Residents in surgical residency programs are taught through a hands-on apprenticeship under the supervision of surgical subject matter experts despite the fact that those experts are largely unaware of the automated strategies that guide most of their problem-solving. In fact, experts often omit as much as 70% of the procedural knowledge that novices need to learn. This study examines the amount of procedural steps in an open cricothyrotomy procedure that can be learned from multiple surgical subject matter expert interviews using Cognitive Task Analysis (CTA) techniques. CTA focuses on measuring the mental models used in task performance, capturing not only declarative knowledge but also procedural knowledge.
Using CTA-based interview techniques, six expert trauma surgeons employed by the Department of Surgery of a private, urban medical school in the western United States were separately interviewed about how to perform an open cricothyrotomy procedure. The interviews were coded and converted into ordered, procedural checklists that listed all of the equipment, conditions, action steps, and decision steps that each subject matter expert mentioned in his or her interview as being necessary to successfully perform the procedure. Those individual checklists were then converted into a single criterion standard, hereafter termed as the ‘gold standard’, for the open cricothyrotomy procedure against which each expert's checklist was graded for completeness.
This study found that, on average, each surgical subject matter expert who participated in this study omitted 44% of the total steps, 34% of the action steps, and 72% of the decision steps contained within a six-expert open cricothyrotomy ‘gold standard’ procedure. The results of this study also show that interviewing four experts was necessary to reach a 10% point of diminishing marginal utility for the elicitation of additional procedural steps. This appears to contradict the conclusions of previous studies that showed that interviewing three experts was optimal for knowledge elicitation.
|Advisor:||Clark, Richard E.|
|Commitee:||Sullivan, Maura E., Yates, Kenneth A.|
|School:||University of Southern California|
|School Location:||United States -- California|
|Source:||DAI-A 71/06, Dissertation Abstracts International|
|Subjects:||Educational psychology, Cognitive psychology, Health education|
|Keywords:||CTA, Cognitive task analysis, Cricothyrotomy, Medical education, Subject matter expert, Surgery|
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