iView Expert: Explicating practitioner expertise in complex medical procedures, for transfer to trainees.
As doctors become expert in a complex procedure, they develop automatic nuances of performance that are often difficult to explain to a peer or a trainee (so called ‘unconscious competence’). In addition, traditional methods which attempt to establish a shared understanding of decision making are associated with limitations. Whilst concurrent reporting alters the flow of the task at hand, retrospective reporting is subject to bias and often incomplete.
iViewExpert is a technique (validated in the aerospace domain) which externalises an expert’s cognitive processes, without disrupting task flow. Similar methods have been used to study clinical reasoning of expert occupational therapists and emergency physicians.
The aim of this novel project is to assess the feasibility of adapting the technique to training technical skills in medicine.
This was an observational pilot study in which expert medical practitioners wore a headmounted camera to capture complex procedures (colonoscopy,epidural insertion and laparoscopic cholecystectomy).
Footage captured was reviewed along with a facilitated debrief in order to externalise cognitive processes. The debriefs were structured upon a validated narrative and undertaken by a psychologist, trained in the technique. The debriefs were recorded and formed an audio commentary.
The videos and accompanying audio commentaries were edited and formed learning packages, which were watched by a group of learners. The learner group comprised junior doctors, who ranged from foundation to specialty trainees, and nurse endoscopists (endoscopy video only). The technique differs from standard procedural videos in that it theoretically provides a more detailed insight into thought processes of the expert. This is facilitated through the video debrief which encourages reflection upon kinaesthetic (head movement) as well as auditory and visual cues, resulting in a higher level of experiential immersion.
Questionnaires examined educational value of the technique using Likert scales and free text answers. Quantitative data were presented in terms of agreement with statements.
Fifteen learners watched the videos. Most (13/15 (87%)) agreed that the learning package was useful and 13/15 (87%) felt it gave useful insight into the operator’s thoughts.
Learners felt that the technique revealed useful nuances of the procedure with “better understanding of difficult steps.”
The intervention could represent a powerful adjunct to training. Rather than generating a procedural description, it appears to elicit important subtleties of a procedure, more relevant to experienced practitioners rather than novices or beginners. Therefore, we are currently undertaking a larger study focusing on a cohort of experienced practitioners as learners.
We also wish to evaluate whether the experts who participated in the ‘cued recall debrief’ process found it valuable and whether there are particular environments, procedures or individuals for which this technique works best. Preliminary results show that experts found the process highly immersive and that they were able to gain insights into their own practice of which they were not previously aware. In addition, the technique appears to be best suited to non-routine, especially challenging procedures.