1. Payton four step methodology (Pristup 4 koraka učenja)
Dejan Bokonjic
Srdjan Masic
Mirza Oruc

2. Pyramid of knowledge: Miller (1990)
„show“
„knows how“
„know“
Miller, Acad Med 1990

3. Introduction
Graduate nursing and medical students should know how to perform some basic skills
Different methodologies for learning skills
Catalogue of knowledge and skills
Payton 4 step

4. How to learn a skill
Simulated patients, videos, manikins, computers and virtual reality technology are increasingly being used to ensure that trainees learn skills in a safe environment, receive feedback, and reach a certain level of competence before they use the skills on patients.
The first trainee year is critical for learning many of these skills.
Skills centers are playing an increasing role that laboratory-learnt skills are safely implemented in the workplace.
Our teaching role is to decide whether students can safely carry out procedures on patients

5. Simulation possibilities
Simulated patients
Video material
Virtual patients and computer programs
Manikins

6. Advantage of simulations
Safe environment
Feedback
Achieving competences before working with the real patient.
Students are actively involved in process

7. Performing skills It is not only important to perform the skill but:
Knowledge ( indications, contraindications, complications, prevention ...)
Skill ( preparation, technique... )
Communication ( conformity, respect patient rights and informations..)

8. Methodology 4 step Payton
Demonstration: trainer demonstrates skill slowly. He is not explaining what is he doing.
Deconstruction: trainer is performing skill and explaining what is he/she doing.
Comprehension: trainer demonstrates only what student is telling him to do.
Performance: student demonstrates and in the same time describes performed steps.

9. Approach to 4 step Payton methodology
Disintegrate studying process on manageable steps,
Students must explain what they are doing,
Provide possibility for repeating,
Provide possibility for correction of mistakes

10. Structure of the session
Main elements
Dialogue
End of the session

11. Main elements of the session
Clear learning outputs after session: realistic in time,
Outputs relevant and important for students,
Explained on adequate level,
Is space for learning adequate,
Good estimation of previous knowledge,
Position of students comparing with trainer and etc.

12. Dialogue 10-15 minutes Eye contact with students
Is procedure disintegrate on the enough number of steps,
Is task to long to be accepted during one session,
Did trainer give proper positive comments and etc.

13. End of the session
Are students are capable to perform skill individually without help ?
Do they get suggestions how to perform skills in different circumstances?
Do they get summary with message in the end?
Useful literature and links for independent studies

14. Usage of method in practice
Step 1 can be done on real patient
Steps 1 and 2 are done in bigger group (video)
Steps 3 and 4 can be done in smaller groups and pairs
Steps 2 and 3 can be performed theoretically and with equipment
Skill should be repeated more than once

15. Steps in process of gaining skills