Assessing the Teaching of Procedural Skills: Can Cognitive- Task-Analysis Add to our Traditional...
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Transcript of Assessing the Teaching of Procedural Skills: Can Cognitive- Task-Analysis Add to our Traditional...
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)
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 ExpertiseDeclarative vs. Procedural Knowledge
Cognitive
Associative
Autonomous
Expertise Expertise is highly automated
Ericsson, et al. 2006; Gagne et al. 1993; Clark & Estes, 1996
Automaticity interferes with articulationClark 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.
Experts underestimate novice difficultyHinds, 1999
Experts not fully aware of 70% of own decisions Clark & Elen, 2006; Feldon & Clark, 2006
Experts’ decisions can be put into training materialsMerrill, 2002; Schaafstal et al. 2000
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
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 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
“What” to do
26-step Procedure
14 Decision Points
Surgeon A 61% 43%
Surgeon B 46% 25%
Surgeon C 50% 38%
Results cont.
26-step Procedure
14 Decision Points
Surgeon A 61% (50%) 43%
Surgeon B 46% (30%) 25%
Surgeon C 50% (26%) 38%
“What” to do“How to” do it
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
Small N # of experts # of cases observed
No established “Gold Standard” No inter-coder reliability
Future Studies Quantify
educational effectiveness
Determine number of experts needed
Determine number of cases required
Establish reliability Accelerate the
learning curve
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
[email protected](323) 442-2368