Situation Awareness – Bridging Neuroscientific and Human Factors/Ergonomics Perspectives and Implications for Clinical Practice
Main Article Content
Abstract
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.
Keywords:
Situation Awareness, Neuroscience, Cognition, Human Factors, Ergonomics, Medical Education, Patient Safety
Article Details
How to Cite
PRINEAS, Stavros.
Situation Awareness – Bridging Neuroscientific and Human Factors/Ergonomics Perspectives and Implications for Clinical Practice.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6457>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6457.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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5. Hughes C, Pain C, Braithwaite J, Hillman K. 'Between the flags': implementing a rapid response system at scale. BMJ Qual Saf 2013; 23(9): 714-7. doi: 10.1136/bmjqs-2014-002845
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7. Ganguly K, Poo M. Activity Dependent Neural Plasticity from Bench to Bedside. Neuron 2013;80: 729-41
8. Agilari E, Aquaro M, Barra A, Fachechi A, Marullo C. From Pavlov Conditioning to Hebbian Learning. Neural Comput 2023; 35(5): 930-57. doi: 10.1162/neco_a_01578
9. Maguire EA, Spiers HJ, Good CD, Hartley T, Frackwiak RS, Burgess N. Navigation expertise and the human hippocampus: a structural brain imaging study. Hippocampus 2003; 13(2): 250-9. doi: 10.1002/hipo.10087
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14. Vatansever D, Menon DK, Emmanuel A. Stamatakis EA. Default mode contributions to automated information processing. Proc Nat Acad Sci 2017; 114 (48): 12821-12826. doi: 10.1073/pna s.1710521114
15. Cisek P. Resynthesizing behavior through phylogenetic refinement. Attent Percept Psychophys. 2019; 81: 2265–2287. doi: 10.3758/s13414-019-01760-1
16. Bennett MS. What Behavioral Abilities Emerged at Key Milestones in Human Brain Evolution? 13 Hypotheses on the 600-Million-Year Phylogenetic History of Human Intelligence. Front Psychol 2021; 12:685853. doi: 10.3389/fpsyg.2021.6 85853
17. Graciano MSA. Rethinking Consciousness – A Scientific Theory of Subjective Experience. WW Norton Pubs. 2019
18. Loeb GE, Fishel JA. Bayesian Action & Perception: Representing the World in the Brain. Front Neurosci. 2014; 8. doi:10.3389/fnins.2014.00 341
19. Nour MM, Nour JM. Perception, Illusions and Bayesian Inference. Psychopathology 2015; 48(4); 217-221. doi: 10.1159/000437271
20. Born RT, Bencomo G. Illusions, Delusions and your Backwards, Bayesian Brain: A Biased Visual Perspective. Brain Behav Evol 2020; 95(5) 272-285. doi:10.1159/000514859
21. Bruckmaier G, Krauss S, Binder K, Hilbet S, Brunner B. Tversky and Kahneman’s Cognitive Illusions: Who Can Solve Them, and Why? Front Psychol 2021; 12. doi: 10.3389/fpsyg.2021.584689
22. Friston K. The history of the future of the Bayesian brain. NeuroImage 2012; 62: 1230-1233 doi:10.1016/j.neuroimage.2011.10.004
23. Hipólito I, Kirchhoff M. Breaking Boundaries: the Bayesian Brain Hypothesis for perception and prediction. Consciousness and Cognition 2023; Available at https://doi.org/10.1016/j.concog.2023.103510
24. von Helmholtz, H. Concerning the perceptions in general, 3rd Ed. Treatise on Physiological Optics, Vol. III (Translated by J. P. C. Southall 1925 of the 1866 manuscript; reprinted New York: Dover, 1962.) Opt Soc Am 1925;26:4.. Available at
https://archive.org/details/helmholtzstreati0003jame/page/338/mode/2up retrieved 27 Mar 2025
25. Sox HC Jr. Probability theory in the use of diagnostic tests. An introduction to critical study of the literature. Ann Intern Med 1986 Jan;104(1):60-6. doi: 10.7326/0003-4819-104-1-60.
26. Krauss S Wang XT. The psychology of the Monty Hall problem: discovering psychological mechanisms for solving a tenacious brain teaser J Exp Psychol Gen 2003 Mar;132(1):3-22. doi: 10.103 7/0096-3445.132.1.3.
27. Simons DJ, Chabris CF. Gorillas in our midst: sustained inattentional blindness for dynamic events. Perception 1999; 28: 1059-1074. doi:10.1068/p28 1059
28. Simons D. Selective Attention Test (video). Available at
https://www.youtube.com/watch?v=vJG698U2Mvo retrieved 16 Mar 2025
29. Quirkology. Colour Changing Card Trick (video). Available at
https://www.youtube.com/watch?v=v3iPrBrGSJM retrieved 16 Mar 2025
30. Potié A, Roelants F, Pospiech A, Momeni M, Watremez C. Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications. Anesthesiol Res Pract 2016:2942416. doi: 10.1155/2016/2942416.
31. Fusco N, Bernard F, Roelants F, Watremez C, Musellec H, Laviolle B, Beloeil H. Hypnosis and communication reduce pain and anxiety in peripheral intravenous cannulation: Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE), a multicentre randomised trial. BJA 2020;124(3):292-298. doi: 10.1016/j.bja.2 019.11.020
32. Slater P, Van-Manen A, Cyna AM. Clinical hypnosis and the anaesthetist: a practical approach. BJA Education 2024; 24(4): 121e128. doi: 10.1016/j.b jae.2024.01.005
33. Klein G. Naturalistic decision making. Hum Factors 2008; 50(3): 456–60. doi:10.1518/0018720 08X288385
34. Klein GA. A recognition-primed decision (RPD) model of rapid decision making. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, editors. Decision making in action: models and methods. Norwood, NJ: Ablex Publishing; 1993; 138–47.
35. Klein G. Sources of Power: How people make decisions. Cambridge (Mass.): MIT Press. 1998
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