Center for Cognitive Technology, Rossier School of Education, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
J Surg Res. 2012 Mar;173(1):e37-42. doi: 10.1016/j.jss.2011.09.003. Epub 2011 Oct 2.
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.
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.
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.
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.
外科手术培训严重依赖于专家外科医生提供复杂手术的完整、准确描述的能力。然而，来自不同领域的研究表明，专家在解决困难问题或执行复杂任务时，经常会省略他们做出的判断、分析和决策的关键信息。在这项研究中，我们比较了三种方法来捕捉外科医生描述如何进行股动脉分流器插入手术的方法（无辅助自由回忆、无辅助自由回忆加模拟、认知任务分析方法），以确定哪种方法产生更准确、更完整的结果。认知任务分析比无辅助自由回忆和/或模拟时的自由回忆更完整、准确，准确率提高了约 70%。
在一家主要城市创伤中心的 10 名专家创伤外科医生分别接受采访，要求他们描述如何进行紧急分流手术。4 名外科医生提供了无辅助自由回忆描述的分流手术，5 名外科医生使用视觉辅助工具和手术器械（模拟）提供了无辅助自由回忆描述的手术，1 名（随机选择）使用认知任务分析（CTA）方法进行了采访。一位血管外科医生对最终的 CTA 方案进行了审核。
与多名专家外科医生进行的无辅助自由回忆访谈相比，对仅一位专家外科医生进行的 CTA 访谈导致描述的准确性和完整性显著提高。无辅助组的外科医生遗漏了近 70%的必要决策步骤。在自由回忆组中，在无辅助自由回忆访谈中大量使用模拟提高了外科医生描述手术步骤的完整性。
CTA 显著提高了外科医生对手术过程的教学描述的完整性和准确性。此外，在无辅助自由回忆访谈中使用模拟可能会提高访谈数据的完整性。
