[Shuttle Challenger disaster: what lessons can be learned for management of patients in the operating room?]. / Catastrophe de la navette Challenger: quels enseignements pour la prise en charge des patients au bloc opératoire?

For many years hospitals have been implementing crew resource management (CRM) programs, inspired by the aviation industry, in order to improve patient safety. However, while contributing to improved patient care, CRM programs are controversial because of their limited impact, a decrease in effectiveness over time, and the underinvestment by some caregivers. By analyzing the space shuttle Challenger accident, the objective of this article is to show the potential impact of the professional culture in decision-making processes. In addition, to present an approach by cultural factors which are an essential complement to current CRM programs in order to enhance the safety of care.

A phenomenological approach to novice nurse anesthetists' experience during simulation-based training sessions.

INTRODUCTION: The aim of this study was to present an empirical phenomonological approach to exploring the experience of novice nurse anesthetists engaged in simulation-based training sessions. This study was conducted within the technologic and methodological framework of the course-of-action theory developed by Theureau. METHODS: The following 3 types of data were gathered: (i) field notes, (ii) continuous video recordings of the nurses' behaviors and communications during the simulated scenarios and debriefing sessions, and (iii) verbalization data during the posttraining interviews.The data were processed in 3 steps as follows: (i) generating a log of the simulated scenarios, (ii) reconstructing the individual course of experience of each nurse-participant and for each simulated scenario, and (iii) analyzing its typical components. RESULTS: The nurse-participants' concerns oscillated constantly between those related to the unfolding simulated procedure and those related to the targeted work. We identified 3 types of course of experience and noted a specific effect of the simulation, which was a particular vigilance regarding potential pitfalls and "traps" and a heightened sensitivity to the artificiality of the simulated scenarios. DISCUSSION: The discussion section emphasizes the importance of double or multiple-intentionality and mimetic experience in simulation-based learning and learning in general. We also try to specify the concept of mimetic experience and its relationship to the learning process. We believe that taking into account the dynamics of lived experience during simulations enriches our understanding of what the participants are dealing with inside the simulated scenarios and thereby provide leads to enhance future training sessions. Our results also call attention to the need to distinguish the mimetic environment from the mimetic experience.

Neurobiological degeneracy and affordance perception support functional intra-individual variability of inter-limb coordination during ice climbing.

This study investigated the functional intra-individual movement variability of ice climbers differing in skill level to understand how icefall properties were used by participants as affordances to adapt inter-limb coordination patterns during performance. Seven expert climbers and seven beginners were observed as they climbed a 30 m icefall. Movement and positioning of the left and right hand ice tools, crampons and the climber's pelvis over the first 20 m of the climb were recorded and digitized using video footage from a camera (25 Hz) located perpendicular to the plane of the icefall. Inter-limb coordination, frequency and types of action and vertical axis pelvis displacement exhibited by each climber were analysed for the first five minutes of ascent. Participant perception of climbing affordances was assessed through: (i) calculating the ratio between exploratory movements and performed actions, and (ii), identifying, by self-confrontation interviews, the perceptual variables of environmental properties, which were significant to climbers for their actions. Data revealed that experts used a wider range of upper and lower limb coordination patterns, resulting in the emergence of different types of action and fewer exploratory movements, suggesting that effective holes in the icefall provided affordances to regulate performance. In contrast, beginners displayed lower levels of functional intra-individual variability of motor organization, due to repetitive swinging of ice tools and kicking of crampons to achieve and maintain a deep anchorage, suggesting lack of perceptual attunement and calibration to environmental properties to support climbing performance.

Analysis of elite swimmers' activity during an instrumented protocol.

The aim of this study was to examine swimmers' activity-technical device coupling during an experimental protocol (MAD-system). The study was conducted within a course-of-action theoretical and methodological framework. Two types of data were collected: (a) video recordings and (b) verbalizations during post-protocol interviews. The data were processed in two steps: (a) reconstruction of each swimmer's course of action and (b) comparison of the courses of action. Analysis from the actors' point of view allowed a description of swimmer-technical device coupling. The results showed that the technical device modified the athletes' range of perceptions and repertoire of actions. They also indicated that changes in coupling between the swimmers and the MAD-system were linked to utilization constraints: the swimmers' experiences were transformed in the same speed intervals, suggesting that this was an essential situational constraint to swimmer-technical device coupling. This study highlights how a technical device and the conditions of its use changed athletes' activity and suggests that it is important to develop activity-centred design in sport.