E S S A Y
Seven Principles for Teaching Procedural and
Technical Skills
Peter J. McLeod, MD, Y. Steinert, PhD, J. Trudel, MD, and R. Gottesman, MD
ABSTRACT
The authors developed a cogni-
tive-theorybased checklist of
seven important principles for
teaching technical skills. They
then used the checklist in a work-
shop for doctors who teach proce-
dural and technical skills. Partici-
pants in the workshop found the
principle-based approach to be
more effective than the traditional
see one, do one, teach one ap-
proach.
Acad. Med. 2001;76:1080.
For decades, teachers have used the see
one, do one, teach one approach to
teaching technical procedures. Re-
cently, our faculty development com-
mittee was asked to develop a workshop
on teaching technical and procedural
skills. To ensure that we created an ef-
fective workshop with broad appeal, we
reviewed some critical principles of
adult learning. Cognitive theory posits
that relevant content, active learner in-
Dr. McLeod is professor of medicine and pharma-
cology, Dr. Steinert is associate dean for faculty de-
velopment, Dr. Trudel is associate professor of sur-
gery, and Dr. Gottesman is associate professor of
pediatrics; all at McGill University Faculty of Med-
icine, Montreal, Quebec, Canada.
Address correspondence and requests for reprints to
Dr. McLeod, Department of Medicine, The Montreal
General Hospital, 1650 Cedar Avenue, Montreal,
Quebec H3G 1A4, Canada; e-mail: peter.mcleod
@muhc.mcgill.ca
1080 ACADEMIC MEDICINE, VOL. 76, NO. 10 / OCTOBER 2001
volvement, self evaluations, context
learning, and early success for motiva-
tion will enhance learning.1 With these
as a foundation we used repeated itera-
tions of a principles list generated by
one of the authors to develop a check-
list that contained seven principles for
teaching technical skills (see List 1).
We then invited educators to attend
a half-day faculty development work-
shop on teaching technical and proce-
dural skills using the principle-based ap-
proach. Forty-seven educators ranging
from physiotherapists to intensivists ac-
cepted the open-ended invitation. A
plenary session outlined features of the
principles checklist. All participants
then used the checklist to evaluate the
teaching performance of an academic
rheumatologist who demonstrated knee
joint injection on a live patient. A se-
nior medicine resident was a simulated
learner. Attendees then broke into
groups of eight for small-group practi-
cums, a discussion of teaching strate-
gies, and an elaboration of the chal-
lenges facing technical-skills educators.
The challenges identified included time
pressure, simultaneously caring for an
unstable patient and teaching, assessing
learners needs and abilities, and teach-
ing important but infrequently per-
formed procedures. In post-workshop
feedback, participants indicated that
they found the principle-based ap-
proach to teaching technical and pro-
cedural skills preferable to the tradi-
tional see one, do one, teach one
approach.
List 1
Seven Principles for Teaching Procedural
and Technical Skills
1. Plan ahead
Review performance objectives
Assess learners needs
Assure that the learner has prepared
(e.g., through lecture, discussion,
visualization, CDs, books)
2. Demonstrate the procedure
Make explicit commentary during the
demonstration
Allow for questions or interruptions
3. Observe the learner in action and allow
for practice
Ask the learner to verbalize what he/
she is doing
Encourage self-assessment and
reflection
4. Provide feedback
Be specific and descriptive
Ensure feedback is nonjudgmental
and performance-based
5. Encourage learners self-assessment of
Perceived level of skill
Perceived areas requiring
improvement
6. Allow for practice under less-than-ideal
conditions
Ensure varying degrees of complexity
7. Prepare to modify approach for
The unprepared learner
Different learning sites
Opportunistic learning and teaching
REFERENCE
1. Miller M. Education, training and proficiency
of procedural skills. Primary Care Clinics in
Office Practice. 1997;24:23141.