Tip Sheet (printable sheet)
“See One -Do One -Teaching One” is often misinterpreted. The point of this venerated saying is not that physicians are experts after doing something once. The poignancy of this message is that we learn by doing. How do we guide a novice to become an expert? The answer varies by person and task. But it is clear that at some point new knowledge is integrated from the conscious part of the brain to the subconscious. This is described in the following model:
Unconsciously Incompetent: the learner is not sure of what they need to know
Consciously Incompetent: the learner can identify what they need to know
Consciously Competent: the learner has awareness of new knowledge
Unconsciously Competent: the learner’s knowledge is so integrated they can perform the skill without “thinking” about it
Consider, a skill such as riding a bicycle. At first the novice will lack understanding about how to balance and propel the bicycle without falling (Unconsciously Incompetent). With explanation and demonstration they will be able to identify what skills they need to master to accomplish the task (Consciously Incompetent). Once successful they will be acutely aware of every moment while riding the bicycle (Consciously Competent). Finally, after enough experience they can easily mount and ride the bicycle while talking and paying attention to the environment without conscious awareness of the act of riding the bicycle (Unconsciously Competent).
Zone of Proximal Learning
The teacher must understand the learner’s current level of understanding in order to guide them to the next level. This is described as the Zone of Proximal Learning. This concept describes the level of understanding that is just beyond, but not too far from, the learner’s current knowledge. Consider the skill of closing a wound with sutures. In order to master this skill the student will need to master many skills: how to hold the instruments, where to pierce the skin, how to tie a knot among other skills. It is the teacher’s responsibility to identify the learner’s level of understanding AND the steps needs to accomplish the final task. While the time course for different learners will vary, all will require progression through stages to master the final skill.
Teaching procedures is unique because it requires both an intellectual as well as a tactile understanding of the information. It is essential that any lesson in procedure instruction include an opportunity to practice the skill. Ideally this would involve a non-patient model that is as realistic as possible. The instructor must demonstrate the sequential steps in small enough segments that every learner can understand and recall. Once guided through all steps the learner should be given the opportunity to perform the tasks from start to finish without prompts. This experience gives the learner an opportunity to make mistakes on the learning model and identify gaps in their understanding.
Use It or Lose It
Finally, learners must practice new skills to retain them. It is not clear exactly how many repetitions and in what time frame is needed to make the learner “unconsciously competent”. What is clear is that the lesson will fail to accomplish its goal if it is not followed by enough repetition to integrate the skill and then reinforced periodically.
Summary: Keys to success
- Understand your learner
- Add new information incrementally and in their Zone of Proximal Learning
- Practice, practice, practice