Task Analysis Study Research Articles

P9. Combating the Learning Curve for DIEP Flaps: Preliminary Results from a Cognitive Task Analysis Study

P9. Combating the Learning Curve for DIEP Flaps: Preliminary Results from a Cognitive Task Analysis Study

69. Combating The Learning Curve For DIEP Flaps: Preliminary Results From A Cognitive Task Analysis Study

69. Combating The Learning Curve For DIEP Flaps: Preliminary Results From A Cognitive Task Analysis Study

ARGUS: Interactive visual analysis of disruptions in smartphone-detected Bio-Behavioral Rhythms

Human Bio-Behavioral Rhythms (HBRs) such as sleep-wake cycles (Circadian Rhythms), and the degree of regularity of sleep and physical activity have important health ramifications. Ubiquitous devices such as smartphones can sense HBRs by continuously analyzing data gathered passively by built-in sensors to discover important clues about the degree of regularity and disruptions in behavioral patterns. As human behavior is complex and smartphone data is voluminous with many channels (sensor types), it can be challenging to make meaningful observations, detect unhealthy HBR deviations and most importantly pin-point the causes of disruptions. Prior work has largely utilized computational methods such as machine and deep learning approaches, which while accurate, are often not explainable and present few actionable insights on HBR patterns or causes. To assist analysts in the discovery and understanding of HBR patterns, disruptions and causes, we propose ARGUS, an interactive visual analytics framework. As a foundation of ARGUS, we design an intuitive Rhythm Deviation Score (RDS) that analyzes users’ smartphone sensor data, extracts underlying twenty-four-hour rhythms and quantifies their degree of irregularity.​ This score is then visualized using a glyph that makes it easy to recognize disruptions in the regularity of HBRs. ARGUS also facilitates deeper HBR insights and understanding of causes by linking multiple visualization panes that are overlaid with objective sensor information such as geo-locations and phone state (screen locked, charging), and user-provided or smartphone-inferred ground truth information. This array of visualization overlays in ARGUS enables​ analysts to gain a more comprehensive picture of HBRs, behavioral patterns and deviations from regularity. The design of ARGUS was guided by a goal and task analysis study involving an expert versed in HBR and smartphone sensing. To demonstrate its utility and generalizability, two different datasets were explored using ARGUS and our use cases and designs were strongly validated in evaluation sessions with expert and non-expert users.

Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study.

Background Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of problems in the coordination of cirrhosis care. Aim To compare and identify differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions. Methods Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling to select family physicians (n = 8), specialists (n = 9), and cirrhosis-dedicated nurse practitioners (n = 2) across Alberta. Results Family physicians do not maintain rich mental models of cirrhosis care. They see cirrhosis patients relatively infrequently, rebuilding their mental models when required (knowledge on demand). They have reactive and patient-need-focused, rather than proactive and system-of-care, mental models. Specialists' mental models are rich but vary widely between patient-centered and task-centered and in the degree to which they incorporate responsibility for addressing system gaps. Nurse practitioners hold patient-centered mental models like specialists but take responsibility for addressing gaps in the system. Conclusions Improving the coordination of cirrhosis care will require infrastructure to design care pathways and work processes that will support family physicians' knowledge-on-demand needs, facilitate primary care-specialist relationships, and deliberately work toward building a shared mental model of responsibilities for addressing medical care and social determinants of health.

Gripping strategies employed by young children aged 3–5 years when interacting with child-resistant push and turn closures used by pharmacies in the United States

Archived video footage from a previous task analysis study where children attempted to open prescription vials outfitted with 42 mm (diameter) push and turn closures was reviewed and grip postures were characterized based on a grip taxonomy presented by Rowson & Yoxall which investigated adult grips (2011). Video review was conducted to identify the types of grip postures children aged 3–5 years utilized when attempting to open continuous thread polypropylene vials outfitted with push and turn, child-resistant closures and compared with grip postures identified with the adults. Children tended to utilize only 3 grip postures (spherical, cylindrical, and pronated cylindrical grips), while adults utilized seven different postures. If children utilize a more limited set of grip postures when opening child resistant closures than their adult counterparts, this difference could be exploited when designing child resistant packaging systems. That said, our study utilized a limited number of CRC designs and confounds existed between the package sizes the children in the archived video footage attempted to open and those that served as the point of comparison which identified grip postures utilized by adults. As such, further investigation is needed across a range of package diameters. Potential implications for child-resistant packaging design are discussed.

How well do software assistants for minimally invasive partial nephrectomy meet surgeon information needs? A cognitive task analysis and literature review study.

IntroductionIntraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such systems, the first question to be asked is: What information does the surgeon need and when does he or she need it? In this article, we present an approach to investigate these surgeon information needs for minimally invasive partial nephrectomy and compare these needs to the relevant surgical computer assistance literature.Materials and methodsFirst, we conducted a literature-based hierarchical task analysis of the surgical procedure. This task analysis was taken as a basis for a qualitative in-depth interview study with nine experienced surgical urologists. The study employed a cognitive task analysis method to elicit surgeons' information needs during minimally invasive partial nephrectomy. Finally, a systematic literature search was conducted to review proposed software assistance solutions for minimally invasive partial nephrectomy. The review focused on what information the solutions present to the surgeon and what phase of the surgery they aim to support.ResultsThe task analysis yielded a workflow description for minimally invasive partial nephrectomy. During the subsequent interview study, we identified three challenging phases of the procedure, which may particularly benefit from software assistance. These phases are I. Hilar and vascular management, II. Tumour excision, and III. Repair of the renal defects. Between these phases, 25 individual challenges were found which define the surgeon information needs. The literature review identified 34 relevant publications, all of which aim to support the surgeon in hilar and vascular management (phase I) or tumour excision (phase II).ConclusionThe work presented in this article identified unmet surgeon information needs in minimally invasive partial nephrectomy. Namely, our results suggest that future solutions should address the repair of renal defects (phase III) or put more focus on the renal collecting system as a critical anatomical structure.

A Task Analysis Study of DECIDE For African American Patients With Type 2 Diabetes

A Task Analysis Study of DECIDE For African American Patients With Type 2 Diabetes

Strengthening nursing education and practice in Ethiopia: A cross sectional task analysis study

Strengthening nursing education and practice in Ethiopia: A cross sectional task analysis study

Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study

BackgroundHealth extension workers (HEWs) are the frontline health workers for Ethiopia’s primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs’ pre-service education and practices. The aim of this study was to identify gaps in HEWs’ practices and recommend changes in their training and scope of practice.MethodsA cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared.ResultsA total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%–57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7–97.2%) perceived themselves as competent and proficient in performing tasks in all program areas.ConclusionHEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs’ scope of practice, update pre-service education curricula and prioritize in-service training modules.

Design of Virtual Endoluminal Surgery Simulator (VESS): Colorectal Endoscopic Submucosal Dissection Training Module

Introduction: ESD is an endoscopic technique for the en bloc resection of gastrointestinal lesions. ESD is a widely-used technique in Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula has restricted its wide acceptance in the US. Thus, we aim to develop the VESS for ESD procedures. The VESS platform will aim to provide a training and assessment platform by highly realistic visualization and high fidelity of simulating the colorectal ESD procedure. The goal of the ESD simulation is to deliver realistic haptic (touch) feedback to provide a more immersive virtual experience. This abstract describes the design and task analysis study performed to date. Methods: Based on the ESD videos, we performed a detailed colorectal ESD task analysis to determine the critical procedural steps for the design of the VESS. Through the task analysis, the critical ESD steps including lesion identification, lesion marking, injection, circumferential cutting, dissection, intraprocedural complication management and post-procedure examination were detailed. Furthermore, endoscopic devices were allocated to each step of the task analysis. Results: Using our task analysis, we constructed a hierarchical task tree that elaborates the order of tasks in these steps (Figure 1). Furthermore, we developed quantitative ESD performance metrics for each phase in the task tree. For the VESS design, we generated three dimensional (3D) virtual models for various colorectal mucosal lesions (Figure 2), using the Paris and Japanese tumor classifications. 3D models of ESD devices were created. We developed realistic ESD instrument-lesion interactions with our custom-designed haptic device. We designed the electromechanical interface with 2-degrees of freedom to manipulate a dummy endoscope to provide the users with haptic feedback (Figure 3).Figure: Hierarchical task tree.Figure: (a) Paris type 0 + Is tumor and (b) Japanese type 0 + ls tumor.Figure. 3D: Design of the simulator.Conclusion: We describe the initial phases of the design of the VESS for colorectal ESD. Through a task analysis, simulation software and Hardware-software interface developments will allow for the manipulation of virtual colorectal lesions using 3D endoscopic accessories with haptic feedback. Our quantitative ESD metrics will be used in future validation studies of the VESS simulator for performance score computation of trainees.

ISQUA16-1513WHAT ARE JUNIOR MEDICAL DOCTORS IN ETHIOPIA ACTUALLY DOING: USING EVIDENCE GENERATED FROM TASK ANALYSIS STUDY TO STRENGTHEN MEDICAL PRACTICE, EDUCATION AND REGULATION

Doctors play critical roles in improving health services quality and realizing the roles requires improving quality of medical education and practice. We conducted a task analysis study to describe practice of junior medical doctors in Ethiopia and generate evidences for strengthening their education, practice and regulation. A cross-sectional study was conducted in February 2015 with nationally representative sample of recently graduated medical doctors (6 months to 4 years of experience) working in public hospitals. We used structured interview to determine how often they performed expected tasks, how competent they felt in …

Using task analysis to generate evidence for strengthening midwifery education, practice, and regulation in Ethiopia.

PurposeRealizing aspirations for meeting the global reproductive, maternal, newborn, and child health goals depends not only on increasing the numbers but also on improving the capability of midwifery workforce. We conducted a task analysis study to identify the needs for strengthening the midwifery workforce in Ethiopia.MethodsWe conducted a cross-sectional study of recently qualified midwives in Ethiopia. Purposively selected participants from representative geographic and practice settings completed a self-administered questionnaire, making judgments about the frequency of performance, criticality, competence, and location of training for a list of validated midwifery tasks. Using Statistical Package for the Social Sciences, Version 20, we computed the percentages and averages to describe participant and practice characteristics. We identified priority preservice education gaps by considering the tasks least frequently learned in preservice, most frequently mentioned for not being trained, and had the highest not capable response. Identification of top priorities for in-service training considered tasks with highest “not capable” and “never” done responses. We determined the licensing exam blueprint by weighing the composite mean scores for frequency and criticality variables and expert rating across practice categories.ResultsOne hundred and thirty-eight midwives participated in the study. The majority of respondents recognized the importance of midwifery tasks (89%), felt they were capable (91.8%), reported doing them frequently (63.9%), and learned them during preservice education (56.3%). We identified competence gaps in tasks related to obstetric complications, gynecology, public health, professional duties, and prevention of mother to child transmission of HIV. Moreover, our study helped to determine composition of the licensing exam for university graduates.ConclusionThe task analysis indicates that midwives provide critical reproductive, maternal, newborn, and child health care services and supports continuing investment in this cadre. However, there were substantial competence gaps that limit their ability to accelerate progress toward health development goals. Moreover, basing the licensure exam on task analysis helped to ground it in national practice priorities.

Task Analysis as a Resource for Strengthening Health Systems.

Task analysis is a descriptive study methodology that has wide application in the health professions. Task analysis is particularly useful in assessment and definition of the knowledge, skills, and behaviors that define the scope of practice of a health profession or occupation. Jhpiego, a US-based nongovernmental organization, has adapted traditional task analysis methods in several countries in assessment of workforce education and practice issues. Four case studies are presented to describe the utility and adaptability of the task analysis approach. Traditional task analysis field survey methods were used in assessment of the general and maternal-child health nursing workforce in Mozambique that led to curriculum redesign, reducing the number of education pathways from 4 to 2. The process of health system strengthening in Liberia, following a long history of civil war conflict, included a traditional task analysis study conducted among 119 registered nurses and 46 certified midwives who had graduated in the last 6 months to 2 years to determine gaps in education and preparation. An innovative approach for data collection that involves "playing cards" to document participant opinions (Task Master, Mining for Data) was developed by Jhpiego for application in other countries. Results of a task analysis involving 54 nurses and 100 nurse-midwives conducted in Lesotho were used to verify the newly drafted scope and standards of practice for nurses and to inform planning for a competency-based preservice curriculum for nursing. The Nursing and Midwifery Council developed a 100-question licensing examination for new graduates following a task analysis in Botswana. The task analysis process in each country resulted in recommendations that were action oriented and were implemented by the country governments. For maximal utility and ongoing impact, a task analysis study should be repeated on a periodic basis and more frequently in countries undergoing rapid change in development of workforce policy.

Advancing cognitive engineering methods to support user interface design for electronic health records

BackgroundDespite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. ObjectiveIn this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. MethodsWe conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. ResultsDentists first reviewed the patient's demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient's intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient's information and additional information needs during a typical clinician–patient encounter. ConclusionThis study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.

Posture analysis of lifting a load for head carriage and comparison between pregnant and non-pregnant women

In Western Africa, women continue performing heavy physical work that includes carrying loads on their heads during pregnancy. Women may adapt to pregnancy related body changes by modifying their postures to perform such tasks. The objectives of this biomechanical task analysis study were to 1) determine sagittal plane postures of the trunk and upper extremities at specific events during the task of lifting and lowering a load to be carried on the head, 2) compare postures of pregnant and non-pregnant participants, 3) evaluate risk for musculo-skeletal disorders (MSD) with the rapid entire body assessment (REBA) criteria. Twenty-six pregnant (26 ± 5 years, 159 ± 9 cm, 63 ± 15 kg, 25 ± 9 weeks of pregnancy) and 25 paired non-pregnant retail merchants were recruited in Porto-Novo (Benin). Participants were recorded on video in a laboratory setting while they lifted a tray (20% body weight) from a stool to their head and then put it back down. Trunk inclination and knee, shoulder and elbow flexion angles were determined using Dartfish® software. The trunk was bent by more than 80° at pick-up and set-down and knees were moderately flexed, significantly less (< 11°) for pregnant women, possibly because it was harder to lift the trunk, or for stability. For all postures analysed, the majority of trials were classified as "high" risk or "very high risk" for MSD. Future research should investigate prevalence of MSDs in this population to confirm the results of this study.

Performance of Experienced Versus Less Experienced Paramedics in Managing Challenging Scenarios: A Cognitive Task Analysis Study

Out-of-hospital care is becoming more complex, thus placing greater reliance on the cognitive abilities of paramedics to manage difficult situations. In adapting to the challenges in their work, paramedics develop expertise. We study the cognitive strategies used by expert paramedics to contribute to understanding how paramedics and the EMS system can adapt to new challenges. We conducted a "staged-world" cognitive task analysis to explore paramedics' handling of cognitive challenges related to sense-making and to resource and task management. A mixed-fidelity simulation was used to present paramedics with 2 challenging scenarios: a pulmonary embolism initially presenting as a myocardial infarction and a 2-person shooting with limited resources available. Participants were 10 paramedics, 6 more experienced and 4 less experienced. Analysis involved comparing the performance of the 2 groups to identify strategies associated with expertise. The more experienced paramedics made more assessments, explored a wider variety of presumptive diagnoses, and identified the pulmonary embolism earlier. They switched attention between the 2 shooting victims more, used their emergency medical technician-basic level partners more, and provided more advanced level care for both patients. Their patients arrived at the emergency department more prepared for specialized emergency care. Our findings correspond to general cognitive attributes of expertise: greater cue gathering and inferential reasoning, and more functional and strategic thinking. These results suggest potential areas and methods to facilitate development of expertise, as well as ways to better support use of expertise. Future studies should expand on these findings through larger sample sizes and more complex scenarios.

Sport performance and perceived musculoskeletal stress, pain and discomfort in kitesurfing

The purpose of this study was to obtain an overview of the specific movement patterns in kitesurfing, and the participants’ perceptions of musculoskeletal stress, pain and discomfort. Task analysis and survey studies were used to provide an overview of the sport, and to identify problematic issues associated with the performance of the tasks. Three different methods were complimentary used for data collection: observations (n=8), a web questionnaire (n=206) and interviews (n=17). Participants were contacted through kitesurfing events and online forums. Their ages ranged from 16-62 years. The results showed that participants experienced high musculoskeletal stress for short times during a session (jumps, tricks and strong winds), and lower, static musculoskeletal stress over a longer time (crossing). High stress was most frequently perceived in abdominal muscles. Knees and feet were the sites most frequently experienced as painful, followed by the shoulders and elbows. This study provides additional information on the performance of kitesurfing and perceived musculoskeletal stress, pain and discomfort. The results can be used as input data to develop training methods and equipment for safe and comfortable performance.

Visual Analysis for Textual Relationships in Digital Forensic Evidence

We present a visual analytics framework for exploring the textual relationships in computer forensics. Based on a task analysis study performed with practitioners, our tool addresses the inefficiency of searching for related text documents on a hard drive. Our framework searches both allocated and unallocated sectors for text and performs some pre-analysis processing; this information is then presented via a visualization that displays both the frequency of relevant terms and their location on the disk. We also present a case study that demonstrates our framework's operation, and we report on an informal evaluation conducted with forensics analysts from the Mississippi State Attorney General's Office and National Forensics Training Center.

Adapting Virtual Reality for the Participatory Design of Work Environments

This paper describes the evolution of a standard PC-based virtual reality tool which has been adapted for the participatory design of work environments. Tool features, method of control and combination with other participatory design tools are investigated in the context of a particular design situation. This research is aimed at participatory design facilitators to aid in the adaptation of similar virtual reality systems for a similar purpose. The context of this work is the Envisionment Workshop, in which a group of workers participate with design experts in using full-scale modelling, pedagogical drama, and democratic meetings to (re)design their workplace. A series of prototypes have been developed and tested during the design of a new university in the region using a case study methodology to provide high ecological validity. These were preceded by a task analysis, brainstorming and pilot study. The results suggest that such a tool can be constructed and used successfully by a small group of people using projected virtual reality. However larger groups suffer from a bottleneck at the input devices such that a virtual reality expert must take control and build what the participants wish.

The 1999–2000 ACC task analysis of nurse-midwifery/midwifery practice: a consideration of the concept of professional issues

The American College of Nurse-Midwives (ACNM) Certification Council periodically conducts a task analysis study as evidence supporting the content validity of the national certification examination in nurse-midwifery and midwifery. The purpose of this article is to report findings related to the examination of the relationship between professional issues and safe beginning-level midwifery as measured by the 1999–2000 Task Analysis of American Nurse Midwifery and Midwifery Practice. Study findings suggest that newly certified midwives place strong emphasis on the importance of tasks related to the ACNM “Hallmarks of Midwifery,” which characterize the art and science of the profession; these include tasks dealing with health promotion and cultural competency. The beginning midwives, however, gave consistently low ratings to tasks related to ACNM “Core Competencies” that mirror the professional responsibilities of midwives; these include tasks related to the history of midwifery, research, or health policy. The study has implications for nurse-midwifery/midwifery educators, experienced midwifery mentors, and other persons interested in reinforcing the relevance of these important professional issues to the new midwife.