Learning and Teaching Procedural Skills

Learning

Students are encouraged to identify their learning styles early during training, in order to best understand how they process information.

 

Graded learning

The stages of skill learning include verbal or cognitive, motor stage, and autonomous stage. Learning should be done in graded manner, with indications, contraindications, and equipment, and procedural steps understood and demonstrated.

 

Mastery

Rural trainees often report higher rates of procedure mastery vs their urban counterparts.

 

Retention

Decay occurs with unfortunate speed without reinforcement. Skills nights are extremely popular, but one-off events are not ideal, as they provide no future contexts. Four or five continous days - overlearning - provides longer retention.

 

Field notes can be helpful in tracking progress and soliciting feedback.

Teaching

The main barrier to procedural training is lack of competent, available preceptors, and students can teach other students extremely effectively if properly experienced and equipped.

 

Demonstration: trainee forms mental picture: trainer does with no commentary

deconstruction: procedure is broken into key steps: trainer does, with commentary

comprenension: demonstrates understanding: trainer does, learner provides commentary

performance: demonstrates steps: learner does and providers commentary

 

Introducing the Procedure

It is important to fully outline the procedure, from start to finish, to create context. Next, deconstruct a performance into constituent parts.

It is important to set expectations for students, letting them know what they'll be doing and you're role, if any.

 

Praise can be encouraging for everyone - learners, patients, and teachers.

 

 

During a Procedure

Procedures can cause anxiety for learners, preceptors, and patients. Effective preparation and discussion beforehand can do much to mitigate this. Set the trainee up for success, eg by partially completing the procedure.

 

It can be helpful to have a signal (ie a tap on the hand) or a code word to let students know they should pause and allow the preceptor take over. However, beyond this, HANDS OFF - let them learn to do it!

 

 

Providing Feedback

Observation and feedback should immediately follow the procedure and follow the sequence of the procedure. It should be specific, critical and constructive, and encourage self-evaluation.

 

It can be important to periodically become a learner again as a teacher to help recall the experience of learning.

 

Evaluation

One rating scale uses the following:

• no errors observed
• occasional errors, corrected by trainee
• frequent errors, corrected by trainee
• frequent errors, not corrected by trainee
• trainee unable to proceed without step-by-step instruction