The use of cognitive task analysis to reveal the instructional limitations of experts in the teaching of procedural skills

Acad Med. 2014 May;89(5):811-6. doi: 10.1097/ACM.0000000000000224.


Purpose: Because of the automated nature of knowledge, experts tend to omit information when describing a task. A potential solution is cognitive task analysis (CTA). The authors investigated the percentage of knowledge experts omitted when teaching a cricothyrotomy to determine the percentage of additional knowledge gained during a CTA interview.

Method: Three experts were videotaped teaching a cricothyrotomy in 2010 at the University of Southern California. After transcription, they participated in CTA interviews for the same procedure. Three additional surgeons were recruited to perform a CTA for the procedure, and a "gold standard" task list was created. Transcriptions from the teaching sessions were compared with the task list to identify omitted steps (both "what" and "how" to do). Transcripts from the CTA interviews were compared against the task list to determine the percentage of knowledge articulated by each expert during the initial "free recall" (unprompted) phase of the CTA interview versus the amount of knowledge gained by using CTA elicitation techniques (prompted).

Results: Experts omitted an average of 71% (10/14) of clinical knowledge steps, 51% (14/27) of action steps, and 73% (3.6/5) of decision steps. For action steps, experts described "how to do it" only 13% (3.6/27) of the time. The average number of steps that were described increased from 44% (20/46) when unprompted to 66% (31/46) when prompted.

Conclusions: This study supports previous research that experts unintentionally omit knowledge when describing a procedure. CTA is a useful method to extract automated knowledge and augment expert knowledge recall during teaching.

Publication types

  • Comparative Study

MeSH terms

  • California
  • Clinical Competence*
  • Cognition / physiology*
  • Cricoid Cartilage / surgery
  • Curriculum
  • Education, Medical, Graduate / methods*
  • Female
  • Humans
  • Male
  • Mental Recall
  • Surgical Procedures, Operative / education*
  • Task Performance and Analysis
  • Teaching / methods*
  • Thyroidectomy / education*
  • Thyroidectomy / methods