Studying Simulations with Distributed Cognition

This thesis adopts distributed cognition as a framework for studying human-centered simulations. Training and assessment of emergency medical management in a Swedish context using the Emergo Train System (ETS) simulator was adopted as a case study. ETS simulations were studied and analyzed using the distributed cognition for teamwork (DiCoT) methodology with the goal of understanding, evaluating, and testing the validity of the ETS simulator. Moreover, to explore distributed cognition as a basis for simulator design, a digital re-design of ETS (DIGEMERGO) was developed based on the DiCoT analysis. The aim of the DIGEMERGO system was to retain core distributed cognitive features of ETS, to increase validity, outcome reliability, and to provide a digital platform for emergency medical studies. DIGEMERGO was evaluated in three separate studies; first, a usefulness, usability, and facevalidation study that involved subject-matter-experts; second, a comparative validation study using an expert-novice group comparison; and finally, a transfer of training study based on self-efficacy and management performance. Overall, the results showed that DIGEMERGO was perceived as a useful, immersive, and promising simulator – with mixed evidence for validity – that demonstrated increased general self-efficacy and management performance following simulation exercises.

This thesis demonstrates that distributed cognition, using DiCoT, is a useful framework for understanding, designing and evaluating simulated environments. In addition, the thesis conceptualizes and re-interprets central constructs of human-centered simulation in terms of distributed cognition. In doing so, the thesis shows how distributed cognitive processes relate to validity, fidelity, functionality, and usefulness of human-centered simulations. This thesis thus provides a new understanding of human-centered simulations that is grounded in distributed cognition theory.