Subscribe to RSS
Download PDF
DOI: 10.1055/a-2633-9032
Do all trainers think the same? Exploring use of the Think Aloud method to understand colonoscopy trainer thought processes
Authors
Abstract
Background and study aims
Colonoscopy is a complex skill to teach. Understanding trainer cognition is an important factor in determining the level of trainer competence. This study aimed to explore colonoscopy trainer thoughts as they observed trainee performance using the Think Aloud method (TA).
Methods
Eleven trainers verbalized their thoughts (TA) while watching three video recordings of trainees performing a colonoscopy procedure. TA audio was transcribed verbatim and content was analyzed to determine valence of verbalizations, frequency of verbalized themes, and level of verbalizations in relation to depth of response.
Results
Descriptive differences were observed between trainers, highlighting a lack of consistency in relation to their thoughts while observing a trainee perform colonoscopy.
Conclusions
This study provides support for use of TA as a method to understand trainer cognition in colonoscopy. It suggests the need for further research to explore consistency of training across trainers.
Publication History
Received: 27 November 2024
Accepted after revision: 03 June 2025
Article published online:
23 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Amy Whitehead, Joe Causer, Melissa Rankin, Kristin McGinty-Minister, Paul O'Toole. Do all trainers think the same? Exploring use of the Think Aloud method to understand colonoscopy trainer thought processes. Endosc Int Open 2025; 13: a26339032.
DOI: 10.1055/a-2633-9032
-
References
- 1
Waschke KA,
Anderson J,
Macintosh D.
et al.
Training the gastrointestinal endoscopy trainer. Best Pract Res Clin Gastroenterol
2016; 30: 409-419
Reference Ris Wihthout Link
- 2
Biswas S,
Alrubaiy L,
China L.
et al.
Trends in UK endoscopy training in the BSG trainees’ national survey and strategic
planning for the future. Front Gastroenterol 2017; 9: 200-207
Reference Ris Wihthout Link
- 3
Siau K,
Pelitari S,
Green S.
et al.
JAG consensus statements for training and certification in colonoscopy. Front Gastroenterol
2023; 14: 201-221
Reference Ris Wihthout Link
- 4
Brown F,
Weidner A,
Wells C.
et al.
UK endoscopy trainer survey: perspectives on current endoscopy training delivery,
experience, barriers and opportunities. Front Gastroenterol 2024; 15: 214-221
Reference Ris Wihthout Link
- 5
Thuraisingam AI,
Levine DF,
Anderson JT.
Can research in sports and other motor skills help improve endoscopy training?. Gastrointest
Endosc 2006; 63: 276-279
Reference Ris Wihthout Link
- 6
Ericsson KA,
Simon HA.
Protocol Analysis. Cambridge: The MIT Press; 1993. 00.
Reference Ris Wihthout Link
- 7
McGreary M,
Jackman PC,
Eccles DW.
et al.
Think aloud research in sport and exercise psychology: A focused mapping review and
synthesis. Sport Exercise Performance Psychol 2024; 13: 162-182
Reference Ris Wihthout Link
- 8
Whitehead AE,
Jones HS,
Williams EL.
et al.
Investigating the relationship between cognitions, pacing strategies and performance
in 16.1 km cycling time trials using a think aloud protocol. Psychol Sport Exercise
2018; 34: 95-109
Reference Ris Wihthout Link
- 9
Whitehead AE,
Cropley B,
Huntley T.
et al.
“Think Aloud”: Toward a framework to facilitate reflective practice amongst rugby
league coaches. Int Sport Coaching J 2016; 3: 269-286
Reference Ris Wihthout Link
- 10
Banning M.
The think aloud approach as an educational tool to develop and assess clinical reasoning
in undergraduate students. Nurse Education Today 2008; 28: 8-14
Reference Ris Wihthout Link
- 11
Pinnock R,
Young L,
Spence F.
et al.
Can think aloud be used to teach and assess clinical reasoning in graduate medical
education?. J Graduate Med Education 2015; 7: 334-337
Reference Ris Wihthout Link
- 12
Zupanc CM,
Burgess-Limerick R,
Hill A.
et al.
A competency framework for colonoscopy training derived from cognitive task analysis
techniques and expert review. BMC Medical Education 2015; 15: 1-11
Reference Ris Wihthout Link
- 13
Birch PDJ,
Whitehead AE.
Investigating the comparative suitability of traditional and task-specific think aloud
training. perceptual and motor skills 2019; 127: 202-224
Reference Ris Wihthout Link
- 14
Siau K,
Crossley J,
Dunckley P.
et al.
Colonoscopy direct observation of procedural skills assessment tool for evaluating
competency development during training. Am J Gastroenterol 2019; 115: 234-243
Reference Ris Wihthout Link
- 15
Kumar NL,
Sewell JL.
Endoscopy teaching competencies for junior faculty: outstanding endoscopy teaching
is within your SCOPE. Am J Gastroenterology 2021; 116: 2318-2320
Reference Ris Wihthout Link
- 16
van Oostveen CJ,
Vermeulen H,
Nieveen van Dijkum EJM.
et al.
Factors determining the patients’ care intensity for surgeons and surgical nurses:
a conjoint analysis. BMC Health Serv Res 2015; 15: 395
Reference Ris Wihthout Link
- 17
Fitts PM,
Posner MI.
Human Performance. New Jersey: Prentice Hall; 1967
Reference Ris Wihthout Link
- 18
Swettenham L,
Whitehead AE.
Developing the triad of knowledge in coaching: Think aloud as a reflective tool within
a category 1 football academy. Int Sport Coaching J 2021; 9: 122-132
Reference Ris Wihthout Link
- 19
Shah SG,
Thomas-Gibson S,
Lockett M.
et al.
Effect of real-time magnetic endoscope imaging on the teaching and acquisition of
colonoscopy skills: results from a single trainee. Endoscopy 2003; 35: 421-425
Reference Ris Wihthout Link
- 20
Stodter A,
Whitehead A.
Thinking again about the use of think aloud and stimulated recall methods in sport
coaching. Qual Res Sport Exercise Health 2024; 16: 456-470
Reference Ris Wihthout Link