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

Objectives w Describe and demonstrate the basic principles for teaching procedural and technical skills w Define competence in performing procedural skills w Discuss common errors made by supervisors when teaching procedural skills

Video Scenarios w So what went wrong?

Model for Teaching Procedures: w A :Assess the learner w B : Basic Concepts w C: Contraindications/ Complications w D: Demonstrate the Procedure w E : Explain and Breakdown the Steps w F: Feedback/ Answer Questions w E:( Learner) Explains and Verbalizes Steps w D: (Learner) Demonstrates the Procedure w F : Feedback on performance

A: Assess the learner w What does the learner already know? w Ask them to teach you the skill first w Plan ahead: Have the learner prepare and do reading ahead of time

B: Basic Concepts w Learner understands the cognitive elements of the skill: why and when it is done w Learner knows the instruments and tools involved in the skill

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

D: Demonstration w The learner sees the skill demonstrated in its entirety w Gives them a mental picture of what the skill should look like when done correctly

E: Explanation w Preceptor repeats the procedure breaking it down into steps and verbalizing each step w Allows learners to see how each step fits into the optimal sequence w Learners perform better with series of small steps

F: Feedback w Ask for feedback w Allow learner to clarify steps or ask questions

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

D: Demonstration w Learner now performs the skill with the preceptor observing

w Start by practicing small portions of the skill w Link small portions together w Practice entire skill continuously

F: Feedback w Provide feedback w encourage self-assessment w be specific and timely (right after the performance) w ensure the feedback is non-judgmental and performance- based w start with what you liked, make a suggestion for improvement, end with a positive aspect of the performance

Allow for practice w Ensure varying degrees of complexity w Allow for practice under less than ideal conditions

Model for Teaching Procedures: w A :Assess the learner w B : Basic Concepts w C: Contraindications/ Complications w D: Demonstrate the Procedure w E : Explain and Breakdown the Steps w F: Feedback/ Answer Questions w E:( Learner) Explains and Verbalizes Steps w D: (Learner) Demonstrates the Procedure w F: Feedback on Performance

Practicing a Procedure w Juggling w Tying tie, shoe w Card trick, shuffling cards w Paper airplane, origami w Putting, tennis serve, dribbling basketball, heading soccer ball w Applying lipstick, blowing bubble gum w Calligraphy w Knot tying

Educational Models w Volunteers w Mannequins/ Models w Mannequins with simulated patient w Cadaver/Animal laboratories w Simulators w Newly Dead

When there is difficulty w Learner problem: fine motor coordination w Inadequate description: not paid attention, too much time lapse w Imprinting incorrect performance w Improper feedback w Affective factors: fear, anxiety, sense of skill irrelevance w Inaccurate learner perception of performance

But are they competent?