Preliminary evaluation of the efficacy of an intervention incorporating precision teaching to train procedural skills among final cycle medical students

Abstract

IntroductionA lack of preparedness for practice has been observed among new medical graduates. Simulation technology may offer one means of producing competency. This paper describes the application of a simulation-based intervention incorporating precision teaching (PT), a method of defining target skills, assessing individual progress and guiding instructional decisions, which is used to monitor learning and the development of behavioural fluency in other domains, to procedural skills training. Behavioural fluency refers to accurate and rapid responding that does not deteriorate with time, is resistant to distraction and can be adapted into new, more complex responses.MethodThis study used a between-groups design to evaluate the efficacy of a simulation-based intervention incorporating PT for teaching venepuncture among 11 medical students. The intervention consisted of timed learning trials during which participants carried out the skill in pairs and received corrective feedback. Two control groups of 11 untrained medical students and 11 junior doctors were also included in the study.ResultsIntervention group participants required an average of five trials and 21.9 min to reach the criterion for fluency. The intervention group demonstrated significantly higher accuracy in venepuncture performance than either control group. Improvements persisted over time, did not deteriorate during distraction, generalised to performance with patients and performance of an untargeted skill also improved.ConclusionsThe outcomes of this preliminary study support the application of PT within medical education. The implications of these data for clinical and procedural skills training are explored and suggestions are made for further research.

The use of 'Precision Teaching' in enhancing medical students’ dermatological diagnostic skills

“…The improvements in the intervention group went beyond learning gained due to traditional dermatology teaching methods. Such findings complement and support the increasing use of PT in healthcare profession education (Lydon, et al, 2017).…”

“…Behavioural fluency differs from mastery of skills in that, whilst mastery aims to enhance levels of accuracy, fluency also considers the pace of performance. There is growing interest in PT in health professional education (Lydon, et al, 2017).…”

A pragmatic randomised controlled trial of SAFMEDS to produce fluency in interpretation of electrocardiograms

“…A large effect size of the intervention was discerned with an average of only 42.5 min of practice time across the intervention group. Our findings are consistent with other studies in medical education showing the efficacy of fluency-based instructional methods [2,3] and the effects of SAFMEDS observed in other educational domains [2,9,10,21,28]. The positive impact of SAFMEDS may not be entirely surprising given the well-established impact of testenhanced learning in medical education [29] and the dearth of opportunities for practice, or examples, offered by many educational programs [6].…”

“…SAFMEDS research in other educational domains has evidenced retention and stability post-intervention [28]. Further, there is some medical education research to suggest that retention and stability are present after a procedural skill is taught to fluency, and that generalisation of learning to the clinical setting is observed [3].…”

“…Behavioural fluency differs from traditional concepts of mastery (commonly used in simulationbased education), as behavioural fluency focuses not only on the accuracy or correctness of performance, but also its pace [2]. Behaviours taught to fluency have been shown to maintain better over time (Retention), to transfer to other contexts (Generalisation) and to endure despite distraction [1,3,4]. Interventions targeting behaviour fluency: 1) are typically criterion-referenced, meaning that learners work towards achieving a pre-determined 'expert' standard that is time-based [5]; 2) are focused on providing learners with opportunities to practice the behaviour, a key element of the learning process often absent in educational programs [6]; and 3) involve both continuous measurement of behaviour and performance feedback for the learner [5,6].…”