Situation Awareness – Bridging Neuroscientific and Human Factors/Ergonomics Perspectives and Implications for Clinical Practice

A key challenge for clinicians is to make sufficient sense of what is happening around them to anticipate what might happen next and take timely action. This review article examines the theoretical basis of Situation Awareness (SA) - defined by Endsley as “the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning and a projection of their status in the near future” (SA Levels I, II and III respectively) – and its relevance to clinical practice. SA is fundamental to good decision-making, and in turn to safe and effective human performance. Traditional models of clinical history taking / examination / investigation / diagnosis / prognosis align with the basic components of SA and can be further refined when viewed through the prism of SA, and its scope further extended by incorporating psychological, neurocognitive and statistical (Bayesian) perspectives.

Stress, fatigue and environmental noise/distractions can significantly impair SA, while other factors can significantly improve it. Experts experience a different perceptual world to novices, and techniques that may accelerate the acquisition of expert clinical SA (e.g. deliberate reflection, simulation, ergonomic environmental design etc.) could be beneficial to clinical practice. Moreover one can distinguish individual SA from ‘shared’ and ‘team’ SA, where specific communication, teamworking and leadership skills become relevant. Clinical emergencies and crises usually entail greater urgency, ambiguity, volatility and uncertainty, and impose a greater challenge on clinicians to form adequate SA in real time. Examples of SA in everyday clinical practice and the extent to which SA can be improved by adapting the clinician (through training) and/or adapting the work environment (through workplace/organisational design) are discussed.