Original Publication
Open Access

A Cognitive-Task-Analysis Informed Central Venous Catheter Placement Curriculum

Published: April 5, 2012 | 10.15766/mep_2374-8265.9135

Included in this publication:

  • CTA Informed Central Line Skills Module.doc
  • CTA Informed Evaluation Tool.doc
  • CTA Informed Procedural Checklist.doc

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Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

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.

Educational Objectives

Program/Module Objectives:

  1. To provide a comprehensive curriculum to teach CVC placement.
  2. To provide a comprehensive assessment tool to determine competency in CVC placement.

Learner Objectives:

  1. To discuss the indications and contraindications for CVC placement.
  2. To identify the landmarks for the internal jugular, subclavian and femoral approaches to CVC placement.
  3. To discuss common errors and error avoidance strategies for CVC placement.
  4. To describe the key factors associated with CVC associated bloodstream infections (including insertion, maintenance and removal) and prevention strategies for each.
  5. To understand the role of ultrasound guided CVC placement.
  6. To demonstrate proper CVC placement on a simulated model.

Author Information

  • Maura Sullivan, PhD, MSN: Keck School of Medicine of the University of Southern California
  • Michael Sullivan, MD: City of Hope Medical Center
  • Craig Baker, MD, FACS: University of Southern California
  • Peep Talving, MD, PhD, FACS: University of Southern California
  • Kenji Inaba, MD, FRCSC, FACS: University of Southern California

Disclosures
None to report.

Funding/Support
None to report.



Citation

Sullivan M, Sullivan M, Baker C, Talving P, Inaba K. A cognitive-task-analysis informed central venous catheter placement curriculum. MedEdPORTAL. 2012;8:9135. https://doi.org/10.15766/mep_2374-8265.9135