Teaching Procedural SkillsBeyond “See one, Do one, Teach one”
Dr. Jason Frank and Janet Nuth,
Dept of Emergency Medicine, University of Ottawa
Objectives
Describe and demonstrate the basic principles for teaching procedural and technical skills
Define competence in performing procedural skills
Discuss common errors made by supervisors when teaching procedural skills
Video Scenarios So what went wrong?
Model for Teaching Procedures: A :Assess the learner B : Basic Concepts C: Contraindications/ Complications
D: Demonstrate the Procedure E : Explain and Breakdown the Steps F: Feedback/ Answer Questions
E:( Learner) Explains and Verbalizes Steps D: (Learner) Demonstrates the Procedure F : Feedback on performance
A: Assess the learner
What does the learner already know? Ask them to teach you the skill first Plan ahead: Have the learner prepare and do
reading ahead of time
B: Basic Concepts
Learner understands the cognitive elements of the skill: why and when it is done
Learner knows the instruments and tools involved in the skill
C:Complications and Contraindications
Learner should know when the procedure is not done and the precautions and complications that are involved
D: Demonstration
The learner sees the skill demonstrated in its entirety
Gives them a mental picture of what the skill should look like when done correctly
E: Explanation
Preceptor repeats the procedure breaking it down into steps and verbalizing each step
Allows learners to see how each step fits into the optimal sequence
Learners perform better with series of small steps
F: Feedback
Ask for feedback Allow learner to clarify steps or ask
questions
E: Explanation
Learner now talks through the skill describing step by step how it is performed
Helps commit the process to memory
D: Demonstration
Learner now performs the skill with the preceptor observing
Start by practicing small portions of the skill
Link small portions together Practice entire skill continuously
F: Feedback Provide feedback encourage self-assessment be specific and timely (right after the performance) ensure the feedback is non-judgmental and
performance- based start with what you liked, make a suggestion for
improvement, end with a positive aspect of the performance
Allow for practice
Ensure varying degrees of complexity Allow for practice under less than ideal
conditions
Model for Teaching Procedures: A :Assess the learner B : Basic Concepts C: Contraindications/ Complications
D: Demonstrate the Procedure E : Explain and Breakdown the Steps F: Feedback/ Answer Questions
E:( Learner) Explains and Verbalizes Steps D: (Learner) Demonstrates the Procedure F: Feedback on Performance
Practicing a Procedure
Juggling Tying tie, shoe Card trick, shuffling cards Paper airplane, origami Putting, tennis serve, dribbling basketball, heading
soccer ball Applying lipstick, blowing bubble gum Calligraphy Knot tying
Educational Models
Volunteers Mannequins/ Models Mannequins with simulated patient Cadaver/Animal laboratories Simulators Newly Dead
When there is difficulty Learner problem: fine motor coordination Inadequate description: not paid attention, too
much time lapse Imprinting incorrect performance Improper feedback Affective factors: fear, anxiety, sense of skill
irrelevance Inaccurate learner perception of performance
But are they competent?