Surgery via text message

(Click image for a downloadable version of the regulations on Scribd)

I have a collection of job aids, some going back more than 50 years.  I keep them for various reasons: some are amusing, many are creative, and all of them are examples of helping people to perform some task.

What makes a job aid a job aid?

  • It presents information that’s external to the performer.
  • It’s used on the job.  It’s part of how the performer carries out some task.
  • It enables accomplishment: when a person uses the job aid, he can accomplish some result that he couldn’t otherwise.
  • It reduces the need for memorization.

I use “memorization” here only as a label for some of what we call learning, which is storing certain knowledge in your memory so you can retrieve it and apply it in the proper context. (I know, I’m oversimplifying.)

Job aids, when used appropriately, offload some of the cost of memorization: instead of learning all the information or steps for some task, the person learns how to use the job aid to carry the task out.

Just as not every task is suited to job-aiding, not every person can use every job aid.  A job aid supports the performance of a particular job, or at least the completion of a particular task.  Implicit in that is a certain level of background knowledge and overall capability.  If you don’t know much about photography and digital images, than a job aid for some advanced feature in PhotoShop probably was not designed for you.

Please understand that I mean no offense, and realize I’m making a possibly unjustified assumption, when I say that you, esteemed reader, probably couldn’t make good use of a job aid for a forequarter amputation.

That’s the surgical removal of someone’s arm and shoulder.  It’s not a common procedure.  In the UK, doctors perform about 10 per year, mainly on cancer patients.

David Nott performed one, too.  He’s a vascular surgeon who volunteers with Médecins Sans Frontières (Doctors Without Borders).  In 2008, while serving in the Democratic Republic of Congo, he was confronted with a boy who’d lost most of his arm.  The child was at grave risk of dying; Nott knew the only procedure that could help him was a forequarter amputation.

As the  BBC reported, Nott believed he had the surgical skill but wasn’t sure he knew all the steps for this specific operation.  There was no way to get real-time support (say, over an open phone line).  So he contacted Dr. Meirion Thomas of London’s Royal Marsden Hospital, who provided performance support… via text message.

Click to view video on The Telegraph's site

Notice how Thomas’s instructions rely on skill and knowledge that Nott already had.  “Cont(r)ol and divide (the) subsc(apular) art(ery) and vein” is one highly compressed step.  Professor Thomas knew that the intended performer could get around the typo, could identify the vessels, and would know the meaning of “control” and of “divide.”

Nott told The Telegraph he was able to carry out the three-hour procedure thanks to the guidance, which is one of the truly distinctive job aids in my collection.

2 thoughts on “Surgery via text message

  1. Hi Dave, I was at your Johns Hopkins speech today and really enjoyed it. I was looking for the link to d/l the Alcatraz manual but couldn’t find it on your blog. So…Help! :-)

  2. I apologize, Bob. When I put up the image, I thought I’d turned it into a link. Thank you for user-testing this. You can download the Institution Rules and Regulations from this link on Scribd.

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