Is Meeting The Needs Of The Average Trainee in Healthcare Creating Crash Landings?


Myth:  Meeting the needs of the “average” is good design.

 The classic example is that of Lt. Gilbert S. Daniels work in the 1950’s.  Lt. Daniels was a Harvard educated human anthropologist who joined the Aero Medical Laboratory at Wright Air Force Base and was on a team tasked with solving a confounding problem at the time.  With the advent of jet powered aircraft in the 1950’s the Air Force had a major safety issue.  An unacceptable number of flight crashes and crew deaths was occurring. Nearly all the accidents and mishaps were investigated and attributed to human error. The jet aircraft worked as expected, but for reasons that were not clear mishaps occurred even with the best Airforce pilots.  

At the time cockpit parameters established by the Army in the 1920’s had been the long-accepted design based on the average physical characteristics of pilots.  After studying over one hundred physical dimensions in over 4,000 pilots Lt. Daniels came to a surprising conclusion.  Although the cockpit was designed for the average pilot (based on a core of nearly a dozen dimensions), there was in fact no pilot amongst thousands that fit the “average” when each was compared individually.  Even when using a limited core of data points, say only about three dimensions, less than 4 percent of pilots fit the “average” profile. Lt. Daniels concluded there was no such thing as an average pilot.  Furthermore, he concluded any design driven by the average would fail, instead the cockpit needed to be adapted to the individual pilot.  

The Airforce embarked on a major redesign of the aircraft cockpit and mandated that it’s parameters fit 90% of pilots.  After a short-lived contentious response to the military’s new design demands, engineers quickly innovated inexpensive solutions resulting in adjustable seats, foot pedals, helmet straps and flight suits.  Soon after the implantation of this new design thinking aviation mishaps declined sharply and the US Airforce grew to dominate its opponents.  The adjustable seats, mirrors, safety belts and scores of other items in the vehicles we drive today are the direct result of the paradigm shift Lt. Daniels introduced nearly seventy years ago. 

 In healthcare patient safety is a major concern and error is a leading cause of harm to patients.  Essentially, crash landings happen everyday in healthcare.  Are we preparing trainees in healthcare using a failed model targeted to the average learner?  There is no one size fits all when it comes to learning in medicine yet the approach many times seem very one size fits all.  Medicine is like a language and world all unto itself, much like aeronautics.  The number of professionals and disciplines required to deliver safe patient care is staggering, perhaps making aviation appear “simple” in comparison.  Most education in healthcare is geared toward establishing minimal competencies and standardization of testing is needed to demonstrate predetermined competencies.  The challenge before us is innovating robust teaching instruments that engage the varied learning styles of students, trainees and professionals in healthcare.  

Not fitting into one category of anything is not a problem, rather it is a trait of the human experience that seems to be severely under appreciated.  The diverse background of experiences and personalities in healthcare are characteristics that can make for a resilient corp.  Individuals may feel like they don’t quite fit and it is possible that “lack of fitting” can make any team they join stronger, if well examined and understood. Not fitting the “average” and leveraging that into a strength is perhaps what makes the collective field within healthcare, such as Emergency Medical Services, so amazingly effective, resilient and forward leaning.

Are we teaching to a mythical average?  Where can we improve healthcare didactics and training to meet the needs of 90% of learners like the cockpit redesigned with Lt. Daniel’s ground-breaking work?  We know in the daily work of healthcare most patients do not fit an average, they fit a range, if we are fortunate.  Food for thought.

About The Writer:  Hector Caraballo, MD is a practicing Board Certified Emergency Physician and Chief Medical Officer at MedCognition.

MedCognition has developed a high-fidelity medical simulation teaching instrument, called PerSim™, that can be adapted to individual learners using holographic augmented reality technology.