Human Factors Training Research Articles

Individual awareness of cyber-security vulnerability - Citizen and public servant

Cyber-security is not concerned so much with average or median vulnerability in an organization. Rather more important is identifying the weakest links. Individual user susceptibility and user behaviour risk assessment are key to measuring the effectiveness of cyber-security awareness programs and policies. Increasingly, it has been demonstrated that managing individual user susceptibility is as critical to organization well-being as maintaining patched IT infrastructure or responding to specific immediate cyber-threat alerts.
 Despite IT systems audits, human factor studies, training courses, user policies, and user documentation, managing user cyber-security awareness remains one of the weakest links in protecting organizations from cyber-threats. Most employees are not aware of the cyber-threats they are most likely to encounter while performing their work. They are susceptible to malicious manipulation (social engineering threats) and they tend not to follow standard procedures (either through ignorance or in attempting to circumvent security procedures to achieve more productivity). Typically, employees only recognize the importance of cyber-security policies and practices after an incident has happened to themselves.
 With the increasing availability and utility of IT network traffic analysis tools and active user behaviour probes (e.g., fake-phishing), employees can be given direct and individual feedback to increase their cyber-security awareness and improve their cyber-security practices. Beyond an organization’s employees, the same holds for a country’s citizens, or a government’s public servants. At their best, these user behaviour monitoring tools can be used in an open and transparent way to increase awareness of individual vulnerability before actual incidents occur.
 In addition to presenting results from the application of user behaviour monitoring tools to cybersecurity, this paper examines the efficacy of the privacy protection safeguards that they incorporate. These results are applied to public sector approaches to: (a) public awareness of citizen cyber-health; (b) securing online pubic services; and (c) public servant awareness of their own vulnerability to cyber-threats.

"Learning in Protected Environment"- Implementation in Continuing Medical Education

Actual concepts in continuing medical education in acute or emergency medicine contain skill training as well as simulation training. Methods and mechanisms to reduce crisis, like human factor training, shared mental models or closed-loop communication are incorporated. It is unknown which training method is optimal for individual departments in hospitals or for the individual level of education of the healthcare provider. A concept we provide is the so called "learning in protected environment": this environment protects the course participants and our patients from negative consequences of a conventional hands-on training. Concurrently the participants benefit from our standardized course concepts. We achieve our goal of an optimal preparation for clinical practice by continuous re-evaluation of the content and educational objects. The implementation of a multimodal team training has to be adopted for each institution individually - methods for an implementation should be standardized. We suggest the use of the "Kern cycle" for a structured approach to curriculum development. On this foundation the combination of "learning in protected environment" and crisis training is optimal to achieve an improved patient safety in acute care.

The Balance Between Safety and Productivity and its Relationship with Human Factors and Safety Awareness and Communication in Aircraft Manufacturing.

BackgroundThis paper presents the findings of a pilot research survey which assessed the degree of balance between safety and productivity, and its relationship with awareness and communication of human factors and safety rules in the aircraft manufacturing environment.MethodsThe study was carried out at two Australian aircraft manufacturing facilities where a Likert-scale questionnaire was administered to a representative sample. The research instrument included topics relevant to the safety and human factors training provided to the target workforce. The answers were processed in overall, and against demographic characteristics of the sample population.ResultsThe workers were sufficiently aware of how human factors and safety rules influence their performance and acknowledged that supervisors had adequately communicated such topics. Safety and productivity seemed equally balanced across the sample. A preference for the former over the latter was associated with a higher awareness about human factors and safety rules, but not linked with safety communication. The size of the facility and the length and type of employment were occasionally correlated with responses to some communication and human factors topics and the equilibrium between productivity and safety.ConclusionAlthough human factors training had been provided and sufficient bidirectional communication was present across the sample, it seems that quality and complexity factors might have influenced the effects of those safety related practices on the safety–productivity balance for specific parts of the population studied. Customization of safety training and communication to specific characteristics of employees may be necessary to achieve the desired outcomes.

Improvement of polytrauma management-quality inspection of a newly introduced course concept.

A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles. The aim of this study was to evaluate the quality of the structure of the course based on course evaluations of participants and its impact on the quality of the process and results for polytrauma care. Single-center retrospective evaluation study (2011 to 2014). It was based on data from simulator training and records from the German Trauma Registry (DGU)®. Subjective evaluation of participants (n=188) of the structure quality of Bonn's shock-room management course was overall positive. Objective measures of course participant performance also improved during simulation training (P=0.012). An increasing number of trained employees also had a positive influence in reducing process time for shock-room care. Further, the course likewise had a positive impact on documentation quality (degree of completion), with regard to 4 relevant predictive parameters. Early mortality during the first 24hours remained constant at 6.0-6.5% between 2011 and 2013, yet it decreased to 3.1% in 2014. The BSM-course® represents a symbiosis of horizontal team approach of trauma care and human factor training. The course format is able to ensure interdisciplinary and interprofessional team training with a high degree of efficiency. Furthermore, the presented work shows that a modern course concept can improve the quality of trauma care.

50 Years of Human Factors Psychology at Texas Tech University

In 1966, the Human Factors Program Psychology of Texas Tech University (TTU) was inaugurated. The program has been accredited by HFES since 2002, when it was one of 14 accredited programs. The panel of former and current faculty (Drs. Halcomb, DeLucia, and Endsley) as well as successful alumni (Drs. Liddell and Chaparro) discusses the development of the program, how training at TTU’s Human Factors Psychology Program prepared graduates for success, provides advice for current students, and also reflects on the challenges and the path for the future for the human factors profession and human factors training.

Incorporating individual differences in human reliability analysis: An extension to the virtual experimental technique

The data required to perform Human Reliability Analysis (HRA) for emergency conditions are not readily available and are difficult to retrieve from accident investigations. In the absence of emergency conditions data, the conventional approach of gathering data for HRA is using expert judgment. Expert judgment often suffers from uncertainty, subjectivity, and incompleteness, which makes the reliability of this data collection technique questionable. A more recent approach is to collect data by conducting experiment in virtual environments with human subjects. Though virtual experimental technique addresses the issues of uncertainty, subjectivity, and incompleteness, it still does not consider individual differences while assigning the influence of different factors on human performance. This paper proposes to advance the virtual experimental technique by enabling the consideration of individual differences. An experiment using virtual environment was done to observe performances of 36 individuals during offshore emergency evacuation. By integrating the data collected from the virtual environment into an HRA model, the reliability of each individual was assessed. Sensitivity analysis was then performed to identify the most influential factors that contributed to failure in emergency conditions. This analysis can help identify specific weaknesses that a participant might have. For example, if a participant is found to be more sensitive to a particular factor, then training scenarios with different variations of the factor can be provided to the participant until an accepted level of competency is reached. Identification of a weakness can be combined with adaptive human factor training so that each individual can obtain competence more quickly.

Safety culture in orthopedics and trauma surgery : Course concept: interpersonal competence by the German Society for Orthopaedics and Trauma (DGOU) and Lufthansa Aviation Training

Patient safety has become acentral and measurable key factor in the routine daily medical practice. The human factor plays a decisive role in safety culture and has moved into focus regarding the reduction of treatment errors and undesired critical incidents. Nonetheless, the systematic training in communication and interpersonal competences has so far only played aminor role. The German Society of Orthopaedics and Trauma (DGOU) in cooperation with the Lufthansa Aviation Training initiated acourse system for interpersonal competence. Several studies confirmed the reduction of critical incidents and costs after implementation of a regular and targeted human factor training. The interpersonal competence should be an essential component of specialist training within the framework of a 3‑column model.

Patient safety: reducing the risk of wrong tooth extraction.

Over recent years there has been an increased emphasis on improving patient safety in all branches of medicine, with reducing wrong tooth extraction being a priority in dentistry. The true incidence of wrong tooth extraction is unknown but it is considered an avoidable harm and is a significant source of dental litigation. Interventions to reduce wrong tooth extraction include educational programmes encompassing human factor training, patient assisted identification, the use of checklists, marking of surgical sites and implementation of patient safety guidelines. Identified risk factors which make wrong tooth extraction more likely include; suboptimal checks and/or cross checking of relevant clinical information, unclear diagnosis, unclear documentation, ambiguity regarding notation of molar teeth, orthodontic extractions, and extractions where there are multiple carious teeth and extractions in the mixed dentition. Accurate and timely reporting of wrong tooth extraction incidents followed by analysis and sharing of findings together with implementation of improved practice will help to minimise risks of wrong tooth extraction.

Feasibility of Human Factors Immersive Simulation Training in Ophthalmology: The London Pilot.

Human factors training can enhance teamworking and reduce error. It is used regularly in certain medical disciplines, but its use has not been established for ophthalmology to our knowledge. To explore the feasibility of providing immersive simulation human factors training for ophthalmic surgical teams. Prospective scenario-based simulation and concept description at University College London Hospital and Moorfields Eye Hospital, London, England, from December 12, 2013, to March 13, 2014. At both sites, fully immersive simulated operating theater environments were used, comprising live interactive communication with patients and theater staff, full anesthetic and operating facilities, replicated patient notes, active vital signs, and the ability to contact surgical or anesthetic teams outside of the theater via telephone. Participants were consultant (attending) and trainee ophthalmic surgeons and anesthetists, operating department assistants and practitioners, and ophthalmic nursing staff. The following 4 previously validated rating tools for nontechnical skills were applied to a replicated series of scenarios based on actual patient safety incidents at Moorfields Eye Hospital and in the literature: Observational Teamwork Assessment for Surgery (OTAS), Non-Technical Skills Scale (NOTECHS), Anesthetists' Non-Technical Skills (ANTS), and Non-Technical Skills for Surgeons (NOTSS). The Pearson product moment correlation coefficient was calculated for each pair of scoring tools. Intertool and interassessor reliability was established. Interassessor consistency was compared by calculating a normalized standard deviation of scores for each tool across all assessors. Twenty simulation scenarios, including wrong intraocular lens implantation, wrong eye operation, wrong drug administration, and wrong patient, were provided. The intertool correlations were 0.732 (95% CI, 0.271-0.919; P = .01) for NOTECHS vs ANTS, 0.922 (95% CI, 0.814-0.968; P < .001) for NOTSS vs ANTS, 0.850 (95% CI, 0.475-0.964; P < .001) for OTAS vs ANTS, 0.812 (95% CI, 0.153-0.971; P = .03) for OTAS vs NOTECHS, 0.716 (95% CI, -0.079 to 0.955; P = .07) for OTAS vs NOTSS, and 0.516 (95% CI, -0.020 to 0.822; P = .06) for NOTECHS vs NOTSS. The normalized standard deviations of scores obtained using each tool across all assessors were 0.024 (95% CI, 0.014-0.091) for NOTSS, 0.060 (95% CI, 0.034-0.225) for OTAS, 0.068 (95% CI, 0.041-0.194) for ANTS, and 0.072 (95% CI, 0.043-0.206) for NOTECHS. This study describes the feasibility of a high-fidelity immersive simulation course specifically for ophthalmic surgical teams. The ANTS and NOTSS had the highest intertool and interrater consistency, respectively. Human factors simulation in ophthalmology offers a new method of teaching team members, with the potential to reduce serious ophthalmic patient safety events. Further work will define its usefulness and practical applications.

Interprofessional Learning - Development and Implementation of Joint Medical Emergency Team Trainings for Medical and Nursing Students at Universitätsmedizin Greifswald.

Introduction: Interprofessional collaboration is of great importance in clinical practice, particularly in the field of emergency medicine. The professions involved in providing emergency care must work hand in hand, and tasks and routines must be coordinated effectively. However, medical and nursing students have only few opportunities to experience interprofessional cooperation during their formal training. Addressing this situation, the Department of Anesthesiology and the Vocational School of Greifswald University Medical School initiated a project to increase patient safety by integrating interprofessional human factor training into the curriculum of both health professions. This manuscript addresses how an interprofessional course module focusing on clinical emergency medicine can be taught with an emphasis on competency and problem-solving. In addition, it was important to identify suitable instruments for systematic quality development and assurance of this teaching and learning format.Project description: The aim of the project, which took place from October 2013 to September 2015, was the development, implementation and evaluation of a simulation-based, interprofessional course module on clinical emergency medicine. Target groups were medical and nursing students. Modern pedagogical models and methods were applied to the design and teaching of the course content. The project was carried out in separate phases: definition, planning, practical implementation, evaluation and documentation. The project was accompanied by systematic quality development. Established guidelines for quality-centered school development were applied to quality development, assurance and evaluation.Results: Over two years, a 16 credit-hour course module was developed and then taught and evaluated during the 2014 and 2015 summer semesters. A total of 120 medical students and 120 nursing students participated in the course module. Eighteen teachers from medicine and nursing were trained as instructors and assisted by 12 student tutors. Regular evaluations focused on different aspects of the project, using instruments for empirical educational research. Excellent ratings given to the course by the attendees indicate a high degree of satisfaction in both participating professions regarding course design and content, as well as the quality of teaching.Discussion: In a position paper, the GMA committee on Interprofessional Education in Health Professions issued recommendations for interprofessional education. The recommendations given for teaching and quality assurance are drawn upon here, and relevant examples from the course concept presented.Conclusion: The design of the course corresponds to the recommendations of the GMA committee on Interprofessional Education in the Health Professions. Based on these, and considering the satisfactory evaluations, both continuation and further development of this interprofessional teaching format are justified.

Simulator Training in Interventional Cardiology

Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.

Using simulation to train orthopaedic trainees in non-technical skills: A pilot study.

To enhance non-technical skills and to analyse participant's experience of a course tailored for orthopaedic surgeons. A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants' feedback on the value and quality of the course itself. Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the course achieved its intended aims with realistic simulation scenarios. Participants believed patient care, patient safety and team working would all improve with further human factors training (4.4-4.6). and felt that NT skills learnt through simulation-based training should become an integral component of their training program. Participants demonstrated improved understanding of non-technical performance, recognised its relevance to patient safety and expressed a desire for its integration in training.

Simulator Training in Interventional Cardiology.

Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.

Pilots' Visual Scan Patterns and Attention Distribution During the Pursuit of a Dynamic Target.

The current research was to investigate pilots' visual scan patterns in order to assess attention distribution during air-to-air maneuvers. A total of 30 qualified mission-ready fighter pilots participated in this research. Eye movement data were collected by a portable head-mounted eye-tracking device, combined with a jet fighter simulator. To complete the task, pilots had to search for, pursue, and lock on a moving target while performing air-to-air tasks. There were significant differences in pilots' saccade duration (ms) in three operating phases, including searching (M = 241, SD = 332), pursuing (M = 311, SD = 392), and lock-on (M = 191, SD = 226). Also, there were significant differences in pilots' pupil sizes (pixel(2)), of which the lock-on phase was the largest (M = 27,237, SD = 6457), followed by pursuit (M = 26,232, SD = 6070), then searching (M = 25,858, SD = 6137). Furthermore, there were significant differences between expert and novice pilots in the percentage of fixation on the head-up display (HUD), time spent looking outside the cockpit, and the performance of situational awareness (SA). Experienced pilots have better SA performance and paid more attention to the HUD, but focused less outside the cockpit when compared with novice pilots. Furthermore, pilots with better SA performance exhibited a smaller pupil size during the operational phase of lock on while pursuing a dynamic target. Understanding pilots' visual scan patterns and attention distribution are beneficial to the design of interface displays in the cockpit and in developing human factors training syllabi to improve the safety of flight operations.

Training in human factors needs to be standardised

Anne Gulland looks at research examining the importance of providing doctors with standardised and explicit training in non-technical skills

Innovative teaching in situational awareness.

In the UK the publication of the Health Select Committee Report highlighted the need to incorporate human factors training in health care education. In response there has been a rise in health care professional training in human factors, focusing on non-technical skills, such as teamwork, leadership and situational awareness. Using simulation and contextualised learning, we have developed a non-technical skills programme for undergraduate medical students that introduces situational awareness training in the first year. Early integration of human factors into the undergraduate programme can be built upon in a constructivist approach throughout the undergraduate curriculum. Initially no formal ethical approval was required as this was an integral part of the undergraduate teaching programme and did not involve patients; however, ethical approval was gained for the analyses of this session from the local University Research Ethics Committee. Approval included the information sheets and consent forms provided to students, which permitted use of data 'in future posters/publications/presentations'. Students were introduced to hazards and cues that they may find in clinical areas, encouraged to explore the simulated clinical areas gathering information, interpret their findings and then consider future states. There has been a rise in health care professional training in human factors, focusing on non-technical skills Initial feedback from both the students and the tutors involved has been positive. In addition, the opportunity for linking this to other non-technical skills developments in different clinical settings and in interprofessional settings is being considered. The next stage is to explore students' perceptions of this session and their learning through questionnaires and focus-group interviews before developing further.

PWE-423 Human factors training (hft) through simulation based scenarios in endoscopic haemostasis improves teamworking

Introduction In the early 1970s, number of air crashes were attributed to human error. HFT is well recognised for improving safety in aviation. Medical errors rank high amongst the leading causes of death and HFT is increasingly been recognised to reduce errors in CPR and anaesthetics. The value of HFT in endoscopy has not been evaluated. Method We delivered haemostasis and HFT to Gastroenterology Specialty trainee Registrars (StRs) at Lancashire simulation centre. A computer-based life-sized manikin with human physiology emulation capability was used. Its vital signs were controlled remotely. The manikin could talk and was connected to ECG, Pulse rate, SpO2 and BP monitor. Endoscopy equipment and porcine stomach models were used. Haemostatic methods including adrenaline injection, haemoclip placement, Haemospray, Sengstaken tube and Danis stent insertion were practiced. Introductory presentations on Human factors were delivered. 4 scenarios were written to provide ‘high-stress/high-stakes’ events that are encountered infrequently, but where rapid and professional responses are crucial i.e. patients with an upper GI bleed developing periarrest whilst in endoscopy unit. Each scenario involving 5 to 6 StRs was facilitated by Gastroenterologists and Simulation skills educators. Feedback was provided by peer observation. Microteaching was delivered using video assisted debrief. Pre and post course feedback was obtained. Results 23 StRs attended. Prior to this course 55% StRs have had no HFT, 14% had self directed learning, 9% received lectures and 22% had formal workshop based HFT. Data analysis showed improvement in all areas of Human Factor: decision making, situational awareness, team working and leadership skills. On the Likert scale (1 strongly disagree, 5 strongly agree) StRs felt scenarios were useful (Median 5, IQR 1), amount of information was appropriate (Median 5, IQR 1) and hands on training was useful (Median 5, IQR 1). StRs reported increased awareness of managing acutely ill patients in relation to sedation issues (Median 4, IQR 2), principles of resuscitation and fluid management (Median 4, IQR 2), improved leadership, teamwork and communication (Median 5, IQR 1). Qualitative feedback was positive. StRs however recommended smaller groups in future courses. 90% StRs felt that training on Human Factors and their influence on patient safety should be compulsory. Conclusion Human patient simulation provides ‘real life’ environment to observe Human Factors and allows chance to debrief, something that is difficult in the busy workplace. StRs benefit from HFT and report improvement in their skills. We recommend that HFT in endoscopy should be incorporated in competency based training curriculum and rolled out nationally. Disclosure of interest None Declared.

‘Sorry, I meant the patient's left side’: impact of distraction on left-right discrimination

Medical students can have difficulty in distinguishing left from right. Many infamous medical errors have occurred when a procedure has been performed on the wrong side, such as in the removal of the wrong kidney. Clinicians encounter many distractions during their work. There is limited information on how these affect performance. Using a neuropsychological paradigm, we aim to elucidate the impacts of different types of distraction on left-right (LR) discrimination ability. Medical students were recruited to a study with four arms: (i) control arm (no distraction); (ii) auditory distraction arm (continuous ambient ward noise); (iii) cognitive distraction arm (interruptions with clinical cognitive tasks), and (iv) auditory and cognitive distraction arm. Participants' LR discrimination ability was measured using the validated Bergen Left-Right Discrimination Test (BLRDT). Multivariate analysis of variance was used to analyse the impacts of the different forms of distraction on participants' performance on the BLRDT. Additional analyses looked at effects of demographics on performance and correlated participants' self-perceived LR discrimination ability and their actual performance. A total of 234 students were recruited. Cognitive distraction had a greater negative impact on BLRDT performance than auditory distraction. Combined auditory and cognitive distraction had a negative impact on performance, but only in the most difficult LR task was this negative impact found to be significantly greater than that of cognitive distraction alone. There was a significant medium-sized correlation between perceived LR discrimination ability and actual overall BLRDT performance. Distraction has a significant impact on performance and multifaceted approaches are required to reduce LR errors. Educationally, greater emphasis on the linking of theory and clinical application is required to support patient safety and human factor training in medical school curricula. Distraction has the potential to impair an individual's ability to make accurate LR decisions and students should be trained from undergraduate level to be mindful of this.

The human factor and simulator training for offshore anchor handling operators

At the Offshore Simulator Centre, Aalesund, Norway, anchor handling simulators have been built and simulator training courses have been developed over the last years. These courses have been offered to companies operating anchor handling vessels. The learning objectives of the course are improving teambuilding, leadership and communication. A total of 369 seafarers who attended the course participated in the study. With few exceptions, the participants in the sample were male. Their mean age was 36years, and 48% were officers. Fully 90% of the sample had more than one year of experience with anchor handling operations. Results indicate that 64% of the variation in practical change intended behaviour (outcome variable) was explained by increased skills, increased knowledge and understanding, and content of the course. Furthermore, overall satisfaction with the course was analysed using ANOVA, with age, occupation and anchor handling experience as independent variables. The implications are addressed, and it is concluded that the methods show great promise for practical applications, particularly in the development and improvement of content and pedagogical approaches.

Integrating human factors training into safety management and risk management: A case study from aviation maintenance

Aviation is facing the challenge of integrating new regulatory requirements on safety management systems with a range of existing processes addressing human factors in line with regulations. This article presents an approach to using mandated human factors continuation training as a tool for risk management within the safety management system. A three-phase blended learning programme was designed to address identified human and organisational hazards within the operation, to enhance knowledge and application of risk management strategies, and to build a stronger safety culture within the operation. The article outlines how the programme is designed to address regulatory, organisational and pedagogical requirements. The ‘Wobbly Steps’ concept, which is elaborated in this article, is used as a central metaphor for conveying the link between organisational resources and individual risky behaviours or unsafe acts. The training programme is embedded in an evaluation process designed to guide the effective design, development and delivery of the programme as well as assessing the impact of the training on the safety culture and performance of the operation.