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Medical judgement analogue studies with applications to spaceflight crew medical officer

Abstract

Background The National Aeronautics and Space Administration (NASA) developed plans for potential emergency conditions from the Exploration Medical Conditions List. In an effort to mitigate conditions on the Exploration Medical Conditions List, NASA implemented a crew medical officer (CMO) designation for eligible astronauts. This pilot study aims to add knowledge that could be used in the Integrated Medical Model.

Methods An analogue population was recruited for two categories: administrative physicians (AP) representing the physician CMOs and technical professionals (TP) representing the non-physician CMOs. Participants completed four medical simulations focused on abdominal pain: cholecystitis (CH) and renal colic (RC) and chest pain: cardiac ischaemia (STEMI; ST-segment elevation myocardial infarction) and pneumothorax (PX). The Medical Judgment Metric (MJM) was used to evaluate medical decision making.

Results There were no significant differences between the AP and TP groups in age, gender, race, ethnicity, education and baseline heart rate. Significant differences were noted in MJM average rater scores in AP versus TP in CH: 13.0 (±2.25), 4.5 (±0.48), p=<0.001; RC: 12.3 (±2.66), 4.8 (±0.94); STEMI: 12.1 (±3.33), 4.9 (±0.56); and PX: 13.5 (±2.53), 5.3 (±1.01), respectively.

Discussion There could be a positive effect on crew health risk by having a physician CMO. The MJM demonstrated the ability to quantify medical judgement between the two analogue groups of spaceflight CMOs. Future studies should incorporate the MJM in a larger analogue population study to assess the medical risk for spaceflight crewmembers.

  • Clinical Judgement
  • Medical Judgement
  • Decision-making
  • Simulation
  • Astronaut Health

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Footnotes

  • Contributors MLM, RAA, AS, MDG, SSA, PH, JCB, LA, JM and RLG have substantial contributions to the conception and design of the work; acquisition, analysis and interpretation of data; drafting and revising the work; final approval of the version to be published; and have agreement to be accountable for all aspects of the work.

  • Funding Financial support for this study was provided entirely by a subcontract grant with Zin Technologies, Inc. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. MLM, LA, RLG: a percentage of time was paid by the subcontract grant with Zin Technologies, Inc. AS, MRG: served as consultants paid by the subcontract grant with Zin Technologies, Inc.

  • Competing interests Summa Health System received financial support for this study. The funding was provided entirely by a subcontract with Zin Technologies, Inc. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The authors report no other conflicts of interest.

  • Patient consent Obtained.

  • Ethics approval FWA00000026.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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