The Use of Cognitive Task Analysis to Improve Anesthesia Skills Training for Postoperative Extubation
Abstract
This study examines knowledge gains in 25 nurse anesthesia trainees, following the implementation of a novel instructional design, which incorporated cognitive task analysis (CTA) to teach an adult postoperative extubation procedure. CTA is a knowledge elicitation technique employed for acquiring expertise from domain specialists to support the effective instruction of novices. Instruction guided through CTA is effective in improving surgical skills training for medical students and surgical resi-
dents. The standard, current method of teaching clinical skills to novices in nurse anesthesia practice relies on recall-based instruction from domain experts. However, this method is limited by the constraints of expertise, including automation of procedural knowledge by the expert practitioner.
Automated knowledge escapes conscious awareness and access, thus impeding clear explication of comprehensive essentials for task execution during instruction. CTA guided instruction has been shown to maximize
conceptual, declarative and procedural knowledge gains in novice practitioners by clearly explicating the essentials employed when experts execute tasks. Knowledge gains for the task of postoperative extubation in 13 junior and senior nurse anesthesia trainees were compared to those of 12 trainees, receiving standard instruction. The study results indicate that CTA-based instruction has a positive and significant effect on procedural knowledge gains in the novice anesthetist.
References
2. Embrey KK. The Use of Cognitive Task Analysis to Capture Expertise for Tracheal Extubation Training in Anesthesiology [dissertation]. Los Angeles, CA: University of Southern California; 2012. http://gradworks.umi.com/3513751.pdf. Accessed September 22, 2013.
3. Chi MT. Two approaches to the study of experts’ characteristics. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR, eds. The Cambridge Handbook of Expertise and Expert Performance. New York: Cambridge University Press; 2006:21–30.
4. Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363-406.
5. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10):S70-S81.
6. Clark RE. Yin and yang: cognitive motivational processes operating in multimedia learning environments. In: van Merrienboer JJ, ed. Cognition and Multimedia Design. Herleen, Netherlands: Open University Press;1999.
7. Feldon DF, Clark RE. Instructional implications of cognitive task analysis as a method for improving the accuracy of experts’ self-report. In: Clarebout G, Elen J, eds. Avoiding Simplicity, Confronting Complexity: Advances in Studying and Designing (Computer- based) Powerful Learning Environments. Rotterdam, Netherlands: Sense Publishers; 2006:109-116.
8. Pugh CM, Santacaterina S, Da Rosa D, Clark RE. Intra-operative decision making: more than meets the eye. J Biomed Informatics. 2011;3:486-496.
9. Yates KA, Sullivan ME, Clark RE. Integrated studies in the use of cognitive task analysis to capture surgical expertise for central venous catheter placement and open cricothyrotomy. In: Symposium of the Association for Surgical Education. Boston, MA; 2011.
10. van Merriënboer JJG, Clark RE, de Croock MM. Blueprints for complex learning: the 4C/ID-model. Ed Technol Res Dev. 2002;50(2):39-61. doi: 10.1007/BG02504993.
11. Schraagen JM, Chipman SF, Shalin VL. Cognitive Task Analysis. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.
12. Clark RE, Feldon D, van Merriënboer JJG, Yates KA, Early S. Cognitive task analysis. In: Spector JM, Merrill MD, van Merriënboer JJG, Driscoll MP, eds. Handbook of Research on Educational Communications and Technology.3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2008:578-591.
13. Crispen PD. Identifying the Point of Diminishing Marginal Utility for Cognitive Task Analysis Surgical Subject Matter Interviews [dissertation]. Los Angeles, CA: University of Southern California; 2010. http://usc.summon.serialssolutions.com. Accessed September 20, 2013.
14. Chao CJ, Salvendy G. Percentage of procedural knowledge acquired as a function of the number of experts from whom knowledge is acquired for diagnosis, debugging and interpretation tasks. Int J Hum Compu Interact.1994;6:221–223. doi:10.1080/10447319409526093.
15. Clark RE, Pugh CM, Yates KA, Sullivan ME. The use of cognitive task analysis and simulators for after action review of medical events in Iraq. In: Technical Report Produced under Contract W81XWH-04-C-0093 from the U.S Army Medical Research and Materiel Command. Fort Detrick, MD; 2006.
16. Sullivan ME, Ortega A, Wasserberg N, et al. Assessing the teaching of procedural skills: can cognitive task analysis add to our traditional teaching methods? Am J Surg. 2008;19:20–23. doi:10.1016/j.amjsurg.2007.08.051.
17. Velmahos GC, Toutouzas KG, Sillin LF, et al. Cognitive task analysis for teaching skills in an inanimate surgical skills laboratory. Am J Surg. 2004;1:114-119.
Keywords
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors agree to the Creative Commons License listed below, which can be viewed by clicking the link below.
This work will be licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
