Facilitate the Development of Healthcare Delivery Skills

IntroductionIntroduction Why do we demonstrate skills? Where do students see core competencies or skills demonstrated? How and when are they given opportunities to practice these skills?

Developing Healthcare Delivery Skills Introducing and demonstrating the skill Observing students as they practice the skill Giving feedback to students on how well they performed the skill Assessing students for competency in the skill

ObjectivesObjectives List the steps of skills development Develop and use competency-based learning tools Introduce and demonstrate a skill Facilitate skills practice and give feedback

Skill Acquisition Students are aware of the skill and know how it should be performed, but do not always perform it correctly.

Skill Competency Students perform the skill correctly, but may not always progress from step to step efficiently. This is the level typically reached in the education of healthcare providers because the final level requires practice over time.

Skill Proficiency This is the last stage of skills development. It usually occurs after students graduate from an academic program and have practiced the skill over time in their daily work. Proficient healthcare providers consistently perform skills correctly and efficiently.

Steps to Develop Skills Let’s take a look at Figure 8-2.

A Peak into the Future Let’s take a look at the steps in the job aid on Page 8-21 paying attention to: Step 1 – Introduce and demonstrate Step 2 – Practice with feedback

Competency-Based Learning Tools Presents the individual steps of a skill in a standardized way. It aims to help students learn the correct steps and the correct sequence of steps for performing a skill. It also helps to measure students’ progress in learning as they gain confidence in the skill.

Examples of Tools Learning guides Decision trees Flowcharts Algorithms Posters Charts

Task Analysis to Develop a Tool #1 Identify a group of healthcare providers who are proficient in performing the skill. Observe several of the healthcare providers as they perform the skill. Record each step that each healthcare provider performs. Develop an initial list of steps.

Task Analysis to Develop a Tool #2 Discuss the skill with the same group of healthcare providers. Test the initial list of steps. Test the final standard way of performing the skill.

Sample Tools Figure 8-3 – Handout Figure 8-4 – Flowchart Figure 8-5 – Page from chart booklet

Using Learning Tools #1 Students can follow the steps in the learning tool while a teacher or other students demonstrate a skill. During classroom sessions, pairs of students can work together. Students who are confident in a skill can use the learning tool to observe each other and give each other feedback.

Using Learning Tools #2 Before clinical practice sessions, pairs of students can work together to remind each other of the steps. Before, during, and after clinical practice sessions, use the learning tool as a reference standard for observing and giving feedback. Students can use the learning tool as a self- or peer assessment tool.

Introducing a Skill Describe what the skill is and why the skill is important When it should be used The objectives of the demonstration The steps involved in performing the skill

Ways to Demonstrate a Skill Demonstrate by following the list of steps Show the steps using slides or a videotape Perform a role play in which a student simulates a patient Use anatomic models to demonstrate a skill Demonstrate the skill with simulated or real patients

Whole-Part-Whole Approach Demonstrate the whole procedure from beginning to end Isolate or break down the procedure or activity into parts and allow practice of the individual parts of the procedure Demonstrate the whole procedure again and then allow students to practice it from beginning to end

Remember to... Always demonstrate the skills correctly Interact with the students Use equipment and materials correctly Use a learning tool for complicated skills

Key Point! Starting with demonstrations that do not involve patients enables you to take time, stop and discuss key points, and repeat difficult steps without endangering the health or comfort of a patient.

Introduce the Practice Session Set up the practice area Review the skill with the students Tell students you will be available as they practice

For Large Numbers Divide the students into small groups, and have them do a staggered rotation. Identify other persons, such as tutors or more senior students, who could assist. Ask students to work in pairs or groups of three and take turns practicing, observing, and giving feedback to each other.

Examples of Skill Practice Methods Role plays Simulations Video, photograph or computer exercises Case studies Projects Work with real patients

Feedback Guidelines #1 Be timely – give your feedback soon after the event Avoid embarrassment Be specific Do not criticize

Feedback Guidelines #2 Take responsibility for your own feedback. Speak for yourself, not for others. Be encouraging. Convey positive feedback by facial expression and tone of voice rather than words, when appropriate. Give students an opportunity to respond to the feedback, while you actively listen during this response.

Active Listening Stop talking and listen to the student. Restate the student’s exact words. Paraphrase in your own words what the student said.

Active Listening #2 Understand and reflect the student’s underlying feelings (identify the emotion). Identify with the student’s emotions and state the implications of those feelings.

Questioning #1 Use both closed and open questions Ask factual questions, beginning with what, where, or when, that obtain information and begin discussion Ask broadening questions that assess additional knowledge

Questioning #2 Ask justifying questions that challenge ideas and assess depth of knowledge and understanding Ask hypothetical questions that help develop critical thinking skills Ask alternative questions that assess decision- making skills Ask checking questions that assess understanding

Summarize the Practice Session #1 Conduct a feedback session immediately after practice. First, ask students how they felt about their own performance. Begin by asking them what they believed they did well and what they would like to improve, or what they would do differently next time.

Summarize the Practice Session #2 Refer to a competency-based learning tool (if available) for a quick review of the steps and ask students where they experienced difficulty. Discuss the strengths of their performance and offer specific suggestions for improvement. Determine if they need additional practice and, if so, arrange for additional independent or facilitated practice sessions.

SummarySummary Let’s take another look at the steps in the job aid on Page 8-21 paying attention to: Step 1 – Introduce and demonstrate Step 2 – Practice with feedback