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Individual Markers of Resilience in Train Traffic Control: The Role of Operators' Goals and Strategic Mental Models and Implications for Variation, Expertise, and Performance.

ABSTRACT: The aim of this study was to examine individual markers of resilience and obtain quantitative insights into the understanding and the implications of variation and expertise levels in train traffic operators' goals and strategic mental models and their impact on performance.The Dutch railways are one of the world's most heavy utilized railway networks and have been identified to be weak in system and organizational resilience.Twenty-two train traffic controllers enacted two scenarios in a human-in-the-loop simulator. Their experience, goals, strategic mental models, and performance were assessed through questionnaires and simulator logs. Goals were operationalized through performance indicators and strategic mental models through train completion strategies.A variation was found between operators for both self-reported primary performance indicators and completion strategies. Further, the primary goal of only 14% of the operators reflected the primary organizational goal (i.e., arrival punctuality). An incongruence was also found between train traffic controllers' self-reported performance indicators and objective performance in a more disrupted condition. The level of experience tends to affect performance differently.There is a gap between primary organizational goals and preferred individual goals. Further, the relative strong diversity in primary operator goals and strategic mental models indicates weak resilience at the individual level.With recent and upcoming large-scale changes throughout the sociotechnical space of the railway infrastructure organization, the findings are useful to facilitate future railway traffic control and the development of a resilient system.

SUBMITTER: Lo JC

PROVIDER: S-EPMC4766964 | biostudies-other | 2016 Feb

REPOSITORIES: biostudies-other

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Project description:BackgroundThyroid nodule image reporting and data systems (TIRADS) provide the indications for fine-needle aspiration (FNA) based on a combination of nodule sonographic features and size. We compared the TIRADS-based recommendations for FNA with those based on the personal expertise of qualified US investigators in the diagnosis of thyroid malignancy.MethodsSeven highly experienced ultrasound (US) investigators from 4 countries evaluated, online, the US video recordings of 123 histologically verified thyroid nodules. Technical resources provided the operators with a diagnostic approach close to the real-world practice. Altogether, 4,305 TIRADS scores were computed. The combined diagnostic potential of TIRADS (TIRSYS) and the personal recommendations of the investigators (PERS) were compared against 3 possible goals: to recognize all malignant lesions (allCA), nonpapillary plus non-pT1 papillary cancers (nPnT1PCA), or stage II-IV cancers (st2-4CA).ResultsFor allCA and nPnT1PCA, TIRSYS had lower sensitivity than PERS (69.8 vs. 87.2 and 83.5 vs. 92.6%, respectively, p <0.01), while in st2-4CA the sensitivities were the same (99.1 vs. 98.6% and TIRSYS vs. PERS, respectively). TIRSYS had a higher specificity than PERS in all 3 types of cancers (p < 0.001). PERS recommended FNA in a similar proportion of lesions smaller or larger than 1 cm (76.9 vs. 82.7%; ns).ConclusionsRecommendations for FNA based on the investigators' US expertise demonstrated a better sensitivity for thyroid cancer in the 2 best prognostic groups, while TIRADS methodology showed superior specificity over the full prognostic range of cancers. Thus, personal experience provided more accurate diagnoses of malignancy, missing a lower number of small thyroid cancers, but the TIRADS approach resulted in a similar accuracy for the diagnosis of potentially aggressive lesions while sparing a relevant number of FNAs. Until it is not clearly stated what the goal of the US evaluation is, that is to diagnose all or only clinically relevant thyroid cancers, it cannot be determined whether one diagnostic approach is superior to the other for recommending FNA.

Project description:IntroductionMental health specialists (MHS, or 68X) play a central role in meeting the growing demand for combat stress care among Service Members. Partnering with civilian institutions may enhance the MHS training experience beyond Advanced Individual Training (AIT).MethodsWe describe a novel military-civilian collaboration to train U.S. Army Reserve MHS's in the psychiatric emergency service (PES) of a public, safety-net hospital. Details of implementation are described. The training rotation was evaluated after 1 year through a comprehensive chart abstraction of patients seen as well as surveys of MHS's and civilian partners.ResultsThe roles of MHS and physician officers in this rotation are described. Over 9 days in the PES, the MHS team evaluated 26 patients. MHS's described a high-quality training environment (83% rated very good or excellent) in which they frequently saw high-risk patients relevant to military practice. Experience with a certain patient presentation was correlated with comfort assessing and managing that presentation (p < 0.01). Many civilian staff (40%) felt the PES operated better with the presence of the Army team and 50% of civilians agreed their impression of the U.S. Army Reserve improved as a result of the partnership. Hundred percent of specialists and 80% of civilians reported very good to excellent rapport between military and civilian staff. Two civilian respondents (11%) expressed concern that the military team's presence impeded patient care.ConclusionThis is the first military-civilian training collaboration for behavioral health specialists, who have already completed AIT. This program provided well-received and mission-relevant training for MHS's without notable adverse effects on patient care or team functioning in a civilian environment. Our findings are based on a small sample size, and no other such programs exist against which to compare these results. We propose that such educational partnerships, which have long been effective for other clinical specialists, may benefit the military, civilian communities, and the country.

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Individual Markers of Resilience in Train Traffic Control: The Role of Operators' Goals and Strategic Mental Models and Implications for Variation, Expertise, and Performance.

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