Manthey David, Fitch Michael
Department of Emergency Medicine, Wake Forest School of Medicine, North Carolina 27157, USA.
Clin Teach. 2012 Oct;9(5):317-9. doi: 10.1111/j.1743-498X.2012.00561.x.
Basic medical procedures have historically been taught at the bedside, without a formal curriculum. The supervision of basic procedures is often provided by the next most senior member of the health care team, who themselves may have very little experience. This approach does not allow for preparatory reading or deliberate practise of the procedure, and trainees often track the number of completed procedures as the only evidence of competency, without documented assessments of quality.
The conscious competence model is a learning paradigm for acquiring a new skill that can be applied to teaching medical procedures. There are multiple stages for effectively learning how to competently perform a procedure, which should not be distilled down into bedside demonstration alone. Learners can be guided through these stages to allow progression towards competency to perform a procedure unsupervised.
We propose a novel approach that divides procedural education into a four-step process that covers knowledge, experience, technical skill development and competency evaluation. The stages of competency outlined here can be tailored, with incremental expectations for any medical procedure and any level of learner.
This educational paradigm alters the current structure of teaching procedures at any level of medical education, with the goals of better comprehension, skill retention and decreased adverse outcomes. Graded objectives based on learner level can be determined by educators for each clinical procedure. This four-step framework for teaching medical procedures will make the adage 'see one, do one, teach one' obsolete.
从历史上看，基础医疗程序是在床边进行教学的，没有正式的课程设置。基础程序的监督通常由医疗团队中下一级资历最深的成员提供，而这些成员自己可能经验也很少。这种方法不允许进行预习或对程序进行刻意练习，学员往往将完成程序的数量作为能力的唯一证据，而没有对质量的记录评估。
有意识的能力模型是一种获取新技能的学习范式，可应用于医疗程序教学。有效学习如何熟练执行一项程序有多个阶段，不应仅简化为床边示范。学习者可以在这些阶段得到指导，以便在无人监督的情况下逐步掌握执行程序的能力。
我们提出一种新颖的方法，将程序教育分为四个步骤，涵盖知识、经验、技术技能发展和能力评估。这里概述的能力阶段可以根据任何医疗程序和任何学习水平进行调整，并逐步提高要求。
这种教育范式改变了任何医学教育水平下当前的程序教学结构，目标是更好地理解、保留技能并减少不良后果。教育工作者可以根据学习者水平为每个临床程序确定分级目标。这种医疗程序教学的四步框架将使“看一遍，做一遍，教一遍”这句格言过时。
