title: The use of cognitive task analysis to reveal the instructional limitations of experts in the teaching of procedural skills.
abstract: OBJECTIVE
  Because of the automated nature of knowledge, experts tend to omit information when describing a task. A potential solution is cognitive task analysis (CTA). The authors investigated the percentage of knowledge experts omitted when teaching a cricothyrotomy to determine the percentage of additional knowledge gained during a CTA interview.
  
  
  METHODS
  Three experts were videotaped teaching a cricothyrotomy in 2010 at the University of Southern California. After transcription, they participated in CTA interviews for the same procedure. Three additional surgeons were recruited to perform a CTA for the procedure, and a "gold standard" task list was created. Transcriptions from the teaching sessions were compared with the task list to identify omitted steps (both "what" and "how" to do). Transcripts from the CTA interviews were compared against the task list to determine the percentage of knowledge articulated by each expert during the initial "free recall" (unprompted) phase of the CTA interview versus the amount of knowledge gained by using CTA elicitation techniques (prompted).
  
  
  RESULTS
  Experts omitted an average of 71% (10/14) of clinical knowledge steps, 51% (14/27) of action steps, and 73% (3.6/5) of decision steps. For action steps, experts described "how to do it" only 13% (3.6/27) of the time. The average number of steps that were described increased from 44% (20/46) when unprompted to 66% (31/46) when prompted.
  
  
  CONCLUSIONS
  This study supports previous research that experts unintentionally omit knowledge when describing a procedure. CTA is a useful method to extract automated knowledge and augment expert knowledge recall during teaching.
authors.affiliation: Dr. Sullivan is associate professor and associate chair for education, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Dr. Yates is associate professor, Rossier School of Education, University of Southern California, Los Angeles, California. Dr. Inaba is associate professor, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Dr. Lam is assistant professor, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. Dr. Clark is professor emeritus, Rossier School of Education, University of Southern California, Los Angeles, California.
authors.forename: Maura E
authors.initials: ME
authors.lastname: Sullivan
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Yates
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Richard E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D002140:California; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D003413:Cricoid Cartilage / Q000601:surgery; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D013514:Surgical Procedures, Operative / Q000193:education*; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D013965:Thyroidectomy / Q000193:education* / Q000379:methods