Cognitive Task Analysis Approach Research Articles

Gastroscopy for dyspepsia: Understanding primary care and gastroenterologist mental models of practice: A cognitive task analysis approach.

Gastroscopy to investigate dyspepsia without alarm symptoms rarely results in clinically actionable findings or sustained health-related quality-of-life improvements among patients aged 18-60 years and is, therefore, not recommended. Despite this, referrals for and performance of gastroscopy among this patient population remain high. The purpose of this study was to understand family physicians' and gastroenterologists' mental models of dyspepsia and the drivers behind referring or performing gastroscopy. Cognitive task analysis routine critical decision method interviews with family physicians (n = 8) and gastroenterologists (n = 4). Family physicians and gastroenterologists hold rich mental models of dyspepsia that rely on sensemaking; however, gaps in information continuity affect their ability to plan and coordinate patient care. Drivers behind decisions to refer or perform gastroscopy were: eliminating risk for serious pathology, providing reassurance, perceived preference by patients to receive information and reassurance from gastroenterologists, maintaining relationships with patients, and saving costs to the health system. Family physicians refer for dyspepsia when they are seeking support from gastroenterologists, they believe that alternative factors may be impacting the patient's health or view it as a cost-saving measure. Likewise, gastroenterologists perform gastroscopy for dyspepsia when they perceive it as a cost-saving measure, they want to support their primary care colleagues and provide their colleagues and patients with reassurance. An improved degree of communication between speciality and primary care could allow for continuity in the transfer of information about patients and reduce referrals for dyspepsia.

"What brought you in today?": Modeling patient-provider clinic visits to characterize rural providers' antibiotic treatment decisions.

Designing clinical decision support (CDS) tools is challenging because clinical decision-making must account for an invisible task load: incorporating non-linear objective and subjective factors to make an assessment and treatment plan. This calls for a cognitive task analysis approach. The objectives of this study were to 1.) understand healthcare providers' decision making during a typical clinic visit, and 2.) explore how antibiotic treatment decisions are made when they arise. Two cognitive task analysis methods were applied - Hierarchical Task Analysis (HTA) and Operations Sequence Diagramming (OSD) - to 39h of observational data collected at family medicine, urgent care, and emergency medicine clinical sites. The resulting HTA models included a coding taxonomy detailing ten cognitive goals and associated sub-goals and demonstrated how the goals occur as interactions between the provider and electronic health record, the patient, and the physical clinic environment. Although the HTA detailed resources for antibiotic treatment decisions, antibiotics were a minority of drug classes ordered. The OSD shows the sequence of events and when decisions are made solely at the provider level and when shared decision making occurs with the patient. Qualitative data from the observations informed a constructed vignette case example portraying select tasks from the HTA. These findings emphasize that the scope of disease states presenting to a generalist clinical setting is broad and could include acute exacerbations of rare diseases within a time-pressured environment. CDS must be accessible, time efficient, and fit within the resource gathering task before treatment decisions are made.

Analysis of shared cognitive tasks in the application of non-invasive ventilation to patients with COPD exacerbation

ABSTRACT Interprofessional teamwork plays a key role in the uptake of evidence-based interventions, such as noninvasive ventilation (NIV) for patients with exacerbated Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify the shared cognitive tasks in interprofessional teams using NIV for patients with COPD exacerbation. We used a cognitive task analysis approach (CTA) to engage nurses, rapid response team members, respiratory therapists, and physicians involved in the use of NIV to treat patients with COPD exacerbation. Clinicians participated in a semi-structured interview (n = 21) that elicited cognitions needed to treat COPD exacerbation. Three shared cognitive tasks were identified: Complete a thorough assessment, Formulate a care plan, and Continuously monitor patient status. Findings attest to the importance of having access to up-to-date information and expertise necessary to make accurate clinical inferences for patient assessment. Shared understanding of the formulated care plan among all members of the care team was important to its execution. Continuous monitoring was crucial; however, this cognitive task relied on patient assessment skills and ongoing collaboration within the clinical care team. Application of NIV for patients with COPD exacerbation may require enhancing collaboration through nontechnical skills and interprofessional training.

Cognitive Task Analysis: Eliciting Management Cognition

Cognitive Task Analysis (CTA) is a powerful qualitative methodological approach which has the potential to add to management researchers’ knowledge of in-depth interviewing techniques, whilst addressing the importance of producing rigorous research that has relevance for management practice. Developed within the Naturalistic Decision-Making community, this set of semi-structured interviewing techniques have much to offer to management researchers. Distinct from traditional semi-structured interview methods, CTA is designed to identify the knowledge requirements that underpin expertise in complex work domains. CTA is underutilised by management scholars, contrary to other applied social science disciplines in cognitive psychology, human factors, and ergonomics where it is widely used. This paper aims to advance understanding of these pragmatic techniques which are theoretically rigorous and easy to use, with results which have high face validity with practitioners. First, we provide an overview of CTA as a robust methodological approach to research oriented around knowledge elicitation. Second, we provide two examples of how the CTA approach has been used to research management; specifically using the Critical Decision Method to explore management in high-stakes environments; and an Applied Cognitive Task Analysis to explore global strategic leadership. In ending, we highlight potential avenues for using CTA for innovative management research.

Exploring navigator roles and tasks in transitioning towards supervisory control of autonomous collision avoidance systems

This study aims to systematically map and assess performance requirements for collision avoidance manoeuvring for two cases. A case where the navigator performs collision avoidance, and a case where collision avoidance is performed by collision avoidance system where the navigator acts as its supervisor. An appraisal of collision avoidance manoeuvring was performed based on three data sources: the collision avoidance regulations, a ferry operator’s procedures, and interviews with navigators including in situ observations. A framework was established in which the gathered data was structured and analysed using a cognitive task analysis approach. Based on the results, performance requirements and information needs were established. Further work will focus on detailing the navigator’s information needs and the corresponding system’s transparency requirements to support effective human performance.

Helicopter Pilots’ Tasks, Subjective Workload, and the Role of External Visual Cues During Shipboard Landing

Helicopter shipboard landing is a cognitively complex task that is challenging both for pilots and their crew. Effective communication, accurate reading of the flight instruments, as well as monitoring of the external environment are crucial for a successful landing. In particular, the final phases of landing are critical as they imply high workload situations in an unstable environment with restricted space. In the present qualitative study, we interviewed ten helicopter pilots from the Italian Navy using an applied cognitive task analysis approach. We aimed to obtain a detailed description of the landing procedure, and to identify relevant factors that affect pilots’ workload, performance, and safety. Based on the content analysis of the interviews, we have identified six distinct phases of approaching and landing on a ship deck and four categories of factors that may significantly affect pilots’ performance and safety of the landing procedure. Consistent with previous studies, our findings suggest that external visual cueing is vital for a successful landing, in particular during the last phases of landing. Therefore, based on the pilots’ statements, we provide suggestions for possible improvements of external visual cues that have the potential to reduce pilots’ workload and improve the overall safety of landing operations.

A cognitive decomposition to empirically study human performance in control room environments

Abstract Monitoring tasks in control room environments require operators to perform various mental and physical sub-tasks in series and simultaneously over long periods of time with minimal error. These tasks vary in cognitive complexity, ranging from low-level sensory processing to high-level decision making. Cognitive load, a measure of the effort required by the working memory, can serve as an indicator of tasks that may have higher risk of error. Task decomposition models for cognitive complexity can be combined with objective and subjective measures of workload to measure human performance in response to control room stimuli. In this study, we demonstrate the effectiveness of a cognitive task analysis approach to structure the design of experiments for the purpose of evaluating human performance in control room simulated use activities. Participants completed monitoring tasks in a simulated unmanned aerial vehicle (UAV) control room that required the completion of tasks ranging in cognitive complexity. Performance measures taken during the study were used to validate the breakdown of tasks complexity, and to identify potential sources of human error in workstation monitoring tasks. These findings can be linked to design specifications for workstation optimization. Results indicated that the task breakdown appropriately represented the use-case scenario, and the classification model adequately captured differences in cognitive workload experienced by participants. This research has broad implications on complex system design validation, providing a structure to achieve cognitive depth for the evaluation of human performance and subsequent design risk mitigation.

Endoscopic submucosal dissection: a cognitive task analysis framework toward training design.

One of the major impediments to the proliferation of endoscopic submucosal dissection (ESD) training in Western countries is the lack of sufficient experts as instructors. One way to address this gap is to develop didactic systems, such as surgical simulators, to support the role of trainers. Cognitive task analysis (CTA) has been used in healthcare for the design and improvement of surgical training programs, and therefore can potentially be used for design ofsimilar systems for ESD. The aim of the study was to apply a CTA-based approach to identify the cognitive aspects of performing ESD, and to generate qualitative insights for training. Semi-structured interviews were designed based on the CTA framework to elicit knowledge of ESD practitioners relating to the various tasks involved in the procedure. Three observations were conducted of expert ESD trainers either while they performed actual ESD procedures or at a training workshop. Interviews were either conducted over the phone or in person. Interview participants included four experts and four novices. The observation notes and interviews were analyzed for emergent qualitative themes and relationships. The qualitative analysis yielded thematic insights related to four main cognition-related categories: learning goals/principles, challenges/concerns, strategies, and decision-making. The specific insights under each of these categories were systematically mapped to the various tasks inherent to the ESD procedure. The CTA approach was applied to identify cognitive themes related to ESD procedural tasks. Insights developed based on the qualitative analysis of interviews and observations of ESD practitioners can be used to inform the design of ESD training systems, such as virtual reality-based simulators.

Stepwise development of a simulation environment for operating room teams: the example of vertebroplasty

BackgroundDespite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. Specifically, our objective was to introduce a guideline for development and application of a modified CTA to obtain task demands of surgical procedures for all three OR professions with comprehensive definitions of OR teams’ technical and non-technical skills.MethodsTo demonstrate our methodological approach, we applied it in vertebroplasty, a minimally invasive spine procedure. We used a CTA consisting of document reviews, in situ OR observations, expert interviews, and an expert consensus panel. Interviews included five surgeons, four OR nurses, and four anesthetists. Ten procedures were observed. Data collection was carried out in five OR theaters in Germany.ResultsAfter compiling data from interviews and observations, we identified 6 procedural steps with 21 sub-steps for surgeons, 20 sub-steps for nurses, and 22 sub-steps for anesthetists. Additionally, we obtained information on 16 predefined categories of intra-operative skills and requirements for all three OR professions. Finally, simulation requirements for intra-operative demands were derived and specified in the expert panel.ConclusionsOur CTA approach is a feasible and effective way to elicit information on intra-operative demands and to define requirements of medical team simulation. Our approach contributes as a guideline to future endeavors developing simulation training of technical and non-technical skills for multidisciplinary OR teams.

Play activities in the classroom: a window into seven- to eight-year-olds' thinking competence

A significant body of research has examined the role of play in children's learning and development. There is little research to date that has studied seven- to eight-year-olds' thinking competence in their play activities. The diversity, unpredictability, and spontaneity of children's play pose a challenge to the analysis and assessment of children's thinking competence in their play activities. This paper reports on a qualitative study that employed a cognitive task analysis approach to investigate children's thinking competence in the play activities of 28 7–8-year-olds in a New Zealand primary classroom. Case examples are discussed to demonstrate the kind of insights that could be obtained into emergent and unanticipated aspects of children's thinking competence. It is argued that play activities provide a window into children's thinking competence and offer meaningful contexts for children to exercise their thinking skills at this stage of formal schooling.

Investigating cognitive task difficulties and expert skills in e-Learning storyboards using a cognitive task analysis technique

E-learning storyboards have been a useful approach in distance learning development to support interaction between instructional designers and subject-matter experts. Current works show that researchers are focusing on different approaches for use in storyboards, and there is less emphasis on the effect of design and process difficulties faced by instructional designers and subject-matter experts. This study explores problem aspects of the cognitive task and the skills required of subject-matter experts by applying a cognitive task analysis approach from the expert point of view. The result shows that subject-matter experts face difficulties in making decisions on three elements during e-learning course development. The three elements are storyboard templates, prescriptive interactive components, and review process. It is found that the representation skills and decision making of the three elements allows subject-matter experts to decide on alternatives of the task process. The result also indicates that it is important to leverage the design and process skills of subject-matter experts as it affects their interaction with instructional designers. Three recommendations are made: training development, prescriptive interactive components development, and interaction design document development. A new framework can be recommended to train subject-matter experts as e-learning storyboard users, and in turn provide for effective interaction between them and instructional designers.

A Comparison of the Decision Ladder and the Recognition-Primed Decision Model

Cognitive work analysis and cognitive task analysis approach the analysis of decisions in ways that are at least superficially dissimilar. In this paper, I review the two approaches, work (or control) task analysis and naturalistic decision making, to identify similarities and differences, and I assess the implications of looking at decisions from these two different perspectives. I conclude that although these two approaches are superficially dissimilar, they are theoretically compatible. However, the standard form of decision ladder, which is the representational product of work (or control) task analysis, does not take full account of contemporary insights from the three-stage model of situation awareness, the distinction between implicit and explicit cognitive processing, or the principles of naturalistic decision making. I propose modifications of the decision ladder to incorporate these ideas.

Cognitive Tools for Assessment and Learning in a High Information Flow Environment

A simulation-based intelligent tutoring system (ITS) was designed for nurses working in a Surgical Intensive Care Unit (SICU). A cognitive task analysis approach was used to identify the cognitive components of clinical decision making of “expert” surgical nurses. Quantitative analyses revealed that expert nurses reached the same decisions. However, a qualitative analysis of the verbal protocols revealed great variability in how the nurses arrived at their clinical decisions. Differences were observed in: hypothesis generation, planning of medical interventions, actions performed, results of evidence gathering, interpretation of the results, heuristics, and the overall solution paths. The results of these analyses were used to design a prototype ITS. The tutoring environment (SICUN) is described in terms of the cognitive tools it provides, and the assessment opportunities it presents. Implications for the evaluation of this system are discussed.