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?