1. Teaching Procedural Skills Beyond “See one, Do one, Teach one” Dr. Jason Frank and Janet Nuth, Dept of Emergency Medicine, University of Ottawa

2. 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

3. Video Scenarios • So what went wrong?

4. 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

5. 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

6. 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

7. C:Complications and Contraindications • Learner should know when the procedure is not done and the precautions and complications that are involved

8. 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

9. 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

10. F: Feedback • Ask for feedback • Allow learner to clarify steps or ask questions

11. E: Explanation • Learner now talks through the skill describing step by step how it is performed • Helps commit the process to memory

12. D: Demonstration • Learner now performs the skill with the preceptor observing

13. Start by practicing small portions of the skill • Link small portions together • Practice entire skill continuously

14. 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

15. Allow for practice • Ensure varying degrees of complexity • Allow for practice under less than ideal conditions

16. 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

17. 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

18. Educational Models • Volunteers • Mannequins/ Models • Mannequins with simulated patient • Cadaver/Animal laboratories • Simulators • Newly Dead

19. 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

20. But are they competent?