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Teaching Procedures

the new paradigm: see one, see one, teach one, do many, teach many

PART ONE: Assess Cognitive Preparation

Before picking up an instrument, learners must have an understanding of the procedure itself, including:

  • Indications and Contraindications

  • Patient selection

  • Alternatives

  • Equipment needed

  • Procedural steps

  • Complications

  • Documentation

  • Post-procedural care

Before teaching the manual components of the skill, it is important that you identify and address any gaps in cognitive preparation. Some education scientists advocate for not allowing students to observe procedures until they have completed the cognitive preparation since learners tend to focus on the manual skills once shown them.


PART TWO: Teach Manual Skills

STEP 1: The learner observes a real-time procedure without instructions or editorializations (consider substituting video).

STEP 2: The learner observes a real-time procedure with the steps of the procedure described in technical detail (consider substituting video).

STEP 3: The learner observes the procedure while explaining each of the steps being performed by the teacher (consider a walk/talk-through by the learner).

STEP 4: The learner performs the procedure multiple times under supervision with gradual independence until competent.

STEP 5: The learner teaches the procedure to others, under supervision, until they are a competent instructor.

PINNACLE TIP: Obviously, applying all six steps in the ED clinical setting would be time-consuming and impossible. Instead, assess the learner's knowledge and comfort with the procedure and choose the most appropriate step to focus on that shift. Don’t forget to complete a procedural evaluation!

Additional resources:

Birnbaumer DM. Teaching procedures: improving “see one, do one, teach one.” CJEM 2015;13(06):390–4.

Wald DA. Teaching Techniques in the Clinical Setting: the Emergency Medicine Perspective. Acad Emerg Med 2004;11(10):1028.e1–1028.e8.




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