Information presentation and gaze-following for grounding in simulated anaesthesia emergencies: A multimodal analysis

Abstract

Unanticipated difficult intubation is a relatively common problem anaesthetists face in everyday practice. Algorithms to manage the problem were issued (Japanese Society of Anesthesiologists, 2014), but how anaesthetists actually perceive the problem and respond to the difficulties with other healthcare professionals present is still to be uncovered. Drawing on the concept of resilient healthcare (Hollnagel et al., 2013), which values “how things go well”, this study analysed interactions in simulated emergencies between a less experienced anaesthetist (trainee) and an experienced anaesthetist (trainer). The latter took a role as a nurse and led the scenario of difficult intubation. Five sessions with the same trainer, one of five different trainees and a manikin as a patient were recorded with a 360-degree camera in an operating room at a large teaching hospital in Japan. The data was transcribed and analysed with discourse and multimodal corpus analytic approaches. In the simulated interactions, four phases of grounding (Clark, 1996) were observed in the joint decision-making process between the trainer and the trainee: (1) the trainer’s information presentation with her gaze address at the referent, (2) the trainee’s gaze following and acknowledgement of information reception, (3) the trainer’s prompt for the trainee’s decision-making, and (4) the trainee’s (or trainer’s) giving instruction to manage the difficulty. The trainer presented the patient’s condition and visual/audio information affordable in the environment (e.g., signals on a vital monitor), using verbal and multimodal resources, i.e., gaze address and deictic gestures. The participants as individual sensory agencies were engaged in the embodied process of shared sense-making in the particular context to establish common ground for joint decision-making on immediate actions required.