Hybrid Cognition in medical simulation: Investigating micro-level organisational cognition

Taking a starting point in research on non-technical skills (e.g., collaboration and situation awareness), this article focuses on organisational practices that aim at improving patient safety and interprofessional collaboration in a Danish medical context. Our data come from a simulation facility at a Danish hospital, which offers courses in Interprofessional Education to promote an organisational vision of patient-centered care. Specifically, we study a course for novice nurses and doctors, which teaches a standard procedure for conducting discharge conversations.
We investigate how practitioners engage in top-down procedures on the interactional microlevel in the simulated medical ecology. Our central claim is that to benefit from simulation-based learning, practitioners must conduct hybrid cognition, where they simultaneously engage in the simulated sphere of the medical task environment and the educational sphere of the training environment. Using methods grounded in cognitive ethnography, we investigate the practitioners’ ways of organizing experience (via Cognitive Task Analysis), and how they coordinate their behavior in the in-situ simulation (via Cognitive Event Analysis). These investigations allow us to assess how the practitioners use (or fail to use) organizational procedures, and how that affects the attainment of the course goals of training relational skills.
The article suggests that it is not sufficient to employ procedures in order to improve organisational behavior and relational skills, but in simulation-based learning practitioners must learn to conduct hybrid cognition that is sensitive to the multi-scalar dynamics in interactions.