title: Interdisciplinary cognitive task analysis: a strategy to develop a comprehensive endoscopic retrograde cholangiopancreatography protocol for use in fellowship training.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography is a challenging procedure performed by surgeons and gastroenterologists. We employed cognitive task analysis to identify steps and decision points for this procedure.
  
  
  METHODS
  Standardized interviews were conducted with expert gastroenterologists (7) and surgeons (4) from 4 institutions. A procedural step and cognitive decision point protocol was created from audio-taped transcriptions and was refined by 5 additional surgeons.
  
  
  RESULTS
  Conceptual elements, sequential actions, and decision points were iterated for 5 tasks: patient preparation, duodenal intubation, selective cannulation, imaging interpretation with related therapeutic intervention, and complication management. A total of 180 steps were identified. Gastroenterologists identified 34 steps not identified by surgeons, and surgeons identified 20 steps not identified by gastroenterologists.
  
  
  CONCLUSIONS
  The findings suggest that for complex procedures performed by diverse practitioners, more experts may help delineate distinctive emphases differentiated by training background and type of practice.
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, 701 N First St., PO Box 19638, Springfield, IL 62794, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Canopy
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, 701 N First St., PO Box 19638, Springfield, IL 62794, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Evans
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, 701 N First St., PO Box 19638, Springfield, IL 62794, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Boehler
authors.affiliation: Medical Education Department, Sophie Davis School of Biomedical Education, New York, NY, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Roberts
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, 701 N First St., PO Box 19638, Springfield, IL 62794, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Sanfey
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, 701 N First St., PO Box 19638, Springfield, IL 62794, USA. Electronic address: jmellinger@siumed.edu.
authors.forename: John
authors.initials: J
authors.lastname: Mellinger
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D002985:Clinical Protocols; D003071:Cognition; D005257:Fellowships and Scholarships; D005762:Gastroenterology / Q000193:education*; D013502:General Surgery / Q000193:education*; D006801:Humans; D013647:Task Performance and Analysis
keywords: Cognitive task analysis; Endoscopic retrograde cholangiopancreatography; Fellowship training