Kunkes Taylor, Makled Basiel, Norfleet Jack, Schwaitzberg Steven, Cavuoto Lora
Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, NY, United States.
U.S. Army Combat Capabilities Development Command - Soldier Center, Orlando, FL, United States.
JMIR Perioper Med. 2022 Apr 21;5(1):e34522. doi: 10.2196/34522.
Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created 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, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies.
This study aims to use the cognitive task analysis (CTA) framework 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 to capture a broad view of task and training requirements from the perspective of multiple medical specialties.
A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task.
The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is 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 paramedics faced the greatest number of constraints based on the environment and available equipment.
Although 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 expanding upon their work by delving into methods of feedback and strategies to assist novices.
正确的气道管理是医院工作人员和救援服务人员必须掌握的一项重要技能，因为它是重症患者护理的首要任务。提供者必须接受适当的培训并具备进行气管插管（ETI）的能力，气管插管是一种广泛应用于气道管理的技术。已经制定了多项指标来衡量ETI操作的能力。然而，仍有必要改进ETI培训和评估，包括专注于跨医学专业的合作研究，以建立更完善的基于能力的培训和评估体系。ETI的培训和评估还应采用现代的、基于证据的程序培训方法。
本研究旨在使用认知任务分析（CTA）框架来确定熟练执行一项任务所需的认知要求和技能，阐明新手和专家表现之间的差异，并了解与该任务相关的工作量。CTA框架应用于ETI，以从多个医学专业的角度全面了解任务和培训要求。
基于先前对ETI任务和评估方法的研究，开发了一份CTA访谈。共采访了来自多个医学专业的6名专家，以获取完成此任务所需的认知技能。对访谈内容进行编码，确定主要主题、每个类别中的子主题以及各专业之间的差异。这些结果被整理成一棵技能树，以确定每项任务的培训需求和认知要求。
CTA显示，通过交谈或出声思考的方法，在设备设置和规划方面保持一致，对于成功掌握ETI至关重要。这些因素使提供者能够避免因患者特征和环境因素导致的错误。各专业之间的差异主要源于进行ETI的环境、后续治疗计划以及可用资源。麻醉学通常代表了最理想的情况，培训潜力巨大，而护理人员则因环境和可用设备面临最多的限制。
尽管技能树无法完美地捕捉所有潜在情况的复杂性和细节，但它为用于让新手为实践中可能遇到的变异性做好准备的细微技能和培训技术提供了见解。重要的是，CTA确定了可以克服新手面临的挑战的方法，以及如何将这种培训应用于未来的情况。通过使这些隐含的技能和变异点变得明确，可以更好地将它们转化为可教授的细节。这些发现与之前关于为ETI开发改进的评估指标以及通过深入研究反馈方法和帮助新手的策略来扩展其工作的研究一致。
