Learn, See, Practice, Prove, Do, Maintain

Abstract

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

Neonatal resuscitation: advances in training and practice

“…The 7th edition NRP educational curriculum follows an evidence-based framework known as the “Learn-See-Practice- Prove-Do-Maintain” (LSPPDM) pedagogy 8. The LSPPDM pedagogy is a six-phase framework for teaching procedural skills, assessing competency, and maintaining competency once acquired.…”

A Simulation-based Quality Improvement Approach to Improve Pediatric Resident Competency with Required Procedures

“…In one study, pediatric residents who received simulation-based education were more successful in peripheral intravenous catheter placement and lumbar puncture than those taught with other methods [10]. Modern procedural training paradigms leverage simulation as the primary educational method [11]. Indeed, the standard practice of “see one, do one, teach one” may eventually evolve into “see one, simulate many, do one competently, and teach everyone” [12].…”

Similarities and differences of graduate entry-level competencies of chiropractic councils on education: a systematic review

“…Only one CCE used the widely accepted and commonly used medical education term of an evidence-based approach, when describing this domain [ 37 ]. There is substantive research surrounding this approach to learning and professional development [ 38 ]. Recent research found that 46 % of USA chiropractors did not take evidence-based practice into account when making clinical decisions [ 39 ].…”