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Assessing the Teaching of Procedural Skills: Can Cognitive-Task-Analysis Add to our Traditional Teaching Methods?. Maura Sullivan, PhD, Adrian Ortega, MD, Nir Wasserberg, MD, Howard Kaufman, MD, Julie Nyquist, PhD, Richard Clark, EdD University of Southern California.

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Assessing the Teaching of Procedural Skills: Can Cognitive-Task-Analysis Add to our Traditional Teaching Methods?

Maura Sullivan, PhD, Adrian Ortega, MD,

Nir Wasserberg, MD, Howard Kaufman, MD,

Julie Nyquist, PhD, Richard Clark, EdD

University of Southern California

cognitive task analysis cta
Cognitive-Task-Analysis (CTA)

Extends traditional task analysis to capture information about both the overt observable behavior and the covert cognitive functions behind it to form an integrated whole.

Schraagen, Chipman & Shalin, 2000

acquiring expertise
Acquiring Expertise

Declarative vs. Procedural Knowledge

Cognitive

Associative

Autonomous

expertise
Expertise
  • Expertise is highly automated

Ericsson, et al. 2006; Gagne et al. 1993; Clark & Estes, 1996

  • Automaticity interferes with articulation

Clark et al., 2007, Feldon, 2004, Crandall & Getchell-Reitter, 1993,

Chao & Salvendy, 1994

  • Learners need to be taught decision making strategies

Ericsson et al., 2006; Clark et al. 2007

expertise cont
Expertise cont.
  • Experts underestimate novice difficulty

Hinds, 1999

  • Experts not fully aware of 70% of own decisions

Clark & Elen, 2006; Feldon & Clark, 2006

  • Experts’ decisions can be put into training materials

Merrill, 2002; Schaafstal et al. 2000

cta gains
CTA Gains
  • Overt observable behavior
    • Deconstruct automated knowledge into concrete steps
  • Covert cognitive functions
    • Identification of decision points throughout procedure
    • Options related to each decision point
  • Ability to gain consensus amongst experts
    • Provide residents with an advanced organizer
purpose
Purpose
  • To determine if surgeons omit relevant steps and decision points when teaching a colonoscopy
  • To determine if CTA can augment our traditional teaching methods
methods
Methods
  • Three experts videotaped teaching a colonoscopy followed by “free recall”
  • Participated in CTA
  • Procedural Checklist and Cognitive Demands Checklist created
  • Videotape transcriptions transposed and omitted steps identified
results
Results

“What” to do

results cont
Results cont.

“What” to do

“How to” do it

conclusions
Conclusions
  • Experts did not articulate all relevant steps while teaching a colonoscopy or during free recall
  • CTA provides a means to capture omitted steps and decision points during traditional teaching
limitations
Limitations
  • Small N
    • # of experts
    • # of cases observed
  • No established “Gold Standard”
  • No inter-coder reliability
future studies
Future Studies
  • Quantify educational effectiveness
  • Determine number of experts needed
  • Determine number of cases required
  • Establish reliability
  • Accelerate the learning curve
implications
Implications
  • CTA can be used to develop more comprehensive curricula for teaching procedural skills
  • Assures exposure to all steps/decisions involved in a procedure
  • More complete training of residents
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mesulliv@usc.edu

(323) 442-2368