About the wise use of automation, as well as advantages and disadvantages in aviation and medicine, you can read here:
1. Self-Determined Use of Automation
At first, many airlines wanted their pilots to apply the widely available automated systems whenever possible. Today, the insight that they should not be used exclusively increasingly prevails. As you already could read in the last article , it is more important to employ them skilfully, which means:
Knowing exactly what one would like to use when, to what degree, and to what avail in order to diminish the workload and maximise safety.
Doing work manually and thinking about procedures actively helps to maintain skills which have been perfected through intense training.
Experts in other lines of business might want to think about this paradigm shift in aviation. Furthermore, we have every right to be proud of our achievements and our abilities which are the result of year-long practising and learning. They are part of our identity and a driving force of our motivation.
In addtion, practical skills are sometimes needed rapidly, as we will highlight using a real case in July. First, however, we will explore how the work is done in a modern cockpit.
2. The Cockpit Is a Modern Workplace
In the 1970s, a flight enineer belonged to a flight crew, as did a navigator in even earlier years. Today, only two pilots are assigned to a flight, though. On long-distance flights, there may be three of them in order to allow for rest time.
Before starting work in the cockpit, the pilots plan their flight and enter the data into the flight management system of their airliner later. During the largest part of the flight, the aircraft will be operated automatically, which involves the autopilot, the autothrottle, navigation, as well as other systems.
This means that computers work the rudder, the elevator, and the ailerons in order to keep the aeroplane on the preselected course. The pilots monitor the flight and continuously gather uptated information on, for instance, the wheather, or the destination airport.
To what degree do today´s expectations match human nature? Where are the advantages and difficulties, which automation brings about? Some of the answers will follow in the next two subchapters.
3. In What Areas Do Humans Outperform Machines, What Are Their Weak Points?
3.1. HABA-MABA
"Humans are better at" and "machines are better at", in short HABA-MABA: Using lists of the respective superiorites, Fitts published his thoughts on automation in 1951. Initially, one aimed at replacing humans with machines by introducing it.
"Humans are better at":
- Ability to detect a small amount of visual or acoustic energy
- Ability to perceive patterns of light or sound
- Ability to improvise and use flexible procedures
- Ability to store very large amounts of information for long periods and to recall relevant facts at the appropriate time
- Ability to reason inductively
- Ability to exercise judgement
"Machines are better at":
- Ability to respond quickly to control signals and to apply great force smoothly and precisely
- Ability to perform repetitive, routine tasks
- Ability to store information briefly and then to erase it completely
- Ability to reason deductively, including computational ability
- Ability to handle highly complex operations, i.e. to do different things at once
3.2. Which of the Two?
The HABA-MABA approach has since been taken up in several publications, for example, by Bradshaw, Filtovich und Johnson (2017). The authors describe that the challenge is not only about assigning a certain task to a human or a machine.
On the one hand, for a number of tasks both are equally suited. On the other hand, humans are needed to monitor the automated systems, namely, all the more the more complex the systems are.
On the whole, it is necessary to allow for a flexible sharing of the workload between humans and automated systems, and it is critical to optimise the interfaces for the interaction between the two. Also, the choice mentioned at the beginning plays a role in the allocation of work.
3.3. The Relevance of Human Abilities and Observations in the Use of Automation
Automation Alters the Work
If automation is applied, the human labour changes. People now have to monitor the automated systems instead of acting themselves. Humans are not very good at monitoring by nature, especially not over longer periods of time.
Taken together, the question arises how much attention HABA-MABA attracts today when procedures are being automated in any line of business. To what extend do decision-makers contemplate the considerations by Bradshaw, Filtovich, and Johnson? Are the people at the affected workplaces asked what they think would be the best manner to organise the workflow?
Manual Skills on the Shop Floor at Toyota
In 2015, Mitsuru Kawai, at that time senior technical executive with the car manufacturer Toyota, explicitly recommended to still value manual work in modern factories, which is absolutely remarkable. In an article in "Consumer Goods and Retail", of March 27th, 2015, the following quotes can be found, which illustrate his motives:
“Today’s automation is the result of quantifying, standardising and building in the exceptional skills that people honed by hand”, and “to keep building better cars, we have to take our manual skills to the next level. Machines can’t train machines.”
In Kawai´s opinion, workers on the production lines should be well-educated instead of being merely "human robots", who forward parts from one machine to the next. Rather, they should detect flaws in the manufacturing process and reflect on improvements.
4. Advantages and Disadvantages of Automation in the Cockpit
In addition to several advantages, automation brought about an array of partly unforeseen difficulties. Due to their multiplicity, we cannot cover them all here. International efforts are being made to cope with them.
4.1. Where Automation Is Helpful
- the flight manoeuvers are carried out more elegantly when computer-controlled, which enhances the comfort for the passengers
- automation completes repetitive tasks
- when the flight management system controls the cruise, the pilots´ workload decreases freeing capacities for other duties
4.2. A Selection of the Identified Difficulties
Programming the Flight Management System and Monitoring
As mentioned above, humans are not very good at monitoring automated procedures. This does not change even if it is required on a flight with several hundred passengers on board.
Automation has to be managed. Amongst others, data has to be entered using a key pad and to be retrieved. This enlarges the workload, especially when entries have to be completed quickly, for example, when a new runway has been assigned.
During the programming, which is necessary in that case, errors can occur due to the rush alone. Furthermore, the pilots´ situational awareness is reduced. It might happen that they lower their heads to attend to their devices, and nobody looks out of the window any more. This, in turn, enhances the likelihood of an accidence, particularly in busy airspaces.
Problems With the Interaction Between Pilots and Automation
With this issue in particular, many difficulties have been identified. One example is that the selection of the flight mode, its display in the flight mode annunciator, and the related commands may be given more attention than values which indicate the attitude of the aircraft, or the current thrust. Hence, in this situation, the pilots occupy themselves more with the handling of the automation than with monitoring their aeroplane on its course.
Decaying Attention and Dependency on Automation
Generally speaking, automation reduces the workload, but the pilots are also less involved in their flight. Thus, it can happen that they, when flying with autothrottle only, overlook to control their speed regularly. Due to that, they might notice even drastic speed changes only at a later point in time.
Pilots show a dependency on automation if they cannot monitor the trajectory of their flight without having all available systems engaged. This is usually caused by a combination of a lack of understanding all the individual systems and already compromised cognitive and manual flying skills. This dependency can have fatal consequences in case of a system failure.
5. Automation in Medicine and the Focus on the Patient
In radiation oncology and prehospital emergency medicine, modern equipment is used today. What does that mean with respect to our attention towards our patients and our sense of them?
5.1. Computer-Controlled Linear Accelerators
Treatment Is Delivered From Several Directions
Cancer patients receive radiation therapy at a linear accelerator , amongst others. During treatment planning, beams from several directions are selected, which include the target volume and the safety margins. Due to that and to additional measures of modern three-dimensional treatment planning, the surrounding tissue is spared in the best possible manner.
Delivery of Radiation in the Past and Today
Up until the 2000s, radiation therapists had to select every single field directly at the linear accelerator. In addtion, they had to place so-called blocks made of lead in the shape of the target volume in the beam path correctly to protect the healthy tissue.
Today, in contrast, the entire treatment with all its fields is delivered automatically, using the thin lead leaves located in the treatment device itsself to form the shapes of the target volume. A session can take up to then minutes, depending on the complexity of the radiotherapy plan. The automation saves the radidation therapists much work, many walks into the treatment room, and having to lift the heavy lead blocks.
Mistakes can be made using either method. Directly at the linear accelerator, therapists may shape a treatment field incorrectly. When the treatment plan is entered into the software, which controls the linear accelerator, wrong values regarding a certain field, or an entirely wrong treatment plan might be input. This can happen especially when a patient has two treatment plans, where the fields are diminished in the second one.
Looking at the Patient Carefully
In the past, radiation therapists entered the room to configure every single treatment field, which was also an opportunity to look after the patient at the same time. Today, the patient is alone during the whole application of the treatment and only monitored using video cameras.
It can be observed that monitoring the patient is sometimes neglected. This can be fatal as not all patients manage to lie still. However, if the patient feels unwell all of a sudden, this should be noticed at once, as should be any movement.
The Effect of Automation on Our Knowledge
In the past, all aspiring radiation oncologists and radiation therapists knew why the treatment fields are shaped in what fashion. Moreover, they could visualise the fields including the blocks three-dimensionally. Such knowledge falls behind today, as everything is done by the computer anyway.
It is essential for good treatment planning and delivery, which also includes to ensure that the fields are applied precisely in relation to the body, to fully comprehend the geometry and physics.
5.2. The Patient Is Being Monitored
Not as intensively as during general anaesthesia, a patient is also monitored in the ambulance with respect to certain vital signs, such as blood pressure, heart rate, and oxygen saturation in the blood. This, of course, is very handy, but also relevant.
However, it is important now to look at the values actively, to draw conclusions, and to detect any changes early. In addition, it is vital to correlate the values with the patient´s clinical presentation. Why does the oxygen saturation suddenly drop?
There are many reasons for that, ranging from a real decrease, to the blood pressure being taken on the same arm on which the fingerclip to monitor the oxygen saturation is applied, and technical failures. Whereas young emergency technicians sometimes concentrate on the displayed value only, one should first of all look at the patient and check whether, for instance, his or her breathing has deteriorated.
5.3. Despite Technical Examinations, We May Not Unlearn the Anamnesis and Physical Examination
Today, it is still about the patient as a human being, with whom we speak first. Through a good anamnesis, we can already make 80% of the diagnoses, or at least establsih a working diagnosis. We should not unlearn excellent physical examination techniques and correlate the results with our anamnesis.
Only then we should consider necessary technical examinations, which, ordered only when really needed and with the correct question to be answered, add considerable value today. With the results of such examinations, and in the light of the anamnesis and the physical exam, we will discuss the treatment options with our patient.
6. In the Next Article: Manual Abilities Are Suddenly Needed
In July, we will concern ourselves with a case in which the pilots had to apply their manual flying skills abruptly. What is more, they were in a situation which apparently had startled and confused them considerably. We will elaborate step by step how this evolved and how many factors played a role in this event.
Author: Eva-Maria Schottdorf
Date: June 28th, 2023
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