Assessing the teaching of procedural skills: can cognitive task analysis add to our traditional teaching methods?

Background: The purpose of this study was to determine if a cognitive task analysis (CTA) could capture steps and decision points that were not articulated during traditional teaching of a colonoscopy. Methods: Three expert colorectal surgeons were videotaped performing a colonoscopy. After the videotapes were transcribed, the experts participated in a CTA. A 26-step procedural checklist and a 16-step cognitive demands table was created by using information obtained in the CTA. The videotape transcriptions were transposed onto the procedural checklist and cognitive demands table to identify steps and decision points that were omitted during traditional teaching. Results: Surgeon A described 50% of "how-to" steps and 43% of decision points. Surgeon B described 30% of steps and 25% of decisions. Surgeon C described 26% of steps and 38% of cognitive decisions. Conclusions: By using CTA, we were able to identify relevant steps and decision points that were omitted during traditional teaching by all 3 experts. (c) 2008 Excerpta Medica Inc. All rights reserved.