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17th International Conference on Naturalistic Decision Making

CTA in Effect: Case studies demonstrating the benefits of Cognitive Task Analysis

An Instructional Design Curriculum for Detecting Colorectal Cancers

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Primary Submitter:

Silvia Sanduleanu,


Clinical Health Care

Generic description of sponsoring organization or customer:

International scientific community whose mission is to enhance endoscopy training by implementing the principles of science of education and science of expertise.

Cognitive Task Analysis Method(s):

We deconstructed the decision-making process for recognizing and managing hereditary colorectal cancer (HCRC) and familial colorectal cancer (FCRC) using a problem-solving decision framework that has been validated for many fields of science (Price et al, Life Science Education 2021).

Number of Participants:

Group A Total Number = 18;
Total Number of Proficient Performers = 18
Group B Total Number= 23;
Total Number of Proficient Performers = 23

Method for determining proficiency:
Pretest-posttest Simulation-Based Mastery Learning (SBML) method for assessments.


Group A = four calendar months.
Group B = three calendar months.


Findings share
We created an instructional design curriculum for achieving Mastery on HCRC and FCRC management, as described elsewhere. We deconstructed the decision-making process for recognizing and managing HCRC and FCRC using a problem-solving decision framework that has been validated for many fields of science. We used a collection of deidentified authentic clinical cases and images of varying complexity to simulate common clinical scenarios for learners to practice decision making with feedback and create mental representations and maps for these conditions.

Instructional and/or training experience
The curriculum was designed by an international panel of endoscopy educators, methodological experts in science of expertise and education and SME in HCRC and FCRC and was delivered via Canva Learning Management System. Figure 2 illustrates the application of a problemsolving decision framework on a clinical case.

Demonstration of value:

Evidence of value
At baseline testing, none of the learners in group A and group B achieved the MPS. At the end of the course, all learners met or surpassed the MPS (figure 3). The curriculum produced a very large pretest to final posttest learning effect size in both groups (Cohen’s d and Hedge’s g coefficients for group A: 5.06; 4.95; and for group B: 4.08; 3.99). The mean (SD) scores Submission to NDMA CTA in E/Affect Initiative 2 significantly increased from pretest to the initial posttest and from the initial posttest to the final posttest: (P<0.0001 for both groups, paired t-test). At 6 months after the course, knowledge retention remained stable in group A (data from group B not yet available).

Customer-provided perspective
Post-course feedback from the participants indicated that the course advanced their knowledge and significantly improved the decisions made in clinical practice. Multiple translational science outcomes were reported, i.e., setting-up specialized clinical programs in their centers for improving clinical care of patients with HCRC and FCRC, transferring knowledge to novices and peers, and conducting collaborative research studies.


Figure 1. Course Structure for teaching clinical decision-making for the recognition of hereditary and familial colorectal cancer

Figure 2. Application of a problem-solving decision model (Price et al, Life Science Education 2021) for teaching hereditary CRC

Figure 3. Test Scores Comparison at Pretest, Initial Post Test and Final Post Test in the 2 groups. The red line indicates the Minimum Passing Standard (MPS) which was set-up at 80%. At baseline, none of the participants achieved the MPS. At the end of the course, all participants met or surpassed the MPS. Mean scores gradually increased between pre-test, initial post-test and final post-test (P<0.0001, paired t-test).


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