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?