Practical Doc

Teaching Procedures


“My student wants to remove sebaceous cysts but can’t tie a surgical knot; where do I start?”

The traditional medical adage “See one, do one, teach one,” has become almost redundant today. Simulations and courses abound, and our patients deserve better. A few procedures can still be mastered after a single viewing or with brief verbal directions. Some examples:

  • Nasal balloon packing
  • Removal of fish-hooks
  • Reduction of a dislocated elbow

Teaching more complex procedures can be taxing. It’s difficult for the “unconsciously competent” to relate to the novice.  Walker and Payton’s 4- step framework for teaching procedural skills is helpful:

Demonstrate

  • Demonstrate the procedure
  • This serves as a model of the finished product

Deconstruction

  • Break the procedure into discrete steps
  • Show how a complex process is made up of simple actions
  • This can be done;
    • Using a patient
    • Using a model
    • Using pen and paper

Learner comprehension

  • Learner describes steps to complete the procedure
  • Again, may be with a patient or simulated

Learner performs

  • Initially with close supervision and help
  • More distant supervision (try not putting your gloves on!)
  • Performs independently

Adapted from Lake and Harndorf

Learning the correct technique is only part of competence. Ensure your learner knows;

  • Indications
  • Contraindications
  • Complications and their management
  • Follow up requirements

Models

Models and simulators don’t have to be complex and sophisticated

  • Cloth remnants for stitching practice
  • Pig’s feet for more complex suturing skills or repairing tendons
  • Chicken bones for intraosseous needle insertion

Transferable skills

Look for transferable skills to allow shortcuts in the learning process. For example, if your resident knows how to insert an IUD, learning to perform an endometrial biopsy will require minimal instruction. Similarly, once competent to inject steroid into a knee, learning how to inject the shoulder simply requires information about joint positioning and landmarks. The learner is already aware of contraindications, complications and the correct amount of resistance to expect when injecting the medication into the joint space.

For more on teaching procedures visit: Teaching a skill

References
Walker M, Peyton JWR. Teaching in theatre. In Peyton JWR editor. Teaching and learning in medical practice. Rickmansworth. UK, Manticore Europe, Ltd, 1998:171-180

Lake FR, Harndorf JM. Teaching on the run tips 5: teaching a skill. Med J Aust 2004;181(6):327-328

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