Utilization of a cognitive task analysis for laparoscopic appendectomy to identify differentiated intraoperative teaching objectives
Utilization of a cognitive task analysis for laparoscopic appendectomy to identify differentiated intraoperative teaching objectives
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DOI：
10.1016/j.amjsurg.2011.11.002
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发表时间：
2012-04-01
影响因子：
3
通讯作者：
Anastakis, Dimitri J.
中科院分区：
文献类型：
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作者：
Smink, Douglas S.;Peyre, Sarah E.;Anastakis, Dimitri J.
背景：专家在进行手术时变得自动化，这使得难以向受训者教授复杂的程序。认知任务分析（CTA），使专家能够阐明手术步骤和认知决策在复杂的程序，如腹腔镜阑尾切除术，然后可以用来确定中央teachingpoints.METHODS：三个当地的外科医生专家在腹腔镜阑尾切除术进行了采访，使用关键决策方法为基础的CTA方法。访谈记录进行了分析，并为每个专家创建了一个认知需求表（CDT）。每个CDT都由每位专家审查其完整性，然后合并成一个主CDT。计算了每位专家在操作步骤和决定点上的一致率。然后，专家们参加了一次协商一致会议，审查CDT总表。每位外科专家被要求在主CDT中确定初级和高级住院医师最重要的教学目标。专家对初级和高级住院医师的回答采用卡方检验进行比较。结果：外科专家确定了24个手术步骤和27个决策点。24个手术步骤中的18个（75%）由所有3名外科医生专家确定。每名外科医生专家识别的手术步骤百分比较高（外科医生1为96%，外科医生2为79%，外科医生3为83%）。在27个决策点中，只有5个（19%）被所有3名外科医生专家确定。确定的决策点百分比因外科医生专家而异（外科医生1为78%，外科医生2为59%，外科医生3为48%）。当被要求确定关键教学点时，外科医生专家更有可能确定初级住院医师的手术步骤（9个手术步骤和6个决策点）和高级住院医师的决策点（4个手术步骤和13个决策点）（P < .01）。结论：CTA可以解构与执行腹腔镜阑尾切除术相关的基本手术步骤和决策点。这些结果提供了一个框架，以确定关键的教学原则，指导术中教学。这些学习目标可以用来指导住院医师水平适当的教学的一个基本的普通外科手术。(C)2012 Elsevier Inc. All rights reserved.
BACKGROUND: Experts become automated when performing surgery, making it difficult to teach complex procedures to trainees. Cognitive task analysis (CTA) enables experts to articulate operative steps and cognitive decisions in complex procedures such as laparoscopic appendectomy, which can then be used to identify central teaching points.METHODS: Three local surgeon experts in laparoscopic appendectomy were interviewed using critical decision method-based CTA methodology. Interview transcripts were analyzed, and a cognitive demands table (CDT) was created for each expert. The individual CDTs were reviewed by each expert for completeness and then combined into a master CDT. Percentage agreement on operative steps and decision points was calculated for each expert. The experts then participated in a consensus meeting to review the master CDT. Each surgeon expert was asked to identify in the master CDT the most important teaching objectives for junior-level and senior-level residents. The experts' responses for junior-level and senior-level residents were compared using a chi(2) test.RESULTS: The surgeon experts identified 24 operative steps and 27 decision points. Eighteen of the 24 operative steps (75%) were identified by all 3 surgeon experts. The percentage of operative steps identified was high for each surgeon expert (96% for surgeon 1, 79% for surgeon 2, and 83% for surgeon 3). Of the 27 decision points, only 5 (19%) were identified by all 3 surgeon experts. The percentage of decision points identified varied by surgeon expert (78% for surgeon 1, 59% for surgeon 2, and 48% for surgeon 3). When asked to identify key teaching points, the surgeon experts were more likely to identify operative steps for junior residents (9 operative steps and 6 decision points) and decision points for senior residents (4 operative steps and 13 decision points) (P < .01).CONCLUSIONS: CTA can deconstruct the essential operative steps and decision points associated with performing a laparoscopic appendectomy. These results provide a framework to identify key teaching principles to guide intraoperative instruction. These learning objectives could be used to guide resident level-appropriate teaching of an essential general surgery procedure. (C) 2012 Elsevier Inc. All rights reserved.