Yeung Celine, McMillan Catherine, Saun Tomas J, Sun Kimberly, D'hondt Veerle, von Schroeder Herbert P, Martou Glykeria, Lee Matthew, Liao Elizabeth, Binhammer Paul
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Plastic & Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Surg Educ. 2017 Sep-Oct;74(5):889-897. doi: 10.1016/j.jsurg.2017.01.008. Epub 2017 Mar 23.
To describe the development of cognitive task analysis (CTA)-based multimedia educational videos for surgical trainees in plastic surgery.
A needs assessment survey was used to identify 5 plastic surgery skills on which to focus the educational videos. Three plastic surgeons were video-recorded performing each skill while describing the procedure, and were interviewed with probing questions. Three medical student reviewers coded transcripts and categorized each step into "action," "decision," or "assessment," and created a cognitive demands table (CDT) for each skill. The CDTs were combined into 1 table that was reviewed by the surgeons performing each skill to ensure accuracy. The final CDTs were compared against each surgeon's original transcripts. The total number of steps identified, percentage of steps shared, and the average percentage of steps omitted were calculated.
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, an urban tertiary care teaching center.
Canadian junior plastic surgery residents (n = 78) were sent a needs assessment survey. Four plastic surgeons and 1 orthopedic surgeon performed the skills.
Twenty-eight residents responded to the survey (36%). Subcuticular suturing, horizontal and vertical mattress suturing, hand splinting, digital nerve block, and excisional biopsy had the most number of residents (>80%) rank the skills as being skills that students should be able to perform before entering residency. The number of steps identified through CTA ranged from 12 to 29. Percentage of steps shared by all 3 surgeons for each skill ranged from 30% to 48%, while the average percentage of steps that were omitted by each surgeon ranged from 27% to 40%.
Instructional videos for basic surgical skills may be generated using CTA to help experts provide comprehensive descriptions of a procedure. A CTA-based educational tool may give trainees access to a broader, objective body of knowledge, allowing them to learn decision-making processes before entering the operating room.
描述基于认知任务分析（CTA）为整形外科实习医生制作的多媒体教育视频的开发过程。
采用需求评估调查来确定5项整形外科技能，以此为教育视频的重点内容。3位整形外科医生在演示每项技能并描述操作过程时进行录像，并接受深入提问访谈。3名医学生评审员对文字记录进行编码，并将每个步骤分类为“动作”“决策”或“评估”，并为每项技能创建一个认知需求表（CDT）。将这些CDT合并成一个表格，由执行每项技能的外科医生进行审核以确保准确性。将最终的CDT与每位外科医生的原始文字记录进行比较。计算所确定步骤的总数、共享步骤的百分比以及每位外科医生省略步骤的平均百分比。
加拿大多伦多市的桑尼布鲁克健康科学中心，一家城市三级护理教学中心。
向加拿大初级整形外科住院医生（n = 78）发送了需求评估调查问卷。4位整形外科医生和1位骨科医生进行了技能操作。
28名住院医生回复了调查（36%）。皮下缝合、水平和垂直褥式缝合、手部夹板固定、指神经阻滞和切除活检是最多住院医生（>80%）将其列为学生在进入住院医师培训前应能够掌握的技能。通过CTA确定的步骤数量从12到29不等。每项技能所有3位外科医生共享步骤的百分比从30%到48%不等，而每位外科医生省略步骤的平均百分比从27%到40%不等。
可以使用CTA生成基本外科技能的教学视频，以帮助专家全面描述操作过程。基于CTA的教育工具可能使实习生能够获取更广泛、客观的知识体系，使他们在进入手术室之前就能学习决策过程。
