Swaby Lizzie, Shu Peiyao, Hind Daniel, Sutherland Katie
ScHARR, University of Sheffield, Sheffield, S1 4DA, UK.
China National Petroleum Corporation (CNPC) Research Institute of Safety & Environment Technology, PetroChina Innovation Base, Shahe Town, Changping District, Beijing, China.
Pilot Feasibility Stud. 2022 Mar 8;8(1):57. doi: 10.1186/s40814-022-01002-6.
At times, clinical case complexity and different types of uncertainty present challenges to less experienced clinicians or the naive application of clinical guidelines where this may not be appropriate. Cognitive task analysis (CTA) methods are used to elicit, document and transfer tacit knowledge about how experts make decisions.
We conducted a methodological review to describe the use of CTA methods in understanding expert clinical decision-making. We searched MEDLINE, EMBASE and PsycINFO from inception to 2019 for primary research studies which described the use of CTA methods to understand how qualified clinicians made clinical decisions in real-world clinical settings.
We included 81 articles (80 unique studies) from 13 countries, published from 1993 to 2019, most commonly from surgical and critical care settings. The most common aims were to understand expert decision-making in particular clinical scenarios, using expert decision-making in the development of training programmes, understanding whether decision support tools were warranted and understanding procedural variability and error identification or reduction. Critical decision method (CDM) and CTA interviews were most frequently used, with hierarchical task analysis, task knowledge structures, think-aloud protocols and other methods less commonly used. Studies used interviews, observation, think-aloud exercises, surveys, focus groups and a range of more CTA-specific methodologies such as the systematic human error reduction and prediction approach. Researchers used CTA methods to investigate routine/typical (n = 64), challenging (n = 13) or more uncommon, rare events and anomalies (n = 3).
In conclusion, the elicitation of expert tacit knowledge using CTA has seen increasing use in clinical specialties working under challenging time pressures, complexity and uncertainty. CTA methods have great potential in the development, refinement, modification or adaptation of complex interventions, clinical protocols and practice guidelines.
PROSPERO ID CRD42019128418 .
有时，临床病例的复杂性和不同类型的不确定性会给经验不足的临床医生带来挑战，或者在不适用的情况下单纯应用临床指南也会带来问题。认知任务分析（CTA）方法用于引出、记录和传递关于专家如何做出决策的隐性知识。
我们进行了一项方法学综述，以描述CTA方法在理解专家临床决策中的应用。我们检索了从创刊至2019年的MEDLINE、EMBASE和PsycINFO数据库，查找描述使用CTA方法来了解合格临床医生在实际临床环境中如何做出临床决策的原始研究。
我们纳入了来自13个国家、发表于1993年至2019年的81篇文章（80项独特研究），其中大多数来自外科和重症监护领域。最常见的目的是了解特定临床场景中的专家决策，在培训项目开发中利用专家决策，了解是否需要决策支持工具，以及了解程序变异性和错误识别或减少情况。关键决策方法（CDM）和CTA访谈使用最为频繁，层次任务分析、任务知识结构、出声思维协议和其他方法使用较少。研究采用了访谈、观察、出声思维练习、调查、焦点小组以及一系列更具CTA特色的方法，如系统人为错误减少和预测方法。研究人员使用CTA方法调查常规/典型（n = 64）、具有挑战性（n = 13）或更不常见、罕见事件及异常情况（n = 3）。
总之，在面临具有挑战性的时间压力、复杂性和不确定性的临床专科中，使用CTA引出专家隐性知识的情况越来越多。CTA方法在复杂干预措施、临床方案和实践指南的开发、完善、修改或调整方面具有巨大潜力。
PROSPERO编号CRD42019128418 。
