Teaching complex procedural skill

The problem of metal puzzle

Requirements for the solution

  • You should be aware of the problem

  • You should be interested in the problem and solution

  • You should have the skills

Awareness

Role of teacher

  • make you aware of the problem

  • kindle interest

  • transfer the skills

What is Skill?

  • Conventionally taken as part of psycho-motor domain
  • “Any action which has a measurable impact on outcome”

Different types of skills

  • Intellectual or Cognitive skill

  • Psychomotor or Procedural skill

  • Communication skill

Intellectual skills needed to solve the puzzle

  • Problem-Solving: 

    • breaking down the puzzle into smaller problems

    • identifying potential solutions, and

    • evaluating their effectiveness.

  • Critical Thinking: 

    • analyzing the puzzle,

    • identifying patterns, and

    • making logical deductions to determine the correct sequence of moves.

  • Perseverance

  • Attention to Detail

How to teach this?

Key concept is to activate prior knowledge

  • One minute preceptor (OMP)

  • SNAPPS

  • Mini-CEX

One Minute Preceptor

  • Ask for a Commitment

  • Probe for Supporting Evidence

  • Provide Positive Feedback - what was done well

  • Guidance - Errors / Omissions

  • Teach General Principle

  • Conclusion

One Minute Preceptor

SNAPPS model

  • Summarize the case

  • Narrow the differential diagnosis

  • Analyse the differentials

  • Probe the preceptor about uncertainties

  • Plan management

Solving the puzzle physically

How to teach this?

Peyton’s Four-Step Approach – Cognitive, Integrative, Autonomous Phases

Phase Activity
Demonstrate Trainer demonstrates
De construct Trainer describes the steps and demonstrates
Comprehension Learner describes the steps, trainer demonstrates
Performance Learner describes the steps and demonstrates

If the puzzle was alive..

SPIKES-A Method for communication

  • Setting up the interview

  • Assessing patient’s Perception

  • Obtain Invitation

  • Giving Knowledge and Information

  • Addressing patient’s Emotions with empathic response

  • Strategy and Summary

Another way of looking at skills

Technical Non-technical
History taking Situational awareness
Physical examination Task management
Communication (patients) Communication (team)
Procedural skills Decision making
Information management Prioritization skills

Few definitions

  • Competency is a quality characterised by observability and demonstrability

  • Skill is ability to do something which is measurable

  • Objective is what we want the student to learn/do

  • Curriculum

  • Syllabus

Can be compared to

Take Home Message

  • NMC has specified the methods for skill teaching (Skills module)
  • We should at least be able to enumerate them and practice some of the methods.
  • We should be able to create and execute a lesson plan for skill teaching.
  • We are dealing with NOVICE ADULTS
  • “Though this be madness, yet there is method in’t?” - Shakespeare

Conclusion

“Down the Rabbit Hole”

“Alice: Would you tell me, please, which way I ought to go from here?

The Cat: That depends a good deal on where you want to get to.

Alice: I don’t much care where.

The Cat: Then it doesn’t much matter which way you go.   

Alice: …So long as I get somewhere.

The Cat: Oh, you’re sure to do that, if only you walk long enough.”

Doing the right thing is more valuable than getting things done SOMEHOW

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