Attention (In the Real World)

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Attention (In the Real World)

Medical error is a significant cause of healthcare related harm around the world. Estimates of how common these errors are can be as high as one in ten in-patient episodes. Although the consequences of most of these adverse events are relatively minor, up to one in thirty errors may contribute in some way to a patient’s death.

Situational awareness can be loosely defined as ‘knowing what’s going on’; it means being able to collect relevant information about a situation, integrate that information into a coherent model, and being able to use that model to make decisions. During ‘real-time tasks’, those activities such as piloting an aircraft where the individual must respond to rapidly-changing situations, loss of situational awareness is a well-recognised contributor to a great many accidents.

There are parallels between industries such as aviation and modern healthcare – the environment is complex, time-pressured, and often stressful. Decisions must be made quickly, and the consequences of an incorrect action can be severe. Situational awareness is one aspect of a suite of ‘non-technical skills’ that clinicians are expected to employ to ensure the safety of people under their care.

Experimental Approach

The Brain & Cognition Lab is collaborating with the Oxford Centre for Simulation, Teaching, and Research (OxSTaR) to investigate the well-recognised phenomena of inattentional blindness and change-blindness and how they affect clinicians involved in patient care. We have developed a combination of video-based stimuli along with low- and high-fidelity medical simulation scenarios to determine how attentional focus varies with experience and workload. Medical simulation contributes the controlled environment of a laboratory, whilst maintaining a high degree of realism and thus strong ecological validity.


Most recently we have been inviting healthcare professionals to manage realistic simulations of major medical emergencies whilst tracking their eye movements. The scenarios included events designed to test for inattentional- and change-blindness in real time.

Much of the work that has been done in this field already has been laboratory based, and almost no attention has been paid to these effects in the healthcare environment. We are among the first to look at inattentional- and change-blindness under conditions comparable to real-world clinical practice. Insight from these studies will be of use in designing training interventions to teach teams to collaborate and communicate more effectively, mitigating the effects of perceptual error on situational awareness. These data will also be of use in healthcare workforce planning and determining the optimal composition of emergency teams.

Investigators & Collaborators

The programme of work is being lead by Paul Greig as part of his doctoral studies. Paul is jointly supervised by Helen Higham (NDCN) and Kia Nobre. The Brain & Cognition Lab is collaborating with the Oxford Centre for Simulation, Teaching, and Research (OxSTaR).

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