Postgraduate training in audiology improves clinicians’ audiology-related cue utilisation

The roles of phishing knowledge, cue utilization, and decision styles in phishing email detection

This study investigated the roles of phishing knowledge, cue utilization, and decision styles in contributing to phishing email detection. Participants (N = 145) completed an online email sorting task, and measures of phishing knowledge, email decision styles, cue utilization, and email security awareness. Cue utilization was the only factor that uniquely predicted the capacity to discriminate phishing from genuine emails. Phishing knowledge was associated with greater phishing detection and a bias towards classifying all emails as phishing. A preference for intuitive decision making predicted lower detection of phishing emails, driven by a greater tendency to classify emails as genuine. These findings support the proposition that cue utilization is a distinct cognitive process that enables expert performance. The outcomes indicate that, in addition to increasing phishing knowledge and developing safe behavioral patterns, anti-phishing training needs to provide opportunities for trainees to develop meaningful cue associations.

Cue utilization and pool lifeguarding

INTRODUCTION

Amongst pool lifeguards, the capacity to identify drowning swimmers quickly and accurately depends on the interpretation of critical cues. However, assessing the capacity for cue utilization amongst lifeguards at present is costly, time-consuming, and largely subjective. The aim of this study was to test the relationship between cue utilization and the detection of drowning swimmers in a series of virtual public swimming pool scenarios.

METHOD

Eighty-seven participants with or without lifeguarding experience engaged in three virtual scenarios, two of which were target scenarios where drowning events occurred within a 13 minute or 23 minute period of watch. Cue utilization was assessed using the pool lifeguarding edition of the EXPERTise 2.0 software following which 23 participants were classified with higher cue utilization, while the remaining participants were classified with lower cue utilization.

RESULTS

The results revealed that participants with higher cue utilization were more likely to have acquired experience as a lifeguard, were more likely to detect the drowning swimmer within a three minute period, and, in the case of the 13 minute scenario, recorded a greater dwell time on the drowning victim prior to the drowning event.

CONCLUSION

The results suggest that cue utilization is associated with drowning detection performance in a simulated environment and could be employed as a basis for assessments of performance amongst lifeguards in the future.

PRACTICAL IMPLICATIONS

Measures of cue utilization are associated with the timely detection of drowning victims in virtual pool lifeguarding scenarios. Employers and trainers of lifeguards can potentially augment existing lifeguarding assessment programs to quickly and cost-effectively identify the capabilities of lifeguards. This is especially useful for new lifeguards or where pool lifeguarding is a seasonal activity that might be associated with skill decay.

The role of cue utilization in the detection of phishing emails

This study was designed to examine the roles of cue utilization, phishing features and time pressure in the detection of phishing emails. During two experiments, participants completed an email sorting task containing both phishing and genuine emails. Participants were allocated to either a high or low time pressure condition. Performance was assessed via detection sensitivity and response bias. Participants were classified with either higher or lower cue utilization and completed a measure of phishing knowledge. When participants were blind to the nature of the study (N = 191), participants with higher cue utilization were better able to discriminate phishing from genuine emails. However, they also recorded a stronger bias towards classifying emails as phishing, compared to participants with lower cue utilization. When notified of phishing base rates prior to the email sorting task (N = 191), participants with higher cue utilization were better able to discriminate phishing from genuine emails without recording an increase in rate of false alarms, compared to participants with lower cue utilization. Sensitivity increased with a reduction in time pressure, while response bias was influenced by the number of phishing-related features in each email. The outcomes support the proposition that cue-based processing of critical features is associated with an increase in the capacity of individuals to discriminate phishing from genuine emails, above and beyond phishing-related knowledge. From an applied perspective, these outcomes suggest that cue-based training may be beneficial for improving detection of phishing emails.

The Role of Cue-Based Strategies in Skilled Diagnosis Among Pathologists

OBJECTIVE

This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task.

BACKGROUND

Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information.

METHOD

Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills.

RESULTS

Behavioral indicators of higher or lower cue utilization were based on the participants' performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases.

CONCLUSION

This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists.

APPLICATION

Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases.

Explaining emergency physicians' capacity to recover from interruptions

OBJECTIVE

To assess whether the capacity to utilize cues amongst emergency physicians is associated with differences in the capacity to recover performance following an interruption.

BACKGROUND

Interruptions are implicated in errors in emergency medicine due to the cognitive load that they impose on working memory, resulting in a loss of performance on the primary task. The utilization of cues is associated with a reduction in cognitive load during the performance of a task, thereby enabling the allocation of residual resources that mitigates the loss of performance following interruptions.

METHOD

Thirty-nine emergency physicians, recruited at a medical conference, completed an assessment of cue utilization (EXPERTise 2.0) and an online simulation (Septris) that involved the management of patients presenting with sepsis. During the simulation, physicians were interrupted and asked to check a medication order. Task performance was assessed using scores on Septris, with points awarded for the accurate management of patients.

RESULTS

Emergency physicians with higher cue utilization recorded significantly higher scores on the simulation task following the interruption, compared to physicians with lower cue utilization (p = .028).

CONCLUSION

The results confirm a relationship between cue utilization and the recovery of performance following an interruption. This is likely due to the advantages afforded by associated reductions in cognitive load.

APPLICATION

Assessments of cue utilization may assist in the development of interventions to support clinicians in interruptive environments.

Cue utilisation reduces the impact of response bias in histopathology

Histopathologists make diagnostic decisions that are thought to be based on pattern recognition, likely informed by cue-based associations formed in memory, a process known as cue utilisation. Typically, the cases presented to the histopathologist have already been classified as 'abnormal' by clinical examination and/or other diagnostic tests. This results in a high disease prevalence, the potential for 'abnormality priming', and a response bias leading to false positives on normal cases. This study investigated whether higher cue utilisation is associated with a reduction in positive response bias in the diagnostic decisions of histopathologists. Data were collected from eighty-two histopathologists who completed a series of demographic and experience-related questions and the histopathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioural indicators of context-related cue utilisation. They also completed a separate, diagnostic task comprising breast histopathology images where the frequency of abnormality was manipulated to create a high disease prevalence context for diagnostic decisions relating to normal tissue. Participants were assigned to higher or lower cue utilisation groups based on their performance on EXPERTise 2.0. When the effects of experience were controlled, higher cue utilisation was specifically associated with a greater accuracy classifying normal images, recording a lower positive response bias. This study suggests that cue utilisation may play a protective role against response biases in histopathology settings.

Differentiating Experience From Cue Utilization in Radiological Assessments

OBJECTIVE

This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology.

BACKGROUND

Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance.

METHOD

Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance.

RESULTS

Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization (p = .01).

CONCLUSION

This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task.

APPLICATION

Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature-event relationships and internalize these associations in the form of cues in memory.

Drivers' Cue Utilization Predicts Cognitive Resource Consumption During a Simulated Driving Scenario

OBJECTIVE

This study was designed to examine whether cue utilization differentiates drivers' consumption of cognitive resources during a simulated driving task.

BACKGROUND

Outcomes from previous research have demonstrated that a general capacity for cue utilization differentiates cognitive load during novel process control tasks. However, it was previously unclear whether similar results would be demonstrated during familiar operational tasks.

METHOD

Based on an assessment of cue utilization within a driving context, participants were classified into higher or lower cue utilization typologies. During a simulated driving task, cognitive load was assessed through changes against baseline in cerebral oxygenation in the prefrontal cortex, through eye behavior metrics (fixation rates and fixation dispersion), and through driving performance (frequency of missed traffic signals and speed exceedances).

RESULTS

Drivers with higher cue utilization recorded smaller mean fixation dispersions, smaller increases in cerebral oxygenation, and fewer missed traffic signals compared with drivers with lower cue utilization. These results suggest that compared with drivers with lower cue utilization, drivers with higher cue utilization experienced lower cognitive load during the simulated driving task while maintaining a higher level of performance.

CONCLUSION

The results provide support for the assertion that, among qualified operators, a greater capacity for cue utilization is associated with lower cognitive load during operational tasks.

APPLICATION

Cue-based assessments of driving may be beneficial in predicting performance and assisting in targeted training for recently qualified and/or older drivers.

Streamlining the Cochlear Implant Evaluation: Utility of Community Audiometry in Cochlear Implant Candidacy Assessment

OBJECTIVE

To identify redundancy in the cochlear implant candidacy evaluation and assess its financial impact.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary care academic cochlear implant center.

PATIENTS

One hundred thirty-five patients referred for cochlear implant candidacy evaluation from 2004 through 2019.

INTERVENTION

Community and academic audiometry were compared in a matched-pair analysis.

MAIN OUTCOME MEASURES

Pure-tone audiometry and word recognition scores (WRS) were compared using the Wilcoxon signed-rank test. Cost of repeated audiometry was estimated using the Medicare Provider Utilization and Payment data.

RESULTS

The majority of pure-tone thresholds (PTT) and pure-tone averages (PTA) had no statistically significant differences between community and academic centers. Only air PTT at 2000 Hz on the right and air PTA on the right demonstrated differences with α = 0.05 after Bonferroni correction. Despite statistical differences, mean differences in PTT and PTA were all under 3.5 dB. WRS were on average lower at the academic center, by 14.7% on the right (p < 0.001) and 10.6% on the left (p = 0.003). Repeating initial audiometry costs patients up to $60.58 and costs the healthcare system up to $42.94 per patient.

CONCLUSIONS

Pure-tone audiometry between community and academic centers did not demonstrate clinically significant differences. Lower academic WRS implies that patients identified as potential cochlear implant candidates based on community WRS are likely suitable to proceed to sentence testing without repeating audiometry, saving patients and the healthcare system time and resources.

The Role of Cue Utilization and Cognitive Load in the Recognition of Phishing Emails

Phishing emails represent a major threat to online information security. While the prevailing research is focused on users' susceptibility, few studies have considered the decision-making strategies that account for skilled detection. One relevant facet of decision-making is cue utilization, where users retrieve feature-event associations stored in long-term memory. High degrees of cue utilization help reduce the demands placed on working memory (i.e., cognitive load), and invariably improve decision performance (i.e., the information-reduction hypothesis in expert performance). The current study explored the effect of cue utilization and cognitive load when detecting phishing emails. A total of 50 undergraduate students completed: (1) a rail control task; (2) a phishing detection task; and (3) a survey of the cues used in detection. A cue utilization assessment battery (EXPERTise 2.0) then classified participants with either higher or lower cue utilization. As expected, higher cue utilization was associated with a greater likelihood of detecting phishing emails. However, variation in cognitive load had no effect on phishing detection, nor was there an interaction between cue utilization and cognitive load. Further, the findings revealed no significant difference in the types of cues used across cue utilization groups or performance levels. These findings have implications for our understanding of cognitive mechanisms that underpin the detection of phishing emails and the role of factors beyond the information-reduction hypothesis.