Clarification of expert medical staff behaviors and the internalized knowledge necessary for dealing with situational change during hemodialysis treatment

In clinical hemodialysis, medical staff are expected to adjust or change the contents of operation depending on situational change, i.e. situation awareness and adjustment when the patient is undergoing medical treatment, such as each patient's condition or diseases. On the other hand, the present education of novice staff covers only technical skills, such as procedures of puncture and operation of the hemodialysis device. Staff, therefore, carry out situation awareness and adjustment based on their long-time experience, so novices cannot perform as well as experts. This is one of the educational problems of novice staff during hemodialysis treatment. Therefore, the purpose of this study is to clarify the contents of situation awareness and adjustment that experts use and the internalized knowledge necessary for it. The method was to analyze the differences between experts and novices by observing experts' and novices' performance, and conducting a hearing survey of experts. As a result, this study revealed that experts were able to perform 25 items of situation awareness and adjustment. In order to perform those, experts had internalized knowledge of 69 items related to medical characteristics of each operation, awareness of their own skills, each patient's disease and characteristics of each patient's satisfaction. When a patient is undergoing medical treatment, however, expert staff refer to the checklist which shows the contents of operation less number of times than novice staff. Such behaviors contribute to shortening the time of operation, but we think that staff perform situation awareness and adjustment that is unsuitable for the situation. We believe that methods to educate the novice staff can be improved based on these results, and consequently, medical satety and the quality of hemodialysis treatment can rise.