Some behavioural factors affecting the training of naive users of an interactive computer system

lnt. J. Man-Machine Studies (1975) 7, 817-834

Some Behavioural Factors Affecting the Training of Naive Users of an Interactive Computer System* T. C. S. KENNEDY

North-East Thames Regional Health Authority, Computer Project Office, Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, U.K. (Received 6 January 1975) This paper describes the design considerations underlying the development of a self-contained computer system which is to form the basis of a medical information system at Southend Hospital. A detailed trial has been conducted to examine the problems in training naive computer users in the use of such a system. The trial involved a large sample of clerical and secretarial staff and provided some 50 hr of observation and measurement of man-machine interaction. Analysis of test restilts has required the development of new measures of performance for recording behavioural variables, conceptualization of the system, and level of ability. It is shown that it is possible, with a self-teaching computer system, to train "computer-naive" clerical staff to a high degree of competence in a very small number of short training sessions. Behavioural patterns are examined with regard to their influence on the design of command structures.

Introduction T h e c o m p u t e r p r o j e c t at S o u t h e n d G e n e r a l H o s p i t a l t has been designed t o w a r d s a self-contained system o p e r a t e d b y clerical staff within the hospital ( K e n n e d y & Wallis, 1973). A small n u m b e r o f terminals, p l a c e d at strategic points, are c o n n e c t e d to a c o n f i g u r a t i o n b a s e d on a m i n i - c o m p u t e r . These t e r m i n a l s are used interactively to access a n d m o d i f y file structures m a i n t a i n e d on disc. T y p i c a l o f the p r o c e d u r e s used are those described b y K e n n e d y & F a c e y (1973) a n d G a i n e s & F a c e y (1974). T h e a i m o f the p r o j e c t has been to establish a n effective M e d i c a l I n f o r m a t i o n System [ K e n n e d y & M o s s (1974)] to assist with a d m i s s i o n a n d scheduling tasks. It has been o f considerable interest to the design t e a m to e x a m i n e whether such a system can be m a i n t a i n e d b y " n a i v e " c o m p u t e r users a n d to establish the level o f training r e q u i r e d b y such users. It was explicit in the original p h i l o s o p h y o f the p r o j e c t design [Moss, K e n n e d y & W y n n e (1972] t h a t *This paper is based on a presentation to the European Computing Congress held at Brunel University in 1974 with the addition of new material. fSupported by the Department of Health and Social Security (as part of their programme of experimental computer projects), the North East Metropolitan Region Health Board and the Southend-on-Sea Hospital Management Committee. 817

818

T. KENNEDY

training demands should be at a minimum to reduce the effects of staff turnover. In order to assist with this study, a controlled experiment was carried out using a bureau computer in London (a small time-shared PDP-8 system). A suite of programs, written for the waiting-list system, was adapted to provide a realistic task on which subjects could be tested, and to monitor their performance. A "score" for each subject could be derived from a combination of various performance measures to give a value for rate of learning and level of attainment after a number of training sessions. Naive Users

The term "computer-naive" is employed to describe the users of a computer system whose understanding of the system is limited to generalized descriptions of "records" and "lists" or "files". In the present context, for example, the description of the waiting list system is that a record for each patient is made up from the data which is entered at a terminal and this record is stored in a file for the appropriate consultant. When required, the records can be moved about within t h e file and printed individually or the file listed as a whole. The difficulties inherent with such limited descriptions, due to a conflict of terminology and to a lack of understanding of system boundaries, are discussed later. The design of a command structure for the computer system is greatly influenced by this description of the naive user. It is apparent that it should not be too complex nor should it contain too many abstract concepts. In the hospital context, complexity can be reduced to splitting the work into a number of easily definable tasks such as waiting list management, patient registration, and information services. Each of these tasks is concerned with a manageable portion of the complete system. Conceptualization is simplified by evolving a "natural" communication language for the task (Kennedy, 1974). This language is conversational but terse and basic, with redundancy used only to resolve ambiguities. Despite these rather basic requirements, there exist innumerable systems with data entry procedures requiring fixed entry formats, using highly complex mnemonic command structures, and producing error messages which are often unintelligible to the user. Each of these design faults increases the training problem since the relationship between the complexity of a task and the training required to master it is non-linear and the major element to training is conceptualization of the system. In the event of a fault, the user must be able to perceive that the system

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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is not functioning correctly, and he must have sufficient knowledge to determine whether it is safe to continue. As an example, a corrupted record in a file may prevent the file from being completely listed, even though there may not be a serious fault in the hardware or software. Under these circumStances, the user could probably recover by deleting and re-entering the record. However, this requires a good understanding of the system (which may not be possible for the naive user) and great confidence. It is also inherently dangerous in that a fault may not be reported unless it is automatically logged.

The Training Task During the development of the Southend project, a number of detailed working trials have been run, using bureau services, in areas of particular interest and difficulty, to evolve solutions t o procedural problems. The programs developed for a trial of the waiting list system were adapted to investigate the training problems involved with interactive data entry and file manipulation procedures. A detailed study was conducted with a good sample of hospital clerical staff to examine their rates of learning a specific task, and their ability to grasp the concepts involved in the manipulation of data records and files under different training methods. Each subject involved with the study was introduced to a terminal on the computer system by performing a word-association test. This was designed to derive a basic measure of their individual rates of interaction with the computer and to establish whether they held any strong attitudes towards computer systems. On the basis of an assessment of attitude differences, the subjects were split into two groups, the first consisting of those who were antagonistic or indifferent to computers, and the second of those who were favourably disposed. The second group were given manuals to study, explaining the system they were to use; the first group were to learn from the system itself. Half of each group was tested under different conditions. The first half were given verbal assistance and demonstration during the initial tests; the second half were left to use the system or manual to get any help they needed. The tests were composed of a number (three to five) of sessions at a terminal taken on consecutive days. The same pattern of procedure was followed on each day with different, carefully matched material. The tests were limited to approximately 15 rain in most cases, and each subject was tested at the same time of day in order to avoid differences due to fatigue or variations in natural alertness. The usual work pattern for the subjects varied

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T. KENNEDY

considerably, with maximum pressure periods occurring at different times of the week. It is considered that changes in performance due to these pressures is an important factor when studying individual learning curves, but does not affect combined results. Each test was monitored and timed by the computer as itwas performed, and the results stored for later evaluation. A session consisted of the subject opening a waiting list file for a consultant, adding a number of records to it by an interactive data entry procedure, manipulating records within the file, editing records and producing lists. Three aspects to the task have been distinguished, namely, data entry, record and file manipulation and general conceptualization of the computer system. After the tests, each subject was given a further simple interactive test to establish whether any corrections were necessary to the performance measures, due to their increased expertise with the terminal. TYPING TEST AND PRE-TEST The initial test of each subject's facility with the terminal involved use of the full keyboard. A number of words were presented as cues to which they were requested to respond with the same word. This simulates the interactive question and answer sequence used for data entry but removes the data search time. Responses were timed by the computer (see Appendix I for a note regarding the accuracy of response-timing on a time-sharing computer system). A technique which has been developed by Gedye (1972) for discriminating attitude differences was applied to the subject group in a pre-test before the main test of the interactive system. This consists of a computer-administered word-association test whereby the computer randomly selects one word from a predetermined set and prints it as a cue. The subject responds with an associated word and a new word is then presented. The subject's responses are added to the initial set and the test continues until a limit is reached in terms of time or number of responses, or each cue evokes a previous response to form a closed loop. Chains of words are formed by the computer from these cue-response sequences. Analysis of these chains can either be carried out manually or by using the computer to establish linkages amongst and between sub-sets of the total word set. Two examples are given in Appendix II of the word chains formed. For the purposes of this study, an attempt was made to distinguish those subjects who strongly associated computers with information systems and those who were antagonistic to the concept of the computer system. This method of testing requires a detailed study for the selection of the original word set in order to elicit responses in the area of interest. The word set which

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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was used was not entirely satisfactory; however, it was possible to distinguish the basic attitudes for most of the sample. The purpose of establishing these groupings was to investigate whether any conclusions could be drawn on the effect of attitude on the subject's approach to the task of using the computer system. I N T E R A C T I V E TEST

The main section of the trial consisted of each subject performing a test of the interactive system at a number of terminal sessions. The sessions, for a particular subject, were held at the same time each day on a number of successive days. The number of tests taken varied between three and five with the majority taking four. For the most part, subjects were given a fixed period of 15 min in which to complete as much of the test as possible; some, however, were allowed to progress to completion. The same procedures were followed at each session, but different material was used for data entry. The material was carefully chosen to be balanced so that comparison could be made of the time taken for the data entry in each case. For example, data items were of the same length and complexity for each test. The tests were given simultaneously in two centres, namely Rochford and Southend hospitals, so that significant variations due to the approach or personality of the administrators could be detected. Some subjects were provided with an instruction manual and the remainder were required to learn from the computer system itself, by using a H E L P c o m m a n d and the instructive error messages. The initial conditions for each test were the same; a waiting list file was set up to contain two records which had previously been entered. The first task for a subject was to open the waiting list file and to add three patients to it. The data for these patients was contained on standard cards used in the hospital and entered to the file by an interactive question and answer sequence. An example of the procedure is given below, with the user responses italicized to distinguish them from the cues. TITLE: MRS SURNAME: CANTOR INITIALS: E U N I T N U M B E R : 146513 PRIORITY: 2 D I A G N O S I S : L. K E L L E R S

Null response, i.e. carriage return only is equivalent to "none".

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T. KENNEDY

CODE: B I R T H DATE: 1.10.47 T Y P E - - D A Y / M O N T H / Y E A R OR DAY/MONTH B I R T H DATE: 1[10/47

Date in unacceptable format for machine. Error message. Corrected entry.

S H O R T NOTICE: NO CARE: NO T H E A T R E : 15 STAY: 5 CATEGORY:

Null response--equivalent to N.H.S. since it is the most common.

XRAY: YES CONSTRAINTS:

Null response--none.

PRETREATMENT:

Null response--none.

C A L L E R : ASC RECORD 3

Computer assigns a record number to the record.

As can be seen, errors which can be detected are reported and the user is required to re-enter the item. The sequence is variable in that some items can require a subsidiary entry depending on the primary response. For example, the response to the C O N S T R A I N T S cue can be N O N E as shown, or, if there are constraints on the dates on which a patient can be admitted, the response can be AFTER, EXCEPT or B E T W E E N followed by one or two dates. Records on the waiting list are manipulated by means of a number of commands, some of which are immediately executed while others require additional data. Since the majority of the subjects were almost totally unfamiliar with the procedures involved in the management of hospital in-patient waiting lists, the task was presented to them in the form of a written story with a linked set of instructions which mimicked a realistic hospital situation. At each session a subject was requested to perform the sequence shown below. Book the patients with record numbers 1, 2, 3 and 5 to come into the appropriate hospital on the dates given.

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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WLS: BOOK RECORD NUMBER: 1 140234: M R P. H A L L - - R . M E D I A L M E N I S E C T O M Y C O N T I N U E ?: YES D A T E T C I : 24/8 HOSPITAL: R WLS: BOOK RECORD NUMBER: 2 32432: MISS L. G E R B E R - - A R T H R O D E S I S R. A N K L E C O N T I N U E ?: YES D A T E T C I : 24/8 HOSPITAL: R WLS: BOOK RECORD NUMBER: 3 146513: MRS E. C A N T O R - - L . K E L L E R S C O N T I N U E ?: YES D A T E TCI: 26/8 HOSPITAL: R WLS: BOOK RECORD NUMBER: 5 327651 : M R F. L I N N E T - - P A T E L L E C T O M Y C O N T I N U E ? : YES D A T E TCI: 26/8 HOSPITAL: R Return the patient with record number 1 to the waiting list because of an error. WLS: RETURN RECORD NUMBER: 1 140234: M R P. HALL---R. M E D I A L M E N I S E C T O M Y C O N T I N U E ?: YES R E A S O N : ERROR Expedite the admission of patient with record number 1 because of a request from his general practitioner. WLS: EXPEDITE RECORD NUMBER: 1 140234: M R P. H A L L - - R . M E D I A L M E N I S E C T O M Y C O N T I N U E 9.: YES

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T. KENNEDY

Postpone the admission of patient with record number 2 from the date given to a new date. WLS: POSTPONE RECORD NUMBER: 2 32432: MISS L. G E R B E R C O N T I N U E ?: YES TCI DATE: 24/8/74 NEW DATE: 26/8

A R T H R O D E S I S R. A N K L E

Edit the record of patient with record number 4 because of an error. WLS: CHANGE RECORD NUMBER: 4 53214: MRS D. H E R B E R T - - T O T A L HIP R E P L A C E M E N T C O N T I N U E ?: YES ITEM: BIRTH DATE B I R T H DATE: 2/5/23 B I R T H DATE: 2/5/32 ITEM: Delete the record of patient with record number 5 because of an error. WLS: DELETE RECORD NUMBER: 5 327651: M R F. L I N N E T - - P A T E L L E C T O M Y C O N T I N U E ?: YES CAUSE: ERROR This was followed by requests to list the waiting list and list of patients booked to come into hospital. The concepts which have to be understood by the inexperienced user are, first, that the computer acts only on receipt of commands, that ;s, a "commandaction" sequence is always followed. This is the basic conception that there can be a dialogue between the user and a machine, and that in some instances the initiative may belong to the machine. Second, he must appreciate that the patient data is stored in records which can be read, changed and written, each of which is an abstract concept in computer terms. Finally, the user is faced with the idea that the machine can detect a mistake which he has made, and that he has the ability to make corrections and recover. POST-TEST A brief post-test was performed to examine changes in the ability of a subject to use the terminal. The test was similar to that given initially and

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

825

appropriate corrections were applied to give a figure for typing speed and rate of interaction with terminal during the test. MONITORING PERFORMANCE The performance at each session for each subject was monitored in three ways; first by visual observation, second, by the material left at the terminal, and lastly by the computer. Each part of the test was timed by the computer as it was performed and the results filed. At completion of a test a printout of the file was produced on demand; an example is reproduced below. TEST R E S U L T ON 15/8/73 AT 9.11 SUBJECT: 1 TEST STARTED: 8.53 C O M M A N D RECORD N U M B E R T I M E ON D U R A T I O N ADD 3 8.53 125 SECS ADD 4 8.56 128 SECS ADD 5 8.58 121 SECS BOOK 1 9.00 50 SECS BOOK 2 9.01 43 SECS BOOK 3 9.02 32 SECS BOOK 5 9.03 25 SECS RETURN 1 9.04 40 SECS EXPEDITE 1 9.05 20 SECS POSTPONE 2 9.06 40 SECS CHANGE 4 9.07 79 SECS PRINT 4 9.09 17 SECS DELETE 5 9.10 30 SECS

INTERVAL 60 SECS 32 SECS 30 SECS 23 SECS 21 SECS 18 SECS 48 SECS 37 SECS 52 SECS 24 SECS 40 SECS 36 SECS

Performance Measures It is beyond the scope of this paper to discuss learning, memory or conceptual processes in detail. It is simply intended to examine any features which can be distinguished from the trial, to see if they have any significance for the design of an interactive system and the training of users. Before drawing any conclusions, the dimensions by which the performance of a subject can be measured have to be established. LEARNING CURVES The data entry sequences for each user form a most reliable guide to the rate of learning of the task from one session to another. Simple learning

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T. KENNEDY

curves for each subject can be plotted of the mean data entry times for a session from the individual timings. Examples of these curves are illustrated in Figs 1, 2 a n d 3, where the individual times at a session are indicated by crosses.

X 240 220 200

200

180

180 160

160 X 140

140

x\

120 100

120 ×

I00

×x

80 I

Day I

I

Day 2

x

I

Day 3

FIG. I. Subject I.

X Day 4

X

• -t

80 xIX

I

Day I

De/2

xIX X Day 5 Day 4

FIG. 2. Subject 2.

At a session, each user was required to enter data to form three records; the second of these entries contained a logical branch where admission constraints had to be entered. As can be seen from Fig. 1, the second entry at each session takes longer than the first or third. A consistent, inverted " V " pattern is obtained. The reason for this pattern is that there is a branch in the second data entry which presents an added complexity and requires a deeper understanding of the interactive procedure. It has been shown in a control experiment that when a subject fully understands the data entry concept, the dispersion of the three results in a session is markedly reduced. It is interesting that some subjects improved their mean data entry times without reducing the dispersion of their results, which indicates that they appear to be learning well but do not fully understand the task. Dispersion is taken as a quantitative performance measure of the subject's grasp of one of the concepts of the interactive system. If the task is fully understood, there need be no pause to accommodate the branch. The shape of the curve is a qualitative indication of the subject's reaction to the task. Compare, for example, Figs 1, 2 and 3.

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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Subject 1 has a fairly even rate of learning throughout and never reaches peak of performance. It appears that there is room for further improvement. Comprehension of the task grows toward the end as evidenced by the reduced dispersion of results. Subject 2 learns very rapidly initially, reaches a peak of performance and then shows no further improvement. Comprehension of the task remains virtually constant. Subject 3 learns very slowly throughout. Comprehension actually decreases as the tests progress indicating that learning was probably by rote.

X

X 240;

200

160

X

x

x

x

120 -

x I

Day I

I

Day 2

I

Day 5

Day 4

FIG. 3. Subject 3.

When all the subjects' combined results are ordered, these three achieved the following rankings, out of 35: Subject 1--10; Subject 2--15; Subject 3--35 ; which corresponds well with a qualitative examination of the learning curves and indicates how sensitive a measure they can be.

828

T.

KENNEDY

RECORD MANIPULATION

Performance in the record manipulation part of the task was monitored by recording the time taken to complete a procedure and the interval between procedures. The interval is a measure of th e conceptualization of the "command-action" sequence, whereas the time taken is a measure of the rate of learning of the interactive procedure. Similar patterns to those of the learning curves were produced. In addition, a qualitative assessment was made of the subject's observed behaviour. LEVEL OF ATTAINMENT

A level of attainment for each subject was derived from a combination of the results of the data entry and record manipulation sections of the test. The two independent variables to the data entry task, namely dispersion and level, are plotted at Fig. 4.

7' 6

f, 5 ~3 3

2

'r-

I High

I

I

I

I

I

I

lel

I

I

I

I

I

I

L

I Low

Level of otloinment

Fio. 4.

Spearman's rank correlation coefficient is 0.71, which is significant even at the 1 70 level and allows a score to be derived, with reasonable confidence, from a combination of the variables. Four anomalies require closer scrutiny: (a)

(b)

Rank 32: dispersion; 10: level. Partly explained by the pressure on the individual of his normal work. The subject could only take three tests. The response rate was high while accuracy was low; there was a low level of concentration on the task. The subject was dropped from the test rankings. Rank 25: dispersion; 4: level. Explained by errors made, not connected with branching of the entry procedure. A correction was made.

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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(c)

Rank 6: disperson; 34: level. A very disjointed test due to terminal line dropouts: the subject was dropped from the test rankings. (d) Rank 26: dispersion; 8: level. Due mainly to an accident during the entry procedure. A correction was made. Superimposition of the record manipulation results made only minor changes to the relative scoring, which demonstrates that the data entry sequence contains all the important elements of the task. The subjects were ranked according to their total score, and a control scale of expertise was established by users who were totally familiar with the task and had several months of experience with the computer system. Conclusions

The approach of the subjects to the task and the observed behavioural patterns have led to significant changes in the interactive system design, and to the establishment of an effective training methodology. There was no significant difference noted in performance between those subjects who were judged to associate computers with the provision of information (and could therefore be regarded as being favourably disposed towards them) and those who did not. Of the subjects who expressed complete antagonism towards computer systems, two dropped out of the tests. The remaining sample was too small to draw any significant conclusions. It is concluded that attitude has a small effect on the ability of the subject's performance under test conditions. However, attitude is important when considering the acceptability of the system and the user's preparedness to co-operate with it. For this reason it is essential that the training method does not antagonize the subject and conversely it should produce a more favourable attitude at the end of the training sessions. A majority of the subjects were under considerable tension during the first session at a terminal. This had the observed effects normally induced by fear-invoking situations, such as shaking hands, sweating palms, conversational difficulties and so on, which varied in intensity for different subjects. This tension was undoubtedly heightened by the word-association test which was almost universally disliked. A measure of this initial nervousness is expressed in the high slope at the start of the learning curves. A significantly lower average rate of learning, commencing at a better performance level, was general for those subjects who approached the task calmly. With very few excet3tions, tension had been relieved by the end of the trial, and there

830

T. KENNEDY

was an attitude shift towards acceptance of the system. The exceptions performed badly and it is evident that fear of the system is a major factor, blocking concept learning. This is confirmed by the work of Denny (1966) who found that, with average intelligence subjects, those with high anxiety performed worse than those with low anxiety in the formation of concepts. Dunn (1968) also found that concept attainment was impaired for high anxiety subjects. There was no significant difference in performance between those subjects who were given a manual and those who were not. However, on examination, it was found that only three subjects had read the manual before the trial, and these were ranked in the first three positions. Though the sample is too small for significance, it indicates that preparation for the task can improve performance. It is in this preparation that the definition of terminology and system boundaries assumes its greatest importance. Within a computer system, terminology is of needs exact. " A record", "an index", " a list", all have a precise meaning and their function in the system is known. In the world of the application, these terms may be defined differently, and have wider generality. It is important to avoid overlap and thus a boundary may be drawn around the explanation of a system in the application world. The limits of this boundary can only be set by experience of the capability of the user and the need to avoid confusion. A typical example is where a record is on one file and needs to be moved to another. In this context a patient on one consulta~lt's waiting list may have to be transferred to another. In computer terms, the record has to be removed from the one file and inserted into the other file. As far as the user is concerned it appears as if he has only to change one item of the record, namely the consultant to whom it belongs. Thus the user wishes to perform a C H A N G E whereas in the computer it is necessary to perform a T R A N S F E R . Unless the system definition has been sufficiently explicit this subtle distinction cannot be understood entirely and will cause problems. Though the subjects were given the choice of learning from the machine or using a manual, it was almost universal that the machine provided selfteaching and this has proved to be most effective. Self-teaching, in this context, consists of using the system which provides guidance and indicates errors. Guidance is given to the user on request and consists either of an indication of the type of entry required, such as the format of a date, or, where there are a limited number of choices, a list of those choices. This facility is the single most important factor in building up a user's confidence in his ability to use the system, since it changes the man-machine relationship from that where the machine is an aloof observer of the man, to that where the machine is

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

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involved with him in the task. This concept of learning by trial and error with feedback from the machine, has been shown by Prother, Berry & Bermuday (1972) to give a significantly better performance than prompting or demonstrations. The detection and reporting of errors by the machine showed a surprising result with a number of the test subjects. This was an inability to associate the error message with the entry which they had previously made. The concept that the machine could detect a mistake was the most difficult for them to understand. For this reason, considerably more detail has been included in the error messages which are currently used. In contrast to Nickerson (1969) who suggests that a concise error message is given and the ability provided for the user to request more information, we have separated the function of requests for information from that of error reporting. Error reporting is adapted to the expertise of the user in one of two levels and this is reinforced if necessary by use of guidance obtained from the machine. Overall, the results of the trial indicate that self-teaching is a most effective method of training on the interactive system. Of the subjects tested, more than 70 ~ reached a level of performance which can be described as "competent or better" after a short number of training sessions. To improve the performance of the subjects, the system should be carefully described with regard to its structure and the terminology should be defined exactly. An introduction to the interactive system by means of a simple game which contains some elements of the command-action and cueresponse sequences, is important where the subjects show any anxiety. The method of monitoring the interaction of users with a computer system has a wider application in maintaining the integrity of the system and ensuring that it adapts to its environment.

Appendix I RESPONSE TIMING

The time-sharing system used during the trial supports a language system called QUASIC (Gaines, 1970). A facility within the language enables a program to access areas of the monitor to examine and modify specific core locations. Thus, to time the interval between a cue being presented and the user responding, the following procedure can be used. (1) (2) (3)

Print cue. Examine core and read value of CPU clock. Initiate input. User responds.

832

(4) (5)

T. KENNEDY

Examine core and detect either the input o f a character or the delimiter o f input. R e a d value o f C P U clock.

There is a possibility, on a swapping system, that input at (4) m a y not be detected immediately because the p r o g r a m m a y n o t be in core at the time. However, since the scheduling algorithm allows each user 100 msec, with a small n u m b e r o f users (there were never more than three during the trial) the m a x i m u m error is 300 msec.

AppendixI I ASSOCIATION TEST

The attached lists give the sequence of words formed in word association tests by two subjects. It is beyond the scope of this paper to give an analysis o f the chained sequences. Subject 1 was classified after analysis, as being antagonistic towards the use o f the computer in the hospital context, whereas subject 2 was classified as being favourably disposed. SUBJECT 1

CHAIN SEQUENCES CHAIN 1 AUTOMATION

: : M A D E ESY : : N O T T H I S

CHAIN 2 TYPINS : : ERROR CHAIN 3 COMPUTERS : : PROBLEMS : : TROUBLES : : GIVE UP : : NO MORE CHAIN 4 Y O U R W O R K : ~. W A R D C L E R K : : P A T I E N T S CHAIN 5 ADMINISTRATION

: : OFFICE : : WORK

CHAIN 6 LISTS : : N A M E S CHAIN 7 NUMBERS : : FIGURES : : BODY : : HUMAN : : ERROR : : CHAIN 2 CHAIN 8 FORMS : : PAPER : : NEWS

833

FACTORS AFFECTING TRAINING OF USERS OF A COMPUTER SYSTEM

CHAIN 9 HOW DO YOU

FEEL?

:

C H A I N 10 PAIN : : UNPLEASANT C H A I N 11 HOSPITAL C H A I N 12 TREATMENT CHAIN

: NERVOUS : : AVOID

: : ACCIDENT : : CURE

: : BREAKDOWN : : KEEP

: : CARELESS : : MORE

CLEAR

: : TAKE

WORK

CARE

: : GO HOME

: : CAR

SEQUENCES

SUBJECT 2 CHAIN 1 AUTOMATION : : ROBOT : : COMPUTER MACHINE LIKE : : ROUTINE CHAIN 2 TYPING : : QUICKER TYPE CHAIN 3 COMPUTERS LOOP

THAN

: : QUICK

WRITING

ACCESS

: : REDTAPE

CHAIN 9 HOW DO YOU FEEL? : : INTERESTED OOPEN MIND : : READY TO LEARN

CLEAR

: : MACHINE

: : CHAIN

: :

: :

" :

4

: : LOOP : : WISH TO LEARN : : : :OPEN MINDED : : LOOP

C H A I N 10 PAIN : : SYMPTOM : : POINTER TO CONDITION SYMPTOM : : AID TO DIAGNOSI,~ : : NURSE

MORE

: :

: : AID TO MANAGEMENT

8 : : OFFICIALDOM

CHAIN 1l HOSPITAL

RESPECTS

: : MAANAGEMENT

: : MAANAGEMENT

CHAIN 6 LISTS : : INFORMATION CHAIN FORMS

USUALLY

: : COMPUTER

CHAIN 4 YOUR WORK : : ADMINISTRATION HOSPITAL : : NURSE CHAIN 5 ADMINISTRATION

IN SOME

: : CHAIN

4

: : SIGN

OR

834

T. KENNEDY

C H A I N 12 TREATMENT : : HOSPITAL : : CHAIN 4 References

DENNY, J. P. (1966). Effects of anxiety and intelligence on concept formation. J. Exp. Psychol. 72, 596. DUNN, R. F. (1968). Anxiety and verbal concept learning. J. Exp. PsychoL 76, 286. GAINES, B. R. (1970). QUASIC User's Manual. London: Questel Ltd. GAINES,B. R. & FACEY,P. V. (1974). Some experience in interactive system development and application. Proc. IEEE. (In press.) GEDYE, J. L. (1972). A computer-based aid to self awareness. BIM Conference. December 1972. KENNEDY, T. (1974). The design of interactive procedures for man-machine communication. Int. J. Man-Machine Studies 6, 309. KENNEDY, T. & FACEY, P. V. (1973). Experienced with a mini-computer based hospital administration system. Int. J. Man-Machine Studies 5, 237. KENNEDY, T. • Moss, N. B. (1974). A computer-assisted clerical system for management of hospital waiting lists. Worm Conference in Medical Informatics, Stockholm. August 1974. Pp. 497-501. KENNEDY, T. & WALLIS, C. C. (1973). An interactive computer-based clerical system. DECUS European Conference, 1973. Moss, N. B., KENNEDY,T. & WYNNE, L. (1972). Southend-on-Sea Hospital Management Committee, Experimental Computer Project System Study Report. Report No. 324, March 1972. NICKERSON,R. S. (1969). Man-computer interaction: a challenge for human factor research. IEEE Trans Man-Machine Studies, MMS-10, 164. PROTHER,D. C., BERRY,G. A. & BERMUNDAY,J. M. (1972). The effect of prompting and feedback on performance during learning, stress and transfer of perceptual skill. Proc. Ann. Con. Amer. Psychol. Assoc. 7, 643