Task Deconstruction and Metrics
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Transcript of Task Deconstruction and Metrics
Robert Sweet, MD
Task Deconstruction and Metrics
Robert M. Sweet, MDAssistant Professor Urologic Surgery
and General SurgeryClinical Director of Simulation
ProgramsFounding Director, CREST
Robert Sweet, MD
Procedure vs. Task vs. Exercise
• Procedure-is a “series of steps taken to accomplish an end”
• Task-“piece of work to be done”• Exercise-”effort performed to develop or
maintain fitness or increase skill”
Webster’s Dictionary
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Task deconstruction
• Procedures can be broken down into logical components
• Guidelines for the “order by which this occurs”– Safety considerations– Natural progression of skills from simple to complex– Resources and expense
• Independent opportunities for learning loaded on the front end, but sprinkled throughout
Robert Sweet, MD
Cognitive Technical+ Performance=
Dependent
Independent
Automatic
+Communication
Situational Awareness
Closed-Loop Communication
Leadership Transfer
Team Formation and Reformation
Psychomotor
Visual-spatial
Learning Domains in Simulation Training
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Classify your learners
• Who are your learners• Where are they as far as their level of
understanding?
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Types of Knowledge
• Declarative– Knowing “what”
• Procedural– Knowing “how”
• Schematic– Knowing “why”
• Strategic– Knowing how and when to apply
Wilson et al, Systems for State Science Assessment, 2005
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Learning Domains-Cognitive
• “Discriminate the differences between IJ and Subclavian central lines”
• “What would you do if . . . . .”
• “Asking for the proper equipment you need to have available to put in a central line”
• “Name the venous branches leading to the SVC”Bloom’s Taxonomy
Robert Sweet, MD
Robert Sweet, MD
Cognitive Domain Tasks
• Usually good to load on the front-end of the curriculum as it meets the criteria– Safe– Low resources– Logical to understand before doing– Estimated to comprise 75% of what we learn
in procedures (Spencer et al.)
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Teaching and assessing judgment
Red Llama, Inc.:SimPraxis
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Communication Domain
• Situational Awareness
• Closed loop communication
• Leadership Transfer• Team Formation and
Reformation
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Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
Multi-tasking
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s TaxonomyDave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
Multi-tasking
High-level of performance on auto-pilot
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Psychomotor/Visual-Spatial Skills• Basic skills (adapted from Satava et al., 2002)
– Patient positioning– Knowing steps of procedure– Knowing equipment needed– Sterilization procedures– Instrument handling– Bimanual Dexterity– Navigation– Suturing– Knot-tying– Intubation– Palpation– Cannulation– Cutting– Incising– Exploration– Tissue handling
Berkley et al.,2000
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Psychomotor/Visual-Spatial Skills
• Intermediate Skills (adapted from Satava et al., 2002)– Complex wound closures– Hemorrhage control– Endoscopy– Excision– Anastomosis– Debridement– Complex seldinger
technique
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Psychomotor/Visual-Spatial Skills
• Advanced skills– Sewing in a “deep hole”– Reconstruction– Adopting techniques to abnormal
anatomical/physiologic situations (cognitive too!) – Advanced minimal invasive skills– New adoptions of technology once done with formal training– Occurring in animal labs
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With each curricular subtask, choose a learning domain that
predominates
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Task deconstruction
• Methods to do this?– Look at operative reports/atlases– Practical experience– Remember when you were a student– Ask an introspective student/resident to “keep a diary”
of • What they are learning• Self-assessment of “level” of comprehension• When they are learning it
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Competence vs. Capability
COMPETENCEWhat individuals know or are able to do in
terms of knowledge, skills, attitudeCAPABILITY
Extent to which individuals can adapt to change, generate new knowledge, and continue to improve their performance
Brit. Med. J. 323:799-803, 2001
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Learning curves/criterion levels
MASTERY
COMPETENCY
PROFICIENCY
Hypothetical Learning Curve for a technical skill set
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
Robert Sweet, MD
Learning curves/criterion levels
MASTERY
COMPETENCY
PROFICIENCY
Hypothetical Learning Curve for a technical skill set
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
Simulator Remedial training
Robert Sweet, MD
Learning curves/criterion levels
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
MASTERY
COMPETENCYPROFICIENCY
Hypothetical Learning Curve for a technical skill set
Robert Sweet, MD
Metrics for Assessment
• Each task has two components– The performance task itself– A clearly defined scoring scheme/rubric
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Metrics
Make a list of what is it that is important to measure to determine competence for each subtask?
Establish Criterion levels based on subject matter expert consensus and performance
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Metrics examples (adapted from Satava et al. 2002)
Quality metrics Errors/”near misses”/events/complications
Blunt end vs. sharp end Missed target Improper delivery of energy Bleeding Final product (leaking or inaccurate) Patient outcomes
Ability to recover from error Efficiency metrics
Time to task Economy of motion Path lengths Response latency Use of resources Use of assistant(s) Proper sequence of steps