Learning procedures is a common experience for junior doctors. Some procedures have a significant potential for harmful complications, so knowing how to do them correctly is very important. However, the environment in which junior doctors learn procedures can be extremely challenging.
In this series of articles, I’ll review some of the processes we use to learn motor skills, outline a framework for your learning, highlight some potential barriers to learning and suggest potential options for overcoming them.
The challenges of learning skills
Learning Pace Variability: Every individual has a distinct learning curve. While some may grasp a procedure quickly, others may need more repetitions. Assigning a fixed number of procedures as a learning criterion is therefore problematic.
Continuity of Learning: As learners progress and rotate through different departments or hospitals, they encounter different supervisors. This makes the provision of supervision extremely challenging.
The absence of comprehensive records exacerbates this challenge. Maintaining a detailed logbook, like those on platforms such as Osler, documenting procedures, supervision levels, and feedback, can significantly benefit the learning process.
Unstructured feedback : Learning is critically dependent on feedback. As we will see in the articles that follow, this is particularly true for those who are new to the procedure.
However, feedback is rarely structured, detailed and meaningful, if in fact it is given at all.
24/7/365 clinical demands: This disruption to the learning process is perpetuated by the constant competition between clinical work and learning. The lack of gazetted teaching time further exacerbates this.
Opportunistic Learning: Procedural learning is contingent on the clinical need for the procedure - one can only learn intubation when a patient requires it. This often prevents logical preparation for the performance of a procedure, and potentially limits access.
Lack of Best Practice Guidelines: For many procedures, a universally accepted best practice guideline might not exist, leaving room for diverse learning experiences. This variation in standards can be challenging for learners.
Inconclusive : At the end of the process, learners should be deemed to have sufficiently mastered the skill. This gives them, their supervisors and most importantly their patients, confidence that the learner has been well taught, and has mastered the skill to a sufficient degree. Frustratingly for many, these summative assessments of competency are rarely completed, let alone documented in a verifiable way.
What can I do?
What can you do to overcome some of these challenges?
Prepare : As I highlighted above, many procedures come along when you’re least expecting it. To not be prepared is a wasted opportunity - you will get far more from each if you are well prepared beforehand.
Practice : Simulation has revolutionised the process of skills acquisition. Learners can establish complex motor skills in zero-consequence environments, progressively improving understanding and complex decision making.
Take every opportunity you can to practice these important and potentially hazardous skills in a controlled simulation environment.
Keep records : To be able to tailor their support to your needs, supervisors need to understand what you’ve done before. This works both ways of course - your supervisor may assume you’re more experienced than you really are, leaving you exposed to making a mistake and unable to get the most out of the teaching moment. If they assume you’re less experienced, you might not get the chance to expand your skills further.
Tools such as those provided by Osler allow you to demonstrate your experience, gather feedback from any supervisor and take it you them between placements. This information can be shared with your supervisors to ensure you’re given the assistance you need.
Ask for feedback : This is critical to your development, as we’ll discuss in a future article. Importantly, the less experienced you are the more you need externally provided feedback.
Feedback is more effective when delivered in a structured manner. Using tools like Osler to gather feedback can elevate your learning.
Coming up
In the next article in this series, we’ll look at the theory behind skills learning - understanding how we learn discrete skills can help when it comes to doing it for yourself.
Further reading
Sawyer T, White M, Zaveri P et al. Learn, See, Practice, Prove, Do, Maintain : An evidence based pedagogical framework for procedure skill training in medicine. Acad Med. 2015;90:1025–1033.