Teaching Practical Skills and Scenario Based Learning

Lesson 4.1

The four stage approach

The four stage approach is a widely used method for teaching practical skills.  It moves learners from watching to doing in a controlled way.

1. Demonstration. The tutor performs the skill at normal speed, without commentary, so that learners see what good performance looks like.
2. Deconstruction. The tutor performs the skill again slowly, explaining each step and the reason for it.
3. Comprehension. A learner talks the tutor through the skill while the tutor performs it, following the learner’s instructions exactly.  This reveals whether the learner has understood the sequence.
4. Performance. The learner performs the skill, often talking through it, while the tutor observes and gives feedback.

Stage three is often skipped, but it is valuable.  If the learner gives a wrong instruction, the tutor can pause and ask, “Is that right?” before any error is practised.

With large groups, stages one and two can be done once for everyone, and stages three and four in small groups at practice stations.

Lesson 4.2

Deliberate practice and correcting errors

Skills improve through deliberate practice: short, focused repetitions with immediate feedback, aimed at a specific part of performance.  Ten minutes of focused practice with feedback is worth far more than an hour of unsupervised repetition.

Organising practice

• Keep the ratio of learners to manikins as low as you can; long waits reduce practice time and attention.
• Use rotation systems so that learners waiting their turn observe and give feedback using a simple checklist.
• Build in practice of core skills on several occasions throughout the course.

Correcting errors

Common errors in core skills include incorrect hand position, compressions that are too shallow or too slow, poor positioning of a casualty and insufficient pressure on a bleeding wound.  Correct errors early, before they become habits.

• Be specific: “Move your hands down to the centre of the chest” rather than “That is not quite right”.
• Correct one thing at a time.
• Recognise what was done well.
• Have the learner repeat the skill correctly before moving on.

Consistency

Every tutor must teach each skill exactly as the CFAR course sets it out.  Standards and figures for skills such as compressions are those in the current course materials, not those from another organisation or an older version.

Lesson 4.3

Designing scenarios

Scenarios allow learners to apply skills and make decisions in a realistic but safe setting.  A well designed scenario has a clear purpose and is set somewhere learners recognise.

Elements of a scenario

Keeping it local

Scenarios are most powerful when they reflect learners’ own lives: a collapse at a market, a collision on a busy road, a burn in a family kitchen, a person overcome by heat while working outdoors or a child choking at a celebration.  Start with simple scenarios and add complexity as confidence grows.

Lesson 4.4

Briefing and debriefing

Briefing

Before every scenario, brief learners on:

• the safety word that stops the scenario at once;
• what is real and what is simulated;
• their roles, including the roles of observers;
• what information they will be given and how.

Debriefing

Much of the learning from a scenario happens in the debrief.  A simple three phase structure works well.

1. Reactions. “How did that feel?”  Allow learners to release tension before analysis.
2. Analysis. “What went well?  What would you do differently?”  Ask the responders first, then observers, and only then add your own comments.
3. Application. “What will you take from this into a real emergency?”

Focus on actions and decisions, not on personal criticism.  If a scenario resembles a learner’s real experience and they become distressed, pause, offer support and follow the approach from Unit 1.

Lesson 4.5

Preparing your micro teach

The micro teach is your opportunity to bring together everything from this course.  You will deliver a 20 minute session that includes a practical skill from the CFAR course, either live online with a small group of learners present or recorded in your own setting.

Checklist for preparation

• Choose a skill you can teach well within 20 minutes.
• Write a session plan using the template on the Resources page.
• Write two or three measurable outcomes.
• Plan your four stage demonstration.
• Plan your questions and your check of learning.
• Arrange learners or willing colleagues and obtain their consent to be recorded.
• Check the camera can see both you and the learners’ practice.
• Prepare equipment, cleaning materials and a contingency plan.

How you will be assessed

The observer will use the micro teach observation record on the Resources page.  After the session you will discuss it with the course tutor and then complete your self evaluation.