Lecture 4 'Interuptions'

Question 1

What is prospective memory and its four types?

Answer 1

remembering to perform an act in the future (“remembering to remember”)

1. Time based… ‘at 2pm’
2. Event based… ‘when the doctor arrives’
3. Habitually based… ‘after cleaning, check filter’
4. Resumption from interruption… ‘what was i doing?’

Question 2

Pilots forgetting to set flaps for take off and a surgeon forgetting to remove forceps from a patient are both what type of examples?

Answer 2

naturalistic examples of failed prospective memory

Question 3

According to Einstein and McDaniel (1990), what do interruptions create?

Answer 3

prospective memory tasks

Question 4

According to Einstein and McDaniel in Dismukes (2012), what are the two processes of the multiprocess view of related to prospective memory?

Answer 4

> Bottom up = An automatic process reflexively restores intentions to consciousness (probability of retrieval depends on task and cognitive state)

> Top down = Individuals may unconsciously/consciously be able to maintain a preparatory state

Question 5

According to Altmann & Trafton’s (2003) activation-based account (memory for goals), activation of a memory item depends on what?

Answer 5

the frequency of use and associations with context

activation of original task is maintained during an interruption

Question 6

(Q. 76) What is the relationship between (1) the phenomenon of interruptions and distractions and (2)
theories of prospective memory?

Answer 6

Theories of prospective memory propose factors that may influence the effectiveness of
memory for intentions and memory for the status of an interrupted tas

Question 7

(Q. 77) According to reviews such as Grundgeiger and Sanderson (2009) and Hopkinson and Jennings
(2012) what is the evidence to date on a relationship between interruptions in healthcare and the
presence of clinical error?

Answer 7

Associations have been demonstrated between interruptions and error but few if any causal relationships

Question 8

(Q. 78) What was the main finding of the Westbrook et al. (2010) study on interruptions in healthcare?

Answer 8

Each successive interruption was associated with a 12% increase in the likelihood of procedural failures and clinical errors.

Question 9

(Q. 79) What type of experiment was the stimulator study performed by Trbovich et al. (2010) on interventions that might reduce interruptions in healthcare contexts?

Answer 9

It was a pre-post quasi experiment

Question 10

(Q. 80) What four interventions were tested by Trbovich et al. (2010) in their simulator study
of distractions and interruptions in healthcare?

Answer 10

Verification booths
Visual timers
Signage
Motion sensor lamp

Question 11

What are the three predictions made by Altmann and Trafton (2003) about the availability of goals to memory at resumption?

Answer 11

1. The longer the interruption, the more disruptive
2. If a goal is rehearsed (during interruption lag or interruption) its activation increases
3. Environmental cues prime memory for the goal

Question 12

What four factors influence the disruptiveness of interruptions?

Include HOW each factor influences disruptiveness: HARD BONUS QUESTION

Answer 12

1. length of interruption
   - {longer resumption lag}
2. opportunity for rehearsal
   - {interruption lag used to encode in memory the goal they should do on resumption}
3. environmental cue or reminder on resumption
   - {needs to be strong to work}
4. interruptions can speed up original task performance
   - {steps immediately after the resumption lag can be faster than average due to perceptual speed up}

Question 13

According to sanderson, interruption-handling was affected by what four influences?

Answer 13

1 > stage of interruption
2 > strategies available to handle demands
3 > properties of situation
4 > individual differences

Question 14

In healthcare context:

What is the most common source of interruptions?

Who is most at risk for making errors?

Who is the focus placed on?

Doctors may ____/____/_____ interrupted task.

Literature has dubbed this a _________ problem.

Answer 14

What is the most common source of interruptions?
> OTHER STAFF

Who is most at risk for making errors?
> PHONE CALL MANAGEMENT

Who is the focus placed on?
>INTERRUPTEE (not interupter)

Doctors may
>HURRY / DELAY / NOT RESUME interrupted task.

Literature considers this a
> PROSPECTIVE MEMORY problem.

Question 15

Flynn et al (1999) found that interrupted pharmacists made what kind of errors?

Answer 15

more medication/dosage errors

Question 16

In Prakash, Trbovich (2015) pre-post quasi lab study on the effects of four interventions on interruption and distraction management, what were the results?

Answer 16

> Better performance after intervention
1- less likely to engage with interruption or multitask
2- fewer interruptions happened
3- fewer failures to detect errors
4- fewer errors committed

Question 17

According to a study by Liu, et al (2009) what was the difference between anesthetists who engaged in distractions/interruptions compared to those who multi-tasked, deferred or blocked them?

Answer 17

The two who engaged in distractions/interruptions were the only ones who made errors (forgot to check blood)

Question 18

According to the distraction/interruption-management strategy, how does engaging compare to deferring or blocking on the likelihood of recognizing an safety critical event?

Answer 18

Engaging = more likely to miss safety critical event

Defer/Block = more likely to notice safety critical event

Question 19

HMD with near-focus may promote “_______” of attention to forward field of view; and promote perceptual and cognitive “______” of peripheral events

Answer 19

narrowing

neglect

Question 20

Loft (2015)’s submarine situation awareness experiment had participants interrupted for 20 seconds while completing an essay writing task. What was the study design, its measures and findings?

Answer 20

> Within-subjects (2 interruption/none x2 low/high load)

> SPAM and NASA-TLX measures

> Interrupted results:

• slower reaction in contact engagement task
• lower accuracy in heading change task
• slower reaction in low/high task load conditions

Question 21

In Loft’s (2015) submarine distraction/interruption experiment, answers on the measure of situation awareness SPAM, were less ______ and became ________ with interruptions

Answer 21

less accurate

slower

Question 22

Foroughi et al (2014) had participants interrupted every 3mins during the preparatory phase or the execution phase or not at all in a 12min essay writing task. What were the findings?

Answer 22

Essay quality judged by independent raters

> QUALITY = worse in both interrupted conditions compared to control
QUANTITY of words = less in interrupted execution (but not planning)

*Best work in no-interruptions

Question 23

Foroughi et al (2014)’s follow up experiment interrupted participants at random intervals (vs not at all) during the preparatory/execution phase of an essay writing task. What were the findings and author’s explanation?

Answer 23

> QUALITY = worse in both interruption conditions compared to control
QUANTITY of words = less in interrupted execution (but not planning)

> Potential reason = interruptions cause disruptions in train of thought > leads to reduced amount of words > leads to lower-quality essay

Question 24

By interrupting participants completing a reading comprehension task with math tasks, Foroughi (2015) found that participants in which interruption conditions did better in a reading comprehension test

Answer 24

Participants’ word recognition was not affected by interruptions (whereas, comprehension was)

• interruptions did NOT cause a disruption in memory for goals in this case

Question 25

True or False: A causal relationship between interruptions and “errors” has been proven.

Answer 25

FALSE! We only have associations

Question 26

Can interruptions be a good thing for the interrupted person?

Answer 26

Yes!

Question 27

Introducing a new policy in healthcare that prohibits clinicians from being interrupted will likely have unintended consequences

Answer 27

TRUE!

Question 28

Interruptions impose a kind of _________ and disrupt what?

Answer 28

prospective memory task

disrupt memory for goals