The Use of Cognitive Task Analysis to Improve Instructional Descriptions of Procedures
The Use of Cognitive Task Analysis to Improve Instructional Descriptions of Procedures
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DOI：
10.1016/j.jss.2011.09.003
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发表时间：
2012-03-01
影响因子：
2.2
通讯作者：
Sullivan, Maura E.
中科院分区：
文献类型：
--
作者：
Clark, Richard E.;Pugh, Carla M.;Sullivan, Maura E.
背景。外科训练在很大程度上依赖于专家外科医生对复杂手术提供完整和准确描述的能力。然而，来自不同领域的研究表明，专家在解决难题或执行复杂任务时，往往会忽略有关判断、分析和决策的关键信息。在这项研究中，我们比较了三种获取外科医生对如何执行股动脉分流术的描述的方法（无辅助自由回忆法、无辅助自由回忆模拟法和认知任务分析法），以确定哪种方法产生更准确和完整的结果。在模拟过程中，认知任务分析比自由回忆和/或自由回忆的完整性和准确性大约高出70%。我们分别采访了一家主要城市创伤中心的10位创伤外科专家，并要求他们描述如何实施紧急分流手术。4名外科医生提供了分流手术的无辅助自由回忆描述，5名外科医生使用视觉辅助和手术器械（模拟）提供了手术的无辅助自由回忆描述，1名（随机选择）使用认知任务分析（CTA）方法进行了访谈。第11位血管外科医生批准了最终的CTA方案。仅与一名专家外科医生进行CTA访谈，与与多名专家外科医生进行无辅助自由回忆访谈相比，其描述的准确性和完整性显著提高。无辅助组的外科医生省略了近70%的必要决策步骤。在自由回忆组中，大量使用模拟提高了外科医生在描述手术步骤时的完整性。CTA显著提高了外科医生对手术过程的指导描述的完整性和准确性。此外，在无辅助的自由回忆访谈中进行模拟可以提高访谈数据的完整性。(C) 2012爱思唯尔公司版权所有。
Background. Surgical training relies heavily on the ability of expert surgeons to provide complete and accurate descriptions of a complex procedure. However, research from a variety of domains suggests that experts often omit critical information about the judgments, analysis, and decisions they make when solving a difficult problem or performing a complex task. In this study, we compared three methods for capturing surgeons' descriptions of how to perform the procedure for inserting a femoral artery shunt (unaided free recall, unaided free-recall with simulation, and cognitive task analysis methods) to determine which method produced more accurate and complete results. Cognitive task analysis was approximately 70% more complete and accurate than free-recall and or free-recall during a simulation of the procedure.Methods. Ten expert trauma surgeons at a major urban trauma center were interviewed separately and asked to describe how to perform an emergency shunt procedure. Four surgeons provided an unaided free recall description of the shunt procedure, five surgeons provided an unaided free-recall description of the procedure using visual aids and surgical instruments (simulation), and one (chosen randomly) was interviewed using cognitive task analysis (CTA) methods. An 11th vascular surgeon approved the final CTA protocol.Results. The CTA interview with only one expert surgeon resulted in significantly greater accuracy and completeness of the descriptions compared with the unaided free-recall interviews with multiple expert surgeons. Surgeons in the unaided group omitted nearly 70% of necessary decision steps. In the free-recall group, heavy use of simulation improved surgeons' completeness when describing the steps of the procedure.Conclusion. CTA significantly increases the completeness and accuracy of surgeons' instructional descriptions of surgical procedures. In addition, simulation during unaided free-recall interviews may improve the completeness of interview data. (C) 2012 Elsevier Inc. All rights reserved.