Do medical students with a disability experience adverse educational outcomes on UK medical courses?

BACKGROUND: International data demonstrate that medical students with disabilities experience differential awarding. One cross-sectional study finds lower graduation rates and scores in written exams, with no impact on clinical exams. Disabled students graduated with lower decile scores. This quantitative, retrospective, longitudinal study explored the impact of disability on exam performance, course performance and course discontinuation. METHOD: Anonymised data were obtained for 1743 students on a UK graduate medical programme from 2011 to present. Statistical tests, including t-tests and one-way ANOVA were conducted for main effects of demographic variables on exam results and categorical outcomes. Regression models established the effects of variables and sub-categories of variables on results and categorical outcomes. RESULTS: Significant main effects of disability on exam scores were identified, as well as failure probability. Regressions showed significant differences in outcomes between different types of disability, with mental health conditions predicting course discontinuation. A significant amplifying effect was found for BAME students with disability. CONCLUSION: Disability had a significant negative impact on all course outcomes, illustrating inequity in medical training and an area of focus for curriculum development. Intersectional data identified a key disadvantaged subgroup of medical students.

'It's a man's world': a gender-equitable scoping review of gender, transportation, and work.

The deeply embedded inequalities in gender which mark most contemporary societies have led to a world shaped by male perspectives. This world fails to accommodate adequately the needs and experiences of women: no more evident than in the transport sector, where a 'default male' perspective dominates the planning and policies that shape our roads, railways, airlines, and shipping. This paper argues that the ways in which masculinity infuses transport systems mean they are integral to debates on gender and work. They impact both the way women experience travel and their access to places of work. A multi-transport domain scoping study has been conducted to review the literature for key gender factors that influence the use of road, rail, aviation, and maritime transport modes. A multi-disciplinary approach is proposed which incorporates perspectives and methods from the social sciences that can help to foster Gender-Equitable Human Factors (GE-HF).Practitioner summary: This paper seeks to identify the gender issues related to transport and work. A scoping review provides key factors that detail how women are disadvantaged by current transport systems. It presents gaps in knowledge that future research needs to fill. Women must be included in key decisions within the transport sector.

Modelling distributed crewing in commercial aircraft with STAMP for a rapid decompression hazard.

Changes to crewing configurations in commercial airlines are likely as a means of reducing operating costs. To consider the safety implications for a distributed crewing configuration, system theoretic accident model and processes (STAMP) was applied to a rapid decompression hazard. High level control structures for current operations and distributed crewing are presented. The CONOPS generated by STAMP-STPA for distributed crewing, and design constraints associated with unsafe control actions (UCAs) are offered to progress in the route to certification for distributed crewing, and improve safety in current operations. Control loops between stakeholders were created using system-theoretic process analysis (STPA). The factors leading to the Helios 255 incident demonstrated the redundancy that a ground station could offer without the risk of hypoxia, during a decompression incident. STPA analysis also highlighted initial UCAs that could occur within the hypothetical distributed crewing configuration, prompting consideration of design constraints and new CONOPS for ground station design. Practitioner Summary: SPO in commercial aircraft is likely as a means to reduce costs. This paper makes a case for distributed crewing using STAMP-STPA. Comparing current operations with a distributed crewing configuration, the redundancy offered by a ground station is demonstrated. Design constraints and new CONOPs for distributed crewing, and current operations are proposed.

Distributed cognition in aviation operations: a gate-to-gate study with implications for distributed crewing.

The network analysis method, Event Analysis of Systemic Teamwork (EAST), was used to examine routine aviation operations from multiple perspectives from six key areas (i.e. Dispatch, ATC, ATM, Maintenance, Loading, and the Cockpit). Data was collected over a five-day observational field trial at an international air cargo operator. Researchers recorded the activities of agents operating within the six key areas over three outbound and two inbound flights. Three networks (i.e. social, information and task) were created for four key phases of flight: (i) pre-flight checks and engines start (ii) taxi, take-off and assent, (iii) descent, landing and taxi, and (iv) park and shut down. The networks represent a 'work audit' of short-haul cargo operations, which enabled a detailed understanding of the interactions and connections within the current system. Implications for the future of distributed crewing concepts are discussed. Practitioner Summary: An analysis of the aviation system was undertaken using the amalgamated data from three outbound and two inbound flights. These analyses show the social, information and task interactions for cargo operations. This has been used to specify requirements for future distributed crewing options.

Combining network analysis with Cognitive Work Analysis: insights into social organisational and cooperation analysis.

Cognitive Work Analysis (CWA) allows complex, sociotechnical systems to be explored in terms of their potential configurations. However, CWA does not explicitly analyse the manner in which person-to-person communication is performed in these configurations. Consequently, the combination of CWA with Social Network Analysis provides a means by which CWA output can be analysed to consider communication structure. The approach is illustrated through a case study of a military planning team. The case study shows how actor-to-actor and actor-to-function mapping can be analysed, in terms of centrality, to produce metrics of system structure under different operating conditions. PRACTITIONER SUMMARY: In this paper, a technique for building social network diagrams from CWA is demonstrated.The approach allows analysts to appreciate the potential impact of organisational structure on a command system.

Training for the safe activation of Automated Vehicles matters: Revealing the benefits of online training to creating glaringly better mental models and behaviour.

Automated Vehicle (AV) systems are expected to reduce the frequency and severity of on-road collisions. Unless drivers have an appropriate mental model for the capabilities and limitations of the automation, they may not activate the automation safely or appropriately on the road, potentially leading to a collision. As such, a training package (L4DTP) was developed to improve drivers' decisions and behaviour when activating an AV system and this was evaluated in a between-subjects simulator experiment. Drivers received no training (NT, control group), read an owner's manual (OM, experimental group 1: current training provision) or underwent the L4DTP (experimental group 2: new training programme). All drivers then experienced five scenarios in a driving simulator where they encountered road conditions which were safe and unsafe for activation. Their activation decisions, behaviour, trust in automation, workload and mental models were measured. This experiment found that drivers who read the OM or underwent the L4DTP made better activation decisions and showed better activation behaviour compared to drivers who received NT. Additionally, drivers who underwent the L4DTP found it easier, less demanding and felt under less time pressure when making their decisions, had to expend less effort to reach the same activation performance and had more appropriate and comprehensive mental models for when the automation can be activated compared to drivers who read the OM. This L4DTP can make roads safer by reducing collisions linked to poor activation decisions and behaviour. Therefore, there is the potential for a real benefit for society if this training programme is adopted into mandatory AV driver training.

A new approach for Training Needs Analysis: A case study using an Automated Vehicle.

Considerable resources are invested each year into training to ensure trainees have the required competencies to safely and effectively perform their tasks/jobs. As such, it is important to develop effective training programmes which target those required competencies. One method that can be used at the start of the training lifecycle to establish the tasks and competencies that are required for a task/job and is considered an important activity to perform when developing a training programme is a Training Needs Analysis (TNA). This article presents a new TNA approach and uses an Automated Vehicle (AV) case study to demonstrate this new approach for a specific AV scenario within the current UK road system. A Hierarchical Task Analysis (HTA) was performed in order to identify the overall goal and tasks that drivers need to perform to operate the AV system safely on the road. This HTA identified 7 main tasks which were decomposed into 26 sub-tasks and 2428 operations. Then, six AV driver training themes from the literature were combined with the Knowledge, Skills and Attitudes (KSA) taxonomy to identify the KSAs that drivers need to perform the tasks, sub-tasks and operations that were identified in the HTA (training needs). This resulted in the identification of over 100 different training needs. This new approach helped to identify more tasks, operations and training needs than previous TNAs which applied the KSA taxonomy alone. As such, a more comprehensive TNA for drivers of the AV system was produced. This can be more easily translated into the development and evaluation of future training programmes for drivers of AV systems.

Models of models: filtering and bias rings in depiction of knowledge structures and their implications for design.

Mental models are poorly specified in three ways: in their defining criteria, their source and the bias to which they have been subjected. Literature from psychology, HCI and human factors sources was reviewed to determine the utility of 'mental models' as a design tool. The definitions and theories offered by key contributors to the notion of mental models were compared. Schematics, representing both the knowledge structures proposed in cognitive processing, as well as the layers of bias evident when forming or accessing mental models, were constructed. Fundamental similarities and differences in the use of this notion, as well as ambiguities in definition, were highlighted graphically. The need for specificity in the use of mental models was emphasised as essential for pragmatic application in design. The use of graphical comparison was proposed as a means of identifying the risk of bias and a means to categorise approaches to mental model research. Practitioner Summary: Mental models are considered significant in user centred design. To apply this notion pragmatically, its definition and methods of construction and access need to be sufficiently specified. This article offers a graphical method to compare existing research in mental models, highlighting similarities, differences and ambiguities.

Promoting passenger behaviour change with provision of occupancy information to help moderate train overcrowding: A cognitive work analysis approach.

Passengers' travel behaviour is one of the significant factors affecting train overcrowding. Train occupancy information has been introduced as a tool to stimulate passengers' behaviour change to ease in-vehicle crowding. However, there are limitations to this strategy as it often fails to consider other elements in the complex rail system that influence behaviour. This research provides insights to service providers to promote passenger behaviour change by revealing the behavioural constraints in the environment. Cognitive Work Analysis (CWA) was applied to systematically analyse passengers' behaviour and related constraints in the environment. Specifically, Work Domain Analysis (WDA) and Social Organisation and Cooperation Analysis (SOCA) were conducted and presented in the forms of Abstraction Hierarchy (AH) and Contextual Activity Template (CAT). Results showed that a wide range of informational, navigational and physical support alongside provision of occupancy information could better encourage passengers to select and use less busy carriages and trains. Behaviour change goals are likely to be achieved more effectively when the constraints of the system are better understood.

A heuristic international glimpse at SARS-CoV-2 effects on work-home equilibrium and women.

This article takes a condensed look at the impact that SARS-CoV-2 has had on the work-life balance of women engineers across the world in industry, military and academia. The same impact has been felt by all women, not only in science, as it is this gender status that inevitably ties women together, facing the same challenges, and cannot be separated by category of employment, or lack thereof. Studies from around the world give us insight into how the pandemic has instigated changes and influenced choices made between work and domestic demands. Globally, women are burdened with challenges that may compromise their progression in male-dominated fields, such as engineering. Taking a glimpse at this issue for women through an international lens, we identify potential human factors methods to respond to this global problem, offering tools and forewarnings for improving our efforts in designing for, and maintaining equilibrium for women in engineering, technology, academia, and beyond.

Breaking the cycle of frustration: Applying Neisser's Perceptual Cycle Model to drivers of semi-autonomous vehicles.

Semi-autonomous cars are already on the road and highly autonomous cars will soon be with us. Little is understood about how drivers will adapt to the changing relationship with their vehicle, but to ensure safety and consumer acceptance, this insight is vital. To this end, an on-road study in a semi-autonomous vehicle was undertaken with six UK drivers. The 'think aloud' technique was employed and video and audio footage of their interaction with the vehicle was captured. Neisser's (1976) Perceptual Cycle Model (PCM) was used to analyse the data and three case studies are presented to highlight how poor synergy between driver and semi-autonomous vehicles can occur from the lens of Schema, Action or World information. Seven key design considerations are proposed to ensure a more positive and safer interaction between driver and autonomous vehicle to guide focus by manufacturers. Further evidence for the existence of a 'counter cycle' (Plant and Stanton, 2015) within the PCM is found and how this relates to the challenges of using verbal protocals expressed during a fast moving dynamic task is discussed.

Mind the gap - Deriving a compatible user mental model of the home heating system to encourage sustainable behaviour.

Householders' behaviour with their home heating systems is a considerable contributor to domestic energy consumption. To create a design specification for the 'scaffolding' needed for sustainable behaviour with home heating controls, Norman's (1986) Gulf of Execution and Evaluation was applied to the home heating system. A Home Heating Design Model (DM) was produced with a home heating expert. Norman's (1986) 7 Stages of Activity were considered to derive a Compatible User Mental Model (CUMM) of a typical Heating System. Considerable variation in the concepts needed at each stage was found. Elements that could be derived from the DM supported stages relating to action specification, execution, perception and interpretation, but many are not communicated in the design of typical heating controls. Stages relating to goals, intentions and evaluation required concepts beyond the DM. A systems view that tackles design for sustainable behaviour from a variety of levels is needed.

Case studies of mental models in home heat control: searching for feedback, valve, timer and switch theories.

An intergroup case study was undertaken to determine if: 1) There exist distinct mental models of home heating function, that differ significantly from the actual functioning of UK heating systems; and 2) Mental models of thermostat function can be categorized according to Kempton's (1986) valve and feedback shared theories, and others from the literature. Distinct, inaccurate mental models of the heating system, as well as thermostat devices in isolation, were described. It was possible to categorise thermostat models by Kempton's (1986) feedback shared theory, but other theories proved ambiguous. Alternate control devices could be categorized by Timer (Norman, 2002) and Switch (Peffer et al., 2011) theories. The need to consider the mental models of the heating system in terms of an integrated set of control devices, and to consider user's goals and expectations of the system benefit, was highlighted. The value of discovering shared theories, and understanding user mental models, of home heating, are discussed with reference to their present day relevance for reducing energy consumption.