MedEdPORTAL (Apr 2012)
A Cognitive-Task-Analysis Informed Central Venous Catheter Placement Curriculum
Abstract
Abstract The ability to competently place a central venous catheter is a skill that is expected of many residents-in-training. Although this is a requisite skill, there has been recent national attention given to the increased amount of central-line associated complications and its impact on patient outcomes and safety. Traditionally, the creation of procedural skills curricula have relied on the ability of experts to describe the procedure. This is problematic due to the fact that experts often omit essential information when trying to describe a task. There appears to be two reasons for this problem. First, as physicians gain expertise, their skills become automated and the steps of the skill blend together. Automated knowledge is achieved by years of practice and experience wherein the basic elements of the task are performed largely without conscious awareness. This causes experts to omit specific steps when trying to describe a procedure because this information is no longer accessible to conscious processes. Second, many physicians are not able to share the complex thought processes that accompany the behavioral execution of technical skills. Even physicians who make an attempt to “think-out-loud” during a procedure often omit essential information because their knowledge is automated. This situation causes problems in medical education because it forces learners to ‘fill in the blanks' by trial and error learning. A potential solution to this dilemma is the use of interview methods that capture the underlying knowledge and skills experts use to perform complex procedures. Known collectively as Cognitive-Task-Analysis (CTA), these techniques enable us to extract implicit and explicit knowledge from experts to inform procedural instruction. The attached CTA informed curriculum to teach and assess competency in central line placement was developed using CTA techniques. Six subject matter experts participated in a formal CTA. The results of each individual report were aggregated into one “Gold Standard” for Central Venous Catheter Placement. This information was used to create the attached Central Line Skills Module, Procedural Guide and Evaluation Checklist. This CTA informed skills module is an effort to overcome the difficulty accessing expert knowledge and presents a novel approach to retrieve the automated expertise of physicians and create comprehensive instructional materials. This curriculum was developed using a complete “Gold Standard” Cognitive-Task-Analysis report with the goal of capturing the automated knowledge of experts that is routinely omitted. We were asked to develop this curriculum by LAC+USC Medical Center administration due to the increasing numbers of CVC related complications. We implemented this curriculum for all residents at LAC+USC beginning in 2008. Since that time there has been a decrease in reported CVC complication rates.
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