Patient Safety

Current Projects

Surgeons' decision-making in the intra-operative environment

Prof Rhona Flin and Dr Lucy Mitchell

Decision-making is considered an important skill for surgeons, particularly since risk management and decisions must be made at every stage of a patient's surgery.  However, at present literature has tended to focus on decisions made prior to an operation, as opposed to decisions made in the operating room.  The aim of the current research project is to examine surgeon risk assessment and decision-making during the intraoperative period. 

Funded by the Scottish Funding Council (2008-2011).

Publications

Pauley, K., Flin, R., Yule, S. & Youngson, G. G. (2011). Surgeons' intraoperative decision making and risk management. American Journal of Surgery, 202, 375-381.

http://www.americanjournalofsurgery.com/article/S0002-9610(11)00124-3/abstract

Pharmacists' non-technical skills

Dr Amy Irwin

Email: a.irwin@abdn.ac.uk

Non-technical skills refer to the human factors that may influence job performance, but which are distinct from the technical or practical skills required to complete a task.  Non-technical skills are generally divided into two sub-groups: 1) cognitive skills (decision-making, situational awareness) and 2) social skills (teamwork, communication).  Despite the potential importance of these skills in pharmacists, particularly in light of links between non-technical skills and patient safety, there is little research directly examining the potential influence of non-technical skills upon the effective functioning of a pharmacy.  The aim of the current project is to determine if non-technical skills are commonly used within pharmacy practice, and to identify the essential skills for safe and effective functioning within the pharmacy team.

Funded by the Scottish Funding Council (2009 – 2012).

Publications

In preparation.

Completed Projects

Pharmacy

Pharmacist selection error

Dr Amy Irwin, Dr Kathryn Mearns and Prof Rhona Flin
 

Email:
a.irwin@abdn.ac.uk

Pharmacists perform an important role in supplying patients with medicines.  They are the final check before a prescription is dispensed and they are responsible for insuring that the right medication reaches the right patient with the correct amount, dose and instructions for use.  There are several potential factors which can impact the likelihood of an error being made during that process.  Using computer simulation to replicate the task of selecting a medicine from a pharmacy shelf, the impact of proximity, time pressure and TALL MAN lettering on the accurate perception and selection of target medicine products was examined.  The results indicated that the presence of multiple similar drug packets in proximity to a target drug packet significantly increased the chance of error and the time taken to select a target.  TALL MAN lettering had no effect on the results.

Funded by the Scottish Funding Council (2009 – 2012).

Publications

Irwin, A., Mearns, K., Watson, M. & Urquhart, J. (2013). The effect of proximity, TALL MAN lettering and time pressure on accurate visual perception of drug names. Human Factors, 55, 253-266.

Conference paper

Irwin, A., Mearns, K., Watson, M. & Urquhart, J. (2011) Pharmacist dispensing error: the effect of neighbourhood density and time pressure on accurate visual perception of drug names. Proceedings of the Human Factors and Ergonomics Conference 2011.

http://pro.sagepub.com/content/55/1/1621.abstract

Retrospective analysis of DATIX dispensing error reports

Dr Amy Irwin, Dr Kathryn Mearns and Prof Rhona Flin
 

Email:
a.irwin@abdn.ac.uk

This project conducted an analysis of DATIX error reports detailing dispensing error, contributory factors and the resultant managerial response in NHS hospitals.  The results indicated that the main incident types were incorrect drug, incorrect strength of drug and wrong quantity, or form, of the drug.  The main contributory factors were reported as drug name similarity, busy wards / pharmacies.  Inexperienced staff and patient centred issues also featured. 

Funded by the Scottish Funding Council (2009 – 2012).

Publications

Irwin, A., Ross, J., Seaton, J. & Mearns, K. (2011).Retrospective analysis of DATIX dispensing error reports from Scottish hospitals. International Journal of Pharmacy Practice, 19, 417-423.

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7174.2011.00136.x/abstract

Aggressive patients and pharmacy practice

Project leads: Dr Amy Irwin, Dr Kathryn Mearns and Prof Rhona Flin
 

Email:
a.irwin@abdn.ac.uk

Aggression towards health care staff has been an important focus for research over the past decade.  Patient aggression, both physical and verbal, can cause long term psychological effects, and even post traumatic stress disorder in affected staff members. However, the majority of this research is based on secondary care, usually with a focus on nursing staff.  Few articles have analysed patient aggression in primary care settings and fewer still have included staff working in community pharmacies.  As a consequence, the primary aim of this project was to examine the impact of patients' aggression on community pharmacists, with a particular focus on the potential impact of an aggressive interaction on the likelihood of a dispensing error being made. 

Funded by the Scottish Funding Council (2009 – 2012).

Publications

Irwin, A., Laing, C. & Mearns, K. (in press). Dealing with aggressive methadone patients in community pharmacy: A critical incident study.  Research in Social and Administrative Pharmacy.

http://www.sciencedirect.com/science/article/pii/S1551741112000022

Irwin, A., Laing, C. & Mearns, K. (in press). The impact of patient aggression on community pharmacists: A critical incident study. International Journal of Pharmacy Practice.

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7174.2012.00222.x/abstract

Ward nurses

Leadership behaviours of senior charge nurses

Cakil Sarac, School of Psychology

Email: r.flin@abdn.ac.uk

The NHS Confederation published a series of papers to stimulate the discussion on NHS leadership. The key points highlighted the long standing focus on senior managers and called for a shift to leaders at all levels of the organizations. Especially, the need to establish leadership development as a core part of the line managers' role was emphasized.  However, the recent patient safety literature has not drawn specific attention to the leadership behaviours of senior charge nurses and safety-related outcomes. Consequently, the focus of this project is on ward leaders and safety. The principal aim of this study is to identify the leadership behaviours of the front-line leaders (senior charge nurses) at the unit level (i.e. ward) and the secondary aim is to describe these behaviours and if possible to determine the extent to which they relate to the wards' safety and other performance metrics (e.g. safety-related behaviours, incident reports, infection rates).

Funded by the Scottish Funding Council (2011 – 2012)

Publications

In preparation.

Handover

Doctors shift handovers in acute settings

Dr Michelle Raduma-Tomas, School of Psychology

Email:
w.booth@abdn.ac.uk

Patient handover in healthcare encompasses two main factors.  First the exchange of patient information detailing the patient's current condition, ongoing treatment and developments or complications.  Second the transfer of responsibility and accountability for a patient from one caregiver to another.  Handovers are considered a high risk process where communication failures can cause problems in the continuity of patient care and potentially contribute to the occurrence of an adverse event.  The aim of this research project was to examine doctor handovers in acute medical admissions units using observations and interviews.

This PhD project was funded by the Scottish Funding Council (2008 – 2011).

Publications

Raduma Tomas, M., Flin, R., Yule, S. & Williams, D. (2011). Doctors' handovers in hospitals: A literature review. BMJ Quality & Safety, 20, 128-133.

http://qualitysafety.bmj.com/content/20/2/128.abstract

 Raduma Tomas, M., Flin, R., Yule, S. & Close, S. (2012). The importance of preparation for doctors' handovers in an acute medical assessment unit: a hierarchical task analysis. BMJ Quality and Safety, 21, 211-217.

http://qualitysafety.bmj.com/content/21/3/211.short

Safe Handover - Handover practices assuring patient safety at care transitions from anaesthesia

Dr Tanja Manser, Prof Rhona Flin, School of Psychology

Email: r.flin@abdn.ac.uk

The definition of patient handover is 'the transfer of professional responsibility and accountability for some or all aspects of care for a patient or group of patients to another person or professional group on a temporary or permanent basis'.  Recent research suggests that patient handover is a critical aspect of care and yet a lack of training and formal requirements for patient handover can impede good practice.  Consequently the main aim of this research project was to identify handover strategies that help clinicians to assure continuity of care and maintain safety of surgical patients during care transitions between anaesthesia and the recovery room or the intensive care unit (ICU). Ultimately, the results of this study will contribute to the advancement of patient safety by providing important input on effective patient handover guidelines and training modules that can be integrated into the education of undergraduate and practising health professionals.

This research project was funded by the European Commission (FP7 Marie Curie Intra-European Fellowship) (2009 – 2010).

Publications

Manser, T. & Foster, S. (2011). Effective handover communication: an overview of research and improvement efforts. Best Practice & Research Clinical Anaesthesiology, 25, 181–191.

http://www.sciencedirect.com/science/article/pii/S1521689611000255

Manser, T., Foster, S., Flin, R. & Patey, R. (in press). Team communication during patient handover from the operating room: more than facts and figures. Human Factors.

Anaesthesia

Distributed Situation Awareness in the Anaesthetic Management of Major Obstetric Haemorrhage.

Dr Evie Fioratau, Prof Rhona Flin, School of Psychology

Email: r.flin@abdn.ac.uk

The aim of this research was to explore the role of Distributed Situation Awareness (DSA) on the anaesthetic management of challenging Major Obstetric Haemorrhage (MOH) cases.  DSA refers to the anaesthetist's perception of the elements of the theatre environment (Level 1), the understanding of their meaning (Level 2) and the anticipation of their progress (Level 3) in interaction with other people, e.g., patient, team members, and external artefacts in the management of a case.  The results suggest that methods for improving effective practice and training in MOH should address the interactive nature of DSA and thus of decision making, by emphasising the need to go beyond the monitoring of anaesthetic displays.

This project was funded by the Scottish Funding Council (2008 – 2011).

Publications

Fioratou, E., Flin, R., Glavin, R. & Patey, R. (under review). Situation awareness in major obstetric haemorrhage.

Fioratou, E., Flin, R., Glavin, R. & Patey, R. (2010). Beyond monitoring: distributed situation awareness in anaesthesia. British Journal of Anaesthesia, 105, 83-90.

http://bja.oxfordjournals.org/content/105/1/83

Tactical Decision Games as a Training Tool in Anaesthesia.

Dr Evie Fioratau, Prof Rhona Flin, School of Psychology & Dr Rona Patey, School of Medicine and Dentistry

Email: r.flin@abdn.ac.uk

Non-technical skills (NTS), such as decision making and situation awareness, are essential to patient safety however, there is typically no formal training related to NTS for novice anaesthetists beyond some limited high fidelity simulation sessions. Tactical Decision Games (TDGs) are a novel training tool, designed to improve decision making.  The aim of this project was to develop and deliver a programme of TDGs for anaesthetists in their first year of anaesthetic training in one school of anaesthesia, to assess the feasibility and acceptability of this training method.  Analysis of the TDG training sessions suggest that non-technical skills have a central role in novice anaesthetists' management of the scenario cases.

This project was funded by the Scottish Funding Council (2008 – 2011).

Publications

Patey, R., Fioratou, E. & Flin, R. (in preparation) Tactical decision games for anaesthetists.

Fioratou, E., Pauley, K. & Flin, R. (2011). Critical thinking in the operating theatre. Theoretical Issues in Ergonomics Science, 12241-255. http://www.ingentaconnect.com/content/tandf/ttie/2011/00000012/00000003/art00004

Human Factors for anaesthesia: difficult airway management

Prof Rhona Flin, School of Psychology

Email: r.flin@abdn.ac.uk

Human factors are known to contribute to surgical adverse events and anaesthetic incidents, such as those resulting from difficult airway management.  Research suggests that 1 in 10,000 patients has an unpredicted difficult airway, of those, approximately 1% will have a failed airway where they cannot be intubated.  The aim of this project was to utilise the Human Factors Investigation Tool (HFIT) to analyse the human factors components of anaesthetic incidents, with a focus on difficult airways. 

Publications

Flin, R., Fioratou, E., Frerk, C., Trotter, C. & Cook, T. (2013) Human factors in the development of complications of airway management: preliminary evaluation of an interview tool. Anaesthesia, 68, 817-825.

Surgery

Leadership and safety in operating theatres

Sarah Henrickson Parker, School of Psychology

Email: w.booth@abdn.ac.uk

Research from the United States and the UK indicates that between 3 and 17% of patients will experience one or more adverse events during a hospital stay.  An area of particular high risk, in terms of patient safety, is the operating theatre (OR).  The OR has many of the characteristics of a high-risk workplace, including the level of complexity, a constantly changing environment and a multi-professional team.  Within this environment, the surgeon is the nominated leader of the surgical team and as such, must demonstrate leadership skills, together with technical excellence, in order to maximise patient safety.  The focus of this research was on surgeons' leadership behaviours within the OR during the intra-operative period and the impact that these behaviours and skills could have on team and patient outcomes.

This PhD was funded by the Scottish Funding Council (2008-2011).

Publications

Henrickson Parker, S., Yule, S., Flin, R. & McKinley, A. (2011a) Towards a model of surgeons' leadership in the operating room. BMJ Quality and Safety, doi:10.1136/bmjqs.2010.040295

http://qualitysafety.bmj.com/content/early/2011/01/05/bmjqs.2010.040295.long

Henrickson Parker, S., Yule, S., Flin, R. & McKinley, A. (2011b) Surgeons' leadership in the operating room: an observational study. The American Journal of Surgery, 204, 347-354.

http://www.sciencedirect.com/science/article/pii/S0002961011003254

System strengths and weaknesses in surgery

Project leads: Dr Steven Yule and Jill Wilkinson

The aim of this project was to collect data from major colo-rectal surgical cases to devise a framework for measuring systems failures in surgery. These are failures which are embedded in the system (eg, organisational factors), and can potentially lead to the occurrence of errors during an operation. A minute by minute account of cases was conducted, with interactions between the surgeon and the rest of the team recorded. The condition and diagnosis of the patient was also taken into account as well as the level of training and experience of all team members.  The results indicated that system factors included: the team, the task, organizational policies, the individual, the work environment and the patient.  Using this data a systems observation tool was developed.

Funded by the Royal College of Surgeons.

Tools

Systems observation tool:

Publications

In preparation.

Safety Culture

Safety culture in Scottish hospitals

Cakil Sarac, School of Psychology

E-mail: r.flin@abdn.ac.uk

Recent concern regarding the safety of patients in healthcare systems has resulted in the adoption of safety management techniques used in high-risk industries. One method is the use of safety culture questionnaires to survey workforce perceptions and attitudes towards safety which have demonstrated the influence of organizational factors on safety outcomes. In the current study, a national safety culture questionnaire was used to assess safety culture in seven acute hospitals during 2009.  A total of 1966 clinical staff completed a questionnaire that included the Hospital Survey on Patient Safety Culture. The main aim of the study was to develop an appropriate safety culture measure for hospitals and to use it to identify the organizational strengths and weaknesses related to safety culture within the sample of Scottish hospitals.  Culture factors where staff were less positive related to the organizational level, such as perceptions of staffing levels, senior management culture, commitment to safety as well as safety behaviours, safety outcomes and handovers across hospital units.

This PhD project was funded by the Scottish Funding Council (2007-2010).

Publications

Sarac, C., Flin, R., Mearns, K. & Jackson, J. (2011). Hospital survey on patient safety culture. Psychometric analysis on a Scottish sample. Quality and Safety in Health Care, 20, 842-848. 

http://qualitysafety.bmj.com/content/20/10/842.abstract

Sarac, C. (2011). Safety climate in Scottish acute hospitals. PhD thesis. University of Aberdeen.

Jackson, J., Flin, R. & Sarac, C. (2010). Hospital climate surveys: measurement issues. Current Opinions in Critical Care, 16, 632-638.

 http://www.ncbi.nlm.nih.gov/pubmed/20827181

ICU

Teamwork and leadership in the intensive care unit

Project leads: Dr Tom Reader, Dr Brian Cuthbertson, Prof Rhona Flin

Email:
r.flin@abdn.ac.uk

Teamwork refers to the way in which team members function and coordinate to produce 'synchronised' output. Patient safety research has demonstrated that poor teamwork is a causal factor underlying critical incidents in the intensive care unit (ICU). Due to this, a growing amount of research has been conducted within the ICU in order to identify the specific components of teamwork that influence patient outcomes.  Consequently, the main aim of this research project was to investigate aspects of teamwork and team leadership in the intensive care unit. The primary focus was on the leadership behaviours used by consultants to manage complex multidisciplinary teams during normal and crisis operations.

This project was funded by the Scottish Funding Council (2007 – 2008).  Then by a Leverhulme Early Career Fellowship (2008 – 2010).

Publications

Reader, T., Flin, R., Mearns, K. & Cuthbertson, B. (2009). Developing a team performance framework for the intensive care unit. Critical Care Medicine, 37, 1787-1793.

http://journals.lww.com/ccmjournal/Abstract/2009/05000/Developing_a_team_performance_framework_for_the.35.aspx

Reader, T., Flin, R. & Cuthbertson, B. (2011). Team leadership in the intensive care unit. The perspective of specialists. Critical Care Medicine, 39, 1683-1691.

 http://journals.lww.com/ccmjournal/Abstract/2011/07000/Team_leadership_in_the_intensive_care_unit__The.12.aspx

Non-technical skills

Scrub practitioners' non-technical skills (SPLINTS)

Project leads: Prof Rhona Flin and Dr Lucy Mitchell

Non-technical skills are not explicitly taught or assessed for healthcare professionals. This is why non-technical skills taxonomies and behavioural rating systems for anaesthetists (ANTS), surgeons (NOTSS) and now scrub practitioners (SPLINTS) have been developed by our research team.  In the current project task analyses were used to identify the critical non-technical skills for the scrub practitioner.  A literature review, observations and an interview study with experienced scrub practitioners and consultant surgeons indicated that situation awareness, communication and teamwork, as well as skills relating to task management were critical.  A skills taxonomy and behavioural rating method were developed and produced as a SPLINTS handbook. This tools details the skill categories and underlying elements, each with examples of poor and good practice to guide the user of the system, and provides a rating form. 

Jointly funded by NHS Education Scotland (2007-2009) and the Scottish Funding Council (2009–2011).

Tools

SPLINTS handbook: www.abdn.ac.uk/iprc/splints

Publications

Mitchell, L & Flin, R. (2008). Non-technical skills of the operating theatre scrub nurse: literature review. Journal of Advanced Nursing, 63, 15-24.

http://www.ncbi.nlm.nih.gov/pubmed/18598248

Mitchell, L., Flin, R., Yule, S., Mitchell, J., Coutts, K. & Youngson, G. (2010). Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills. International Journal of Nursing Studies, 48, 818-828.

http://www.ncbi.nlm.nih.gov/pubmed/21190685

Mitchell, L., Flin, R., Yule, S., Mitchell, J., Coutts, K. & Youngson, G. (2012). Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system.  International Journal of Nursing Studies, 49, 201-211.

http://www.ncbi.nlm.nih.gov/pubmed/21974792

Surgeons' non-technical skills (NOTSS)

Project lead: Prof Rhona Flin 

Email: r.flin@abdn.ac.uk

This project identified the non-technical skills (eg, decision making, teamworking, communication) necessary for effective surgical practice. A behavioural marker system to support training and development has been developed and trialled in Scotland.

Jointly funded by the Royal College of Surgeons (Edinburgh) and NHS Education Scotland, (2003 - 2006).

Tools

NOTSS handbook: http://www.abdn.ac.uk/iprc/notss/

Selected Publications

Yule, S., Rowley, D., Flin, R., Maran, N., Youngson, G., Duncan, J. & Paterson-Brown, S. (2009). Experience matters: Comparing novice and expert ratings of non-technical skills using the NOTSS system. ANZ Journal of Surgery 79, 154-160.

http://www.ncbi.nlm.nih.gov/pubmed/19317781

Yule, S., Flin, R., Maran, N., Rowley, D., Youngson, G. & Paterson-Brown, S. (2008). Surgeons' non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of Surgery, 32, 548-556.

http://www.ncbi.nlm.nih.gov/pubmed/18259809

Yule, S., Flin, R., Rowley, D., Mitchell, A., Youngson, G., Maran, N. & Paterson-Brown, S. (2008). Debriefing surgeons on non-technical skills (NOTSS). Cognition, Technology & Work, 10, 265 -274.

http://dl.acm.org/citation.cfm?id=1417028

Flin, R., Youngson, G. & Yule, S. (2007). How do surgeons make intraoperative decisions? Quality and Safety in Healthcare 16, 235-239.

http://www.ncbi.nlm.nih.gov/pubmed/17545353

Flin, R., Yule, S., Paterson-Brown, S., Maran, N., Rowley, D. & Youngson, G. (2007). Teaching surgeons about non-technical skills. The Surgeon, 5, 86-89.

http://www.ncbi.nlm.nih.gov/pubmed/17450689

Anaesthetists' non-technical skills (ANTS)

Project leads: Prof Rhona Flin, (School of Psychology), Drs Ronnie Glavin, Nikki Maran (Scottish Clinical Simulator Centre), and Dr Rona Patey (Aberdeen Royal Infirmary)

Email: r.flin@abdn.ac.uk

This project identified the non-technical skills (eg, decision making, teamworking, communication) necessary for effective anaesthetic practice and then developed these into a behavioural marker system that can be used to support training and assessment. The output of the first stage of the project was the Anaesthetists' Non-Technical Skills (ANTS) System, which contains fifteen skill elements grouped into four main skill categories with behavioural markers describing good and poor practice for each element. The ANTS System was then evaluated in a number of trials organised by the Royal College of Anaesthetists to ensure it can be used reliably to assess anaesthetists' non-technical skills in both simulator and operating theatre environments.

Funded by NHS Education Scotland.

Tools

ANTS handbook: http://www.abdn.ac.uk/iprc/ants/

Publications

Fletcher, G., Flin, R., McGeorge, P., Glavin, R., Maran, N. & Patey, R. (2003). Anaesthetists' Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. British Journal of Anaesthesia, 90, 580-588. To replace this placeholder, please upload the original image (C:\Users\psy495\AppData\Local\Temp\msohtmlclip1\01\clip_image001.gif) on server and insert it in the document.Download pdf article (229 kb)

Fletcher, G., Flin, R., McGeorge, P., Glavin, R., Maran, N. & Patey, R. (2004). Rating non-technical skills: Developing a behavioural marker system for use in anaesthesia. Cognition, Technology & Work, 6, 165-171.To replace this placeholder, please upload the original image (C:\Users\psy495\AppData\Local\Temp\msohtmlclip1\01\clip_image001.gif) on server and insert it in the document.Download pdf article (184 kb)

Fletcher, G., McGeorge, P., Flin, R., Glavin, R. & Maran, N.  (2002). The role of non-technical skills in anaesthesia: A review of current literature. British Journal of Anaesthesia, 88, 418-429. To replace this placeholder, please upload the original image (C:\Users\psy495\AppData\Local\Temp\msohtmlclip1\01\clip_image001.gif) on server and insert it in the document.Download pdf article (125 kb)

Flin, R., Fletcher, G., McGeorge, P., Sutherland, A. & Patey, R. (2003). Anaesthetists attitudes to teamwork and safety. Anaesthesia, 58, 233-242. To replace this placeholder, please upload the original image (C:\Users\psy495\AppData\Local\Temp\msohtmlclip1\01\clip_image001.gif) on server and insert it in the document.Download pdf article (118 kb)

Walk rounds

Patient safety leadership walk rounds in NHS Grampian.

Project leads: Dr Jeanette Jackson and Helen Robbins (NHS Grampian)

E-mail: helen.robbins@nhs.net

The process of walk rounds in healthcare is well established and actions are logged via a standard reporting template. However, the benefits and barriers of the walk round programme, as well as the actual impact on clinical practice are not known.  In addition, there are concerns that the process may not be getting close enough to specific patient safety issues.  The aim of this project was to evaluate the walk round service part of the SPSP programme and leadership work stream, in order to refine the process of walk rounds and to enhance its effectiveness.

Publications

In preparation.

Pathology

Diagnostic processes under fixation induced conditions in cervical cytopathology.

Project leads: Dr Evie Fiouratou

Cervical cytopathology represents an effective technique to detect precancerous conditions in the uterine cervix.  However, previous research has questioned the reliability of cervical screening with the failure to find or identify cancerous features on a slide identified as a possible cause of recorded 'false negatives', where cancerous cells are present but not identified.  Following cognitive psychology theory, the main hypothesis of this study was that false negative diagnosis in this work domain could be attributed to the inherent nature of slide screening, where the vast majority of cases are negative so that previous negative case encounters may prime, i.e., increase sensitivity, towards false negative diagnosis.    Eight experienced screeners from two Scottish NHS hospitals participated in three experimental sessions, with one week between sessions.  Each session consisted of a series of nineteen negative slides with one positive test slide, embedded either at the beginning, middle or end of those series, thus comprising our three experimental conditions. The screeners' task was to diagnose a series of slides whilst thinking aloud.  The findings revealed that a false negative diagnosis was more likely to be rendered when the positive slide was presented early in the testing session, with less abnormal features being identified.  

This project was funded by the British Academy (2011).

Publications

In preparation.

Email: r.flin@abdn.ac.uk