Pfandler Michael, Stefan Philipp, Wucherer Patrick, Lazarovici Marc, Weigl Matthias
1Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany.
2Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, TU Munich, Boltzmannstrasse 3, 85748 Garching, Germany.
Adv Simul (Lond). 2018 Sep 26;3:18. doi: 10.1186/s41077-018-0077-2. eCollection 2018.
Despite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. Specifically, our objective was to introduce a guideline for development and application of a modified CTA to obtain task demands of surgical procedures for all three OR professions with comprehensive definitions of OR teams' technical and non-technical skills.
To demonstrate our methodological approach, we applied it in vertebroplasty, a minimally invasive spine procedure. We used a CTA consisting of document reviews, in situ OR observations, expert interviews, and an expert consensus panel. Interviews included five surgeons, four OR nurses, and four anesthetists. Ten procedures were observed. Data collection was carried out in five OR theaters in Germany.
After compiling data from interviews and observations, we identified 6 procedural steps with 21 sub-steps for surgeons, 20 sub-steps for nurses, and 22 sub-steps for anesthetists. Additionally, we obtained information on 16 predefined categories of intra-operative skills and requirements for all three OR professions. Finally, simulation requirements for intra-operative demands were derived and specified in the expert panel.
Our CTA approach is a feasible and effective way to elicit information on intra-operative demands and to define requirements of medical team simulation. Our approach contributes as a guideline to future endeavors developing simulation training of technical and non-technical skills for multidisciplinary OR teams.
尽管医学模拟在教育中的重要性日益增加，但关于如何开发医学模拟环境的指导却很有限，特别是在技术和非技术技能以及多学科手术室（OR）团队培训方面。我们引入了一种认知任务分析（CTA）方法，该方法包括访谈、结构化观察和专家共识，以系统地获取医学模拟器开发所需的信息。具体而言，我们的目标是引入一种改进的CTA的开发和应用指南，以获取所有三种手术室专业人员的手术操作任务需求，并全面定义手术室团队的技术和非技术技能。
为了展示我们的方法，我们将其应用于椎体成形术，这是一种微创脊柱手术。我们使用了一种由文献综述、手术室实地观察、专家访谈和专家共识小组组成的CTA。访谈包括五名外科医生、四名手术室护士和四名麻醉师。观察了十台手术。数据收集在德国的五个手术室进行。
在汇总访谈和观察的数据后，我们确定了外科医生的6个手术步骤和21个子步骤、护士的20个子步骤以及麻醉师的22个子步骤。此外，我们还获得了关于所有三种手术室专业人员的16个预定义术中技能类别和要求的信息。最后，在专家小组中得出并明确了术中需求的模拟要求。
我们的CTA方法是获取术中需求信息并定义医疗团队模拟要求的一种可行且有效的方法。我们的方法为未来开发多学科手术室团队技术和非技术技能模拟培训的努力提供了指导方针。
