Educational Design Part 4b: INSTRUCTIONAL METHODS

On Tuesday, I shared Sue Dojeiji’s and Lara Cooke’s overview of common instructional methods.   Today, I want to focus on teaching procedures.

For the master clinician, it may be hard to deconstruct the necessary steps to perform (and hence, teach) a procedure.  Successfully learning the procedures that define a specialty involves integration of procedural teaching within an overall curriculum.  The actual process of efficiently teaching procedures includes:

  • mixed practice (e.g. learning on a spectrum of patients);
  • feedback that is tailored to the learner;
  • mastery learning (e.g. providing discrete milestones that must be achieved before the next step in the procedure can be learned); and
  • repetition.

Dojeiji and Cooke describe the sequential process of repetition that is key to learning a procedure.

“One model, advocated by Peyton  , uses four steps

1. Demonstration: the teacher demonstrates the skill without commentary

2. Deconstruction: the teacher demonstrates the skill (often at a slower speed) while describing the steps

3. Comprehension: the teacher performs the skill while the learner describes each step in sequence

4. Performance: the learner demonstrates the skill while describing the steps”

Where in this sequence does simulation fit? In an era of enhanced attention to patient safety, what is the threshold that requires competent simulated performance prior to performing a procedure on a patient?