients with known or suspected coronary disease. 5An osmotic diuretic given intravenously.
Figure
9. Episode:
Evaluating
the effects
of interventions.
36
Domain-Independent Description
TRANSCRIPT [1 13:23:40] R: I'm gonna go ahead and send another gas 1 A: yeah, let's send another and
R informs A of measurement he plans to take A concurs
gas
R states expectation for measurement value and reason
R: see where we're at.Have a feelingit's 2 still gonna be low, he's justoozing allover the place3 A: [ think once we bring the temperature up we have done all we can do, you know, he's putting out urine 4 1 think I see more there.
A states concern for particular parameter, summarizes state of management : '_ve've done all we can do" A states an observation: parameter that has been of concern seems better
R: yeah, there is a little more there. I'm gonna empty that in a couple of minutes
R verifies, mentions taking an action that will allow them to assess value
A: yeah. (..) Dr [R] R: temporarily yeah A: I mean, there is nothing we can do other than Bear Hugger TM now. We can get one more and put it on the lower part of the body. Another Bear Hugger TM. we can get some heating lights on the field. 5
[blood gas taken; episode
A summarizes management plan concerning one parameter: provides two options
continues]
1 Blood gas. Sending a blood gas refers to sending a sample of blood for analysis of: pH, partial p_ssure of o-xygen, pa-rtial pressure of carbon dioxide, hematocrit, base excess, sodium,
potassium, calcium and-glucose. z Hemabx'riL 3A reference 4 Low urine
to the patient's bleeding. level has been a concern so far in this case.
5 All of these options
concern
efforts
Figure
to maintain
adequate
temperature.
10. The state of management.
--
37
Figure
10 (continued),
TRANSCRIPT
Domain
Independent
Description {Blood gas taken 9 minutes [continued]
ago}
A: we'll see how the blood hematocrit comes back, if it is low then we'll add a unit of blood. I'd rather more blood
than crystaloids
R: I think it's gonna be low. I bet you it'll be 25, maybe 28 {they look at surgeons} A: are you gonna be taking grafts also or just
any
S: oh yeah, man we're gonna be we're gonna you name it this is a bear, yeah we gotta we're gonna give him some bone so maybe he'll fuse, heal {Phone rings, JR} answers} R: OR [#] {patient name} umhm, umhm, {A looks over for a moment to area where R is writing, then looks up} A: [N], I'll take 2 units of blood. R: 1.4, 8,4 {pause} alright, thank you {hangs up} A: I think ...should
be air and 02
only {adjusts knobs} he's not liking nitrous very much A: What was the calcium? at record on table} Ri It was down
A informs of plan, dependent on test result value
alittle
{looks
bit, 1.84
A: I'd give him 500... {R gets up}
R states expectation
A requests information from different team member which could affect course of management
A looks at incoming result
A directs another team member
A takes action, informs and provides explanation
A requests parameter value R responds, provides reference information A directs management action
"-
38
TRANSCRIPT
Domain
Independent
Description I511:54:43
I A offers general assistance
A: Something I can help ya with? RS: Nothing, he's doing okay. A: Did you get an output recently? RS: {turning vs. knob} yeah, 7,9, let's see A: really!? RS: yeah. That was a combination of 3 outputs so it's pretty
A requests information on a parameter of concern
accurate. His index 1 is 3,4. It's still low but I'm just A: .I would just ..LR. 2..otherwise...
A suggests management action
R informs of value
R elaborates with information about accuracy of value, informs of related parameter value
R indicates he will take it, elaborates
RS: I'll put a little LR up on there {indicates to left IV tree}, I'd rather.. [a few omitted gas results]
utterances
about
RS: yeah {pause} I think we did the right thing, I think things went really nice this morning. 3 A: you can never be faulted for over-monitoring somebody, I'm sorry. RS: Prone position just adds another factor that you have to think about.
R evaluates past action/strategy
A confirms, elaborates
futher confirming and elaborating of past action/strategy
1Cardiac index, which is the cardiac output divided by the surface area. It allows one to adjust for the size of the patient; the cardiac output should generally be larger for larger people. 2Lactated Ringer's solution, a kind of IV fluid that contains a substrata that can be converted in the body for use as an energy souce. 3 A reference to the decision to place a Swan-Ganz catheter earlier in the case. At the beginning of the case there was some uncertainty about the extent of the patient's heart disease.
Figure
11. Evaluating
a course
of action.
39
Explanations
for
In the have
two
Interpretations
transcripts
basic
and
many
characteristics.
One
are provided along with the given in response to a query. there
is no
simply other
external
that
they
are
explanations
(i.e.,
for
explicitly they
are
not
make
grounds
In the resident
and
following
interaction,
non-case
related
on
something
he
A: .... He probably dark. RS: Yeah,
let's
In this directive dark").
needs
give
example,
the domain
some
fluid
the
attending
in this context) with Note also, that stating
an the
during because
in some the case. it relies
cases
it may
actions
that
is, they
environment, team
tend
not
knowledge
example
but
member.
The
to be "deep
explicit).
level"
In the
provide grounds (the relationship
below has
I would
being that
illustrate
been
think,
both
talking
then
to the
without
his
(the
pause
urine
looks
he
pretty
of this. tags
his
assessment
(which
is also
a
unprompted explanation ("his urine's data on which the assessment is based,
evidently suffices as an explanation. shared mutual knowledge (i.e., such layperson),
another
and
knowledge,
noticed:
some
in the
attending
has
him
unprompted
members often than warrants The
and
or action, rather than is not meant to imply
by
brief
domain
claim).
about
comments
often
team rather
the
are
explanations
requested
terminology of Toulmin (1958), data on which a claim is made) between the characteristics.
the
not do
they
interpretation that this term
is that they
for interpretations
is that
stated Note
stimulus
characteristic
Actions
explanations
pretty
For this to be possible, there needs to be explanations would be cryptic to a
rely
on mutual
Another way to put this on various contexts (see
knowledge
is that section
established
explanation on Contexts
can be for
"compact"
Communications.) Communications explanations turns down be air and nitrous requires
for these actions. the nitrous oxide, 02
only"
and
also
are also
sometimes
coupled
For example, when the he informs the resident supplies
the
explanation
all of the
listener's
unprompted common
point
spontaneously of view.
explanations ground
Long
and
However,
the
is useful thereby
explanations
offered
explanations general
because
forestall
of reasoning
with
("...he's
not
cryptic will
tendency
future
to add
exception
rather
than
team members. are in tutorial
and
there
of action.
explanations,
which
are about
the
to the
misunderstandings.
of management and diagnosis among retrospective explanations of reasoning are disagreements
from
to provide
in episodes sees long, when
liking explanation
be needed
it is a mechanism
are the
brief
attending in Figure 10 of his action ("..should
very much.") As in the above example, this brief, mutual knowledge to be completely understood. Not
the
of actions
about
a course
subject
matter
and
practice
Where situations
Tutorial of
the
rule one
4O
TRANSCRIPT
Domain Independent Description
[1010:40:001 R: you know we're not gonna be able to get anything bigger than a 7-0 down his nose A: that's fine .... A: [R2] let's draw up some, grab a 10cc syringe, and a 16 gauge IV catheter, take the needle out of the catheter. And then draw this stuff up {hands object to R2} he does have tight nostrils. R: I just think an oral's the way to go A: I'll tell you why later, draw it up just from the syringe then we'll just drip that down this nostrils first...
A defers explanation (for course of action)
R: {to R2} .....we need a second IV and we need an A-line we haven't started on yet. R: I'm gonna start on the A-line. {goes to P's left arml [omitted
utterances]
[1010:44:35] R: I think topicalizing with that is the way to go, I think it's the best there is A: Oh I agree, but I still believe that (first medicine) was absolutely necessary, I'll explain why when(...)experiences on Thursday.
A provides partial explanation
R: Oh I heard about that, I think I walked through while you were doing that A: So, I'm just gonna be very conservative. [conlinuedl
Figure
12. Deferring
Explanation.
41
Figure
12 (continued), TRANSCRIPT
Domain Independent Description
[R has difficulty doing the nasal intubation; a new scope is brought tries it]
fiberoptic in; finally
A
[1011:13:15] A: Deep
breath
{to P}
R: Let's just try an oral just once, see if we can do it A: Deep breath
breath
R: ..think
{A inserts
tube} pressure
(.) deep
he got it
{A listens for sounds of correct placement} A: See [R]. {then to P} Alright you're gonna go to sleep now ..... I haven't lost my touch. We're going to sleep now {A injects P, R squeezes ventilator bag} A: When an oral
he's asleep
I'll tell you why
{R adjusts anesthetic agent} R: Okay, is that what you tried day? you had to ....
I didn't
Deferment of explanation of action)
do
to do the other
A: We tried everything. This has to be jammed a little tighter. {referring to some apparatus connected to P}
in
[1011:15:08] A: ..some
agent?
R: yeah A provides explanation A: I just think with orals sedate him a lot more...
you
really
R: See I don't. I've done enough have to sedate them at all
have
of them,
A: (..) that big airway... R: Absolutely. A: But you should be able to do them
to
you don't
both
R: No, I just think, my choice with a guy like this with very small nares, and he's this large, I rather have a bigger tube, and to do that you have to go oral {R adjusts ventilator settings} A: I think
a 7 will be no problem
with
him,
we'll
(for course
_-
42
anesthesiology,
1 are
a medical
student
intended
or sometimes
teaching setting where of the work environment: medical
students The
events potentially expected the
explanations
given
rather
based
at least
has
decided
do
an oral
in part
on
There
are
numerous
engage in the
and
high
then
degree own
in tasks
turning
a patient
finished
activity
because many or on existing
about
the
on-going of
in question
a course
intubation, The
been
and
but
resident
the
is
of action:
the
resident
voices
situation
intubated
the
the
topic
his
and
not
is
being
anesthetized
that
is dropped.
before by
anesthesiologist
taken
of those track
variant
activities
(in order
of others
various to know
has
been
what because
done
and
For
incision.
that
may
affect
ask
that
that
what
has
team
process depends
not
be
the this the
members
be
process. is critical
of an anomaly). to do
of
anesthesia
that
monitored
on the
be the cause(s)
knowing what
the
others
of the operation taken by other
anesthesiologist
requires
as
is important
information Note
is
of others.
adequate
typically
to begin?"
influences
may
This
phase been
If this
This
explicit such
inform
example,
the
patient
activities
activity.
will
diagnosis
potential
members such
surgeon
to inform and
the
on a particular actions having
of: "is it okay serves
for management what
the
includes
synchronization,
Team
others).
begins
means,
management of the
by
anesthesia. the
of anesthesia.
which about
fine
about
contingent (i.e., other
coordinative question also surgeon is ready to begin. Distributed
table.
to get
maintenance
queries
requires
to perform
in order
talk,
and
that
surgeon
other
some
of the
information
been
the
some
required
activities
as part
operating
seek
or not
exist
established
on and
actions
activities
activities are preconditions
members
knowing
that timing
explanation
or on
of coordinative
obvious
important
has
different
of one's
is most
diagnosis
12). The
pressures
physical
This
Keeping
part
Activities
in many
descriptions
aware
In the
final say. Note that at least twice the for the course of action. This deferment
patient
about
for anesthesia
should
the
fiberoptic
completed,
Exchanges
Practitioners
team
role
intubation.
time
after
important in affecting
is a disagreement
a nasal
knowledge.
Communications
Information
reflected
the
is finally
Unprompted
the
Figure
domain
(typically
participate.
have
fiberoptic
on
It is only
explanation
ready
(See there
practitioner
teaching and learning are is an apprenticeship and
and
illustrates
because
gain
gathered, training
of activity
but the attending has defers his explanation
appropriate. the
tempo
experienced
a resident)
to attend
episode
long
a less
data were residency
allowed
the
attending
opposition attending
the
that
and
would
are
following
and
to help
for
It is also in part
is expected.
1For example, they can be about "how something works" (e.g., the cardiovascular response to a particular drug) or about how to perform a particular technique, or about how some equipment operates.
on
--
43
Team
members
communications instances have case
assist
about
of team
one
their
relevant
members
done, are doing in which a team
activity he is about activities:
another
in this
respect
activities.
spontaneously
The
telling
by
unprompted
transcripts
one
show
another
many
what
they
or are about to do. The following example illustrates member informs several other team members about to undertake
that
may
affect
their
current
a an
or planned
[510:26:35] {RS on
brings
a tray
it; someone
RS" Okay, {opens
I'm
he is about
going
to be giving
The
stand
to P's
a couple
be opening
a junior
to do.
resident
know
letting
it allows
gonna
cases
senior besides
stands
left side,
of feet
up
from
a kit here
sets
a sterile
"kit"
tray} so just
watch
your
elbows
it up}
In some what
on a movable
else
for
For
that
team
example,
These member
confirmation,
following
will
inform
the
he is turning
a drug.
the
member
junior
on
prevention which
occurs
just
before
turn
on just
a little
Forane,
another on
of the
induction,
of
lets
or that
influence
or modification
episode,
agent have
a new
member
sometimes
anesthetic
of activity
about
senior
resident
the
"informs" know
a more
the he is
purpose the
process;
planned
action.
illustrates:
[810:48:40] R: I'm gonna agent} A: No
since
{moves
towards
anesthetic
R: No? A: I mean
you
Generally below).
This
relatively
have though,
(syringes
in your
one
that
is to be expected
knowledgeable,
finds given
experienced
hand)... actions
the
2 are
informing and
approved team
(see
members
example are
grounded.
[212:31:35] RJ: I'm
gonna
turn
the
nitrous
back
on now
RS: yeah... Not
only
do
relevant activities, taken by a third assists dose
in preventing
team
members
inform
one
another
about
their
own
they may also inform one another about a relevant team member. In the following episode, the information an undesirable
situation
(administration
action
of a second
of a drug):
2This appears to be a comment about preferringto use intravenous anesthetic agents inhaled agents, which increase cerebral blood flow and hence intracranial pressure, undesirable in certain circumstances, such as in a patient with a head injury.
instead of the potent which would be
44
[210:50:33] RS: Why
don't
monitor,
the
RJ: Yeah,
he just
RS: Did
left
Besides
want
goes
events
or because
away,
{RJ turns
gets
knob
complete
on v.s.
waveforms}
high
of concern
scorer
it is worth
the
Coleman,
Ken
of activities, another,
they
(1973).
team
voice
members
concerns
and
talk
or plans. Particular parameters may either because of some preexisting
become
anomalous
importance
during
of monitoring
the
and
case.
The
communicating
of concern, even when they are not necessarily during updates, team members will often comment
episode
lead
noting
"
of concern whether it is abnormal become normal is also informative.
following can
parameters
to one
they
conveys
about certain parameters anomalous. For example, on the parameter of concern has
and
of past interventions important to monitor
above
illustrates
to a discussion
how
about
past management actions and attempts comes from a case involving a patient episode. His urine output.
her
ephedrine.
communication
and
condition
The
on
to be a Sportscaster.
unprompted
about evaluations become especially
of concern
window some
he is doing.
you
anomalies
quotation
ephedrine
is a particularly how
---So
patient
upper
events
a player
periodically
out
a little
gave
anomalies,
When
try
he? Okay.
Highlighting
point
we
temperature
became
or not;
drawing
that
a parameter
attention
management
that
to a parameter both
evaluates
to develop new ones. This episode who has lost a lot of blood prior to this
a parameter
of concern
early
on,
as did
his
[1 11:43:44] A: {looking at the v.s. monitor} temperature R: yeah, I turned the room temperature back A: but R: I think A: oh
it slipped
down
somehow
R: I turned A: running
it up when .... and the
I came in humidifier
R: got
the
humidifier
on
A:
other
the
sometimes radiation monitor}
thing we
we
back}..hopefully these
A: supposed
to, but
do
wrap
that the
has
circuit
helped this
it kind of just keeps since now they have
it should
R: I thought
maximum
can
can just
is less and but I think
heating you
35.2 eh? up but
be.
But
wires know
is have way
the
that loss
aluminum of heat
ah were
by
it little warmer {looking at covered the field {indicates
supposed
to keep
it warm
foil.
45 R: anything helps A: anything helps just a little less heat loss here and just alittle less heat loss there An hour and a half later the attending makes another reference to the temperature. [113:3:40] {A and R looking A:
been
unless
we
turning get,
demonstrated A: yeah,..bring R: {gets
as in the aware
above and
we
any
there's
of those
have
not
urn,
interop
also
the
process
they
may
point
serve
not
about
of concern
reference
Information
Bear
to make
that
do
they
another may be generated,
team
team
member
member
believes
about
anomalies
noticed.
how
team
is that
they
the
parameter
to what
members
often
talk value
through
and
about
seeing
potential
which
environments
he foster
understandable
environments
the
what
state
other
influences
also
what
terms
in a relative
earlier.
down." states
of problem team
on
the
consequential
"open" by
that have already drugs other team
them
For
example,
In episode that it was
in
10, the "down a
Noticing
information and
talk
about was
resident states that "her SVR came about the calcium and the resident
overhearing
by seeing
can
HuggerTM..
another
another
have
solving
members
process
able to observe the activities and interactions crews, Segal (1994) notes the importance for observe the activities of other team members
and
time,
we
interop?
are
necessary for team members to always direct attention this information to one another. Valuable information
exchange
more
References
episode 9, the attending asks little bit, 1.84."
intentions
much
one
be used know
one
It can
about
important
Much
up,
anomalies and parameters of concern to one about management in which new ideas may
which
parameters with
temp
have
could
of something
An
room
don't
segment.
Relative
by
they
on phone}
significant,
way,
the
a Bear Hugger that could the Bear Hugger TM, you
Pointing out to a discussion
and
monitor}
temperature...
R: I've
lead
at v.s.
allow
i.e., 1990).
team
members
can
are
empty
on the
drug
Aspects
up
Some
by being
that
work are
observable
of work
information
cart.
provide members'
In studying cockpit of being able to of information
interactions
to gain
up
it is not
be picked
been taken. For example, anesthesiologists members have given by looking at the ampules
doing;
communication.)
(Huchins,
be picked
and explicitly about team
of others. coordination (a form
interactions,
others
can
about
can anesthesia
Assessments
activities
tell what record, and
plans
or
__
46
may
also
be picked
team
members.
team
members
monitored
All
or inferred
of this
to update
by
overhearing
information their
interactions
is ultimately
situation
between
valuable
assessment
other
in allowing
and
expectations
of the
and
on
relatively
rare
team
member
process.
Team occasions with
up
members
may
their
notice
observe
assistance.
able
to pick
They up
"unusual."
that
or that
suggests
have
a sense
about
possibilities context
his
See
for individuals and
to initiate
they
don't
understand,
the
activity
instances
that
doesn't
--when
a team
member
and
things allow
be inappropriate
outcome
failures
into
mouth,
are
seem
questions
interactions
may
fit
could
be occurring
activity Open
actions
before
that
should
that
below.
to detect
other
expected
episode
recovery
doing
that
in the
in such
activity.
are
of how
on discrepancies
It is generally
another
others
behavior
expectations,
use
what
in
occur.
[4 10:39:251 {RS
sprays
turns
numbing
back,
medication
RJ is lifting
P's
RS: What are you looking RJ: 1ust to see if that was that. 3 RS: {looks very
doing
this.
Another Team
actions
the
assistance,
putting
talk out.
aloud This
who
This
may
It is also activities, is accomplished
of a task
coordinating finished. Heath underground talk by other unusual"
for
Overhearing others
are
or subtask.
This
behavior
by letting
and
(1991)
line team team and
doing.
Luff
can,
in some
someone
point
out
else that
members The
structures
to explicitly actions
allows
of certain
give work
of all, it other
team
to provide distracting
or
which is found or "alright" upon
that
assist
a particular
coordination
in the
in in
stage
is
London
monitoring of selfit was "relatively
information
them
allows and
without
control room relies on "surreptitious" members. Their field study found that monitoring
me
or when
circumstances,
know
the
with
of required
that
generally
correlating
First
(e.g.,
or reasoning
line}
of others.
purpose.
track"
demanding attention. A common, brief form of self-talk the transcripts is saying (or sometimes sighing) "okay'' completion
were
in a task
a mechanism plans
cuff with
anxious
"self-talk"
a dual
gloves,
pressure
They
engaged
to "keep
to get
correlating
a little
is the
serve
is talking
someone's
monitor}
just
when
turns
touching
on gloves}
of information
alternatives.)
if necessary.
towards
source
something
to notice
slightly,
back to P} She's
practitioner
or possible
members
arm
{looks
occasionally
to figure help
monitor,
well.
notable
members
trying may
towards
yeah,
left
for? {points
P's
to keep environments
to one aware
another. of what
coupled
with
3 The blood pressure measurement as indicted by the arterial catheter and that measured by the sphygmomanometer (pressure cuff). A check on the arterial line bloodpressure measurement is done intia_y by seeing if it correlates with the blood pressure cuff measurement. _lIle arterial line may fail or stop reading because of a blood clot at the tip of the catheter or some technical problem.).
47
the demands and tasks performed may make members to explicitly tell one another about even
though
Shared
coordination
is required.
it unnecessary their actions
and
for team assessments
4
Tools Information
about
the
state
of the
also be picked up from the tools that members, such as the various displays maintain information
a common access
frame of reference, these in a way that is consistent
expectations. Consider a shared several people both for recording given
when
minute
and
how
intervals
information. different episode, resident
much,
throughout
ways
the
can
create
the
case)
that rifts
senior resident annotated the
and
of problem
as well
in the
to
as for
record. It is used what drug was has
been
retrieving
modified ground.
about junior
of the blood gas sample which was drawn anesthesia record. However, the last time page is 12:30 (see Figures 13a and b).
pressure
and
common
comments record. The
can
team In order
public tools need to afford with all team member
blood
is used
solving
to the record.
artifact like the anesthesia actions and values (e.g.,
or what
A representation the has
process
are publicly available and the anesthesia
by
5
that team
In the
the different resident has
for
by
members
in
following
way the junior written the results
at 1:45 on the first written across the
page of the top of the first
[101 7:56:40] {The
senior
who remained senior resident
resident
returned
from
in the operating room looks at the record.}
begins
RS: {looking at record} RJ: yeah, I just sent
has just
oh,
you
just
RS: I usually end up putting the over here so you can look down RJ: oh so you
can follow
RS: it's not a big issue,
drew
next
gas,
a break. to
update
another when
The
junior
him,
resident
while
the
gas you
go to a new
page
it that's
what
I usually
do. No
big deal.
4Humans have mechanisms that allow them to become aware of stimuli that are not directly attended to, e:g., peripheral vision, sensitivity in divided and focused attention tasks to important words, and to changes m volume or pitch. This is exploited in domains that use voice loops (e.g., ili mission control or aircraft carrier operationsJ.. Rochlin et al., (1987) _p°ints out that in aircraft" career" op.erations" checks are routinel" performed on decisions via a constant conversation loop. Rochlin et al. say "At first little of this chaYtter seems coherent, let alone substantive, to the outside observer. With experience one discovers that seasoned personnel do not 'listen' so much as monitor for deviations, reacting almost instantaneously to anything that floes not fit their expectations of the correct routine."
Figure time
13a. Page
1 of the anesthesia
record.
Note
time
of blood
gas and
last
on page.
[]RI_INAL PAGE m OF POOR QUALITY
Figure time
13b. Page 2 of the anesthesia
record.
Note time of blood
gas and first
on page.
ORIGINAL PAGE IS OF POOR QUAL.JT_
50
Queries
and
Informative
Team
Responses
members
or parameters,
sometimes
such
as "What
request
during
an aneurysm
clipping
surgery.
ended,
such
variant
of "What's
as some
returning to the operating An observation statement earlier
episode,
besides
being
point
the information appropriately tutoring,
But
is that
team
members
questions
learners
lack
an assessment
have
about
or action,
ask
open-
may
temperature like
"tell
being
me
what
to explicitly
ask upon
what
responders
about
all
of
they
relevant specific
is know
query
information
often
low, you
can respond in the case
missing (e.g., Miyake and Norman, 1979), but it is also situations. Indeed, even when team members generate the process,
are more
attendings
team members This is important
knowledge
events
might
fall somewhere in the middle. 35.2, eh?" in the context of an
on the
don't
about
as a surgeon
which
something
they may need, because to open-ended questions.
when
other
up?"
a comment
to mean low."
information
pressure?"
room. Some queries such as "temperature
interpreted by the resident about this parameter being The
specific
is the blood
are
in updating queries about
do not
simply
answer
the explicit what they
question posed to them. They deem an informative response.
"go beyond" the question to provide People are sensitive to the
intentions
and
when
they answer can provide not formulate One
goals
requesters
have
asking
accordingly (e.g., Pollack, Hirschberg relevant information even though the question precisely. way
elaborating.
that
For
team
members
example,
Q: What is the A: It's 110 over
The
that
consider
blood 60.
answer
go beyond the
and Webber, an information a minimal
following
information;
Consider
given
here
if the
generally
the
clipping.
blood
used
following Before
in order
placement of the clip Cullen and Stoelting, member
who
concerning two
instances
the
might
be called
pressure
a minimal
answer
pair:
the
from
clipping,
duration the
and surgeon
it answers
depending in some a minimal response. seeker to find out about
highly
a surgery
deliberately the
drugs,
response;
erratic
recently,
or it
action whose effect is not yet apparent. and even critical to the team member
example the
to minimize
administers start,
has been
chances
and also to reduce blood 1991). The anesthesiologist,
in which
and
is by
pressure?
is expected to go vary due to a recent Knowing these factors may be useful requesting the information. aneurysm
and
1982). People seeker does
response
question
the explicit question posed. But, it may be informative circumstances, to provide an answer that goes beyond For example, it may be important for the information trend
for information,
must
degree asked
involving induced
for rupture, loss
is
facilitate
if bleeding occurs (Barash, because he is the team
coordinate
with
of hypotension. the
a cerebral
hypotension
anesthesiologist
the Figure
surgeon 14 shows about
the
51
blood
pressure:
figure
also
right
shows
clipping.
In the
response
plus
drop
to the
brought a tag picture"
this
time,
the
data, providing factors that will future.
resident. pretty value
clipping, minimal
how
the
members
seeker
an informative or might affect
around
when
the
pressure
which
question.
In answering
to the
response the value
means within
that
are
resident's
of the
cardiac
response output
is to provide (i.e.,
"that
was
are
commonly
found
Surgeon:
"What's
in the
a minimal is to be
sensitive
further
along value.
be provided
by
about
process
information about horizon of the to the
goals
of the
is found in Figure 11. told to him by the information
a combination about cardiac
about
of 3 outputs
another index).
parameter Such
data.
the blood
pressure
Resident:
now?"
Resident: "100 over 50, back up to normal."
"Still at 100, I'm giving Nipride right now."
blood pressure
time
aneurysm Figure
14.
Different
context-sensitive
clipping elaborations
with
"complete
queries
providing a certain
soon
normal
a more would
of
should
is provided,
provide
accurate"). He also provides information that is related to the one asked about (i.e.,
elaborations
value
The
time
provides the
is related
that
clipping. the
that response
value
than
the
anesthesiologist
team
explicit
after
values
example of a unprompted elaboration seems surprised by the parameter value
The
accuracy
that
information
the
same
shortly
surgeon
ability to provide responses seekers is important.
Another attending
The
the
After
specifies
their
the
informs the
and
pressure
instance,
that
illustrates
answering
The information
asking
almost
clipping
blood
value.
again,
for
simply
first a "tag"
example
the
desired
expected
up that,
This
before
the
for the
same
query.
the so it's
52
Another
way
that
team
members
go beyond
providing responses that vary on the data. At one end there are statements interpretations
of what
they
mean.
a minimal
response
dimension of interpretability of data values and at another
Consider
the
following
is by
of process end are
exchange:
[812:24:20] S: Did he get a good
diuresis?
R: I just emptied uh 350ccs or less, S: Huh, did he get a good diuresis? R: 350 cc's (.) half hour. In this question. "good"
fewer
the
the
The
humans
process
monitoring
The
attending
to the When
periods
episode
engage
in joint
of it asked
a qualitative
implies
a judgement
chooses
to answer
a Team fault
interacting
long
ago.
(e.g.,
was
it
it quantitatively,
surgeon.
dynamic
Member
Returns
management
subprocesses
Consequently,
following
surface
responder
Ground
systems.
on the question
the
in complex,
for relatively
updates?
has
of the
judgement
Common
trend
of intelligent
surgeon form
However,
leaving
Updating
the
is, the
or "not").
in effect
and
case,
That
25 minutes
through
the human of time.
may
What
is particularly
domains
is to have
the
increased
be distanced
is the
nature
interesting
use
from
the
of effective
because
the resident
diagnosis.
7"
Overview
of Episode The
episode
occurs
during
clip a cerebral aneurysm. and before the surgeons the
only
anesthesiologist
an hour
and
resident
detects
corrective He has enquires The
The have
the
resident
an anomaly
action
by
maintenance
episode exposed
present;
junior
the
the
occurs about the aneurysm. attending (very
arrives
after
a few
been
away
episode
low
a drug
of an operation
an hour after The senior
In this
atropine,
the attending paged. He mentions whether they "might have been
attending
has
is on break.
-- bradycardia
administering
phase
heart that
minutes
and
together
induction resident
is
for about the
half
senior
rate).
raises
the event to the doing anything."
to
He takes the
heart
rate.
surgeons and They answer
they
arrive
no.
at a
diagnosis. Anomaly
Detection,
Corrective
To a practitioner, rate as indicated The resident,
the
by the beeping who
has bent
begin a cardiac output monitor. Five seconds
Action
bradycardia down
and
of the pulse (apparently
measurement), later he injects
Investigation
event
is quite oximeter
suddenly
to check
immediately the atropine.
dramatic. the
urine
The
pulse
slows
down.
output
gets up to look See Figure 15.
at the
or to
53
he.aft tale
i:i!!ii
40:30
40:50
40:40
41:00
41:10
41:20
l R at monitor-gets cardiac output screen, then turns away, bends down
R stands up, looks at monitor
R: {to RJ.
indicating
"She's I gave atropine
R in :cts atrc
bradying her some
R adjusts niU'ous
_
J
to display) out,
here."
_...
oxide, oxygen
line R: {to R J) ya?"_ "Call [A], will
heart
tale
i i !' ': _ ?! :. ! :i!ii_!/!i!! : i!_i: :i!i_?:ii: I::_:I::::::f:I::[::]::[::|::]:: ::::: : I::]:1::,'::[[::1:::]:: [ :_:: i:::: [::6: [:::l:::L::[::[:::_:l:::_: I::1: ]:]::H::[: t::[:]:[:l::".,: I:]::]::_:h::t r:]::[:l::::_::[ ::::::::::::::::::::::::
i 41:30
41:40
!
:
41:50
42:00
i 42:10
42:20
R adjusts agent
I "She just had an episode of bradycardia, down I about 39. Anything that you're doing up there [that you can think of would be
anesthetic
IS: (R: No. {facing
S' s}
: Very good.
Figure
15. Context
for Bradycardia
tl I didn't
Update.
think
so.
-
54 Bradycardia drugs
given
may
during
rate. s Also,
a low
in certain
maintenance heart
known artifact with bradycardia of such to treat
be expected rate
can
result
indication
before
For
in a lower
could
example,
than
be expected
monitoring equipment. severity is unexpected.
it immediately,
situations.
certain
normal
in the
heart
case
of a
However, in this case, Because of its severity it is critical
its consequences
begin
to propagate.
It is also
important to understand its etiology because it could be an premonitory event, i.e., indicative of a fault that needs to be managed or corrected prevent
the
condition
disturbances. event,
After
the
also
from investigating
resident
pages attending
aware
and
Joint
Problem
Solving
16 shows
of all,
that
rather
detailed
these
the
severe
the
antecedent
(blood
process
event.
event,
the
reached
the
corrective
he informs
the
update, the attending the same, unelaborated. story,
the
basically
action
queries
form
However, about He
the
then
continues
management
attending
then
due to the surgeons. He seems to be an important
or large doses
lists
solving
by (i.e.,
what
the
causes
In reaction to this, into his conclusion
or fentanyl
bradycardia
(Chung
by a reflex
to it.
for
solving,
i.e.,
that
response
to reach
process
reasons
response
explain
on
"revisits" what, based time frame. He then
of morphine
6Severe hypertension may cause rules out this mechanism.
seems
problem
providing
of
process values
a recounting
necessarily the
the
limiting
recounts
discounting--mentioning
and
been in his past experience. reevaluate the data that fed
5Halothane
the
in hypothesis
solving
he "can't
before
dynamics parameter
resident's
resident Such
of
(i.e., "nothing [the At the end of the initial
The
The
of events.
influences
hypotheses
The
that
process
a
One
the on
the
first
with
occurred
of problem
point.
Notice,
relevant
taking
hypothesis elaborate.
this
of problem
says
resident
engages
(incomplete)
state
the
state
update.
order
that about
event,
and
the
on
initial
the
attending
various
took
about
him
of the
preserving
the
he
he was
of the
and
event.
query
of another
action
He has rejected one though he doesn't
to benefit causal analysis. At this point, the when
what dynamics
cause
of information.
bradycardia) and
of the
the
arrives.
information
itself,
attending
he has no explanation. surgeons] were doing"),
Notice
event
the
attending pieces
severe
as a source uncover
open-ended
several
he provides
of the
occurred,
the
to
possible
premonitory
attending's
(less
that
6 He mentions
event and
Finally
the
includes
event
Notice
pressure).
while
that
him
of a potential
when
other
actions
to help
occurs
answers
account
is a related
the
what
resident
surgeons'
attending
the
Figure
or to prevent
the
the
to make
Update
(i.e.,
recurring
telling drugs a few
discounting
of this
kind
it like
a
would
seem
an impasse that.") the
attending
being
given).
potential them.
of event
the resident seems to that it could not have on the attending's point out in detail
is
have been
knowledge, what was
and Lam, 1990). pathway
but the absence
of high blood
pressure
55
occurring
then--that
activity
that
it was
could
have
This example in content
optimal
characteristics
access to the the attending
essential
the
one
event.
appropriate call
One
aspect
of the
are
Some suggested
intelligent situation knowing
coherent
team of the
One
point
team
that
diagnosis
can
episode
the
In this
present during knowledge.
problem in the
taken
interaction
solving
the Both
sense
as the seems
to reexamine
best
that
are
data
is to be able
to recognize
is
an initially
explanation
important past
episode
for
the
to its in the
cooperative interaction in supervisor One is that an important characteristic member
is
case.
by this and
is that
autonomous.
It is robust
resident
in an
that
light
of
updates of an the
is in danger of escalating beyond his or her (or its) competence, i.e., when to call the supervisor. Secondly, the subordinate must be able
to provide events,
update some
in this
illustrated
implications for by this example. subordinate
that this particular use it to illustrate
than
diagnosis
is reintroduced
robustness is the ability the attending's concerns.
engaged
solving.
rather
"robustness."
hypothesis
were
event.
relevant data by having been has access to more etiological
characteristic
might
discarded
problem
cooperative
resident has event, while for
the surgeons
to the
is used, not to suggest or pattern. Rather, we
and
Another
when
rise
of cooperative
be collaborative
what
actually
given
some
actions
kind and
recounting
of reconstruction
relationships of the
events
of the
in order that
led
event
to provide to the
that the
present
emphasizes supervisor state.
relevant with
a
--
56
TRANSCRIPT
DOMAIN
INDEPENDENT
PHASE OF PROBLEM
DESCRIPTION A: {enters
room}
tachycardic R: Yeah,
Nice
and
better
than
A comments
SOLVING on process
1
well,
nice and bradycardic
A: What's
going
A makes open-ended request for update
on guys?
R: {takes end of printout, seems to show to A} She had an episode of just kinda, all of the sudden bradying down to 50, 52 then came right back up, nothing they were doing, then all of the sudden out of the blue, an output2and down
I was shooting she dropped
to 32, 383 somewhere
around there, pressure 4 dropped down to 60 so I gave
her .5 of atropine
5
and ah, kicked her up to 6.5; she liked that, but no explanation. This is at 50 millimeters per second, twice
the speed 6.
A: They weren't in the head doing anything?
R mentions:
Initial
-previous related event, including dynamics and approx values
update
of
significant
event
Hypothesis
building
-discounting of other agents' activities as cause -action taken while event occurred - dynamics and approx values of relevant parameter during event -corrective process'
action taken and response
-no good candidate for diagnostic search R supplements description with artifact preserving data history A requests specific past observation information (concerning other agents' activities) at time of event.
[continuesl lTachycardia refers to rapid heart rate, while bradycardia refers to a slow heart rate. 2 Cardiac output refers to the volume of blood per unit time that the heart moves. The measurement of cardiac output requires injection of a measured amount of IV fluid and is done infrequently. 3 These are very low heart rate values, requiring treatment 4 blood pressure. 5 A drug that increases heart rate by blocking the parasympathetic system. 6 Chart speed for EKG recording is usually 25 mm/sec. Because it's running at 50mm/sec, recorded events occupy twice the length of chart paper than they would at normal speed.
Figure
16. Bradycardia
Update.
--
57
Figure
16 (continued),
TRANSCRIPT
DOMAIN INDEPENDENT
PHASE OF PROBLEM
DESCRIPTION
SOLVING
R answer discounts hypothesis, but does not elaborate.
R: Nothing.
A: Okay. Well I can't necessarily R: The only thing A: I can't necessarily that
explain
R: Yeah, neither can I. The only thing we're doing right now is just trying to open her up and fill her up. {points to right IV tree} She's up to a mic per kilo of nitro 7 and then she's still
A states has no candidates
R provides more information on current actions and previous actions
Context
building
at the 5, started out at 3 and a half of dobutamine 8 and it did absolutely nothing, so I'm up to 5 A: Okay
[continues]
7Nitroglycerine. 8 Dobutamine
A vasodilator,
for controlled
hypotension.
is generally given for low cardiac output, in order to increase contractility.
--
58 Figure 16 (continued), TRANSCRIPT
R: So ! don't know if she doesn't like contractility or, l can't think of anything else we're doing. The line went in perfectly normal, I can't imagine that she has a pneumo or anything that would be causing tension, her peak area pressures have not changed. Just all of the sudden -boom-out of the blue-her potassium is 3 point 3 and we're getting ready to replace that and we have been hyperventilating, but I don't know if low potassium can affect heart rate A: Yeah, I don't know, I can't give you cause and effect on that. In my experience it's usually been stimulation of the trachea, it's something traction on the dura
DOMAIN INDEPENDENT
PHASE OF PROBLEM
DESCRIPTION
SOLVING
R offers hypothesis but discounts based on his knowledge
Hypothesis
discounting
Case-based
discussion
R offers another hypothesis but discounts it based on data
Dynamics of event repeated Process variables mentioned, action to be taken mentioned R offers a third hypothesis but voices his lack of knowledge
A mentions two causes of the significant event based on his past experience
R: yeah, (absolutely) A: you know things R: yeah, it may have been dura
R remarks that one of these causes may have been cause in this case
A: ...sort of a reflex, pressure on an eye
A provides another possible cause based on past cases
R: {animated} Actually it was when they were sawing the dura open.
R remarks that event occured during a time when one of the causes mentioned by A could have occured
A: well that's [continues]
Discounted hypothesis reconsidered
59
Figure
16 (continued),
TRANSCRIPT
R: putting
DOMAIN INDEPENDENT
PHASE OF PROBLEM
DESCRIPTION
SOLW, iG
tension on it
R2: traction on the dura A: you touch the dura you'll get that
A states mechanism
R: okay A: cause the dura is ennervated by the fifth [ believe, and it somehow makes its way back to the (.) ganglion, same thing that causes oculocardiac reflex
A describes mechanism whereby hypothesized cause leads to the significant event
R: I'd be willing to bet you're absolutely right {RS waves pen over ventilator setting knobs, then leaves view}
R expresses confidence for hypothesis
A: is the same mechanism
A continues explanation of mechanism
whereby you get (bradycardial traction) on the dura, so my guess is that's exactly what it was R: Okay. A: you now and for future reference, if you suspect {pause} this lady's probably not going to mind this experience because she, we don't think she's really significantly sick, we're being a little overly cautious with her, my preference is, if you have a patient that you think has a bad heart, and you think they have a vagal problem via traction, or an eye... RS: so that's why A: It's traction on the dura
Hypothesis acceptance
R concurs (with hypothesis)
6O
CHAPTER
V
DISCUSSION It has fault busy
al., 1991; this
been
a consistent
management times, creating Malin
term
diagnostic
fault
that
data
both
explanation
evolving
implications are lines of thought, understand tasks
to integrate
In
contrast,
engaged agent
fault
(problem
solver)
coming members
to a mutually is to maintain
of concern members to the
another example, also
picture support
of the cognitive Some
are
of the
interaction
one-shot
time,
characteristics
and
management
are
to another
both
given
held interpretation. a common ground
speak
provide
about
them
informative
needs
Team
involved
current
members
long
chunk
from
members
in a process
of
The strategy among human team as the situation evolves. They
relative
responses,
in the
management
team
in one
holder). are
to on-going to read and
data.
among
not
(problem
in which
process
explanations
of
cognitive
in interface
with
of
dissociated
its context-
The
to engage
information
situation. of
in a diagnostic,
nature,
relationship.
one
demands
explanations
in several and parameters
to expectations. i.e.,
context.
with
Team
elaborations
Communication
tailored among
human team members, like conversation in general, reflects a sensitivity what is informative and relevant to others (Grice, 1975). Team members provide influences evaluate context
unprompted communication of relevant on the process) and assessments. They the
effects
in which
strategies
and
simulator
study
of past information
expectations of coordinated
interventions. takes among
on team
activity
et
of why
evolving
to a form
in maintaining an up-to-date interpretation they draw attention to anomalies, events
they
information
spatially.
a clearer
occurs as an interruption by requiring the practitioner
system's
interpretations
and
and
for dynamic
contrast,
to refer
to the when
a cooperative
interpretations
in joint
one For
adapted
at a busy
in dynamic
by
used
occurs
explanation workload
the
engage
assist ways.
was
its retrospective,
an explanation
and
well
systems
that congregate at for operators (Woods
provides
members,
its expert-to-novice
that the increases
advisory
understanding
This impede
are
and
study
team
temporally
that
situation
independence
field
updated
is not
that
and explanations cognitive burdens
explanation"
management.
process
classic
This human
an
"clumsy
support
dynamic from
that
in maintaining The
observation
diagnoses tasks and
et al., 1991).
is so: it indicates
another
one
provide extra
These meaning.
activities talk about
(i.e., their strategies
communications This
members
has
in aircraft
flight
crews
and
provide
articulation been
to also
noted
a
of in a
(Orasanu,
1990)
and investigation of coordination between airline operatios center and central flow control in air traffic management (Smith, Orasanu, McCoy et al., 1994).
61
In both
cases,
investment the
the
model
for
Similar
results
have
activity
A result it is unusual do
what
common
pilots
and
activities
between 1987).
the
Invest
human
One
for
say
marked
that?"
in
1981). is that
or "why
did
for explanations, by just
that?
what
to assist level
as team
interaction
these will
questions: it do
next?
players
and
1995)
(Woods,
Such
in press
system indicate cooperation (e.g.,
Roth
et al.,
the state
in communicating
of the
entails
process,
members
this
solving
and
in keeping
may
machine one
in the
the
of which
the
process.
investment
disentangling
some
(human
to assist
problem
to make
about
various be due
agents).
another
to the
Hence,
aware
process.
in the management
members.
an update
to keep This
and
someone
is reflected
to a medical
it can allow for more efficient less needs to be said because mutually
concerning
the
it
of
level, an important reason to invest in the common keep other team members in a state of readiness so they
of effort
is already
Woods,
system
heavily
diagnosis
members the
and
with intelligent to support true
for them
monitored
on
(Sarter
diagnosis
of faults
updated
in an episode
student
was
in the
cut
short
found
a common
communication during higher information can be communicated
known3
This
temporal-sensitive
The
if they
are not
in one
in order
is consistent nature
with
are
process.
is not warranted
perceived to be a more pressing task. Another important function of maintaining
10
Manos,
in cooperative
AI advisory
invest and
is that team
team
interventions
findings
of
in particular
and
a need
system
and
reasons
on the
At another ground is to help
what
and
of
studies
in communications
you
is it doing
perspectives
Ground?
process
of other
is important
team
are
the
1990)
Breakdowns
function
members
good
acting
do not
Common
monitored
interventions
true
express
requires
in other
Foushee
do
of human interaction frame of reference
team
ground.
influences
which
which
why
and
obtained
ground
"why
practitioners
are several
same
common to ask
automated
systems
studies a common
in the
of the
common
able
(e.g.,
automation
of the
silent"
In general,
their
situation
been Hutchins,
ground.
doing?
activity
1989). These breakdowns in cooperation between people and systems have been linked to weak feedback about the current but
There
cockpit
automation
(e.g.,
of the
questions,
Similarly, need for
state
role
members
in the
anticipated
Why
of the
the
management
These
(Wiener, automated
a). the
people
a rift is the
"strong
across resource
for team
that?"
between
coordinated
a shared
of cockpit
indicate
that
agents.
coordinated
you
find
to build
different
studies
investigators
case
to deal ground
in what
was
is that
tempo periods; relative to
Orasanu's
of communication
F r example, grounding allows references to the same item to become more concise during communication task (Clark & Wilkes-Gibbs, 1990; Krauss and Weinheimer, 1964).
(1990) among
the evolution of a
62
cockpit
crew
talked also,
members;
less the
than
captains
captains
information
during
such
abnormal
when
understanding
crews
crews
requested
phases
of flight,
rather
(recall
less
the
captains
This
the
in a team
attending
puts
anticipatory
behaviors
1991;
Xiao,
1994),
be easier
later
on, when
moment,
so that
to be more
things
will
for Human-IS
Much
research
explanation
off an
In this purpose, preparatory
i.e.,
a task they
be expected
Cooperative
on artificial
is linguistic.
assumes
that
Interaction
intelligence
Swartout
explanation
and Moore
(1993)
state
that for an expert
multisentential
This
text
sophisticated
to achieve
explanations
intelligent
systems
incorporate
"chatty"
The
fault
suggest that team players
presented
of linguistic
need
to invest 2
though fault says
the
in the
the
The
of more
danger
of
that
is that
notion
maintaining
common
metaphor
direct
they
features
strategies interaction
from human-human design; these include:
with
are
certain
This
conversation.
of conversation),
ground.
How
would
end
have
this
points
ways
We is, all or
is to be done
that
out
is a
is problematic may
Brennan's
succeed
apply feedback
ground.
system"
is basically
Brennan
distributed
of analysis; that whether human
lessons
interfaces
conversation provide
that
a common
of a "conversational there
manipulation
important
2
on
communication. that
aspect
management
competence
supports
relies
management,
human-human
"backchannels"
stage.
fault
this is a conclusion at a competence level engaged in dynamic fault management,
issue.
she
research
dynamic
herein
management
separate
Even
in the
goal."
of
distracting.
machine
dynamic
is still
degree
and
study
dynamic
a communicative
for supporting
a limited
being
when
at
can
desideratum a coherent
from
or
undertaken
system to generate good explanations, it must meet the linguistic competence, i.e., "it must be able to construct
for
member's
busy.
Implications
up
because high-
to understanding
a problem
in which
high;
of poor
is useful
to be devoted
opportune time). to anesthesiologists'
the
was
less
during these phases. the need for retrospective
of his decision until a more common ground is similar et al.,
workload
slightly
explanation maintaining
(Cook
crews
at high-tempo,
in mending
episode
when
necessary.
needs
than
performing
whereas
be resource-consuming
concentration
behavior,
in high
performing
or actions
would
times,
captains
more information ground can make
of assessments
process
that
performing
requested common
explanations
criticality the
found in low
of high
performing crews Establishing explanations
she
(1990)
because that
be drawn they
point share
general
to human-computer (akin to the
of establishing
that
Th e distinction I am making here is like the distinction Mart (1981) made between a computational theory (that specifies the goals to be achieved and the logic of the strategy) and the representation and algoritb_rn level of description (thafspecifies how the theory can ire implementecl).
63
understanding and
is sufficient
provide
ways
For
for
current
purposes,
and
dynamic
fault
management,
some
competence
be listed (though these might be implemented Team members limit the need for others Human the
team
right
members
time:
they
unprompted sensitive support with
the
Mastaglio
(recall
Reeves,
in the
they are member.
currently
usual
doing
members
compactness
we mean
-- meaning that extra information this
knowledge can communication simultaneously
of data "man
of team
communicate member that
compactness.
provide context°
that
force
problem
mutual
first share
are
not
in dynamic with
a break
members from
fault
the
in the
another
is their
"compactness."
knowledge
or mutual
A salient By
with
context
knowledge
potential
is shared about
meaning
without kinds
kinds of shared context within contexts of various kinds are shared
of
what
team
contexts. is packed
in
flow
to drop
shared
or gesture
domain
to find
to explanations;
increase
information
notable
serial
is that
it is difficult
problematic
for team
word
many associated
not be extractable by a lay person, 3 Mutual knowledge of various
be viewed as different occurs. These shared The
which approach
at
distracting. Communication team members are engaged
members
communications
This
members
The
demands 1994).
can
information
and
designs
within
in various
a phrase,
right
and
1995).
page"
necessary to gain
would generally or explanation.
team
interface
Woods,
cognitive (Woods,
it is not
the
events,
is particularly
in order
available. The
occur
principles
in press b). By contrast, create cognitive burdens
communicate without generally occurs while case,
of team
knowledge.
and
the
This
communications
characteristic
for
1992).
members members
The
will
ways): for information.
or assessments
e.g.,
(Cook
an avalanche
activity;
Team
to relevant
information, data
provide
activity.
errors
level
in various to search
in finding
activities
applications because criticality of operations
Team team
allows
attention
information and
management tempo and
another
to queries (Woods, characteristics that
related
systems relevant
one
about
relevant
to highly
among
direct
information
retrieving
these
assist
elaborations systems have
access
assume
to repair.
the
which domain subject
matter and practice of anesthesiology, example, what a phrase like "taking
which allows them to understand for a gas" means. It allows one to understand
why
give
the
attending
might
say
"Let's
him
some
dobutamine"
and
how
to
31nterestingly, reference can be so compact that it involves neither words nor direct pointing. In one episode observed, a medical student elicits an explanation of the resident by "waving' towards the vital signs display. The resident turns to look at the monitor and states "cause the cuff is up. That's the pulse oximeterY Of all-that is on the vital signs display, the resident picks out the flattenedpulse oiimeter wavbform as the reference. From the resident's po/nt of view, the tar waveform is expected-because the blood pressure cuff was on the same arm as the pulse oximeter monitor; whenever the cuff inflates it squeezes off blood flow, which leads to a spurious pulse reading. However, it is the atypical item - that which would be anomalous in another context. The reference is understood partly because of the critical role of anomalies in dynamic fault management.
64
take this action, or what "Why don't you would need to be done and how to do it. Another about
how
be done
context
the
team,
in more
something, them, different
the
the
one
For
knowledge were taken, problem
A brief
its significance
(i.e.,
intervene?) These
is the
factors drugs
have
about
to occur
be induced (coupled
(i.e.,
an aneurysm
shared
environment
context and
Communicating that
domain
allow
set
is less
and
team
costly
because
cotemporality
members
of
are
to ground
the
the
(see
without
for it.
The
other
views.
The
transcripts
interpretations reference)
on
display
the
e.g., analogical, deitic reference. Agents
makes can
Certain
of the
physical
showed
of the
(deitic situations.
aspect
that
process for
while
information,
process
that
can
context to be
the
environment
of copresence, 2). These
informing;
visibility,
monitored
talk and
is
access-monitoring process
about pointing.
Pointing
--pointing
to some
or an explanation
in some
be had
"for
task means
information
the
a wealth
the
constraints
through peripheral one is not explicitly often
on
representations.
physical
at displays
provide
hypotension
of both
communication can
that
temporal
consists
concerns
for a description
representations
or are
which
members
looking
compact
substitute
trend
context team
whether
occurred
depending
explicit
case.
hypertensive,
a statement
Chapter
available about what other team members do being able to see what others do, even though
to
or high,
same
of gains
of the
low
constraints
present
to
have
shared such
either
monitored
context
are
do anything
requires
The
context
of available
the
in their
refers
course
events
allows
e.g.,
physical
we
typically
knowledge)
have
in an update
past
is a chronic
clipping).
a state, case.
is the
within
grounding
audibility,
the
to the
of doing may
variations
This
should
certain
clipping
prior
ways varied
100"
in the
patient
can
to do
members these
"pressure's
whether
that
ways
attendings
it
knowledge
things
particular team
why
including what interventions of the process has been and
normal,
the
shared
to do
context.
established
given,
understood qualitatively--as mutual knowledge of the A fourth
expected,
whether been
immediately with
like
means,
"correct"
Also,
showed
of the process, of the state
on factors
include:
certain
is,
tend
have
temporal
statement
is this
depending
may
data
shared
the history the evolution
solving.
that
multiple
to use.
in"
or fluid replacement therapy; by other team members 4.
context
about what
drug the
A-line
members, there
or team
example,
approach to drug dosage stable and are recognized Another
Often
induction
the
knowledge,
team
way.
department
default
"styles."
local
or particular
than
and
e.g.,
is shared
put
of other free"
when
item
information using
vs. Tools
4In case 2, the senior resident tells the junior resident
"[All likes to fill them up, [A21 likes to keep them dry."
__
65
The strategy,
need
to maintain
in which
the
a common
intelligent
ground
system
means
draws
that
attention
a "dark
(i.e.,
sounds
only when "something is wrong" between human practitioners and
is inappropriate model for intelligent systems (Woods,
What,
approach
then,
would
assessments
and
maintained
actions
between
on
pseudo-animacy accord
of such
s -- human
them
and
process?
and
intermediate assessments, the
Norman
provides
it has
continual,
require
limit
that
relevant
ground
actions
than
current
be
feedback
team
that about
of awareness, this
(Woods,
has
an
this
in the
and offer and to
human
operators.
to provide
feedback
He
out
points
state
of affairs,
a monitoring
to do
towards
deserve
among fails
ability.
members
To be able
they
that
another
approach
systems
is to design
them
activity
(Roth,
information other
Bennett from
raw
data
In the
of the
of the
The critical with
the
of this
tempo
is that
process
of its own
general
case,
Woods,
1991;
1993).
form
of data
situation
Monitored
Intelligent the
Woods,
assessment.
explanations,
of activity,
from
1987;
linguistic
desiderata
human-machine
requires
and
in their In this
In this by
of
field
of
view,
to be integrated
with
approach,
assessments but
a
cognitive
practitioners
is another activities
assessments
views.
dissociated
joint
to support
AI system's
sophisticated 6
Context
creating
Woods,
AI system
in supporting
understanding by more apparent.
and
the
for as tools
for
it
of intelligence that is not yet been attained in the research labs. Rather than developing the agent-like or stand-alone properties
machines,
in and
own
stance
to take actions all abnormalities
found
autopilot
of their
automation
of its compensatory
a "higher-level
capabilities."
IS's
an intentional
it is smart enough to act to handle
of an
to inform
the
common
to take
to take
intelligence
out
appropriate the
to be able
monitoring degree
more
points
an example
reached
a system would
with
(1990)
can
communication in press b).
system?
seem
be wont
level of intelligence; but not smart enough
provide
How
conveying
alarms)
from human-human communication (Suchman, 1987). Because of the opacity
may
them
a). Norman
for
intelligent
systems--they
partners
to imbue
in press
and
the
human
People import expectations interactions with machines
their
that
be an effective
board"
is supported,
making
not
functioning
Process for diagnostic
efficient
support
and
not
be integrated system
process
views
Remington
and
can
distracting.
in the
assessments lead
Shafto,
is that An
context and
of the
activities
to extra 1990).
it be "in synch" important that
cognitive
Studies
aspect
monitored
indicate
are
tasks
(Potter, that,
when
5The aircraft flight management system (FMS) responds to operator inputs as well as to situational and system factors. For example, the FMS initiates a mode transition when a preprogrammed intermediate target attained (Salter and Wobds, 1993). 6This is related to Suchman's (1987) point about explain itself as a human might do when queried,
an artifact being self-explanatory in two senses: 1) it can or 2) its functioning or use can be easily discoverable.
is
66
communication during and
demands
high
tempo
switch
1994).
periods,
Continuous
operator's
attention Integrating
made Roth,
likely
away
from
it means
the
high,
abandon
reasoning,
is used
data
presentation
what
referents,
if dissociated because
for diagnosis, to the
the
the
process
basis
One
Common
are
Frame
distributed
isn't
on which
do
made
frame
not
that
process
the
simply
relevant
be used
members
access
should
is being used source of
be
(e.g.,
are
that
being
allow
for
state
concept
solving
of which to the
team
used
arises
that
may
state
a common
of problem
relationships
will
It can lead ideas about
strategies,
indicates
common
know
IS's
of the
problem
agents common
(Roth, frame
and
accurate
solving
across
work
if
abandon frame
distributed
problem
framework
that
be emphasized,
with
use
1993a,
not
or the
been
of the
support
Remington
and
of reference solving
highlights
known
problem
system
data
of the
concept
of integrating relationships
will
potentially and of the
Cook the
information among
the
of
from
and solving practitioners costs
support
system
cooperative its use and need into
data
be divorced
because when the
or constrain
expresses
state
of data about agent." When piecemeal,
diverging problem
solving
1991;
solving
Woods, 1987; is about the
members.
to abandon
Shafto,
in problem
Bennett and of reference
team
a decision/problem
have
occur
engaged
understanding
and
in
breakdowns
to increased cognitive workload various sources of data. Also,
practitioners
(Woods,
for
members
in the
from
be machines)
team members to form the state of the process
in coordination high,
a context
important to convey because they set up the A common frame of reference is supported
collaborating 1987). The
process. It can also lead are required to integrate
The
about
that
to provide
--so
predictions
of reference
by other Suchman,
and
its context. inaccurate
ways
the
diagnostic
of information
As mentioned earlier, there are typically many sources the process, some of which may be processed by an "intelligent there is no common flame of reference, data will be available
too
the
draw
apparent.
(some
have
resources
team
problem
agents
taken 1990;
also
and
(multi-agent)
multiple
approach Hutchins,
are
from
of Reference
The common
involved
Sarter,
it would
views
source
it could
human
Expectations are for explanations.
expectations
solving
and
process.
into
apparent.
expectations,
assessments. contrast cases
when
strategies
Cook
used by model-based intelligent systems is the context-sensitive values generated for critical parameters. While this model-based
capability
these
particularly
cooperative
Johannesen,
apparent in the representation is what process data Butterworth and Loftus, 1985). Another important
information expected
the
will
are
to be distracting
making
is generated,
agent
(Woods,
of AI system
is still
IS assessments
contiguity;
information
machine
strategies
display
process,
the
practitioners
to single-agent
monitored
spatial
with
and
in severe
Woods,
1995).
in effective a single places
data
in
67
the context
of assessments
16 attempts
to illustrate
Effective common
(Roth,
problem been
solving
of others,
and
right
the
time
Woods,
approach-and
the
rejected,
concerning
is tailored
the
to the
and
this
Figure
for
for
dynamic to the
hypotheses
about
have and
the
activities
monitored
information
information
means
of the
a
solving
assessments
relevant
expectations
allow
means
what
relevant
Relevant
that
1) accessibility
to know
of the
process.
problem
information
aware
process.
What
the
to relevant
interests
of the
to have:
capability
to become
of the idea.
resources
and
1987).
to know
2) accessibility capability
state
it is important
states
of reference
requires
problem
and
is that
considered
process-that
Bennett
expected
frame
solving
of the
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and
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joint
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at the information
observer.
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I
..............,
v
................ i Data .... _ source _ i source .............. : i............
Figure An
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agents
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it supports
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being some external representation of the referent that is available to all agents. A shared
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t I ,-,
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coordinated with the IS's assessments and Potter et al. (1994) indicate how a functionto use of the
the
IS's computational
monitored
process.
power The
to help
function-based
the
68
display
integrates
monitored and
the
process
Roth,
1988).
reference
intelligent
among
the
events
Integrating technology,
to avoid
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team
intelligent so that
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and
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This
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In this
to the
of 1991).
relationships
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Woods,
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Future
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results
state,
has been
support
a first
in dynamic
step
towards
fault
explanation. To further understanding common ground, it would be useful
understanding
management
and
the
the role
of how team members to refine the conditions
nature
of
of
establish under which
they tell one another about assessments and activities. For example, in updates it would be useful to be able to predict what parameters team members
will
the
history.
case's
based that
on some updaters
that
from
call have
anomalous
A factor nature
We
of team
What
patterns
flight
controllers
and can
how
assistance
The members investigate common created
findings maintain
and
support
of expertise,
the team
The
offer
in this
regard,
have
hypothesis that
member's
absence. between
roles
for example, and
and
have the
relationships.
among
relationships
who
support
a flight
director
NASA among
(supervisor)
decisions. of this
study
a common
indicate ground.
several Another
a useful
approach
ways
in which
important and and particular
at this stage.
issue
is
become
parameters
those among the attending and the are several flight controllers, each with
is how team members detect gaps ground. A simulator study in which may
given
relationship
member
roles
them
one
that and
team
is the
are found,
control? from there
example,
parameters
deeply
about
hypotheses For
during
in mission
area
study.
to certain
more
others
preliminary the
to normal
member
level
inform
to be anomalous
of diagnostic
high
some from
attention
to investigate
specialized
in making
will
continued
team members are different residents; in mission control highly
they
form
of the findings will
anomalous, gone
mention
team to
repair "rifts" in the scenarios can be
a
69
APPENDIX LIST OF CASES
CASE
TYP, E
1
Laminectomy
10 hrs.
1
Cerebral aneurysm clipping Brain tumor
5 hrs
2
5 hrs
Laminectomy
4 1/2 hrs 4 hrs
1 2
2 3 4 5 6
Laminectomy Laminectomy
7
Cerebral
8
clipping Cerebral
LENGTH
RESIDENTS
2
3 hrs
2
aneurysm
6 hrs
2
wound
5 1/2 hrs
infection 9 I0
Laminectomy
2 3/4 hrs
2
Laminectomy
8 hrs
2
,
__
70
BIBLIOGRAPHY
Aaronson,
A. and
protocol study (4), 393-402. Bainbridge,
Carroll,
J. M. (1987).
of intelligent
help.
L. (1987)
Leplat. Sons.
[Eds.]New
Barash,
P. G., Cullen,
Philadelphia, Bentley,
Ironies
of automation.
technology
PA:
The
and
B. F. and
answer
is in the
and
Information
Behavior
human
error.
Stoelting,
Chichester:
R. K. (1993).
view.
In
J. A., Randall,
D., Rodden,T.
C. (1991). Human-centered NASA Technical Memo S. (1990).
Conversation
B. Laurel
lEd.]The
Addison
Wessley.
Cawsey,
A.
Ninth
(1991).
National
Conference
A. (1992).
Cawsey,
A., Galliers,
strategies Chapanis, answers
on
J., Reece,
in collaborative
Chandrasekaran,
and
John
&
Wiley
J.
anesthesia.
(1978).
Interactive
for a technological
and
interaction.
S. and
Jones,
IEEE
the
K. S. (1992). Use
and
MA: The
role [Ed.]
of the
MIT
Press.
of Proceedings
of Knowledge-based
J. (1989).
communication: presented
_'_
Boston:
Systems
Explaining
4 (1).
Paper
I.,
iconoclastic design.
Proceedings
P. Brezillon.
Josephson,
Expert,
explosion.
An
interface
Cambridge,
solving.
human
A concept
explanations.
AAAI-91.
M. C. and
P. Sommerville,
systems design for air Work Proceedings.
manipulation:
AI.
"Improving
solving.
Sawyer,
of human-computer
problem
B., Tanner,
in problem A.
K. Duncan
Clinical
automation:
interactive
Explanation
of the ECAI-92 Workshop. with Explanations."
aircraft 103885. as direct
art
Generating
Cawsey,
explanation
6
Lippincott.
R., Hughes,
Brennan,
A
Technology,
In J. Rasmussen,
and Shapiro, D. (1992). Ethnographically-informed traffic control. Computer-Supported Cooperative November.
Billings, guidelines.
question:
A few
research
at the Annual
control
--
71
Meeting
of the
American
Psychological
Association.
Toronto,
Canada.
(August). Clark,
H. H. and
Resnick,
Brennan,
J. Levine,
Washington
and
DC:
S. Teasley.
American
Clark, Science
H. H. and Schaefer, 13, 259-294.
Clark,
H. H. and
Cognition,
The
communication.
Cognition.
to discourse.
Referring
Report
Coombs,
users
Cognitive
as a collaborative
of cases.
Cognitive
explanation
Studies,
12,
McKeown,
process.
Foushee,
H. C. and
cockpit:
Problems
Cheaney
[Eds.], Technical
Galegher, social and Erlbaum.
and
Systems
technology
Face-to-face
Human
in the
performance
Engineering
Ohio
advisory
in intracockpit Paper
1875).
R. E. and
State
in
Laboratory,
University.
guidance
of university
interactions.
Coordinating
text
3,
and New
Information
International
and
graphics
transfer
communications. transfer
Journal
in
Egido,
Field,
C. [Eds.]
York:
in CA:
the
(1990).
work.
Press.
and
the and
system.
Ames
E. S. _i_
Research
Intellectual
In P. Cole
Academic
aviation
NASA
of cooperative
conversation.
within
In C. E. Billings
problems
Moffett
foundations
Logic
Semantics,
to new publication.
OH:
K. L. (1981).
Information
technological
H. P. (1975).
97-146.
AAAI.
Manos,
J., Kraut,
of
407-429.
K. (1990).
generation.
modality
J. S. (1991).
Columbus,
J. L. (1980).
the
10(2),
for
McDonald,
Alty,
and
Adapting
submitted
II: Characterizing
of Man-Machine S. and
D. D. (1995)
91-TR-03,
M. J. and
computer
of referring
D. D. and
A corpus
Technical
Syntax
Shared
Contributing
Linguistics,
Manuscript
R. I., Woods,
anesthesia:
Grice,
Socially
D. (1986)
pragmatics
Woods,
room.
(NASA Center.
In L.
in communication.
Association.
E. F. (1989)
Computational
R. I. and
operating
Feiner,
[Eds.]
Psychological
Wilkes-Gibbs,
P. (1984).
Cook,
Grounding
22, 1-39.
Cohen,
Cook,
S. E. (1991).
teamwork
Hillsdale,
NJ:
J. Morgan
[Eds.],
-
72
r
Grosz,
B. J. (1981).
Focusing
A. K. Josh.i,
B. L. Webber,
understanding.
Cambridge:
Hasling,
D. W.,
and and
Clancey,
W. J. and
S. and
a process 13,512-521.
in comprehension.
Computer
Clark,
Heritage,
In Antaki,
of methods.,
London:
D. (1990)
Psychological
C.
197
E., Pederson,
performance
analysis.
Electronics
Department. J., Randall, Computer
Hutchins,
Acquiring
new
Learning
and
information Verbal
work,
Johns,
G. (1990)
issues
and
Jordan,
(CSCW)
as accounts:
1, 69-94.
a conversation
Analyzing
everyday
processes
O.M. RISO
and
and
Rasmussen,
National
D. and
analytic
explanation.
causal
A
casebook
explanation.
J. (1981).
Laboratory,
Shapiro,
Cognition
practice. Karsenty, validation
Hillsdale, Graphic
D. (1992)
Notes
Roskilde,
Faltering
Cooperative
Work.
in the wild.
MIT
Mitre
Henderson,
Institute L. and
NJ:
on human Denmark.
from
ethnography
Falzon,
dialogues.
to intelligent
Technical A. (1994).
for Research
to
November. Press,
Cambridge
MA. R. bases
Erlbaum.
interfaces
guidelines.
B. and
as
Behavior,
Hutchins, E. (1990) The technology of team navigation. In J. Galegher, Kraut, and C. Egido [Eds]. Intellectual teamwork: Social and technical cooperative
for
(1).
Supported
E. (1994).
explanation
of Man-Machine
and control: Crisis management underground line control rooms.
Work
lEd.J,
Strategic
Sage.
Bulletin,
design.
new?
In
Press.
Journal
of Verbal
Collaboration in London
Conversational
Hughes,
What's
Journal
Explanations
perspective.
HoUnagel,
(1974).
dialogues.
of discourse
G. (1984).
International
Cooperative
J. (1988).
Hilton,
H.
Luff, P. (1992) technology
Supported
Rennels,
language
Elements
University
system.
Haviland,
in natural [Eds.],
Cambridge
a diagnostic consultation Studies 20, 3-19.
Heath, C. and and multimedia
description
I. A. Sag.
Report. Interaction
on Learning.
P. (1992).
In P. Brezillon.
Spontaneous [Ed.],
fault
management
MTR-90W00103. analysis:
IRL Report
foundations
and
94-0027.
explanations Proceedings
systems: NASA.
in cooperative
of the ECAI-92
of
-
73
Workshop.
"Improving
the
Use
of Knowledge-based
Systems
with
Explanations." Krauss,
R. M. and
environments. Cognition.
Fussell,
In L. Resnick, Washington,
Krauss,
R. M. and
C., Smith,
Development (1), 94-119.
J. Levine
and
S. Teasley
in social
E. and
of Cooperative
in reference
interaction.
explanation
evaluation.
Lewis,
Convention.
Cambridge,
Mass:
D. (1969).
J. and
design
for
Intelligence Malin,
Schreckenghost, intelligent
conditions.
D. (1993).
monitoring
D., Woods,
Forbus, K. (1991) Making And Design Issues. NASA D.
Mastaglio, solving Cognitive McCarthy,
User
Concepts
Cognitive
Science,
as intelligent
15,
Quarterly.
agent: on
35
Press.
Philosophical
Conference
for the
Factors,
University
American
systems.
study.
Human
Harvard
as a
Interface
Artificial
Applications.
(1982).
representation Freeman.
common
and
J., Schreckenghost,
M., and Studies Marr,
Causes
Design
Systems.
Goal-based
Shared
phrases
A preliminary
T. (1994).
Problem-Solving
Socially
Association.
Changes
Bihari,
communicative
[Eds.],
Psychological
S. (1964).
P.J., McCoy,
shared
Leake, D. (1991) 509-545.
Malin,
¸
Constructing
American
of usage 4, 343-346.
Mackie, J. L. (1965). Vol 2 (4).
V
DC:
Weinheimer,
function of frequency Pyschonomic Society, Layton,
S. (1991).
and
T. and systems. Science
Vision:
Reeves,
compuational of visual
B. (1990).
Proceedings Society.
J. C., Miles, ground
A
processing
D., Potter,
July
in text-based
investigation
Twelfth Cambridge,
Monk,
San
the
Annual
_:
Case
human
Francisco:
in cooperative
W.H.
problem
Conference
of the
MA.
A. F. (1991).
communication.
L., Holloway, Players:
into
information.
Explanations
of the 25-28,
V. C. and
S., Johannesen,
Intelligent Systems Team Tech Memo 104738.
CHI
An
experimental
'91. ACM
Press.
study
of
-
74
Miyake,
N.
and
to know what 18, 357-364. Moore,
J. and
Proceedings Intelligence, Moore,
Norman, is not
Swartout,
of the Detroit,
J. and
dialogue. Boston.
W. (1989).
Swartout,
H. and
Norman, and
of the
Royal
(1990).
'problem'
of London,
B 327, Shared
University
Paris,
making
C. (1988).
Computational
models
Report
Pavard,
Tailoring
B., Salembier,
Simulation
CSL
Perrow, C. (1984). York: Basic Books. Pollack, reasoning
object
M., Hirschberg, processes
feedback
Transactions
and
crew
Issue
and
on
decision
accidents:
J. and Webber, of expert
of the
making.
in complex and C. Zsambok
methods.
New
to a user's
level
User
E. and
Modeling),
Benchekroun,
de proces:
Evaluation
Jersey:
systems.
Living
with
B. (1982) Proc.
AAI
high-risk
User
64-78.
T. (1989). de
differentes T5403T,
technologies.
participation
'82, 358-361.
Ablex.
of expertise. 14 (3),
d'Ergonomie, Technical Report ARD-AID des Arts et Metiers, Paris, France.
Normal
AAAI-90.
46. (October).
descriptions
(Special
de la conduite
Laboratoire National
on AI.
Inappropriate
decision making R. Calderwood,
Models
P., de Medeiros,
cognitive
approaches. Conservatoire
in action:
Linguistics
York:
585-593.
Orasanu, J. and Salas, E. (1991) Team environments. In G. Klein, J. Orasanu, [Eds.],Decision
New
in abductive
Conference
Philosophical
mental
Technical
In
Artificial
AAAI-90.
to the moon.
of automation:
enough Behavior,
explanation
on AI.
of coherence
National
'over-automation.'
J. M. (1990).
Princeton
role
Eighth
on
towards
Conference
The race
know Verbal
to explanation.
Conference
A way
Apollo:
must and
approach
National
On the
of the
The
not
Society
Orasanu,
R. (1990).
Proceedings
D.A.
Eighth
one
Learning
Joint
Pointing:
C. B. (1989).
Mooney,
interaction,
a question,
of Verbal
A reactive
W. (1990).
Proceedings
explanation. Boston.
To ask
Journal
Eleventh International MI, August 20-25.
Murray, C. and Cox, Simon and Schuster. Ng,
D. (1979).
known.
in the
New
--
75
Potter,
S. and
message
Woods,
lists
IEEE
International
Potter,
S. and
Conference
Woods,
management: Systems
D. (1991).
and
Engineering
Roth,
Bennett,
M. G.
the
Human
Sacks,
G. and
Placing Factors
H. and
Meeting.
E. (1979).
language:
Studies
N.
and
Woods,
experimental
management Sarter, 37(1),
and
their
awareness
Pilot
Human
The
in the
Journal "How
of
of
York:
with
cockpit
did
we
dontrol.
lEd.J,
automation flight
Psychology,
world
of
Irvington.
of the
of Aviation in the
Proceedings
organization
awareness
in supervisory
27,
In G. Psathas
New
and
with
Studies,
problem
interaction.
interaction
model
interaction
4(1),
get into
Human
1-28.
that Factors.
in press.
Searle,
J. (1992).
Publishing Segal,
L. (1994). for
Ergonomics
Sheridan,
(On)
Searle
on Conversation.
Philadelphia:
John
Benjamins
Co.
information and
of pilots'
D. D. (1995).
error
preferences
and
to
1-2.
in context.
ethnomethodology.
International
Woods,
Mode
in
Two
D. D. (1994). study
system.
N. and
mode?"
M. (1985).
Annual
Schegloff,
interfaces
of Man-Machine
Society--29th
Everyday
II: An
Journal
answers
in conversation
Sarter,
D. D. (1987).
generated
to persons
human
April
computer
reference
fault
Cognitive
94-TR-02.
Building
WA.,
Loftus,
in cooperative displays.
the human interface to support Workshop on Computer-Human
Seattle,
International
of the
Cybernetics.
barriers
Report,
(1990).
Beyond
Proceedings
and
down
I: Designing In CHI "90
K. B., & Woods,
E. M., Butterworth,
explanation:
displays:
information
Technical
Systems.
machine.
Man
Breaking
Shafto,
in Aerospace
an "intelligent" 479-525.
Systems,
Laboratory,
R. W. and
E. M.,
Roth,
interaction.
functional
fault diagnostic expert systems cooperative fault diagnosis. Interaction
timeline
system on
D. (1994).
Temporal
Remington,
Event-driven
in human-intelligent
Actions crew Society
T. (1988).
lEd.J, Handbook Science.
Task
speak
louder
than
communications. 38th
Annual
allocation
of human-computer
words:
How
Proceedings Meeting. and
Oct.
24-28.
supervisory
interaction.
pilots
of the
control. North
use
nonverbal
Human
Factors
Nashville,
TN.
In M. Helander,
Holland:
Elsevier
76
-I
Smith, P., McCoy, E., Orasanu, J.,et al. (1994). Cooperative Problem-Solving the Interactions of Airline Dispatchers with ATCSCC. Cognitive Systems Engineering Columbus
Laboratory OH.
Technical
Sperber, D. and Wilson, Cambridge, Mass: Harvard Stalnaker,
R. C. (1978).
Pragmatics, Suchman,
9.
New
L.
(1987).
D.
York: Plans
Suchman,
L. (1990).
W. Zachary Norwood,
and J. B. Black NJ: Ablex. L. and
reflection
Sutcliffe, and
discourse
situated
[Ed.],
State
Syntax
University,
and
and
cognition.
semantics:
in
28-July
and
practice:
video
as a medium and
human-human
Samos Lab
cooperation.
in groupware
M. A. (1992).
explanation.
Press.
In S. P. Robertson,
Readings
Assisting Kaufmann.
of humanUniversity
computing
Cooper,
1. Research
problem
interaction.
R. lEd.J,
work. Morgan
N.A.M.,
The
Cambridge
Understanding
In Baecker,
structure
Actions: England:
[Eds.],Cognition,
cooperative Mateo, CA:
June
Ohio
Communication
is human-machine
R. (1993).
A. G., Maiden,
Explanation.
In P. Cole
and
What
design.
computer-supported collaboration. San
Relevance. Press.
Cambridge,
Trigg,
and
94-TR-04,
Academic.
communication,
for
(1986). University
Assertion.
machine
Suchman,
Report,
in
Information
Workshop
of Samos,
on
seeking
Task-Based
University
of the
Aegean. Suthers,
D., Woolf,
B. and
to model on AI.
construction
Swartout,
W. R. and
expert
systems.
generation Toulmin, Press.
S. (1958).
Turnball,
W.
resolution.
Moore,
In J.-M.
expert
Everyday for
the
of
Steps
Proceedings
York:
and
explanation
IOth
National
in second
R. Simmons.
planning Conference
generation [Eds.]
Second
Springer°Verlag.
argument.
explanation: Theory
from
of the
Explanation
J.-P. Krivine
New
The uses
M (1992)
J. D. (1993).
David,
systems.
(1986). Journal
Cornell,
dialogues.
of Social
Cambridge:
The
Cambridge
pragmatics
Behaviour,
I6,
of puzzle 141-160.
University
77
v/'
Turnball,
W. and
processes
in causal
Slugoski,
Natural
Explanation.
Weiner,
E. (1989)
transport Research
Woods, behavior Olsen,
Coping
in complex
systems.
Woods,
from
The
Woods,
with
intelligent
directions.
CSEL
Report
D. D. (1993a).
Knowledge-Based
NASA
L., and
Holloway
Vol. The
The price
[Eds].
State
of flexibility
and
and
S.E.
& Francis.
human's
role:
H. Orlady,
[Eds.]
Research
Center,
Ames
1. Trends,
Ohio
of human
Taylor
the
realities,
139-171.
(1991). problems
Human and
new
University.
in intelligent
interfaces.
6, 1-8.
Decision
methods for the In G. A. Klein,
making
in action:
Models
study of cognition J. Orasanu and R. and
methods.
New
Ablex.
Woods,
D. D. (1994).
management: Stanton (Ed.), Woods, error:
Woods,
Cognitive
demands
and
activities
in dynamic
fault
Abductive reasoning and disturbance management. In N. Human factors of alarm design. London:Taylor & Francis.
D. D., Cognitive
Ergonomics
Real and
systems.
on
Ames
II: From
51 (2),
Andersen,
In S. Norman
D. D. (1993b). Process tracing of the experimental laboratory.
Calderwood Jersey:
and
1991-001.
Systems,
H.B. London:
of automation
and
cockpit")
NASA
performance
The psychology
errors.
industries.
CA:
Humain,
Goodstein,
and
S., Johannesen,
interaction
Woods, outside
effects
Promises
D. D., Potter,
Woods,
tasks
non-aviation
Flightdeck automation: Moffett Field CA.
complexity:
In L.P.
models,
D. D. (1989).
Experience
with
("Glass
Field,
human
Le Travail
Science
Press.
technology Moffett
Aiding
systems.
linguistic
Contemporary
University
117528.
E. M. (1988).
to support
Mental
York
and
[Ed.],
of advanced
Report
D. D. (1988). [Eds.],
New
Factors
Roth,
analysis
Conversational
In D. J. Hilton
York:
Technical
D. D. and
cognitive
New Human
aircraft. Center.
Woods,
B. R. (1988).
attribution.
Johannesen, systems,
Information D. D. (in press
L., Cook, computers Analysis
R. I. and and
Center),
a). Decomposing
Complexity. In R. Parasuraman Human Performance, Erlbaum.
Sarter,
hindsight. Dayton
N.
Behind (Crew
human
System
OH.
Automation: and
(1994).
CSERIAC
M. Mouloua,
Apparent editors,
Simplicity, Automation
,!
--
78
Woods, dynamic
D. D. (in press fault
b). The
management.
alarm
problem
and
directed
attention
in
Ergonomics.
Xiao, Y. (1994). Interacting with complex work and a planning model. Unpublished Dissertation. Engineering, University of Toronto.
environments: A field Dept. of Industrial
study
