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Standardizing bimanual vaginal examination using cognitive task analysis
Author(s) -
Plumptre Isabella,
Mulki Omar,
Granados Alejandro,
Gayle Claudine,
Ahmed Shahla,
LowBeer Naomi,
Higham Jenny,
Bello Fernando
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12260
Subject(s) - checklist , medicine , task (project management) , observational study , cognition , medical physics , physical examination , radiology , psychology , pathology , psychiatry , cognitive psychology , management , economics
Objective To create a standardized universal list of procedural steps for bimanual vaginal examination ( BVE ) for teaching, assessment, and simulator development. Methods This observational study, conducted from June–July 2012 and July–December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis ( CTA ) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. Results BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9–27.9, 53%–93%). Conclusion This approach identified 30 essential steps for performing BVE , producing a new technique and standardized tool for teaching, assessment, and simulator development.