We ve all heard it:

1. We�ve all heard it: Good afternoon! Can someone help me out and fill in the blanksGood afternoon! Can someone help me out and fill in the blanks

2. 2 We�ve all heard it: See One, Do One, Teach One- We�ve all heard it. Many of us have said it, Many of us have been taught with this method, And some of us maybe still use this mantra. It�s catchy. It seems to make sense. but let�s put it to a test. I�m going to show you a short clip of the Dave Matthews Band, my favorite band. They are a contemporary rock band if you�re not familiar. For our purposes, pay attention to his hands. �See� his hands.See One, Do One, Teach One- We�ve all heard it. Many of us have said it, Many of us have been taught with this method, And some of us maybe still use this mantra. It�s catchy. It seems to make sense. but let�s put it to a test. I�m going to show you a short clip of the Dave Matthews Band, my favorite band. They are a contemporary rock band if you�re not familiar. For our purposes, pay attention to his hands. �See� his hands.

4. 4 We�ve all heard it: Well, I really like this song. Let�s see if I can �do� it. Demo OK, so I saw it, I did it, so I guess I can teach it. Dr. Jeff Leininger is going to come up here. Jeff have a seat. Now, Jeff is a chief resident, very smart, very good with technical skills, so I know this will be pretty easy for him. Jeff, I�m sure you know some things about music as well. Here�s the guitar, here�s your pick. Go for it. Now you saw me right? Show him the hand gesture. It�s just the A flat minor scale so start on A flat 6th string, then D sharp on the 5th string and so on. Grab the guitar from him and say �like this.� OK, thank you Jeff for being a good sport. So what did I do wrong as a teacher? Right so that Well, I really like this song. Let�s see if I can �do� it. Demo OK, so I saw it, I did it, so I guess I can teach it. Dr. Jeff Leininger is going to come up here. Jeff have a seat. Now, Jeff is a chief resident, very smart, very good with technical skills, so I know this will be pretty easy for him. Jeff, I�m sure you know some things about music as well. Here�s the guitar, here�s your pick. Go for it. Now you saw me right? Show him the hand gesture. It�s just the A flat minor scale so start on A flat 6th string, then D sharp on the 5th string and so on. Grab the guitar from him and say �like this.� OK, thank you Jeff for being a good sport. So what did I do wrong as a teacher? Right so that

5. We�ve all heard it:

6. Teaching Technical Skills:A Skill Itself Kevin Kelly, MD MAJ, MC, USA Faculty Development Fellow Again, good afternoon. I�m Kevin Kelly another of the Fac Dev Fellows and going to discus with all of you the Teaching of technical skills and procedures. Hopefully, the demonstration helped get your minds going and thinking about this. Knowing how to do a skill and teaching it are not one in the same. I would propose that teaching technical skills is a skill itself and today we�ll aim to give you some tools to help you better perform as a teacher. Assumptions: 1. when we say technical skills, we�re talking about a wide range of skills, from placing an IV, to setting a fracture, to placing a crown, to performing a coronary artery bypass graft. These procedures have different degrees of difficulty, but the same principles for learning them and thus teaching them apply. 2. We�re not here to teach you to perform technical skills better. We�re assuming that as a teacher you are closer to an expert stage than a student. 3. Many of you in this room have a significant amount of experience teaching technical skills and we�ll ask for your input along the way. Please look at the blue handout on the ride side of your folder, entitled �Teaching Technical Skills.� The top line has a blank spot. Please take a moment and think of a skill that you teach. Maybe it is the most challenging procedure you have tried to teach, or maybe the most enjoyable. Maybe your profession doesn�t involve teaching technical skills. In that case, think of a hobby such as knitting, or fishing, or playing an instrument. Go ahead and write that down in the blank and we�ll revisit this worksheet throughout the discussion. Again, good afternoon. I�m Kevin Kelly another of the Fac Dev Fellows and going to discus with all of you the Teaching of technical skills and procedures. Hopefully, the demonstration helped get your minds going and thinking about this. Knowing how to do a skill and teaching it are not one in the same. I would propose that teaching technical skills is a skill itself and today we�ll aim to give you some tools to help you better perform as a teacher. Assumptions: 1. when we say technical skills, we�re talking about a wide range of skills, from placing an IV, to setting a fracture, to placing a crown, to performing a coronary artery bypass graft. These procedures have different degrees of difficulty, but the same principles for learning them and thus teaching them apply. 2. We�re not here to teach you to perform technical skills better. We�re assuming that as a teacher you are closer to an expert stage than a student. 3. Many of you in this room have a significant amount of experience teaching technical skills and we�ll ask for your input along the way. Please look at the blue handout on the ride side of your folder, entitled �Teaching Technical Skills.� The top line has a blank spot. Please take a moment and think of a skill that you teach. Maybe it is the most challenging procedure you have tried to teach, or maybe the most enjoyable. Maybe your profession doesn�t involve teaching technical skills. In that case, think of a hobby such as knitting, or fishing, or playing an instrument. Go ahead and write that down in the blank and we�ll revisit this worksheet throughout the discussion.

7. Take Home Points Teaching technical skills is a skill itself Be consciously competent Use the five instructional phases If nothing else, please remember these 3 things when you leave here today. Teaching technical skills is a skill itself, so we owe it to our students to be aware of this as it will lead us to find better ways to do it. Be consciously competent. We�ll discuss this later. Use the five instructional phases. If nothing else, please remember these 3 things when you leave here today. Teaching technical skills is a skill itself, so we owe it to our students to be aware of this as it will lead us to find better ways to do it. Be consciously competent. We�ll discuss this later. Use the five instructional phases.

8. Objectives: Listed the psychomotor skills principles Applied a 5 step method to teaching technical skills Addressed teaching challenges Here�s how we�ll get there. By the end of this session, we will have: Listed the principles of psychomotor skills Applied a 5 step method to teaching technical skills And hopefully addressed some of the challenges you face on a day to day basis in teaching procedures. Here�s how we�ll get there. By the end of this session, we will have: Listed the principles of psychomotor skills Applied a 5 step method to teaching technical skills And hopefully addressed some of the challenges you face on a day to day basis in teaching procedures.

9. General Challenges Increased societal expectations Condensed student experience Steep learning curve Increased technology Limited resources Teaching procedures presents us with many challenges and obstacles. I really appreciate the feedback you gave us on the learning needs assessment. I break these challenges into a general category and a specific to the procedure category. These are just some of the general challenges that you all face every day. - Increased expectations- fear of malpractice - Condensed student experience- learn more in less time, less time equals less exposure to the situations requiring these skills - Steep learning curve- for me, in my medical school experience, I had very little hands on experience. - Increased technology- things are constantly changing, but this category can also benefit us I believe. - Limited resources- patients, time Refer back to your sheet. Take one minute and think of the challengesTeaching procedures presents us with many challenges and obstacles. I really appreciate the feedback you gave us on the learning needs assessment. I break these challenges into a general category and a specific to the procedure category. These are just some of the general challenges that you all face every day. - Increased expectations- fear of malpractice - Condensed student experience- learn more in less time, less time equals less exposure to the situations requiring these skills - Steep learning curve- for me, in my medical school experience, I had very little hands on experience. - Increased technology- things are constantly changing, but this category can also benefit us I believe. - Limited resources- patients, time Refer back to your sheet. Take one minute and think of the challenges

10. Psychomotor Principles Before we dive into the 5 phases of instruction, lets take some time to talk about how we learn technical skills. Many people make comparisons of learning technical medical skills to learning competitive sports. This of course is Tiger Woods making a perfect swing- his movements are coordinated, efficient, and smooth. This past summer, my wife wanted to learn to play golf. I�m no Tiger, but I know how to play. So it didn�t take long on the practice range to realize that I was not a golf instructor. I remember saying, honey, just keep your head still, your left arm straight, brink the club straight back in a round motion, break at the wrists at the top of your swing with the club pointed at the target, twist at the hips, transfer your weight from left to right and then right to left, keep your eye on the ball, and follow through. Like this. After getting that glare...all the husbands know what I�m talking about. I said turn your hips and keep your eye on the ball. My point here is that we are experts at the skill. Our learners are not there yet. And we should be cognizant that we need to first teach them to be competent, then teach them to be experts.Before we dive into the 5 phases of instruction, lets take some time to talk about how we learn technical skills. Many people make comparisons of learning technical medical skills to learning competitive sports. This of course is Tiger Woods making a perfect swing- his movements are coordinated, efficient, and smooth. This past summer, my wife wanted to learn to play golf. I�m no Tiger, but I know how to play. So it didn�t take long on the practice range to realize that I was not a golf instructor. I remember saying, honey, just keep your head still, your left arm straight, brink the club straight back in a round motion, break at the wrists at the top of your swing with the club pointed at the target, twist at the hips, transfer your weight from left to right and then right to left, keep your eye on the ball, and follow through. Like this. After getting that glare...all the husbands know what I�m talking about. I said turn your hips and keep your eye on the ball. My point here is that we are experts at the skill. Our learners are not there yet. And we should be cognizant that we need to first teach them to be competent, then teach them to be experts.

11. Psychomotor Principles Read the definitions on cards as group Arrange cards in an appropriate order

12. Psychomotor Principles Conceptualization Visualization Verbalization Practice Correction and reinforcement Skill mastery Skill autonomy Motor vs verbal skills, and tacit vs explicit knowledge Conceptualization � the learner must understand the cognitive elements of the skill, = why it�s done, why it�s not done, and the precautions involved. The learner must know the instruments and tools involved. Visualization � the learner must see the skill demonstrated in its entirety from beginning to end so as to have a model of the performance expected. This leads to learner imitation. Verbalization � the learner must hear a narration of the steps of the skill along with a second demonstration If the learner is able to narrage correctly the steps of the skill before demonstrating there is a greater likelihood that the learner will correctly perform the skill. This leads to learner manipulation. Practice � the learner now performs the skill. The skill may be broken down into discreet units for practice. Represent a chain of responses. Require eye-hand coordination. Require organization of subroutines. Correction and reinforcement � skill errors need immediate correction. Positive reinforcement should be used to cement correct performance. Skill mastery � the ability to routinely perform a sequence of skills in a practice situation without error. Skill autonomy � the ability to regularly perform the skill as a routine in real-life situations without error. Based on these principles, a five-step method was created.Motor vs verbal skills, and tacit vs explicit knowledge Conceptualization � the learner must understand the cognitive elements of the skill, = why it�s done, why it�s not done, and the precautions involved. The learner must know the instruments and tools involved. Visualization � the learner must see the skill demonstrated in its entirety from beginning to end so as to have a model of the performance expected. This leads to learner imitation. Verbalization � the learner must hear a narration of the steps of the skill along with a second demonstration If the learner is able to narrage correctly the steps of the skill before demonstrating there is a greater likelihood that the learner will correctly perform the skill. This leads to learner manipulation. Practice � the learner now performs the skill. The skill may be broken down into discreet units for practice. Represent a chain of responses. Require eye-hand coordination. Require organization of subroutines. Correction and reinforcement � skill errors need immediate correction. Positive reinforcement should be used to cement correct performance. Skill mastery � the ability to routinely perform a sequence of skills in a practice situation without error. Skill autonomy � the ability to regularly perform the skill as a routine in real-life situations without error. Based on these principles, a five-step method was created.

13. Steps in Skill Mastery One last point before we get into the 5 phases. This is another model for how we learn technical skills. You don�t know what you don�t know. Knowing what you don�t know and feeling pretty uncomfortable. Finally know what you�re doing, but your mind is still focusing on your step-by-step movements To lastly, you just do it. How did you do that? I just did it.One last point before we get into the 5 phases. This is another model for how we learn technical skills. You don�t know what you don�t know. Knowing what you don�t know and feeling pretty uncomfortable. Finally know what you�re doing, but your mind is still focusing on your step-by-step movements To lastly, you just do it. How did you do that? I just did it.

14. Steps in Skill Mastery As a teacher, we must take a step backwards to become consciously competent. When I prepared for this lecture and was messing around with the guitar, I had to work on going backwards. I�ve played that song so many times, that my fingers just move. So take home point number 2 was to be consciously competent. You may realize this is quite a challenge.As a teacher, we must take a step backwards to become consciously competent. When I prepared for this lecture and was messing around with the guitar, I had to work on going backwards. I�ve played that song so many times, that my fingers just move. So take home point number 2 was to be consciously competent. You may realize this is quite a challenge.

15. Instructional Phases Overview Preceptor demonstration real time Preceptor performs with discussion Student talks through the skill Student performs the skill OK, we are finally here. We�ll move from the principles of psychomotor learning into An approach on teaching the skills. You�ll note that these phases follow the order that we put our cards in. And this is from the literature. Was developed for teaching office proceduresOK, we are finally here. We�ll move from the principles of psychomotor learning into An approach on teaching the skills. You�ll note that these phases follow the order that we put our cards in. And this is from the literature. Was developed for teaching office procedures

16. Overview Phase Why the skill is needed How the skill is used Emphasize the decision making process To be motivated to learn a skill, the learner must understand why the skill is needed and how it is used in the delivery of care. Student must learn appropriate clinical scenario in which the skill is used. Must know the precautions involved. Know the tools needed to perform the skill. (emphasize the decision making process) ASSESS the learnerTo be motivated to learn a skill, the learner must understand why the skill is needed and how it is used in the delivery of care. Student must learn appropriate clinical scenario in which the skill is used. Must know the precautions involved. Know the tools needed to perform the skill. (emphasize the decision making process) ASSESS the learner

17. Preceptor Demonstration Real time demonstration Give student mental picture Student will reflect on this The preceptor should demonstrate the skill exactly as it should be done without talking through the procedure. This silent demonstration gives students a mental picture of what the skill looks like when it is being done correctly. Allows for visualization of a model of the performance expected. This image is important since students will use this picture to self-evaluate their own performance when practicing the skill.The preceptor should demonstrate the skill exactly as it should be done without talking through the procedure. This silent demonstration gives students a mental picture of what the skill looks like when it is being done correctly. Allows for visualization of a model of the performance expected. This image is important since students will use this picture to self-evaluate their own performance when practicing the skill.

18. Preceptor Performs with Discussion Take time to describe each step Student sees how step fits in sequence Clarify steps if necessary The preceptor then repeats the procedure but takes time to describe in detail each step in the process. Learner hears a narration of steps of the skill, along with a second demonstration. This will help students see how each step fits into the optimal sequence and will allow time for students to ask questions or seek clarification of a step or procedure.The preceptor then repeats the procedure but takes time to describe in detail each step in the process. Learner hears a narration of steps of the skill, along with a second demonstration. This will help students see how each step fits into the optimal sequence and will allow time for students to ask questions or seek clarification of a step or procedure.

19. Student Talks Through the Skill Student describes step by step Student visualizes skill and commits to memory Imprints steps in mind By asking students to describe step by step how to do the skill, the preceptor will ensure that the student understands and remembers each step in the sequence of performing the skill. This will also help the student commit the process to memory so he can recall steps as they move to the next procedure. Visualization: Mentally rehearse the motor skill in the minds eye Helps imprint the steps in involved Use by athletes Useful in considering underlying anatomy Zen Surgery: �your whole consciousness should ride the tip of the needle as it comes through it�s trajectory� Emphasizing the cognitive skill with fewer task repetitions reaches the same goal as solely teaching technical skills (Kohls-Gatzoulis JA, Can J Surg)By asking students to describe step by step how to do the skill, the preceptor will ensure that the student understands and remembers each step in the sequence of performing the skill. This will also help the student commit the process to memory so he can recall steps as they move to the next procedure. Visualization: Mentally rehearse the motor skill in the minds eye Helps imprint the steps in involved Use by athletes Useful in considering underlying anatomy Zen Surgery: �your whole consciousness should ride the tip of the needle as it comes through it�s trajectory� Emphasizing the cognitive skill with fewer task repetitions reaches the same goal as solely teaching technical skills (Kohls-Gatzoulis JA, Can J Surg)

20. Student Performs the Skill Preceptor carefully observes Preceptor coaches or provides feedback as needed On a real patient or a simulator? Now student is ready to do the first attempt at the skill with the preceptor carefully observing and providing feedback or coaching as needed. Following a successful attempt, student should continue to practice until he reaches the desired level of proficiency.Now student is ready to do the first attempt at the skill with the preceptor carefully observing and providing feedback or coaching as needed. Following a successful attempt, student should continue to practice until he reaches the desired level of proficiency.

21. Task #1: Apply 5-step method for a simple laceration repair Select at least one teacher Select at least one learner Select an evaluator Develop plan and record on handout

22. Example: Guitar Challenges- hand stretch, pick control Overview- music term., guitar anatomy Real time demo Step-by-step demo - breakdown each note, finger transitions Student verbalizes Student performs with feedback

23. Task #1: Apply 5-step method for a simple laceration repair Select at least one teacher Select at least one learner Select an evaluator Develop plan and record on handout

24. Task #2 Read Table 1

25. Task #3 Teacher(s), learner(s), and evaluator execute your roles Prepare to share your experience

28. Student Having Difficulty Learner trait ability Inappropriate task description Inadequate demonstration Imprinting of previous incorrect performance Improper correction or reinforcement Affective factors Inaccurate learner perception

29. Objectives: Listed the psychomotor skills principles Applied a 5 step method to teaching technical skills Addressed teaching challenges

30. Take Home Points Teaching technical skills is a skill itself Be consciously competent Use the five instructional phases

31. Discussion Questions?? Thanks!!Questions?? Thanks!!