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Teaching a skill. V. Ashoorion MD., Msc Medical Education Research Center. Lesson Plan. After this session you should : Define Clinical Skills and Clinical Procedures Nominate Four goal of any skill training exercise Rethink about the way acquiring a procedural skill
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Teaching a skill V. Ashoorion MD., Msc Medical Education Research Center
Lesson Plan • After this session you should : • Define Clinical Skills and Clinical Procedures • Nominate Four goal of any skill training exercise • Rethink about the way acquiring a procedural skill • Describe different teaching methods for procedural skills • Discuss pros and cons of different teaching methods
Clinical Skills • clinical procedures • collaboration/ communication with professionals • communication with patients and/or families • health promotion and risk assessment • legal, ethical, and value concerns • maintaining currency within the discipline • management and diagnosis • management of specific conditions • organ systems examinations
A procedure is defined as a skill that involved physical interaction with patients that was either invasive or required the use of tools or equipment. • Example • suturing • spinal tap • circumcision
Skills training must be • systematic • carefully planned • fully evaluated
Four goal of any skill training exercise • Acquisition: effective performance in appropriate circumstances. • Competency: the skilled behavior will be performed to a predetermined level • Retention: the skilled activity will be retained over time. • Transfer: the training time directed to one skill will enhance the future the acquisition or application of new skills
teaching procedural skills methods • Teaching methods can be divided to two categories: • Traditional • giving lecture • see one, do one, teach one • Non-traditional
"see one, do one, teach one" • the most common method of teaching procedural skills in medical school and residency settings
Some critiques about the strategy • This method may threaten patient safety • Some articles has suggested some modifications • "read about one, go to a course on one, do fifteen simulated ones, be evaluated about one, have some clinical experience about one, then teach one and expect ongoing evaluation" • “see one, do one, teach one, have one" • Shortage of enough opportunity for students to do procedures • Physicians are often unwilling to provide training • Some procedures are so rare in clinical practice for trainees to "see one, do one" let alone teach. • Training based on a systematic methodology is preferred to the traditional "see one, do one, teach one" approach
Skills require more than performing tasks. • They include: • Knowledge (indications, contraindications, complications and their prevention) • Skill (preparation, technique, dexterity) • Communication (consent, comfort and dignity of patients; realising when to get help).
Five step to design • This model, which is applicable to any procedural skill to be acquired in a medical context, can be summarized as having five steps: • 1. Establishing the need • 2. Task analysis • 3. Developing objectives • 4. Instructional design and implementation of skill training • 5. Program evaluation
Seven principle for Teaching Procedural and Technical Skills
A four-step approach to teaching skills • Demonstration. Trainer demonstrates at normal speed, without commentary. • Deconstruction. Trainer demonstrates while describing steps. • Comprehension. Trainer demonstrates while learner describes steps. • Performance. Learner demonstrates while learner describes steps.
Session structure • Setting • Have you made assumptions about the learners’ basic knowledge • (“You know that, don’t you?”). • Consider their orientation: • are they sitting beside you or opposite (mirror image)? • Are they left- or right-handed? can they see?
Dialogue. • Have you broken the procedure into clear steps? • Is the task too large to learn at one sitting? • Are you giving positive feedback (what they did well, what they could improve)? • Have you corrected mistakes? Avoid talking too much — either giving too much detail (trying to cover too much in one sitting) or chatting about something else (worried they are bored).
Closure. • Can they do it? • Do you need to explain how the procedure may differ under different circumstances?
Application in practice • Step 1 should be demonstrated with a real patient. It is important to allow the learner to identify with a competent performance. • Steps 2and 3 can be done theoretically or with the equipment, away from the patient. • Steps 1 and 2 can be repeated in a larger group (eg, with a video), then steps 3 and 4 can be done in small groups. • Steps should be done in more than one sitting.
Consider the way you currently teach a skill and think about what the four-step approach may add
The trainee has shifted from being “consciously incompetent” to being “consciously competent” • Only with repeated practice will he or she be able to perform satisfactorily in a variety of situations.
Take-home message • Teaching a skill involves knowledge • Indications • Contraindications • complications and prevention) • skill (dexterity, performance) • communication (consent, dignity, realizing when to get help) • interpret the results of diagnostic procedures
When teaching a skill, consider using or adapting a four-step approach. • Consider the structure of your teaching session: • set (prior learning, orientation) • dialogue (manageable steps) • Closure (application to other settings).
Facilities for teaching clinical Skills • Simulated patients • Videos • Manikins • Computers • virtual reality • lectures • slides • demonstrations • supervised hands‑on • practice on manikins • classmate volunteers
Benefit of Teaching with facilities • Learning skills occurs • in a safe environment • receive feedback • reach a certain level of competence • before they use the skills on patients.
Thank you Any Question?
