Date of Award

12-24-2025

Date Published

1-16-2026

Degree Type

Dissertation

Degree Name

Doctor of Professional Studies

Department

Information Management

Advisor(s)

John Jordan

Keywords

Aviation safety;Context asymmetry;Context modeling (AI);Contextual reasoning (AI);Distributed cognition;Interpretive divergence

Abstract

This thesis examines instances where pilots in a tightly regulated environment, the modern airline cockpit, exhibit diverging responses when presented with identical information. Despite explicit standardization of procedures, instrumentation, and Crew Resource Management, observable patterns of operational divergence persist. The study adopts distributed cognition (Hutchins, 1995) as the primary lens and analyzes the crew–procedures–artifacts system using cockpit transcripts and flight data. Operational context is the evolving set of roles, procedures, cognitive artifacts (including automation), constraints, and environmental conditions, while the operational configuration denotes its time-indexed instantiation at moment t. Within this frame, the thesis documents when cues do—and do not—propagate into coordinated action, using a five-stage, trace-based method across five incidents. The study focuses on observable response patterns documented in transcripts and system data rather than inferring internal mental states. This framework locates observable response-level mismatches within the distributed crew–artifact–procedure system. This study provides systematic documentation of divergence from expected responses despite information symmetry and develops a framework for analyzing failures in standardized environments, addressing a critical gap that has direct implications for future aviation safety improvements.

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Open Access

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