Sometimes called “checklists”, we think of cognitive aids in medicine as structured pieces of information designed to enhance cognition and adherence to medical best practices. The format of the information in a cognitive aid can be as simple as a piece of paper with a written reminder, to something as complicated as an interactive and dynamically-changing computer-driven interface.
The goal of our Stanford AIM Lab research group is to explore how to best design and measure the impact of the use of cognitive aids in medicine. We are focusing our initial efforts on high-stakes medical interventions that we believe would most likely benefit from aiding cognition: critical events in medicine.
The Design Process
The design process for our static cognitive aids starts with a pen and a piece of paper. Our medical team then works on identifying key aspects of medical management that are important for medical cognition during a crisis. They start by using their intution and medical judgement, and refine the process through feedback among their peers and members of their team.
The medical content is then transfered to a design schematic where the information is prioritized by importance using design features to highlight tasks and assist users in the process of critical thinking during a crisis. Once the aid is designed, it goes through a final round of review by our group of advisors. We take their feedback and suggestions and finalize the design for publication online.
Once the design is published on the CogAIDS website, it becomes an online proof upon which people can place comments and suggestions for improvement. To learn more about our post-hoc publication review process, click here.
The design process for our interactive cognitive aids is a bit more complex and we will work on providing a detailed explanation of this process in the future. Our collaborators in the human-computer interaction group at Stanford have done a pretty good job of explaining the process on their website, iCogAids.
Measuring Impact: The Evaluation and Medical Cognition Process
Once a cognitive aid is developed, our team then works to evaluate the aid in the real clinical environment during stressed and non-stressed situations. Copies of the cognitive aid are given to physicians working routine cases in the operating rooms to review during non-critical times. We then solicit feedback from these physicians about how the aids might be improved.
Our team also uses high-fidelity simulation of a medical crisis to evaluate how doctors use the cognitive aids during stressed situations. By observing not only the frequency of cognitive aid use, but also how they are used in a crisis, we can better understand the medical cognition process during critical events in medicine and improve the ability of our aids to support cognition during these times.
Our team has also deployed low-fidelity simulation through our collaboration with the human-computer interaction group at Stanford to rapidly assess different design prototypes and how they may impact use by physicians during critical events in medicine.1