Elicitation of risk perception strategies in emergency rooms based on KYT technique and eye tracking stimulated retrospections

In the present paper, we aim at eliciting risk perception strategies from medical doctors and nurses in emergency rooms (ERs). In the research processes, a series of cognitive task analyses including an effective debriefing procedure aided by eye movement recordings as well as eye movement data interpretation scheme are developed to identify individual risk perception strategy and its characteristics. To uncover the cognitive processes performed to find risks/hazards in an ER, we adopt KYT (KIKEN YOCHI Training, hazard prediction training in English) technique. In this technique, examples of various photos found in an ER (e.g., photos in which doctors are caring a patient moved by an ambulance) are shown to a medical staff. By seeing the photos, he/she is asked to explain what are risks, hazards, and potential issues. We record his/her eye movements to analyze his/her risk perception processes. In addition, we use the data as cues to verbalize his/her cognitive processes to obtain elaborated information regarding hidden cognitive processes.A series of KYT-styled experiments in which 15 medical doctors majoring in emergency and critical care medicine and 14 nurses participated were carried out. Six photos were shown to each participant. The photos were taken at ER/ICU in Tokyo Medical and Dental University Hospital. The participant was asked to see the photo based on the assumption that he/she see it in his/her daily working conditions, and what he/she would do in the given situations. Additionally, we asked him/her whether he/she found something relating to hazards/risk. During seeing photos, the participant’s eye movements were recorded. Immediately afterwards, an interview where eye tracking recordings were used as cues to verbalize the participant’s implicit cognitive/perceptional processes during seeing was conducted.Based on the verbal protocols obtained in the interview session, each participant’s cognitive/perceptual processes were carefully traced. In addition, the areas/objects to which most of attention (i.e., more than 80% of time spent) were paid in photos were clearly identified for each participant. From these results, we could find that the exist clear difference between doctors and nurses in risk perception strategies. Medical doctors tended to focus their attention mainly on information sources related to a patient’s vital signs. Nurses, on the other hand, seemed to pay their attention not only to vital signs, but also to information sources related to patient’s mental situation (e.g., a patient’s face to know his/her hidden needs) and other medical staffs to know the status of workloads. Based on all results as well as implications obtained, we discuss insights relating to effective medical care teams composed by doctors, nurses, and other co-medical staffs.