Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: A Cognitive Task Analysis (Preprint)

BACKGROUND Proper airway management is an essential skill for hospital personnel and rescue services to learn as it is a priority for the care of critically ill patients. It is critical that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created in order to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation including a focus on collaborative research across medical specialties in order to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. OBJECTIVE Cognitive task analysis (CTA) is a framework developed to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI in order to capture a broad view of task and training requirements from the perspective of multiple medical specialties. METHODS A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. Six experts from multiple medical specialties were interviewed in order to capture the cognitive skills required in order to complete this task. Interviews were coded for main themes, sub-themes in each category, and differences among specialties. These findings were compiled into a skills tree in order to identify the training needs and cognitive requirements of each task. RESULTS The CTA revealed that consistency in equipment setup and planning through talk or think-aloud methods are critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas emergency medical personnel faced the greatest number of constraints based on the environment and available equipment. CONCLUSIONS While the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expand upon their work by delving into methods of feedback and strategies to assist novices.

Building Clinical Skills Teaching Materials: A Study of Cognitive Task Analysis Versus Free Recall Instruction to Teach Canine Indirect Ophthalmoscopy

Ophthalmoscopy is a core component of a complete ophthalmic examination. Due to its complex technical aspects and patients becoming uncooperative if the procedure is prolonged, it can be a difficult skill for a novice to learn and develop proficiency in. Skills instruction is typically provided by subject matter experts (SMEs) through free recall without an agreed-upon instructional framework. This can lead to unintentional omission of essential steps and knowledge required to perform skills correctly. Cognitive task analysis (CTA) allows for construction of standardized instructional protocols that encompass the knowledge and skills experts apply when performing tasks. The objectives of this study were to (a) develop a CTA-based teaching protocol for canine indirect ophthalmoscopy and (b) compare the steps verbalized or demonstrated by SMEs during free recall instruction versus those ultimately identified by CTA. Four SMEs participated in free recall instructional sessions and interviews used for the development of a CTA-based teaching protocol for novice learners. The CTA-based protocol identified 66 steps and sub-steps considered essential for successfully performing canine indirect ophthalmoscopy. During instructional sessions, SMEs on average failed to verbalize 57.1% of clinical knowledge steps, did not verbalize or demonstrate 68.3% and 9.5% of action steps and did not verbalize or demonstrate 73.2% and 40.4% of decision steps, respectively. This study demonstrates that SMEs teaching indirect ophthalmoscopy by free recall may unintentionally omit important steps, suggesting that compared with free recall, CTA may generate more comprehensive and thus potentially more effective instructional materials for teaching technical skills in veterinary medicine.

Cognitive Task Analysis to Improve Student Competencies: a Pilot Study based on the Use of the Square of PErceived ACtion Model

The aim of this pilot study was to test a method developed in the Cognitive Task Analysis paradigm for adult occupational training in the field of education. The method used was based on the Square of Percieved ACtion (SPEAC) protocol using the SPEAC model (explaining how to successfully put competencies in action). The study was conducted in two secondary education classes, with a sample of 36 students (control group and test group) for an activity in Economics & Social science. The application of this innovative SPEAC-based method resulted in a significant and homogeneous increase in student performance. Beyond showing that the protocol can be applied both for adults and the young and in both occupational and academic contexts, the study demonstrates the benefits in learning and training with this method. Cognitive processes underpinning the improvement in teaching and limitations of the method are discussed.