Approaches to Teaching Medical Procedural Skills: A Scoping Review
Main Article Content
Kersi Taraporewalla
http://orcid.org/0000-0002-3568-5340
Lars Eriksson
http://orcid.org/0000-0001-5060-7706
Paul Barach
http://orcid.org/0000-0002-7906-698X
Jeffrey Lipman
http://orcid.org/0000-0002-5965-9876
André Van Zundert
http://orcid.org/0000-0002-1836-6831
http://orcid.org/0000-0002-3568-5340
Lars Eriksson
http://orcid.org/0000-0001-5060-7706
Paul Barach
http://orcid.org/0000-0002-7906-698X
Jeffrey Lipman
http://orcid.org/0000-0002-5965-9876
André Van Zundert
http://orcid.org/0000-0002-1836-6831
Abstract
Background. Current approaches to teaching medical procedural skills were developed over 70 years ago. Developments in teaching, movement control, motor learning, educational technology, and understanding of human cognition need to be integrated into the contemporary teaching of medical procedural skills.
Objective. This scoping review analyses approaches to developing motor skills and examines the key elements supporting contemporary medical procedural skills training.
Design. The PRISMA-ScR extension was employed in this review. The methodology had twenty applicable items. The databases used were PubMed, ERIC, PsycINFO, CINAHL, SPORTdiscus, ProQuest Education database, A+Education, Scopus and Web of Science to identify papers and texts published between 1980 and 2023 related to frameworks for teaching medical psychomotor tasks, motor skills, and motor learning to inform approaches to developing medical procedural skills. Data were extracted independently by each of the two researchers, using a standardised form.
Results. Three main framework models were identified. An early model, a ‘see one, do one, teach one’ mentoring model, was recognised. The cognitive-based representative model gained popularity for medical procedural skill development in the 1990s and persists in simulation-based training. Most biomedical publications promote a cognitive representative model of skill development. The non-medical domains propose an ecological model of movements leading to a constraint-led approach. There is a lack of experimental evidence to support the effectiveness of these frameworks.
Conclusions. While medical education trains with a cognitive-based representative model, other domains have successfully evolved to a constraint-led approach. Further investigation into the applicability and evaluation of ecological models in medical procedural skills development is needed.
Scoping review registration: This protocol has been registered with the Open Science Framework.
Keywords:
Procedural skills, mentoring, representative model, constraint-led approach
Article Details
How to Cite
TARAPOREWALLA, Kersi et al.
Approaches to Teaching Medical Procedural Skills: A Scoping Review.
Medical Research Archives, [S.l.], v. 12, n. 5, may 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5394>. Date accessed: 30 june 2024.
doi: https://doi.org/10.18103/mra.v12i5.5394.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Nicholls D, Sweet L, Muller A, Hyett J. Teaching psychomotor skills in the twenty-first century: Revisiting and reviewing instructional approaches through the lens of contemporary literature. Med Teach. 2016;38(10):1056-63.
2. Health AIo, Welfare. Admitted patient care 2017‐18: Australian hospital statistics. Canberra. 2019.
3. Tan L, Ong K. The impact of medical technology on healthcare today.. HKJEM. 2002;9(4):231-6.
4. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
5. Muratori LM, Lamberg EM, Quinn L, Duff SV. Applying principles of motor learning and control to upper extremity rehabilitation. J Hand Ther. 2013;26(2):94-102; quiz 3.
6. Newen A, Gallagher S, De Bruin L. 4E cognition: Historical roots, key concepts, and central issues. 2018.
7. Chu LF, Erlendson MJ, Sun JS, Clemenson AM, Martin P, Eng RL. Information technology and its role in anaesthesia training and continuing medical education. Best Pract Res Clin Anaesthesiol. 2012;26(1):33-53.
8. Regenbogen SE, Greenberg CC, Studdert DM, Lipsitz SR, Zinner MJ, Gawande AA. Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients. Ann Surg. 2007;246(5):705-11.
9. Apramian T, Cristancho S, Watling C, Ott M, Lingard L. “They have to adapt to learn”: Surgeons’ perspectives on the role of procedural variation in surgical education. J Surg Educ. 2016;73(2):339-47.
10. Birkmeyer JD, Finks JF, O'reilly A, Oerline M, Carlin AM, Nunn AR, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434-42.
11. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
12. Peters MD, Godfrey C, McInerney P, Khalil H, Larsen P, Marnie C, et al. Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022;20(4):953-68.
13. Norris TE, Cullison SW, Fihn SD. Teaching procedural skills. J Gen Intern Med. 1997;12 Suppl 2:S64-70.
14. Birnbaumer DM. Teaching procedures: improving “see one, do one, teach one”. Canadian J Emerg Med. 2011;13(6):390-4.
15. Kovacs G. Procedural skills in medicine: linking theory to practice. J Emerg Med. 1997;15(3):387-91.
16. Fraser J. Teaching practical procedures in general practice. A primer for supervisors of medical students and registrars. Aust Fam Physician. 2003;32(7).
17. Wang TS, Schwartz JL, Karimipour DJ, Orringer JS, Hamilton T, Johnson TM. An education theory-based method to teach a procedural skill. Arch Dermatol. 2004;140(11):1357-61.
18. Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ. 2008;336(7653):1129-31.
19. Swing SR, Collaborators IC. Perspectives on competency-based medical education from the learning sciences. Med Teach. 2010;32(8):663-8.
20. Wearne S. Teaching procedural skills in general practice. Aust Fam Physician. 2011;40(1-2):63-7.
21. Buscombe C. Using Gagne's theory to teach procedural skills. Clin Teach. 2013;10(5):302-7.
22. Sawyer T, White M, Zaveri P, Chang T, Ades A, French H, et al. Learn, See, Practice, Prove, Do, Maintain: An Evidence-Based Pedagogical Framework for Procedural Skill Training in Medicine. Acad Med. 2015;90(8):1025-33.
23. Garcia-Rodriguez JA. Teaching medical procedures at your workplace. Can Fam Physician. 2016;62(4):351-4.
24. Oermann MH, Muckler VC, Morgan B. Framework for teaching psychomotor and procedural skills in nursing. J Contin Educ Nurs. 2016;47(6):278-82.
25. Ojevwe C, Rana J, Burgin S. Teaching & Learning Tips 11: Teaching a procedure. Int J Dermatol. 2018;57(9):1114-7.
26. Burgess A, van Diggele C, Roberts C, Mellis C. Tips for teaching procedural skills. BMC Med Educ. 2020;20(Suppl 2):458.
27. Coro-Montanet G, Sánchez-Ituarte J, de la Hoz-Calvo A, Pardo-Monedero MJ. Protocol for conducting procedural skills training with simulators: A critical proposal. High Learn Res Commun. 2021;11(1):1.
28. Manthey D, Fitch M. Stages of competency for medical procedures. Clin Teach. 2012;9(5):317-9.
29. Razavi SM, Karbakhsh M, Panah Khahi M, Dabiran S, Asefi S, Shahrak GH, et al. Station-based deconstructed training model for teaching procedural skills to medical students: a quasi-experimental study. Adv Med Educ Pract. 2010;1:17-23.
30. Davids K, Handford C, Williams M. The natural physical alternative to cognitive theories of motor behaviour: An invitation for interdisciplinary research in sports science? J Sports Sci. 1994;12(6):495-528.
31. Davids K, Araújo D, Vilar L, Renshaw I, Pinder R. An ecological dynamics approach to skill acquisition: Implications for development of talent in sport. JTDE. 2013;5(1):21-34.
32. Brymer E, Renshaw I. An introduction to the constraints-led approach to learning in outdoor education. JOEE. 2010;14:33-41.
33. Renshaw I, Chow JY, Davids K, Hammond J. A constraints-led perspective to understanding skill acquisition and game play: A basis for integration of motor learning theory and physical education praxis? Phys Educ Sport Pedagogy. 2010;15(2):117-37.
34. Coker CA. Intervention Strategies for Performance Enhancement. Phys Health Educ J. 2014;79(4).
35. Renshaw I, Davids K, Newcombe D, Roberts W. The environment design principles. In: The constraints-led approach: Principles for sports coaching and practice design. London: Routledge; 2019. p. 73-85.
36. Roberts W. A theoretical basis for a constraints-led approach: Background. In: The Constraints-Led Approach: Routledge; 2019. p. 9-39.
37. Parry T, O'Rourke L. Theories of skill acquisition: Implications for tennis coaching. Int J Sports Sci Coach. 2023;31(89):51-6.
38. Renden PG, Dikken J. Introducing the constraints-led approach in nurse education: An innovative perspective on skill acquisition. Nurse Educ Today. 2023;121:105672.
39. Unalan PC, Akan K, Orhun H, Akgun U, Poyanli O, Baykan A, et al. A basic arthroscopy course based on motor skill training. Knee Surg Sports Traumatol Arthrosc. 2010;18:1395-9.
40. Tjiam IM, Schout BM, Hendrikx AJ, Scherpbier AJ, Witjes JA, Van Merriënboer JJ. Designing simulator-based training: an approach integrating cognitive task analysis and four-component instructional design. Med Teach. 2012;34(10):e698-e707.
41. Stieglitz V, Buggenhagen H, Strelow K-U, Schmidtmann I, Skala C, Kurz S. Action competence in obstetric emergencies—can this be achieved via e-learning? Interprofessional blended learning module on diagnostics and emergency treatment of shoulder dystocia. BMC Med Educ. 2023;23(1):1-12.
42. Wong JA, Matsumoto ED. Primer: cognitive motor learning for teaching surgical skill—how are surgical skills taught and assessed? Nature clinical practice Urology 2008;5(1):47-54.
43. Peyton JR. Teaching in the Theatre. In: Teaching & learning in medical practice: Manticore Europe Limited; 1998.
44. Cannon-Bowers J, Bowers C, Stout R, Ricci K, Hildabrand A. Using cognitive task analysis to develop simulation-based training for medical tasks. Mil Med. 2013;178(suppl_10):15-21.
45. Sullivan ME, Brown CV, Peyre SE, Salim A, Martin M, Towfigh S, et al. The use of cognitive task analysis to improve the learning of percutaneous tracheostomy placement. Am J Surg. 2007;193(1):96-9.
46. Renshaw I, Davids K, Newcombe D, Roberts W. The constraints-led approach: Principles for sports coaching and practice design. London: Routledge; 2019.
47. Clark ME, McEwan K, Christie CJ. The effectiveness of constraints-led training on skill development in interceptive sports: A systematic review. Int J Sports Sci Coach. 2019;14(2):229-40.
48. Seifert LB, Schnurr B, Stefanescu M-C, Sader R, Ruesseler M, Sterz J. Comparing video-based versions of Halsted’s ‘see one, do one’and Peyton’s ‘4-step approach’for teaching surgical skills: a randomized controlled trial. BMC Med Educ. 2020;20(1):1-11.
49. Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ. 2020;8:e10129.
50. Regan L. Comparing the traditional and constraints-led approaches to skill acquisition in tennis. Int J Sports Sci Coach. 2021;29(84):28-30.
51. Gottwald V, Davies M, Owen R. Every story has two sides: evaluating information processing and ecological dynamics perspectives of focus of attention in skill acquisition. Front. Sports Act. Living. 2023;5:167.
52. Schöllhorn WI, Rizzi N, Slapšinskaitė-Dackevičienė A, Leite N. Always pay attention to which model of motor learning you are using. Int J Environ Res Public Health. 2022;19(2):711.
2. Health AIo, Welfare. Admitted patient care 2017‐18: Australian hospital statistics. Canberra. 2019.
3. Tan L, Ong K. The impact of medical technology on healthcare today.. HKJEM. 2002;9(4):231-6.
4. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
5. Muratori LM, Lamberg EM, Quinn L, Duff SV. Applying principles of motor learning and control to upper extremity rehabilitation. J Hand Ther. 2013;26(2):94-102; quiz 3.
6. Newen A, Gallagher S, De Bruin L. 4E cognition: Historical roots, key concepts, and central issues. 2018.
7. Chu LF, Erlendson MJ, Sun JS, Clemenson AM, Martin P, Eng RL. Information technology and its role in anaesthesia training and continuing medical education. Best Pract Res Clin Anaesthesiol. 2012;26(1):33-53.
8. Regenbogen SE, Greenberg CC, Studdert DM, Lipsitz SR, Zinner MJ, Gawande AA. Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients. Ann Surg. 2007;246(5):705-11.
9. Apramian T, Cristancho S, Watling C, Ott M, Lingard L. “They have to adapt to learn”: Surgeons’ perspectives on the role of procedural variation in surgical education. J Surg Educ. 2016;73(2):339-47.
10. Birkmeyer JD, Finks JF, O'reilly A, Oerline M, Carlin AM, Nunn AR, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434-42.
11. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
12. Peters MD, Godfrey C, McInerney P, Khalil H, Larsen P, Marnie C, et al. Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022;20(4):953-68.
13. Norris TE, Cullison SW, Fihn SD. Teaching procedural skills. J Gen Intern Med. 1997;12 Suppl 2:S64-70.
14. Birnbaumer DM. Teaching procedures: improving “see one, do one, teach one”. Canadian J Emerg Med. 2011;13(6):390-4.
15. Kovacs G. Procedural skills in medicine: linking theory to practice. J Emerg Med. 1997;15(3):387-91.
16. Fraser J. Teaching practical procedures in general practice. A primer for supervisors of medical students and registrars. Aust Fam Physician. 2003;32(7).
17. Wang TS, Schwartz JL, Karimipour DJ, Orringer JS, Hamilton T, Johnson TM. An education theory-based method to teach a procedural skill. Arch Dermatol. 2004;140(11):1357-61.
18. Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ. 2008;336(7653):1129-31.
19. Swing SR, Collaborators IC. Perspectives on competency-based medical education from the learning sciences. Med Teach. 2010;32(8):663-8.
20. Wearne S. Teaching procedural skills in general practice. Aust Fam Physician. 2011;40(1-2):63-7.
21. Buscombe C. Using Gagne's theory to teach procedural skills. Clin Teach. 2013;10(5):302-7.
22. Sawyer T, White M, Zaveri P, Chang T, Ades A, French H, et al. Learn, See, Practice, Prove, Do, Maintain: An Evidence-Based Pedagogical Framework for Procedural Skill Training in Medicine. Acad Med. 2015;90(8):1025-33.
23. Garcia-Rodriguez JA. Teaching medical procedures at your workplace. Can Fam Physician. 2016;62(4):351-4.
24. Oermann MH, Muckler VC, Morgan B. Framework for teaching psychomotor and procedural skills in nursing. J Contin Educ Nurs. 2016;47(6):278-82.
25. Ojevwe C, Rana J, Burgin S. Teaching & Learning Tips 11: Teaching a procedure. Int J Dermatol. 2018;57(9):1114-7.
26. Burgess A, van Diggele C, Roberts C, Mellis C. Tips for teaching procedural skills. BMC Med Educ. 2020;20(Suppl 2):458.
27. Coro-Montanet G, Sánchez-Ituarte J, de la Hoz-Calvo A, Pardo-Monedero MJ. Protocol for conducting procedural skills training with simulators: A critical proposal. High Learn Res Commun. 2021;11(1):1.
28. Manthey D, Fitch M. Stages of competency for medical procedures. Clin Teach. 2012;9(5):317-9.
29. Razavi SM, Karbakhsh M, Panah Khahi M, Dabiran S, Asefi S, Shahrak GH, et al. Station-based deconstructed training model for teaching procedural skills to medical students: a quasi-experimental study. Adv Med Educ Pract. 2010;1:17-23.
30. Davids K, Handford C, Williams M. The natural physical alternative to cognitive theories of motor behaviour: An invitation for interdisciplinary research in sports science? J Sports Sci. 1994;12(6):495-528.
31. Davids K, Araújo D, Vilar L, Renshaw I, Pinder R. An ecological dynamics approach to skill acquisition: Implications for development of talent in sport. JTDE. 2013;5(1):21-34.
32. Brymer E, Renshaw I. An introduction to the constraints-led approach to learning in outdoor education. JOEE. 2010;14:33-41.
33. Renshaw I, Chow JY, Davids K, Hammond J. A constraints-led perspective to understanding skill acquisition and game play: A basis for integration of motor learning theory and physical education praxis? Phys Educ Sport Pedagogy. 2010;15(2):117-37.
34. Coker CA. Intervention Strategies for Performance Enhancement. Phys Health Educ J. 2014;79(4).
35. Renshaw I, Davids K, Newcombe D, Roberts W. The environment design principles. In: The constraints-led approach: Principles for sports coaching and practice design. London: Routledge; 2019. p. 73-85.
36. Roberts W. A theoretical basis for a constraints-led approach: Background. In: The Constraints-Led Approach: Routledge; 2019. p. 9-39.
37. Parry T, O'Rourke L. Theories of skill acquisition: Implications for tennis coaching. Int J Sports Sci Coach. 2023;31(89):51-6.
38. Renden PG, Dikken J. Introducing the constraints-led approach in nurse education: An innovative perspective on skill acquisition. Nurse Educ Today. 2023;121:105672.
39. Unalan PC, Akan K, Orhun H, Akgun U, Poyanli O, Baykan A, et al. A basic arthroscopy course based on motor skill training. Knee Surg Sports Traumatol Arthrosc. 2010;18:1395-9.
40. Tjiam IM, Schout BM, Hendrikx AJ, Scherpbier AJ, Witjes JA, Van Merriënboer JJ. Designing simulator-based training: an approach integrating cognitive task analysis and four-component instructional design. Med Teach. 2012;34(10):e698-e707.
41. Stieglitz V, Buggenhagen H, Strelow K-U, Schmidtmann I, Skala C, Kurz S. Action competence in obstetric emergencies—can this be achieved via e-learning? Interprofessional blended learning module on diagnostics and emergency treatment of shoulder dystocia. BMC Med Educ. 2023;23(1):1-12.
42. Wong JA, Matsumoto ED. Primer: cognitive motor learning for teaching surgical skill—how are surgical skills taught and assessed? Nature clinical practice Urology 2008;5(1):47-54.
43. Peyton JR. Teaching in the Theatre. In: Teaching & learning in medical practice: Manticore Europe Limited; 1998.
44. Cannon-Bowers J, Bowers C, Stout R, Ricci K, Hildabrand A. Using cognitive task analysis to develop simulation-based training for medical tasks. Mil Med. 2013;178(suppl_10):15-21.
45. Sullivan ME, Brown CV, Peyre SE, Salim A, Martin M, Towfigh S, et al. The use of cognitive task analysis to improve the learning of percutaneous tracheostomy placement. Am J Surg. 2007;193(1):96-9.
46. Renshaw I, Davids K, Newcombe D, Roberts W. The constraints-led approach: Principles for sports coaching and practice design. London: Routledge; 2019.
47. Clark ME, McEwan K, Christie CJ. The effectiveness of constraints-led training on skill development in interceptive sports: A systematic review. Int J Sports Sci Coach. 2019;14(2):229-40.
48. Seifert LB, Schnurr B, Stefanescu M-C, Sader R, Ruesseler M, Sterz J. Comparing video-based versions of Halsted’s ‘see one, do one’and Peyton’s ‘4-step approach’for teaching surgical skills: a randomized controlled trial. BMC Med Educ. 2020;20(1):1-11.
49. Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ. 2020;8:e10129.
50. Regan L. Comparing the traditional and constraints-led approaches to skill acquisition in tennis. Int J Sports Sci Coach. 2021;29(84):28-30.
51. Gottwald V, Davies M, Owen R. Every story has two sides: evaluating information processing and ecological dynamics perspectives of focus of attention in skill acquisition. Front. Sports Act. Living. 2023;5:167.
52. Schöllhorn WI, Rizzi N, Slapšinskaitė-Dackevičienė A, Leite N. Always pay attention to which model of motor learning you are using. Int J Environ Res Public Health. 2022;19(2):711.