title: Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.
abstract: Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.
authors.affiliation: T. Sawyer is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington. M. White is assistant professor, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. P. Zaveri is assistant professor, Division of Emergency Medicine, Children's National Health System, Washington, DC. T. Chang is assistant professor, Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Los Angeles, California. A. Ades is associate professor, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. H. French is assistant professor, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. J. Anderson is associate professor, Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon. M. Auerbach is assistant professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut. L. Johnston is assistant professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut. D. Kessler is assistant professor, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Taylor
authors.initials: T
authors.lastname: Sawyer
authors.forename: Marjorie
authors.initials: M
authors.lastname: White
authors.forename: Pavan
authors.initials: P
authors.lastname: Zaveri
authors.forename: Todd
authors.initials: T
authors.lastname: Chang
authors.forename: Anne
authors.initials: A
authors.lastname: Ades
authors.forename: Heather
authors.initials: H
authors.lastname: French
authors.forename: JoDee
authors.initials: J
authors.lastname: Anderson
authors.forename: Marc
authors.initials: M
authors.lastname: Auerbach
authors.forename: Lindsay
authors.initials: L
authors.lastname: Johnston
authors.forename: David
authors.initials: D
authors.lastname: Kessler
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D004521:Educational Measurement; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D017145:Models, Educational