Association for Surgical Education
The use of cognitive task analysis to improve the learning of percutaneous tracheostomy placement

https://doi.org/10.1016/j.amjsurg.2006.09.005Get rights and content

Abstract

Objective

The purpose of the current study was to determine the effectiveness of using cognitive task analysis (CTA) to develop a curriculum to teach the behavioral skills and the cognitive strategies of a percutaneous tracheostomy (PT) placement.

Methods

Postgraduate 2, 3, and 4 general surgery residents were randomly assigned to either the CTA group (N = 9) or the control group (N = 11). The CTA group was taught percutaneous tracheostomy placement using the CTA curriculum. The control group received the traditional curriculum.

Results

The CTA group performed significantly higher on the PT procedure at 1 month (CTA: 43.5 ± 3.7, control 35.2 ± 3.9, P = .001) and at 6 months post-instruction (CTA: 39.4 ± 4.2, control: 31.8 ± 5.8, P = .004). In addition, the CTA group demonstrated superior cognitive strategies than the control group (CTA: 25.4 ± 5.3, control: 19.2 ± 2.0, P = .004).

Conclusions

The use of CTA was effective in improving the cognitive processes and technical skills of performing a PT for surgical residents.

Section snippets

Part 1: task diagram

Three PT experts at our institution (C.B., A.S., M.M.) were identified and interviewed by a trained CTA analyst (M.S.). The experts were asked to recall the last time they performed the procedure and to outline the steps involved. The steps of the procedure were transcribed and a broad overview of the procedure was obtained. The steps were then analyzed and 7 to 10 steps were then grouped (chunked) into tasks (Fig. 1). These tasks or chunks were sized to be easily assimilated into the working

Results

There was no difference between the groups regarding previous PT experience, time frame related to last PT placement, or baseline knowledge on the 10-item pre-test (CTA: 9.0 ± 1.0, control 8.8 ± .91, P = .46).

The CTA group performed significantly higher than the control group on technical competence at 1 month (CTA: 43.5 ± 3.7, control 35.2 ± 3.9, P = .001) and at 6 months post-instruction (CTA: 39.4 ± 4.2, control: 31.8 ± 5.8, P = .004). There was not a consistent pattern of missed steps by

Comments

CTA has emerged as a promising set of methods that enables us to tap into the mental models of experts in order to improve the teaching and assessment of technical skills. While many programs are moving away from the “see one, do one, teach one” approach to a more structured skills curriculum, it is important to recognize that most programs focus on the overt observable behavior of skill execution and not on the many covert cognitive functions that underlie the behavior. Many of the checklists

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