Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic...
-
Upload
claribel-maxwell -
Category
Documents
-
view
218 -
download
0
Transcript of Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic...
![Page 1: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/1.jpg)
Robert Sweet, MD
Task Deconstruction and Metrics
Robert M. Sweet, MDAssistant Professor Urologic Surgery
and General SurgeryClinical Director of Simulation
ProgramsFounding Director, CREST
![Page 2: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/2.jpg)
Robert Sweet, MD
Procedure vs. Task vs. Exercise
• Procedure-is a “series of steps taken to accomplish an end”
• Task-“piece of work to be done”
• Exercise-”effort performed to develop or maintain fitness or increase skill”
Webster’s Dictionary
![Page 3: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/3.jpg)
Robert Sweet, MD
Task deconstruction
• Procedures can be broken down into logical components
• Guidelines for the “order by which this occurs”– Safety considerations– Natural progression of skills from simple to complex– Resources and expense
• Independent opportunities for learning loaded on the front end, but sprinkled throughout
![Page 4: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/4.jpg)
Robert Sweet, MD
Cognitive Technical+ Performance=
Dependent
Independent
Automatic
+Communication
Situational Awareness
Closed-Loop Communication
Leadership Transfer
Team Formation and Reformation
Psychomotor
Visual-spatial
Learning Domains in Simulation Training
![Page 5: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/5.jpg)
Robert Sweet, MD
Classify your learners
• Who are your learners
• Where are they as far as their level of understanding?
![Page 6: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/6.jpg)
Robert Sweet, MD
Types of Knowledge
• Declarative– Knowing “what”
• Procedural– Knowing “how”
• Schematic– Knowing “why”
• Strategic– Knowing how and when to apply
Wilson et al, Systems for State Science Assessment, 2005
![Page 7: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/7.jpg)
Robert Sweet, MD
Learning Domains-Cognitive
• “Discriminate the differences between IJ and Subclavian central lines”
• “What would you do if . . . . .”
• “Asking for the proper equipment you need to have available to put in a central line”
• “Name the venous branches leading to the SVC”Bloom’s Taxonomy
![Page 8: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/8.jpg)
Robert Sweet, MD
![Page 9: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/9.jpg)
Robert Sweet, MD
Cognitive Domain Tasks
• Usually good to load on the front-end of the curriculum as it meets the criteria– Safe– Low resources– Logical to understand before doing– Estimated to comprise 75% of what we learn
in procedures (Spencer et al.)
![Page 10: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/10.jpg)
Robert Sweet, MD
Teaching and assessing judgment
Red Llama, Inc.:SimPraxis
![Page 11: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/11.jpg)
Robert Sweet, MD
Communication Domain
• Situational Awareness
• Closed loop communication
• Leadership Transfer• Team Formation and
Reformation
![Page 12: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/12.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
![Page 13: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/13.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
![Page 14: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/14.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
![Page 15: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/15.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
![Page 16: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/16.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
Multi-tasking
![Page 17: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/17.jpg)
Robert Sweet, MD
Psychomotor/Visual-spatial Domain
Imitation
Manipulation
Precision
Articulation
Naturalization
Dave’s Taxonomy
Dave, R. H. (1975). Developing and Writing Behavioural Objectives. (R J Armstrong, ed.) Educational Innovators Press
Observing and patterning behavior after someone else
Performance after training, with errors
Refining technique with few errors
Multi-tasking
High-level of performance on auto-pilot
![Page 18: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/18.jpg)
Robert Sweet, MD
Psychomotor/Visual-Spatial Skills
• Basic skills (adapted from Satava et al., 2002)– Patient positioning– Knowing steps of procedure– Knowing equipment needed– Sterilization procedures– Instrument handling– Bimanual Dexterity– Navigation– Suturing– Knot-tying– Intubation– Palpation– Cannulation– Cutting– Incising– Exploration– Tissue handling
Berkley et al.,2000
![Page 19: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/19.jpg)
Robert Sweet, MD
Psychomotor/Visual-Spatial Skills
• Intermediate Skills (adapted from Satava et al., 2002)– Complex wound
closures
– Hemorrhage control
– Endoscopy
– Excision
– Anastomosis
– Debridement
– Complex seldinger technique
![Page 20: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/20.jpg)
Robert Sweet, MD
Psychomotor/Visual-Spatial Skills
• Advanced skills– Sewing in a “deep hole”– Reconstruction– Adopting techniques to abnormal
anatomical/physiologic situations (cognitive too!) – Advanced minimal invasive skills– New adoptions of technology
once done with formal training– Occurring in animal labs
![Page 21: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/21.jpg)
Robert Sweet, MD
With each curricular subtask, choose a learning domain that
predominates
![Page 22: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/22.jpg)
Robert Sweet, MD
Task deconstruction
• Methods to do this?– Look at operative reports/atlases– Practical experience– Remember when you were a student– Ask an introspective student/resident to “keep a diary”
of • What they are learning
• Self-assessment of “level” of comprehension
• When they are learning it
![Page 23: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/23.jpg)
Robert Sweet, MD
Competence vs. Capability
COMPETENCEWhat individuals know or are able to do in
terms of knowledge, skills, attitudeCAPABILITY
Extent to which individuals can adapt to change, generate new knowledge, and continue to improve their performance
Brit. Med. J. 323:799-803, 2001
![Page 24: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/24.jpg)
Robert Sweet, MD
Learning curves/criterion levels
MASTERY
COMPETENCY
PROFICIENCY
Hypothetical Learning Curve for a technical skill set
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
![Page 25: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/25.jpg)
Robert Sweet, MD
Learning curves/criterion levels
MASTERY
COMPETENCY
PROFICIENCY
Hypothetical Learning Curve for a technical skill set
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
Simulator Remedial training
![Page 26: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/26.jpg)
Robert Sweet, MD
Learning curves/criterion levels
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Student AMean
MASTERY
COMPETENCY
PROFICIENCY
Hypothetical Learning Curve for a technical skill set
![Page 27: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/27.jpg)
Robert Sweet, MD
Metrics for Assessment
• Each task has two components– The performance task itself– A clearly defined scoring scheme/rubric
![Page 28: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/28.jpg)
Robert Sweet, MD
Metrics
Make a list of what is it that is important to measure to determine competence for each subtask?
Establish Criterion levels based on subject matter expert consensus and performance
![Page 29: Robert Sweet, MD Task Deconstruction and Metrics Robert M. Sweet, MD Assistant Professor Urologic Surgery and General Surgery Clinical Director of Simulation.](https://reader035.fdocuments.net/reader035/viewer/2022062500/5697bfe71a28abf838cb5c93/html5/thumbnails/29.jpg)
Robert Sweet, MD
Metrics examples (adapted from Satava et al. 2002)
Quality metrics Errors/”near misses”/events/complications
Blunt end vs. sharp end Missed target Improper delivery of energy Bleeding Final product (leaking or inaccurate) Patient outcomes
Ability to recover from error Efficiency metrics
Time to task Economy of motion Path lengths Response latency Use of resources Use of assistant(s) Proper sequence of steps