N. J. Zyromski1, M. G. House1, A. Nakeeb1, M. Boehler1, G. L. Dunnington1 1Indiana University School Of Medicine,SURGERY,Indianapolis, IN, USA
Introduction:
Intraoperative ultrasound (IOUS) is an indispensable asset in contemporary hepato-pancreatico-biliary (HPB) surgery. However, few formal instructional objectives exist with which to teach this complex task. The educational construct of cognitive task analysis (CTA) provides ideal methodology with which to deconstruct complex cognitive strategies and goal structures underlying the automated procedural skills of experts. We sought to define specific tasks associated with IOUS by means of CTA.
Methods:
One analyst broadly experienced in CTA evaluated three expert HPB surgeons (mean IOUS experience 15 years). Evaluation included direct observation of IOUS as well as focused interviews with each expert during which action and decision steps of specific tasks were interrogated. The results of these interviews were aggregated into a document defining the task, including a stepwise protocol as well as action and cognitive decision points involved with the procedure.
Results:
CTA defined the objective, prerequisite skills and knowledge, conditions and equipment required for HPB IOUS. The task list included: 1) initial scan and exposure; 2) equipment preparation (orientation, image refinement); and 3) systematic scanning and interpretation. Systematic scanning steps were defined for the liver, pancreas, and biliary tree.
Conclusion:
Defining concrete measurable procedural steps by cognitive task analysis will facilitate achieving expertise in the complex cognitive technical skill of hepato-pancreatico-biliary intraoperative ultrasound.