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Cover -- Contents -- List of Figures -- List of Contributors -- Preface -- 1 Cues in Diagnostic Reasoning -- The Basis of Cues -- Cues and Causality -- Cues and the Cognitive Miser -- Cues and Diagnosis -- Conclusion -- 2 Situational Awareness and Diagnosis -- Diagnostic Reasoning -- Situational Awareness -- An Alternative View of Situational Awareness -- Cognitive Engineering -- Conclusion -- 3 Communication and Diagnostic Cues -- Communication Breakdowns in Aviation: Causes and Consequences -- Communication, Misunderstanding, and Non-Understanding -- Communications Protocols: Accident Prevention -- Hearing but Not Seeing Speech: Prosodic Cues as Indicators of Non-Understanding -- 'World Englishes' in the Flying Tower of Babel: Linguistic Diversity and Communication Errors -- Conclusion -- 4 Vigilance, Diagnosis, and its Impact on Operator Performance -- Evolutionary Context -- Sustained Attention -- Conclusion -- 5 Designing for Diagnostic Cues -- Changing the Modality of Cues -- Miscueing and Poorly Differentiated Cues -- Designs and Incorrect Relationships -- Alarm Floods -- Feature Design Options -- Abstract or Iconic Features -- Conclusion -- 6 The Social Context of Diagnosis -- The NDM Context -- Emotion and Decision-Making -- Mood and Diagnosis in NDM Settings -- Conclusion -- 7 Diagnosis and Instructional Systems Design -- The Nature of Cue-Based Learning -- Approaches to Cue-Based Training -- When to Implement Cue-Based Learning -- Developing a Learning Environment for Cue-Based Associations -- Diagnostic Cues and Skill Acquisition -- Conclusion -- 8 Diagnostic Cues in Medicine -- Diagnosis and Clinical Decisions in Healthcare -- Diagnostic Challenges in the Hospital Environment -- Expert versus Competent, Non-Expert Clinicians -- Signature Cues and Cue-Matching Amongst Medical Experts -- Conclusion.

Objective This study was designed to examine whether cue utilization differentiates drivers' consumption of cognitive resources during a simulated driving task. Background Outcomes from previous research have demonstrated that a general capacity for cue utilization differentiates cognitive load during novel process control tasks. However, it was previously unclear whether similar results would be demonstrated during familiar operational tasks. Method Based on an assessment of cue utilization within a driving context, participants were classified into higher or lower cue utilization typologies. During a simulated driving task, cognitive load was assessed through changes against baseline in cerebral oxygenation in the prefrontal cortex, through eye behavior metrics (fixation rates and fixation dispersion), and through driving performance (frequency of missed traffic signals and speed exceedances). Results Drivers with higher cue utilization recorded smaller mean fixation dispersions, smaller increases in cerebral oxygenation, and fewer missed traffic signals compared with drivers with lower cue utilization. These results suggest that compared with drivers with lower cue utilization, drivers with higher cue utilization experienced lower cognitive load during the simulated driving task while maintaining a higher level of performance. Conclusion The results provide support for the assertion that, among qualified operators, a greater capacity for cue utilization is associated with lower cognitive load during operational tasks. Application Cue-based assessments of driving may be beneficial in predicting performance and assisting in targeted training for recently qualified and/or older drivers.

Objective: This research was designed to examine the impact of heuristic-based approaches to the acquisition of task-related information on the selection of an optimal alternative during simulated in-flight decision making. Background: The work integrated features of naturalistic and normative decision making and strategies of information acquisition within a computer-based, decision support framework. Method: The study comprised two phases, the first of which involved familiarizing pilots with three different heuristic-based strategies of information acquisition: frequency, elimination by aspects, and majority of confirming decisions. The second stage enabled participants to choose one of the three strategies of information acquisition to resolve a fourth (choice) scenario. Results: The results indicated that task-oriented experience, rather than the information acquisition strategies, predicted the selection of the optimal alternative. It was also evident that of the three strategies available, the elimination by aspects information acquisition strategy was preferred by most participants. Conclusion: It was concluded that task-oriented experience, rather than the process of information acquisition, predicted task accuracy during the decision-making task. It was also concluded that pilots have a preference for one particular approach to information acquisition. Application: Applications of outcomes of this research include the development of decision support systems that adapt to the information-processing capabilities and preferences of users.

Objective: The present study sought to examine the utility of a self-report tool that was designed as a partial substitute for a face-to-face cognitive interview for critical incidents involving night vision goggles (NVGs). Background: The use of NVGs remains problematic within the military environment, as these devices have been identified as a factor in a significant proportion of aircraft accidents and incidents. The self-report tool was structured to identify some of the cognitive features of human performance that were associated with critical incidents involving NVGs. The tool incorporated a number of different levels of analysis, ranging from specific behavioral responses to broader cognitive constructs. Method: Reports were received from 30 active pilots within the Australian Army using the NVG Critical Incident Assessment Tool (NVGCIAT). Results: The results revealed a correspondence between specific types of NVG-related errors and elements of the Human Factors Analysis and Classification System (HFACS). In addition, uncertainty emerged as a significant factor associated with the critical incidents that were recalled by operators. Conclusion: These results were broadly consistent with previous research and provide some support for the utility of subjective assessment tools as a means of extracting critical incident-related data when face-to-face cognitive interviews are not possible. Application: In some circumstances, the NVGCIAT might be regarded as a substitute cognitive interview protocol with some level of diagnosticity.

Objective: To examine whether differences in water safety–related cue utilization might be associated with differences in exposure to water-related recreational contexts. Background: A disproportionate number of incidents of drowning were attributable to recent visitors to New South Wales in the 2016–2017 summer swimming season. This was due to their assumed lack of exposure to the water-related recreational settings in which Australians engage and therefore, the absence of cues that are associated with danger. Method: In Study 1, the water safety cue utilization of 101 Australian residents and 328 recent visitors to the country was compared using the Expert Intensive Skills Evaluation (EXPERTise 2.0) program. Accounting for differences between the samples, Australian residents demonstrated significantly superior water safety cue utilization. In Study 2, the water safety cue utilization of a sample of 219 Australian residents was examined, the outcomes of which indicated that those participants who learned to swim before the age of 11 years demonstrated superior water safety cue utilization to participants who learned to swim at a later age. Results: Overall, the results suggest that there are individual differences in water safety cue utilization that are explained, in part, by differences in country of residence and the age at which participants first learned to swim. Conclusion: Water safety cue utilization is likely to be dependent upon exposure to water-related activities. Identifying individual differences enables the development of more targeted, drowning-prevention strategies.

Objective To examine the role of cue utilization in the management of interruptions during a high workload, rail control simulation. Background High-risk, high-consequence environments are characterized by cognitively demanding, time-critical activities, in which operators are required to manage frequent interruptions under conditions of high workload. Interruptions are deleterious to performance as they impose excessive cognitive demand on limited working memory resources, thereby depleting residual resources for the primary task. Cue utilization may enable superior performance in managing interruptions through efficiencies gained by the application of implicit patterns stored in long-term memory. Method Two experiments were conducted. In Experiment 1, 46 university students undertook an assessment of cue utilization and subsequently engaged in a high workload, simulated rail control task while managing multiple interruptive tasks. Experiment 2 replicated and extended Experiment 1, wherein 52 university students completed a measure of cue utilization and engaged in a high workload, simulated rail control task while managing multiple interruptions and breaks. Results The analyses revealed that participants who demonstrated a greater capacity for cue utilization also demonstrated a reduced loss of performance following interruptions. Conclusion The outcomes suggest a relationship between a greater capacity for cue utilization and superior performance in the management of interruptions in high workload conditions. Application Assessments of cue utilization may assist in the selection and training of operators in high-consequence, high-risk environments, to ensure efficient and accurate performance during the management of interruptions.

Objective: To examine whether social cue utilization impacts the performance of ad hoc dyads through its relationship with closing the loop, a communication process whereby team members respond more frequently to initiating statements made by others. Background: There lacks unequivocal experimental evidence for any single cognitive-based process that might predict the performance of ad hoc teams. Method: Using a quasi-experimental design, 80 participants were classified into 40 dyads based on their levels of social cue utilization and attempted a team problem-solving task. A serial mediation model revealed an indirect effect of social cue utilization on the performance of ad hoc dyads through closing the loop. Results: Analyses indicated that social cue utilization impacts on the performance of ad hoc dyads independently of nonverbal reasoning ability and emotional intelligence. Further, the level of social cue utilization within dyads exhibits a positive indirect impact on the performance of ad hoc dyads through closing the loop. Conclusion: Ad hoc dyads with higher levels of social cue utilization engaged in a greater frequency of closing-the-loop statements and showed better subsequent performance on a problem-solving task in comparison to dyads with lower levels of social cue utilization. Application: Potential applications include the optimization of ad hoc team composition within high reliability environments like aviation and power control as well as improving training interventions with a specific mechanism for improving the performance of ad hoc teams.

Objective: The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of firefighting. Background: Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Method: Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. Results: The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. Conclusion: It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Application: Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Objective:The present study investigated whether performance across a range of cue-based cognitive tasks differentiated the diagnostic performance of power control operators into three distinct groups, characteristic of novice, competence, and expertise.Background:Despite its increasing importance in the contemporary workplace, there is little understanding of the cognitive processes that distinguish novice, competent, and expert performance in the context of remote diagnosis. However, recent evidence suggests that cue acquisition and utilization may represent a mechanism by which the transition from novice to expertise occurs.Method:The study involved the application of four distinct cue-based tasks within the context of power system control. A total of 65 controllers, encompassing a range of industry experience, completed the tasks as part of an in-service training program.Results:Using a cluster analysis, it was possible to extract three distinct groups of operators on the basis of their performance in the cue-based tasks, and these groups corresponded to differences in diagnostic performance.Conclusion:The results indicate assessments of the capacity to extract and utilize cues were able to distinguish expert from competent practitioners in the context of power control.Application:Assessments of the capacity to extract and utilize cues may be used in the future to distinguish expert from nonexpert practitioners, particularly in the context of remote diagnosis.

Children's Hospital at Westmead, Sydney, Australia Objective: The authors describe the development of a new, more objective method of distinguishing experienced competent nonexpert from expert practitioners within pediatric intensive care. Background: Expert performance involves the acquisition and use of refined feature-event associations (cues) in the operational environment. Competent nonexperts, although experienced, possess rudimentary cue associations in memory. Thus, they cannot respond as efficiently or as reliably as their expert counterparts, particularly when key diagnostic information is unavail- able, such as that provided by dynamic cues. Method: This study involved the application of four distinct tasks in which the use of relevant cues could be expected to increase both the accuracy and the efficiency of diagnostic performance. These tasks included both static and dynamic stimuli that were varied systematically. A total of 50 experienced pediatric intensive staff took part in the study. Results: The sample clustered into two levels across the tasks: Participants who performed at a consistently high level throughout the four tasks were labeled experts, and participants who performed at a lower level throughout the tasks were labeled competent nonexperts. The groups differed in their responses to the diagnostic scenarios presented in two of the tasks and their ability to maintain performance in the absence of dynamic features. Conclusion: Experienced pediatricians can be decomposed into two groups on the basis of their capacity to acquire and use cues; these groups differ in their diagnostic accuracy and in their ability to maintain performance in the absence of dynamic features. Application: The tasks may be used to identify practitioners who are failing to acquire expertise at a rate consistent with their experience, position, or training. This information may be used to guide targeted training efforts.

Objective: An experiment investigated the efficacy of auditory icons as warning signals in an aviation context. Background: Iconic signals, such as a cough to signal dangerous levels of carbon monoxide, convey information about the nature of an incident and alert the operator that there is a problem, whereas signals that are arbitrarily associated with a critical incident provide relatively less information. Warning recognition speed and accuracy are likely to be influenced by modality of presentation (visual, auditory, auditory + visual) and task demand (low, high). Methods: The 172 participants completed a computer-based training session and test task that involved responding to abstract or iconic auditory (1 s), visual, or auditory + visual warnings associated with seven critical incidents while performing low- and high-demand concurrent tasks. Results: Significantly fewer training trials were required to learn iconic warnings than abstract warnings. An advantage for iconic warnings persisted into the test phase, evident most consistently as greater warning recognition accuracy. The effect was observed in both high- and low-demand conditions. Auditory abstract warnings, in particular, elicited slow reaction times and poor accuracy. Conclusion: Associations between a small number of meaningful environmental sounds and critical incidents can be learned with ease relative to more abstract associations, although training is required and response times are relatively slow. Application: Sets of distinctive auditory iconic warnings can be designed to alert and inform pilots about non-time-pressured events. Potential applications of language-neutral icons as informative warnings include civil, commercial, and defense aircraft.

Objective The purpose of this meta-analytic review is to examine the relationship between increased psychological pressure and Use of Force (UOF) behaviours, identifying current training methodologies and effectiveness of transfer of training interventions in high threat-simulated scenarios. Background Data from UOF performance within Law Enforcement indicates a low transfer of marksmanship training into real-world UOF, resulting in unnecessary damage to property, personal injury and increased risk to loss of life. This meta-analysis examines both the impact of increased pressure and current training interventions. Method A meta-analysis was conducted across a wide range of published research to answer the primary research questions. Results Increased levels of perceived pressure demonstrated an average decrease in marksmanship accuracy of 14.8%, together with a small increase in incorrect Decision Making (DM) and faster reaction Times (RT). Experience demonstrated a mitigating effect for pressure for marksmanship with a 1.1% increase for every one year of service but no effect on DM or RT. Training interventions utilizing a variety of early contextually relevant exposures to increased pressure improved performance over traditional training on average by 10.6%. Conclusion The outcomes illustrate the negative effect of pressure on marksmanship and UOF behaviours, and that early exposure to contextually relevant pressure may increase the transfer of training to real-world performance. Application Occupational experience is an important component in reducing the impact of pressure on UOF performance, and transfer of training may be enhanced through training methodologies that combine early exposure to contextually relevant pressure, that may replicate the benefits of experience.

Objective This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology. Background Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance. Method Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance. Results Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization ( p = .01). Conclusion This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task. Application Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature–event relationships and internalize these associations in the form of cues in memory.

Objective This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task. Background Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information. Method Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills. Results Behavioral indicators of higher or lower cue utilization were based on the participants' performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases. Conclusion This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists. Application Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases.