1. Adapted from PPT developed by Jhpiego corporation
Adapted from PPT developed by Jhpiego corporation. Available at:
Developing Clinical Skills Name of presenter Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project PATH

2. Objective
7-1
After completing this session, future mentors will be able to demonstrate a clinical skill and coach skill development.
Notes to the facilitator:
Introduce the session by presenting the overall objective for the session: read the objective, briefly summarize, or ask a participant to read it aloud.

3. Enabling Objectives
7-2
Identify phases in the skill transfer and assessment process
Coach development of a skill
Use anatomic models for clinical training
Conduct an effective clinical demonstration
Notes to the facilitator:
Introduce the session by presenting the enabling objectives for the session: read the objectives, briefly summarize, or ask a participant to read them aloud.

4. AMTSL mentor roles Demonstrate skills on anatomic models
7-3
Demonstrate skills on anatomic models
Facilitate small group discussions, role plays, and working through case studies
Coach the learners as they practice skills on the model and then in the clinical area
Evaluate the learner when she/he is ready
Notes to the facilitator:
Briefly review the roles of a mentor for assisting learners in developing clinical skills.

5. Steps in learning a clinical skill
7-4
Skill acquisition
Skill competency
Skill proficiency
Notes to the facilitator:
Briefly review the steps a learner takes when learning a new skill. The following slides provide more information on each step.

6. Skill Acquisition
7-5
Represents the initial phase in learning a new clinical skill or activity
One or more practice sessions are needed for learning how to perform the required steps and the sequence (if necessary) in which they should be performed
Assistance and coaching are necessary to achieve correct performance of the skill or activity
Notes to the facilitator:
Review what is meant by “skill acquisition.”

7. Skill Competency
7-6
Skill competency represents an intermediate phase in learning a new clinical skill or activity
The learner can perform the required steps in the proper sequence (if necessary) but may not progress from step to step efficiently
Notes to the facilitator:
Review what is meant by “skill competency.”

8. Skill Proficiency
7-7
Skill proficiency represents the final phase in learning a new clinical skill or activity
The learner efficiently and precisely performs the steps in the proper sequence (if necessary)
Notes to the facilitator:
Review what is meant by “skill proficiency.”

9. Developing Clinical Skills
7-8
The mentor demonstrates the clinical skill using the practice checklist
Practice checklists are used to facilitate learning the steps or tasks (and sequence, if necessary) in performing a particular skill or activity
Learners practice the skill under the supervision of the mentor, first on models and then with clients
The mentor evaluates the learner’s skill competency using the evaluation checklist
Evaluation checklists are used to evaluate performance of the skill or activity objectively
Notes to the facilitator:
Present the three phases in clinical skill development: demonstration, practice, evaluation.

10. Work in pairs
7-9
What is the difference between the practice and evaluation checklists?
Notes to the facilitator:
Ask participants to work in pairs to review the practice and evaluation checklists.
Give them 5 minutes to try to find any differences between them.
Complete their answers with the information below:
A practice checklist contains the individual steps or tasks required to perform a skill or activity in a standardized way. They are designed to help the learner learn the correct steps and sequence in which they should be performed (skill acquisition).
A practice checklist differs from an evaluation checklist because it contains information about how and why a particular task is performed, rather than just listing the task that the learner needs to perform.
The practice checklist has verbs in the infinitive (Give, Provide, etc.) while the evaluation checklist has verbs in third person singular (gives, provides, etc.).
The evaluation checklist is used to evaluate if the learner performed the important tasks.

11. Demonstration of the skill
7-10
The skill should be demonstrated:
During interactive classroom presentations, explanation of the skill or activity to be learned
Using slides or a videotape in which the steps and their sequence are demonstrated
Demonstrating the skill or activity using an anatomic model or role play while following steps as described in the practice checklist
Performing a role play in which a learner simulates a client
Notes to the facilitator:
Review ways that a mentor can demonstrate the skill: illustrated lecture, slide show, video, and demonstration.

12. Demonstration: Whole-Part-Whole Approach
7-11
When first demonstrating the procedure, the mentor may follow the steps below:
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 or activity
Demonstrate the whole procedure again and then allow learners to practice the procedure from beginning to end
Notes to the facilitator:
Explain that mentors can demonstrate the whole skill, then focus on particularly difficult parts of the skill, and then demonstrate the whole skill again.
Breaking the demonstrating into parts will help learners master the more difficult parts of the skill.

13. Why use practice checklists?
7-12
Ensures that training is based on a standardized procedure
Standardizes training materials and audiovisual aids
Forms the basis of classroom or clinical demonstrations as well as learner practice sessions
Can be used as a self- or peer-assessment tool
Notes to the facilitator:
Ask participants to brainstorm why using practice checklists is important when teaching / learning a clinical skill.
Complete their answers with the bullets on the slide.

14. Using practice checklists
7-13
learners follow the steps as the trainer demonstrates a clinical procedure using anatomic models
learners use the practice checklists during classroom practice as trainer observes and coaches
learners assess each other using the practice checklist
Notes to the facilitator:
Explain how to use the practice checklist.

15. Guidelines for demonstrating a Skill #1
7-14
State the objectives of the demonstration and point out what the learners should do
Use the practice checklist – ask someone to read the steps aloud as you demonstrate them
Make sure that everyone can see the steps involved
Never demonstrate the skill or activity incorrectly
Demonstrate the procedure in as realistic a manner as possible
Notes to the facilitator:
Review guidelines for demonstrating a skill.
Remind mentors that they should always use the practice checklist when demonstrating and not try to “wing” it by demonstrating it from memory.

16. Guidelines for demonstrating a Skill #2
7-15
Include all steps of the procedure in the proper sequence according to the approved performance standards
Explain to learners what is being done—especially any difficult or hard-to-see steps
Ask questions of learners
Take enough time so that each step can be observed and understood
Use equipment and instruments properly
Notes to the facilitator:
Continue reviewing guidelines for demonstrating a skill.

17. Advantages of Using Anatomic Models / Simulation #1
7-16
Learners should first practice and be found competent on an anatomic model before attempting the procedure on a client because:
Clients are not harmed or inconvenienced if a mistake is made on the model
The demonstration or practice can be stopped at any time
Several learners can practice simultaneously
Difficult tasks can be practiced repeatedly
Notes to the facilitator:
Explain advantages for using anatomic models for developing a clinical skill.

18. Advantages of Using Anatomic Models / Simulation #2
7-17
Practice is not limited to the clinic or operating room, or to the time when clients are scheduled
Practice of a sequence of steps or skill can be repeated at any time and as often as needed
Clinical training is possible even when client caseload is low
Training time is reduced
Notes to the facilitator:
Continue explaining advantages for using anatomic models for developing a clinical skill.
An important fact to understand is that learners become competent much more quickly in the clinical area when they become competent first on anatomic models.

19. Using Models During Training
7-18
Ensure that sufficient models are available (usually one model for two or, at most, three learners)
Make sure the model is positioned as if it were a client
As much as possible, duplicate the real situation conditions (e.g., instruments, infection prevention practices)
Always treat the model gently and with the same respect given an actual client
Notes to the facilitator:
Explain guidelines for using anatomic models for developing a clinical skill.

20. Group exercise – Demonstrating AMTSL
7-19
Review the practice checklist for AMTSL.
Gather all of the equipment you need.
Designate a member in your group to be:
The person who read the steps as the provider practices them
The provider
The woman
The person accompanying the woman
Practice the demonstration and be prepared to demonstrate to the entire group
Notes for the facilitator:
Divide the group into as many models as are available – if there are only 2 models then divide them into 2 group, if there are 3 models then divide them into 3 groups, and so on.
Give them 20 minutes to prepare the demonstration.
Allow each group time to demonstrate to the whole group.
When each group has completed their demonstration:
Ask presenters how they feel about their demonstration – first listing strong points and then areas needing strengthening
Ask the large group to list strong points and then areas needing strengthening
Provide your own feedback, first listing strong points and then areas needing strengthening
Make a plan for their next demonstration

21. Practicing the skill
7-20
Learners practice the demonstrated skill or activity on an anatomic model using the practice checklist
Facilitators and fellow learners observe the learner who is practicing while following the practice checklist.
After the learner has completed practicing, the mentor and fellow learner review the practice session and give constructive feedback.
Notes for the facilitator:
Explain that after demonstrating the skill, the learners will be given time to practice the skill using the practice checklist.
Fellow learners and the mentor will observe the performance and then provide constructive feedback.

22. Guidelines for giving feedback
7-21
Be timely—give your feedback soon after the event
Be specific
Be descriptive and not judgmental
Take responsibility for your own feedback
Notes for the facilitator:
Review guidelines for giving feedback.

23. Giving feedback: Before practice session
7-22
1. Greet learner.
2. Ask the learner to review her/his performance in previous practice sessions.
3. Ask the learner which steps or tasks s/he would like to work on during the practice session.
4. Review any difficult steps or tasks in the checklist that will be practiced during the session.
5. Work with the learner to set specific goals for the practice session.
Notes for the facilitator:
Ask participants to refer to pages in the Mentor’s Guide, where clinical coaching is described.
Review steps for giving feedback before the practice session.

24. Giving feedback: During practice session
7-23
1. Observe the learner as s/he practices the procedure.
2. Provide positive reinforcement and suggestions for improvement as the learner practices the procedure.
3. Refer to the checklist during observation.
4. Record notes about learner performance on the checklist during the observation.
5. Be sensitive to the client when providing feedback to the learner during a clinical session with clients.
6. Provide corrective comments only when the comfort or safety of the client is in doubt.
Notes for the facilitator:
Review steps for giving feedback during the practice session.

25. Giving feedback: After practice feedback session (1)
7-24
1. Greet the learner.
2. Ask the learner to share feelings about the practice session.
3. Ask the learner to identify those steps performed well.
4. Ask the learner to identify those steps where performance could be improved.
Notes for the facilitator:
Review steps for giving feedback after the practice session.

26. Giving feedback: After practice feedback session (2)
7-25
5. Refer to notes on the practice / evaluation checklist.
6. Provide positive reinforcement regarding those steps or tasks the learner performed well.
7. Offer specific suggestions for improvement.
8. Work with the learner to establish goals for the next practice session.
Notes for the facilitator:
Continue reviewing steps for giving feedback after the practice session.

27. Group exercise – Role play
7-26
Prepare a role play on giving feedback:
Group 1: Before the practice session
Group 2: During the practice session
Group 3: After the practice session
Prepare a role play to present to the whole group
Notes for the facilitator:
Divide the group into 3 smaller groups.
Give them 20 minutes to prepare the demonstration.
Allow each group time to demonstrate to the whole group.
When each group has completed their demonstration:
Ask presenters how they feel about their demonstration – first listing strong points and then areas needing strengthening
Ask the large group to list strong points and then areas needing strengthening
Provide your own feedback, first listing strong points and then areas needing strengthening
Make a plan for how to provide constructive feedback to learners.

28. Evaluation of skills
7-27
When learners feel competent on models, the mentor evaluates them using the evaluation checklist.
When learners are competent on models, they begin to practice the skill or activity with clients under a mentor’s guidance.
When learners feel competent in the clinical area, the mentor evaluates them using the evaluation checklist.
Notes for the facilitator:
Review times that the learner will be evaluated – first on the model and then in the clinical area.

29. Summary What are the phases for developing a clinical skill?
7-28
What are the phases for developing a clinical skill?
What checklist will the learner use while learning the skill?
What are the advantages of using an anatomic model to learn clinical skills?
When will you provide feedback to learners on their performance?
When will you evaluate learners?
Notes for the facilitator:
Review the most important points of the session by asking the questions on the flipchart/overhead/PowerPoint slide.
Involve participants as much as possible in the summary.
Answers:
What are the phases for developing a clinical skill?
The mentor demonstrates the clinical skill using the practice checklist
Learners practice the skill under the supervision of the mentor, first on models and then with clients
The mentor evaluates the learner’s skill competency using the evaluation checklist
What checklist will the learner use while learning the skill?
Practice checklist.
What are the advantages of using an anatomic model to learn clinical skills?
Clients are not harmed or inconvenienced if a mistake is made on the model
The demonstration or practice can be stopped at any time
Several learners can practice simultaneously
Difficult tasks can be practiced repeatedly
Practice is not limited to the clinic or operating room, or to the time when clients are scheduled
Practice of a sequence of steps or skill can be repeated at any time and as often as needed
Clinical training is possible even when client caseload is low
Training time is reduced
When will you provide feedback to learners on their performance?
Before the performance
During the performance
After the performance
When will you evaluate learners?
When learners indicate they feel competent and are ready to be evaluated.

30. 7-29
Do you feel able to demonstrate a clinical skill and coach skill development?
Notes for the facilitator:
Ask future mentors if they feel comfortable demonstrating and coaching skill development.
Answer any questions or concerns they may have.
If individuals are having particular difficulties or concerns, meet with them individually after the class.