• Conditions that drive the need for JITT (what makes the astronaut need JITT over refresher training - i.e. How different are the tasks?)
• The context that shifts training requirements (is it the task criticality that drives the need for JITT or just the time since training?)
• The metrics that illustrate training deficiencies and how these metrics can be used to predict when astronauts will need JITT over refresher training
• Outline training processes that optimize task performance (and this could involve a mix of JITT with refresher training)

Flight surgeons (FS) on the ground in Mission Control will be expected to direct the crew medical officer (CMO) during medical situations. If there is a loss of signal and the crew is unable to communicate with the ground, a CMO would be expected to carry out medical procedures without the aid of a FS. In these situations, performance support tools can be used to reduce errors and time to perform emergency medical tasks.  The feasibility of just-in-time (JIT) training techniques and concepts for real-time medical procedures, and the availability of FS performance support tools / Information needed by the FS during the ISS mission support, especially for an emergency situation (e.g., fire onboard ISS) is needed to mitigate the risks associated with long duration space operations.
A performance support tool prototype was developed to address this issue by bringing all of the relevant information together in one place. The tool was designed to include procedures and other information needed by a FS during an emergency, as well as procedures and information to be used after the emergency is resolved.

1. Determined the state-of-the-art in medical training technologies.
2. Determined correspondence between current Computer -Based Training (CBT) standards and NASA CBT guidelines (JSC led).
3. Determined the feasibility of a computer implementation of the paper prototype Flight Surgeon Performance Support tool developed in FY09 (JSC led).

The overall aim of the proposed study is to determine whether the communications delays likely to be experienced on a mission to Mars will result in clinically or operationally significant decrements in crew behavior and performance.  As a first phase of a planned two-phase investigation, we hope to accomplish the following utilizing analog environments (which are further described below):

Aim 1:  Determine the feasibility and acceptability of conducting such a study in ground-based analogs and aboard the International Space Station.

Aim 2:  Determine if there is an association between delays in communication experienced during a Mars mission is associated with decrements in individual and crew behavior and performance

Aim 3: Identify confidence intervals for determining range of communication delays to be examined in subsequent ISS increments.

In-flight emergencies represent a significant risk for mission failure. The potential for an unforeseen medical emergency to compromise crew health and capacity is heightened when considering the unique nature of deep space, long duration missions. Effective medical emergency management training can ameliorate this risk, and is vital for building crew resilience in order to achieve mission goals. Current training approaches in both medical and non-medical contexts focus on specific non-technical skills (e.g., situation awareness, leadership, crew coordination) for successful management of non-routine events. Training curricula have been developed targeted at individual and team management of medical events in terrestrial settings; however, a valid training framework and a set of objective measures of non-technical skills is currently lacking for space crews.

1. Identify objective measures of non-technical skills that enhance crew management of in-flight medical emergencies
2. Develop a simulated spacecraft medical bay, and run a series of simulation scenarios to measure crew behavior during high acuity, low frequency medical emergencies

This project will address IRP Gap TRAIN-01 in three distinct steps:

1. Formalize current state of guidelines for medical non-technical skills training

2. Identify and validate needed objective measures of operator proficiency and training effectiveness

3. Document recommended validated objective measures of operator proficiency and of training effectiveness for future missions. Report in appropriate publications, standards, stakeholder panels, and/or risk evidence reports.

This project will also address IRP Gap TRAIN-03. Specifically, we will identify which components of medical non-technical skills training are more suited to in-flight vs. pre-flight training, and prioritize those that can be conducted in-flight. Gathering data longitudinally will allow us to advise on the decay function of knowledge and skills in space operations, and determine the basis upon which to set requirements and intervals for recurrent/refresher training.

During exploration-class missions the time-delay in communication will necessitate crew autonomy for medical testing which is currently done using remote guidance by an expert on the ground. To overcome this problem, just-in-time (JIT) training has been used to provide specific steps and information to crew members to guide them through routine ultrasound medical tests. However, these tutorials do not provide real-time interactive guidance to assist the crew members in improving image quality. Thus JIT training must be employed through which astronauts can access a library of procedures to help guide them through technically challenging medical procedures in which they have little or no previous training. However, because ultrasound and optical coherence tomography (OCT) imaging require operator dependent skills, simply having knowledge available prior to attempting these procedure will not necessarily result in images with sufficient quality to ensure adequate results. Advances in augmented reality technology provide the opportunity for crew members to interact with a patient while receiving feedback on how to complete and improve medical image acquisition.

1. Develop an audio-visual tutorial using augmented reality glasses that guides non-experts through an abdominal trauma ultrasound protocol.

2. Develop an audio-visual tutorial using augmented-reality glasses to guide an untrained operator through the setup and acquisition of an OCT protocol.

3. Evaluate the quality of abdominal ultrasound and OCT images acquired by untrained operators using augmented reality guidance during ground-based testing with images acquired using current JIT techniques.

4. Compare the time and costs required to develop tutorials and complete imaging studies using augmented reality tutorials with the time and costs of to current JIT practices to determine whether time efficiencies exist.

    

This task will address the gaps by improving the just-in-time (JIT) training materials for ultrasound imaging using augmented reality and expand the crew’s medical, diagnostic, and research capabilities to include OCT guidance by providing advanced training using a detailed, timely, and user-friendly method.

Through a literature review, two controlled experiments, and a validation study, the task examined the potential attributes of cognitive aids as they interact with task demands, time pressure, and number of team members. All studies were performed using a dual-task/interruption paradigm to better approximate the environments where cognitive aids are likely to be used. The hypothesis was that a taxonomy of cognitive aids for non-experts will need to contain differential information on aid design for number of operators, highly spatial versus highly verbal sub-tasks, highly visual versus highly auditory sub-tasks, and combinations thereof.
A product to come from these studies is a prototype of a hybrid aid for medical equipment maintenance tasks, while at the same time building a library of tools to create similar aids for other procedures. Second, we developed a taxonomy of cognitive aid design that considers the most important variables affecting performance with aids: user knowledge and experience, time pressure on performance, task criticality, and the number of operators expected to interact with the aid.  Our Hybrid Aid toolkit (HAT) is a prototype of an innovative cognitive aid technology that is designed to support non-expert operators in complex tasks, while also offering tools to the procedure designers and the operators themselves as they perform the task.

Aims:

1. Complete a literature review of interactive cognitive aids

2. Determine Resource Demand Conflict between Sub-tasks and Cognitive Aid

   a. How is performance affected by task-aid resource conflict?

   b. How does aid design, in terms of resource conflict with the task, affect resumption of task after an interruption?

3. Examine the benefits to non-expert operator(s) of adaptively including more information at the operator’s request and including support tools helpful to the task within the aid, also accessed at the operator’s request.

   a. How does adding more operators change use of the cognitive aid during a procedure?

   b. Do aid attributes, such as specifically encouraging theory of mind between team members and inclusion of task-specific tools, offer benefits to task performance and subjective assessments of the aid?
   
   
   The task will contribute to gap closure by providing design guidelines for interactive cognitive aids. These will be critical for autonomous long-duration crewmembers.

Future space missions involve both a long-duration and long communication delays (up to 30 seconds for Near Earth Asteroid / Near Earth Orbit missions and up to 40 minutes for Mars missions). These factors mean that training crewmembers for these missions requires durable training, surviving long delays between training and actual use of the learned knowledge and skills. Yet, the current intervals of on-board-training (OBT) for emergencies and to maintain currency on EVA and the robotic arm are largely based on anecdotal experience. Furthermore, all our theories and knowledge about skill acquisition, retention, and transfer to new situations are based on studies conducted at university laboratories with undergraduate students as research subjects. We do not know how well these studies apply to astronauts in space operations.
We do not know how well crews retain knowledge trained pre-flight, how well the knowledge transfers, how frequently critical skill should be refreshed, or what type of information or guidance need to be available for autonomous crews in terms of Just-in-Time (JIT) training and performance support tools.

Three specific aims are included in this study:

1. Test the retention and transfer of specific technical content learned pre-launch to assess the need for (and possible schedule of) onboard refresher and JIT training.
2. Compare the process of skill decay on orbit with that of a closely matched subject on Earth, and with that of university undergraduate students on Earth.
3.  Collect naturalistic data from onboard and previously flown crew on training-related crew performance including: performance errors, requests for ground support, need to review previously learned material, and training success stories. 

These results, along with results from the subsequent Training Retention – Flight Validation study, will help close the gap on how to determine retention in operational spaceflight and will identify information and guidance likely to be needed in the form of refresher training, JITT, or performance support tools.

The study addresses interests of three different Elements within the Human Research Program (HRP), and will thus be a close collaboration among these elements: Human Factors and Behavioral Performance (HFBP) and (ExMC) Exploration Medical Capabilities.

Long-duration, exploration-class missions (LDEM) present new training challenges, as these missions significantly differ from our past exploration experience. We cannot predict all the tasks crewmembers may be required to perform during such missions, and thus cannot design pre-flight training to address tasks about which we do not yet know. This lack of knowledge requires a shift from task-based training typical of past and current space missions to skill-based training that focuses on the long-term retention and generalization of pre-flight training to transfer to new and unexpected onboard operations. However, we do not know the characteristics of skills and knowledge that lead to better retention, generalization, and transfer nor do we know the best training principles that support retention, generalization, and transfer.

1. Identify characteristics of skills and knowledge that lead to better retention, generalization, and transfer. (i.e. identify what enables learners to apply trained skills and knowledge to new tasks.)

2. Identify training practices that support retention, generalization, and transfer, such as integrated training in the operational context.

These results will help close the gap on generalizable skills by identifying characteristics of skills and training practices that support training retention, generalization, and transfer.