Cognitive Task Analysis: Creation of a Neonatal Mask Ventilation Checklist for Instruction and Assessment

Background: Neonatal mask ventilation (NMV) is a vital competency for trainees. Although NMV delivery has been shown to be inconsistent, no objective NMV instruction and assessment checklists exist and NMV performance standards have not been established. Checklist development relies on literature review and subject matter expert (SME) recall. However, unaided recall is imprecise/incomplete and results in checklists that fail to highlight the underlying cognitive processes and steps that are potentially challenging. Cognitive task analysis (CTA) is a family of techniques used to elicit the automated knowledge and cues that underlie expert performance. Purpose: To: 1) develop a NMV checklist using CTA and 2) set mastery performance standards for NMV. Methods: CTA conducted with five neonatologists (SMEs) included: 1) simulated NMV, 2) dynamic checklist, and 3) semi-structured interview. Using CTA data, a NMV checklist was created for each SME. Individual checklists were combined to create a preliminary checklist. SME agreement was achieved through two Delphi rounds, and a final checklist was created. Using two mastery standard setting approaches, SMEs set NMV performance standards. Results: CTA resulted in a detailed 17-step checklist for instruction and assessment of NMV. The performance (passing) standard for NMV was set at 100%. Discussion: CTA afforded a degree of detail not achievable through traditional checklist development methods. The high performance standards must be interpreted in the context of instruction/assessment in the simulated environment, taking into consideration the limitations of this environment and the intricacies of the clinical environment that contribute to degradation of performance on actual patients.