Brainwaves Research Moves into the Operating Room
This project is a collaboration between Dr. Ron Stevens and Trysha Galloway, the developers of Team Neurodynamics (The Learning Chameleon, Inc.), JUMP Simulation researchers and Dr. Jamie Gorman, an expert in speech analysis from Georgia Tech. Since this work began in 2015, the group has been working to quantitatively model how teams cognitively organize in response to environmental and task changes. This has been achieved by capturing and studying the brainwaves of diverse sets of teams as they work through a simulated scenario.
Collecting Data in a Real Clinical Space Working with a surgical team from the OSF HealthCare Illinois Neurological Institute, Team Neurodynamics outfitted two surgeons, an anesthesia provider and scrub nurse with electroencephalogram (EEG) monitors and collected their brainwaves as they completed a straightforward peroneal nerve dissection, a surgery that reduces the pressure on a nerve located in a person's lower leg. Although the case was uncomplicated, there were some significant problem-solving opportunities that will allow the research team to compare the neurodynamic signatures those moments created in the live OR with comparable moments in a simulated environment.
Teamwork Assessment Using Neurodynamic, Communication, and Observational Measures
We are working with medical teams associated with JUMP Simulation to research teamwork in healthcare settings. The goal is to expand upon established team neurodynamic research of physiologic neurodynamic markers of teamwork to new and expert surgical teams going through simulation.
Fire in the OR! Predicting Team Breakdown
Dr. Stevens and Galloway were recently at Jump for the second round of collecting data. Back in February, wireless EEG headsets were secured to groups of experienced operating room teams. There were two sessions with the experienced teams, each consisting of four individuals from the OSF Saint Francis Medical Center operating rooms. One simulation began in the virtual Operating Room with the anesthesia personnel sedating the patient – one of our high-fidelity manikins – for a standard surgery. After the patient was sedated, the circulating nurse prepped the site of the incision. While this was going on, the scrub tech and surgeon gowned and gloved. After the prep, the patient was draped, and the surgeon began making an incision on a simulated skin plate using an electrocautery unit. Pop! The room was suddenly drenched in darkness as smoke and a flame shot up from the equipment. As the backup lights kicked on, the surgical team quickly evacuated the patient from the OR. The simulation was over. The EEG headsets collected brainwave data the entire time as the physicians and nurses went about the simulation. Now that the Learning Chameleon and Jump have data showing the neurodynamics of experienced health care teams, we've moved on to novice learners. Brainwave data was collected this month from medical students entering their fourth year of study. They were also in a simulated environment, but the scenarios were more in line with their medical education to date. "What we're working on is the ability to study trainees in medical school, from practicing to expert," said Dr. Stevens. "We want to understand how neurodynamic expertise develops, and how these different groups handle these perturbations when they arise. That's really good for theory building."
Montgomery College Innovation Works Forum - How Teams Work, Think, and Feel
The Learning Chameleon in collaboration with Team Results USA has been researching teams in commerce.
Presenters shared the neurodynamic research that helps us understand this topic.
There is such a thing as “too formal.” Some of the more interesting research that has contributed to the STBT is an ongoing DARPA-funded study of submarine teams under stress. Contributing to the emerging science of Team Neurodynamics, a group of UCLA scientists studied the behavior of Submariners at various levels of proficiency in the Submarine Piloting and Navigation (SPAN) trainer. The subjects were outfitted with wireless electroencephalograph (EEG) monitors, enabling the scientists to record the neurological activity of the team throughout the scenario.
The scientists were specifically concerned with something called “NS Entropy,” which basically signifies the flexibility and randomness in a subject’s neurological state—the speed at which thought patterns change. Low entropy suggests a narrow focus, rigidly adhering to a specific set of thought patterns or routines. High entropy suggests a lack of focus and rapidly changing mental states. This is all very fascinating, but what does it have to do with operating a submarine? The findings might surprise you.
The worst-performing teams, those with essentially zero training, were those with the highest entropy levels, suggesting a general lack of structure to the team’s thoughts and behaviors. Only slightly better, though, were teams with rudimentary training, who exhibited the lowest levels of entropy. These teams used formal language and adhered to their procedures, but they were so narrowly focused and rigid that they easily lost focus on the big picture. When something went wrong, the individual team members would all become fixated on the same problem, and it could take 10 minutes or more for the team to reorganize into a functional battle rhythm.
The best-performing teams, composed of experienced submarine piloting parties, exhibited moderate levels of neurological entropy. The scientists called this region of performance the “sweet spot,” which they believe represents a transition point from an optimal state of mental flexibility into randomness. While the inexperienced teams were either too rigid or too random, the experts were fluid, and could quickly communicate concerns and priorities to one another with appropriately varying degrees of formality. When they encountered unexpected problems, the expert teams could quickly deal with them and recover without losing sight of the big picture.
The takeaway from this isn’t that formality is bad for us in high doses, just that it alone will not get us home. The expert teams presumably had to transition through a state of mental and procedural rigidity to achieve a state of fluid proficiency. Part of what made them able to quickly transition between formal reports and procedures to efficient discussions and flexible action is that the formality was well-rehearsed and took very little mental effort to execute.
Staying ‘in the groove’
(An excerpt from the article)
For both teams, focus levels fluctuate during the course of scenarios. Perhaps the quartermaster of the watch is very engaged in something while everyone else’s attention drifts - a situation that, if it persists for a minute or two, could put the sub in danger. The sub team is better able to break out of this discord than the junior officer team, Stevens said. “We’re maybe getting at what ‘in the groove’ looks like, at a cognitive level,” Stevens said. “Everybody can see when a team’s out of groove or out of sync, but they don’t know how they got there. And if they’re out of sync, they don’t know how they’re going to get back in sync.” It takes Stevens’ three-man research team weeks to arrange and analyze the six streams of brain-wave data from the study participants. But as the technology advances and his team discovers quicker functions to calculate engagement levels, Stevens hopes to get that down to minutes, maybe even seconds - in time for an instructor to use it. “I think we’re just at the tip of the iceberg, here,” Stevens said. “Somewhere down the line, I could see metrics being made for trust” or leadership, he said. “You could actually envision a time where there’s this whole library of different cognitive states that would be modeled in real time.”
By Sam Fellman