title: The use of cognitive task analysis to improve instructional descriptions of procedures.
abstract: BACKGROUND
  Surgical training relies heavily on the ability of expert surgeons to provide complete and accurate descriptions of a complex procedure. However, research from a variety of domains suggests that experts often omit critical information about the judgments, analysis, and decisions they make when solving a difficult problem or performing a complex task. In this study, we compared three methods for capturing surgeons' descriptions of how to perform the procedure for inserting a femoral artery shunt (unaided free-recall, unaided free-recall with simulation, and cognitive task analysis methods) to determine which method produced more accurate and complete results. Cognitive task analysis was approximately 70% more complete and accurate than free-recall and or free-recall during a simulation of the procedure.
  
  
  METHODS
  Ten expert trauma surgeons at a major urban trauma center were interviewed separately and asked to describe how to perform an emergency shunt procedure. Four surgeons provided an unaided free-recall description of the shunt procedure, five surgeons provided an unaided free-recall description of the procedure using visual aids and surgical instruments (simulation), and one (chosen randomly) was interviewed using cognitive task analysis (CTA) methods. An 11th vascular surgeon approved the final CTA protocol.
  
  
  RESULTS
  The CTA interview with only one expert surgeon resulted in significantly greater accuracy and completeness of the descriptions compared with the unaided free-recall interviews with multiple expert surgeons. Surgeons in the unaided group omitted nearly 70% of necessary decision steps. In the free-recall group, heavy use of simulation improved surgeons' completeness when describing the steps of the procedure.
  
  
  CONCLUSIONS
  CTA significantly increases the completeness and accuracy of surgeons' instructional descriptions of surgical procedures. In addition, simulation during unaided free-recall interviews may improve the completeness of interview data.
authors.affiliation: Center for Cognitive Technology, Rossier School of Education, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Clark
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Yates
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Maura E
authors.initials: ME
authors.lastname: Sullivan
mesh_terms: D001296:Audiovisual Aids; D003071:Cognition / Q000502:physiology*; D013502:General Surgery / Q000193:education*; D006801:Humans; D011939:Mental Recall; D013647:Task Performance and Analysis; D014193:Trauma Centers