How Do Endoscopists Maintain Situation Awareness

Disorientation is common for endoscopists performing colonoscopy. The objectives of this study were to examine how endoscopists acquire and maintain spatial awareness or situation awareness (SA), and how SA varies as a function of available perceptual cues, and as a function of the different segments of the colon. Retrospective analysis of verbal protocols from 11 colonoscopy procedures was conducted for evidence of spatial disorientation, assessment of situation and problemsolving. Analysis of verbal data revealed that the perceptual cues used for SA maintenance in colonoscopy are unreliable (i.e., anatomical landmarks are variable and ambiguous), giving rise to uncertainty in situational assessment (i.e., segments of the colon may be tortuous and twisted; loops may form in the colon), and multiple trial-and-error attempts at implementing strategies to regain control of the situation. Experienced endoscopists were better able to maintain SA than less experienced ones, and thus, better able to implement strategies in navigating the colon. However, all were equally likely to get lost or disoriented in the colon, especially in the sigmoid and transverse segments. Although the inferred degree of SA was not correlated with the incidence of disorientation, this study showed that SA is involved in colonoscopy. Endoscopists maintain SA by constantly seeking out relevant cues to update the situational model of the work domain. When the situational model is accurate, consequent decision-making, action-selection and execution are appropriate. This work has implications for the design of navigational systems for colonoscopy, a dynamic and impoverished environment.