Dissertation Defense

Posted on Jun 30, 2012 in Biomedical Informatics | No Comments

I defended my dissertation titled, “Understanding Adaptive Behaviors in Complex Clinical Environments” (abstract and interactive presentation below) in June 2012. The abstract and link to my interactive presentation (created using Prezi) is available below. This is a good place to start, if you want an overview of my major PhD research work.


If you have never used Prezi before, here is a quick tutorial. You can press right and left keys to follow the preset path on the presentation. If you want to explore the research space on your own, you you can either use the magnify buttons or simply click the element you are interested in. For more information check out the “Get Started” Prezi module. From the half way point, the first tutorial covers the ways in which you can explore a presentation.

Dr. Robert Greenes, Co-Chair (Dept. Biomedical Informatics, Arizona State University)
Dr. Vimla Patel, Co-Chair (New York Academy of Medicine)
Dr. Diana Petitti, Member (Dept. Biomedical Informatics, Arizona State University)
Dr. Valentin Dinu, Member (Dept. Biomedical Informatics, Arizona State University)
Dr. Mark Smith, Member (Banner Good Samaritan Medical Center)

ABSTRACT: Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments can become chaotic very quickly, due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or “deviations” from expected behavior that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians’ adaptive mechanisms and presents a methodology for studying the same.

Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma (a complex clinical environment) is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework.

The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma. A mean recognition rate of 87.5% was obtained in automatically recognizing the activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01).

The results show that while expert clinicians deviate to innovate, deviations of novices often results in errors. Experts’ flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.


  • [CONFERENCE PROCEEDINGS] Vankipuram M, Ghaemmaghami V, Patel VL, “Adaptive Behaviors of Experts in Following Standard Protocol in Trauma Management: Implications for Developing Flexible Guidelines”, American Medical Informatics Association (AMIA) Annual Symposium, (2012). [Download PDF]
  • [JOURNAL ARTICLE] Kahol K*, Vankipuram M*, Patel VL, Smith ML, “Deviations from Protocol in a Complex Trauma Environment: Errors or Innovations?”, J Biomedical Informatics, (2011); 44(3): 425-31. [Download PDF]
    (This paper was cited in the Institute of Medicine (IOM) 2012 report on Health IT and Patient Safety: Building Safer Systems for Better Care)
  • [JOURNAL ARTICLE] Vankipuram M, Kahol K, Cohen T, Patel VL, “Toward Automated Workflow Analysis and Visualization in Clinical Environments”, J Biomedical Informatics, (2011); 44(3): 432-40. [Download PDF]
  • [CONFERENCE PROCEEDINGS] Vankipuram M, Kahol K, Cohen T, Patel V, “Visualization and Analysis of Activities in Critical Care Environments”, American Medical Informatics Association (AMIA) Annual Symposium Proceedings, (2009); 662–6. [Download PDF]

* Equal contribution by authors for the publication.

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