Xu Jie, Slagle Jason M, Banerjee Arna, Bracken Bethany, Weinger Matthew B
Faculty of Science, Center for Psychological Sciences, Zhejiang University, Hangzhou, China.
Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States.
Front Hum Neurosci. 2019 Mar 5;13:85. doi: 10.3389/fnhum.2019.00085. eCollection 2019.
The aim of this study was to investigate the utilization of a portable functional near-infrared spectroscopy (fNIRS) system, the fNIRS Pioneer, to examine team experience in high-fidelity simulation-based crisis event management (CEM) training for anesthesiologists in operating rooms. Effective evaluation of team performance and experience in CEM simulations is essential for healthcare training and research. Neurophysiological measures with wearable devices can provide useful indicators of team experience to compliment traditional self-report, observer ratings, and behavioral performance measures. fNIRS measured brain blood oxygenation levels and neural synchrony can be used as indicators of workload and team engagement, which is vital for optimal team performance. Thirty-three anesthesiologists, who were attending CEM training in two-person teams, participated in this study. The participants varied in their expertise level and the simulation scenarios varied in difficulty level. The oxygenated and de-oxygenated hemoglobin (HbO and HbR) levels in the participants' prefrontal cortex were derived from data recorded by a portable one-channel fNIRS system worn by all participants throughout CEM training. Team neural synchrony was measured by HbO/HbR wavelet transformation coherence (WTC). Observer-rated workload and self-reported workload and mood were also collected. At the individual level, the pattern of HbR level corresponded to changes of workload for the individuals in different roles during different phases of a scenario; but this was not the case for HbO level. Thus, HbR level may be a better indicator for individual workload in the studied setting. However, HbR level was insensitive to differences in scenario difficulty and did not correlate with observer-rated or self-reported workload. At the team level, high levels of HbO and HbR WTC were observed during active teamwork. Furthermore, HbO WTC was sensitive to levels of scenario difficulty. This study showed that it was feasible to use a portable fNIRS system to study workload and team engagement in high-fidelity clinical simulations. However, more work is needed to establish the sensitivity, reliability, and validity of fNIRS measures as indicators of team experience.
本研究的目的是调查便携式功能近红外光谱（fNIRS）系统fNIRS Pioneer在手术室中针对麻醉医生的基于高保真模拟的危机事件管理（CEM）培训中对团队体验的检测情况。有效评估CEM模拟中的团队表现和体验对于医疗培训和研究至关重要。使用可穿戴设备进行的神经生理学测量可以提供团队体验的有用指标，以补充传统的自我报告、观察者评分和行为表现测量。fNIRS测量的脑血氧水平和神经同步性可用作工作量和团队参与度的指标，这对最佳团队表现至关重要。33名以两人一组参加CEM培训的麻醉医生参与了本研究。参与者的专业水平各不相同，模拟场景的难度也各不相同。参与者前额叶皮层的氧合血红蛋白和脱氧血红蛋白（HbO和HbR）水平来自于在整个CEM培训过程中所有参与者佩戴的便携式单通道fNIRS系统记录的数据。团队神经同步性通过HbO/HbR小波变换相干性（WTC）进行测量。还收集了观察者评定的工作量、自我报告的工作量和情绪。在个体层面，HbR水平模式与不同场景阶段不同角色个体的工作量变化相对应；但HbO水平并非如此。因此，在本研究环境中，HbR水平可能是个体工作量的更好指标。然而，HbR水平对场景难度差异不敏感，且与观察者评定或自我报告的工作量无关。在团队层面，在积极的团队协作过程中观察到高水平的HbO和HbR WTC。此外，HbO WTC对场景难度水平敏感。本研究表明，使用便携式fNIRS系统研究高保真临床模拟中的工作量和团队参与度是可行的。然而，需要更多工作来确立fNIRS测量作为团队体验指标的敏感性、可靠性和有效性。
