Cognitive ergonomics

Design strategy
Written By Amruta Ghosalkar

👋🏼

Ever looked around your physician’s room when they are doing your check up? It’s the one indicator of what you have gotten yourself into…

Ergonomics, in most people’s minds is a chair, maybe even a keyboard. The slightly tailored tilted monitor stand get the attentions when someone files a complaint about the neck pain. It is a problem of posture, something you fix with the right furniture and forget about.

Surgical robotics makes this tension impossible to ignore. Robotic assisted surgery was designed to solve a physical problem, the postural strain, repetitive motion and fatigue that accumulate over a career of open and laparoscopic procedures. And in that respect, it delivers. Clinical trials comparing robotics assisted and laparoscopic colorectal retention show that overall cognitive strain was measurably lower in the robotic group, with significant differences in mental demand, physical demand, temporal demand, and situational stress. But reducing physical load does not automatically reduce cognitive load, and in some respects, the robotic interface introduces new cognitive demands that have no equivalent in conventional surgery. Although robotic assisted surgery may reduce physical workload for the surgeon, it has the potential to increase cognitive load, while simultaneously increasing both physical and mental workload for other members of the operating room team. the surgeon at the console is physically separated from the patient, operating through a mediated view, managing multiple arms and instruments through a mediated view, managing multiple arms and instruments through an interface that was designed for precision but not necessarily for the full cognitive reality of a live procedure. The rest of the team, scrub nurses, assistants, anesthesiologist, must now co-ordinate around a system, that has changed the spatial and communicative grammar of the room entirely.

Human factors studies of robotic assisted surgery conducted in a real clinical settings rather than in controlled laboratories, reveal that workflow disruptions occur approximately every 5 to 15 min and that communication and co ordination problems are relatively frequent, suggesting the surgical team may need entierly new verbal and non-verbal protocols to function safely within the robotic environment. These are design gaps that were not built with full sociotechnical system in mind.

Surgeons operating robotic systems frequently experience operational difficulties that introduce additional mental workload, including dealing with unfamiliar equipment interfaces, constant switching between surgical subtasks, multitasking, and increased complexity of human-robot interaction all of which may jeopardize surgical performance and increase the risk of error. The robot arm is precise but the cognitive environment in which surgeon is asked to operate needs to adapt.

The next frontier of cognitive ergonomics in medicine would be systems adapting according to the surgeon’s cognitive load. Real-time monitoring and assessment of intraoperative mental workload fluctuations is emerging as a core capability in robotic assisted surgery. With adaptive systems design to intervene automatically when cognitive load threatens surgical performance and decision making. The machine is no longer simply a tool that responds to input, but a system that reads the operator, anticipates overload and adjusts its own behavior accordingly.

At Stanford University, researchers have developed a cognitive surgical robotic system that combined computer vision with reinforcement learning to analyze intraoperative imaging and adjust surgical trajectories in real time, reducing procedure time significantly while continuously learning from individual surgeons operational patterns and generate personalized surgical strategies. The implications of that are something to sit with!

A system that learns from the person using it, adapts to their cognitive style and improves its own performance in response.

What this moment demands is designer and engineers who understand that the cognitive relationship between clinical and a device a fixed variable but a dynamic, contextual and in deep conscious. The hospital of the next decade will not be won by the most technically precise instruments but it would be a system that carry share of cognitive load, that surface the right information at the right moment, that know when to step back and when to intervene.

Amruta Ghosalkar
Next

Patient Zero: Astronauts