Sang Hoon Lee

Module 2 Cognitive Dimension Chart

May 24, 2016
One course I recently completed was an intense two-day Advanced Trauma Life
Support course. Prior to the first day, it also required pre-course work, which
consisted of reading a textbook and taking a pre-test. Most of the education was
through didactic lectures, but also included intermittent small group skills sessions
and discussions. The final exams consisted of both a practical portion and a written
portion. The following excerpt is taken directly from the textbooks preface:
Program Goals:
The Advanced Trauma Life Support (ATLS) course provides its participants with a
safe and reliable method for the immediate treatment of injured patients and the
basic knowledge necessary to:
1. Assess a patients condition rapidly and accurately.
2. Resuscitate and stabilize patients according to priority.
3. Determine whether a patients needs exceed a facilitys resources and/or a
providers capabilities.
4. Arrange appropriately for a patients interhospital or intrahospital transfer (what,
who, when, and how).
5. Ensure that optimal care is provided and that the level of care does not
deteriorate at any point during the evaluation, resuscitation, or transfer processes.

Cognitive Dimension Chart

Knowledg Remem Underst
Apply
e Type
ber
and
Factual

Evaluat
e

Creat
e

Goal 1

Conceptua
l

Goal 1

Procedural

Goal 2

Metacognit
ive

Analyze

Goal 2, 4 Goal 2, 5 Goal 5

Goal 3, 5

Goal 1 requires remembering the signs and symptoms of a healthy versus an

unhealthy patient. The learner then needs to conceptualize the patients
presentation and understand whether he/she is a stable or unstable patient.
Goal 2 requires procedural understanding and application of resuscitation skills. The
learner also needs to prioritize care, which requires analyzing and grading the
acuity of each patient against each other.
Goal 3 requires evaluation of ones own skills and deciding if the patient should be
transferred.
Goal 4 requires application of the transfer procedure.
Goal 5 requires analysis of each step in a patients transfer. To ensure a patients
care is optimal, evaluation of the process, and ones role in the process, must also
take place.

As this course is generated by a panel of experts with the specific aim of

standardizing practice, it is reasonable to exclude a creation piece to the course
goals. I can imagine a creation goal of designing pocket-guides for the ATLS
algorithms, or making an instructional video for one of the resuscitation skills.
I really enjoy this chart and the concepts behind it. I had never learned of Blooms
Taxonomy previously, and it provides a focusing structure in curriculum
development and appraisal. My medical school prided itself in getting through
classroom learning in one-and-a-half years, and going into clinical learning a
half-year earlier than most schools did. Unfortunately, a majority of our classroom
learning revolved around lectures, and even in small group sessions, was more
about reviewing the information we had been instructed to study. I can surmise that
the general idea was to focus on the Remember and Understand levels in the
classroom, hope to achieve Apply during the clinical years, and perhaps Analyze,
Evaluate, and Create continuously now as a supervisor. But, is that not an archaic,
hierarchical, approach to learning?
Assessments in medical school were also reflectively outdated, and seemed to
solely center on written exams an effective way to test for Remember, but more
difficult to test for Understanding and the ability to Apply. One interesting approach
to assessment, which I am now quite suddenly considering as a feasible alternative,
is the nerve-racking oral exam. Although few specialties continue this practice, my
colleagues in Adult Emergency Medicine do so, and their preparation requires all
levels of Blooms Taxonomy. To become certified in their specialty, a panel takes a
candidate through oral boards: a case is presented, and the learner must verbally
walk the panel through their thought process. Not only must they Remember facts
to Understand the case presentation, but they must then Apply those facts to a
diagnosis. If the cases patient requires a procedure, the applicant must guide the
panel through the steps required. Depending on how the case changes, the student
is able to evaluate whether they are on the right course. In preparing for these
exams, a learner might be challenged to make mnemonics or create novel scenarios
for practice.

Reference:
Advanced Trauma Life Support Student Course Manual (9th ed.). (2012). Chicago, IL: American College of Surgeons.