PCRF Research Alert: An Evidence-Based Model for Skills Training

Each month the Prehospital Care Research Forum combs the literature to identify recent studies relevant to EMS education practices.

Sawyer T, White M, Zaveri P, et al. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Acad Med, 2015 Aug; 90(8): 1,025–33.

This month’s research review examines an evidence-based framework for teaching skills in medical education programs. This model would apply to the teaching and learning of any clinical skill, whether a simpler one such as bandaging or a more complex skill like endotracheal intubation.

The goal of this project was to combine adult learning theory and proven instructional design features with new evidence from research on simulation-based education to synthesize a framework for teaching clinical skills. The authors used a two-phased, nonsystematic critical-synthesis approach conducted over two years.

In Phase I they gathered existing evidence to support a unified structure for procedural skills training. Then in Phase II they created and analyzed a model framework with the belief that learning any task follows the same basic process, which could be applied to the learning of any simple or complex clinical skill.

Using accepted theory on the stages of psychomotor skills development and applying this to existing evidence-based training methodologies and current research on simulation-based education, they proposed a pedagogical framework for procedure skills training that follows six steps in three distinct phases. The first phase is the cognitive phase, during which the student learns the “why” of the procedure through multiple methods such as reading, discussing and visuals (step 1: learn), and views demonstrations of the skill (step 2: see).

In the second phase, the psychomotor phase, the student participates in deliberate practice and formative assessments on a simulator (step 3: practice), then receives feedback and develops competency after a summative assessment on a simulator (step 4: prove). They they may perform the skill under supervision on a live patient in the clinical setting (step 5: do). The final phase is ongoing clinical practice supplemented by simulation as part of continuing medical education (step 6: maintain).

Each of these steps has critical features for the student to be successful. For example, in the do phase, the student must be supervised and receive real-time assessment, feedback and formative assessments on the technique to develop clinical competency. This model provides a specific guide for educators to use when developing lesson plans and learning outcomes for psychomotor skills development. It can be exactly what we need as EMS educators to guide us as we implement the NREMT paramedic psychomotor skills portfolio in our programs.

Megan Corry, EdD, EMT-P, is the program director and full-time faculty for the City College of San Francisco paramedic program and on the board of advisors of the UCLA Prehospital Care Research Forum.