No abstract

Teamwork is important in medicine, and this includes team-based diagnoses. The influence of communication on diagnostic accuracy in an ambiguous situation was investigated in an emergency medical simulation. The situation was ambiguous in that some of the patient's symptoms suggested a wrong diagnosis. Of 20 groups of physicians, 6 diagnosed the patient, 8 diagnosed with help, and 6 missed the diagnosis. Based on models of decision making, we hypothesized that accurate diagnosis is more likely if groups (a) consider more information, (b) display more explicit reasoning, and (c) talk to the room. The latter two hypotheses were supported. Additional analyses revealed that physicians often failed to report pivotal information after reading in the patient chart. This behavior suggested to the group that the chart contained no critical information. Corresponding to a transactive memory process, this process results in what we call illusory transactive memory. The plausible but incorrect diagnosis implied that the two lungs should sound differently. Despite objectively identical sounds, some physicians did hear a difference, indicating confirmation bias. Training physicians in explicit reasoning could enhance diagnostic accuracy.

Information overload (IO) indicates the exchange of too much low-quality information in virtual teams. When being overloaded with information, teams need to adapt and to change communication behaviour. This study introduces and tests a structured online team adaptation (STROTA) procedure that enables virtual teams to reduce IO by improving their team mental model quality. STROTA, built from team adaptation models, is a moderated intervention consisting of three stages: (1) individual situation awareness, (2) team situation awareness, and (3) plan formulation. STROTA was tested in the context of an experimental problem-solving task. Participants (N = 363) worked in virtual teams of three and were randomly assigned to one of four experimental conditions: no STROTA, incomplete STROTA (step 1, steps 1-2), and complete STROTA (steps 1-2-3). We found teams that followed a complete STROTA procedure experienced lessened IO over time. Teams with complete STROTA showed the largest development of TMM immediately after STROTA. Finally, multilevel mediation analyses showed that TMM are mediators that explain the influence of STROTA on IO.

A prospective 2-month trial involving 617 respiratory tract specimens was conducted to compare sensitivity, specificity, and predictive values of the newly developed Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test kit (AMTDT; Gen-Probe, Inc., San Diego, Calif.) for the rapid detection of Mycobacterium tuberculosis and of fluorescent acid-fast staining versus combined BACTEC 12B and solid-medium cultures as the "gold standard." A total of 590 specimens were culture and AMTDT negative. Twenty-one (3.4%) cultures yielded M. tuberculosis. Of these, 15 (71.4%) were detected by AMTDT, whereas 6 (28.6%) were missed. M. tuberculosis did not grow in six (28.6%) of AMTDT-positive specimens derived from three patients under treatment for tuberculosis. AMTDT exhibited a sensitivity, a specificity, a negative predictive value, and a positive predictive value of 71.4, 99, 99, and 71.4%, respectively. In comparison, the same values for fluorescent microscopy were 66.7, 98.3, 98.8, and 58.3%, respectively. AMTDT was easy to perform and highly specific. However, a screening test would require an improved sensitivity and, when feasible, the implementation of an internal amplification control.

The relationship of task adaptive behavior (TAB) to performance was studied in 31 computer supported groups using a simulated air traffic control task. Each person could access information on specific plane parameters. Based on messages from two specialists, the commanders assigned threat levels to planes that moved in the airspace. Groups worked on two different days. Shifts 1 to 3 (Day 1) and 4 to 6 (Day 2) were compared. Based on a hierarchical task analysis, measures of TAB were developed to assess conformity to specific task requirements beyond general process variables. As hypothesized, TAB predicted performance better than general process variables. The hypothesis that basic task mastery was a better predictor of performance on Day 1 and more sophisticated TAB on Day 2 was supported for two of the three TAB measures. Results underscore the fruitfulness of assessing behaviors specifically adapted to task requirements, and of observations over longer periods of time.