Psychomotor Learning Kun Huang, PhD Vanneise Collins, Ph.D. Center for Learning & Development UNT Health Science Center

What are some unique challenges in OMT training?

Issues & challenges Lack of application of psychomotor learning theories and empirical research Traditional approach (demonstration followed by paired practice) lacks feedback Teaching fine motor skills Low reliability among instructors/ examiners

What are psychomotor skills?

Psychomotor skills PsychoMotor

How are psychomotor skills developed?

Stages of psychomotor skills StagesCognitiveAssociativeAutonomous What is being learned? Verbal information & Procedural rule Initial errors corrected; psycho-motor connections; deeper understanding of procedural rule Fine tuning How easy is knowledge retrieval? Labor intensive & effortful Still have to think before retrieval Effortless; no conscious retrieval How good is performance? Trial & error; Erratic More fluid with fewer interruptions Smooth, accuracy and speed Novice Expert

How to support psychomotor learning at each developmental stage?

Supporting psychomotor learning StagesSupport Cognitive Associative Autonomous

Feedback Supporting psychomotor learning PracticeVerbalizationVisualizationConceptualization

Critical element: Practice Massed practice Spaced practice ?

Massed vs. spaced practice SpacedMassed If the task Is simple, repetitive, or boring Demands intense concentration Is fatiguing Demands close attention to detail Is complex Has many elements Requires warm-up Is a new one for the performer

Critical element: Practice Whole practice Part practice ?

Whole vs. part practice Emphasize wholesEmphasize parts If the task Has highly dependent (integrated) parts Is simple Is not meaningful in parts Is made up of simultaneously performed parts Has highly individual parts Is very complex Is made up of individual skills Requires limited work on parts or different segments

Critical element: Feedback Provide specific and timely feedback Feedback should not be given prematurely; focus on actual observations Provide intermittent instead of constant feedback Knowledge of results Intrinsic Augmented Internal visual, auditory, and proprioceptive sensations Experts can “read” such feedback and rely a great deal on it Novices often cannot rely on it Novices often rely on augmented feedback provided by experts Instructor should teach what to look for

Can we establish a consistent, structured training approach?

The standardization of the grading on practical exams, is quite important but the process begins at the tables in the OMT labs. It is during this time that what is being taught and how it is being taught has to be standardized amongst table trainers in order to have clear expectations and objectives for grading on the practical exam. “ ” Rapacciuolo, Channell, & Cooley (2013)

Five-step process in psychomotor training 1.Overview: why the skill is needed and how it is used in the delivery of care 2.Silent demonstration 3.Repeat the procedure but explain in detail 4.Students verbally describe the procedure 5.Student perform the skill with preceptor feedback George & Doto (2001).

Simplified model in teaching psychomotor skills Introductory Phase A.Prepare students for learning the skill B.Provide information about the skill C.Require analysis of the skill Practice Phase A.Require practice of the skill B.Observe student practice and prompt when needed C.Provide feedback when needed Perfecting Phase A.Require precision performance B.Observe and prompt on details C.Provide feedback on fine points Beal (1991)

Do’s and Don’ts for examiners Watch & discuss videos showing contrasting examiner behaviors Compile discussions into do’s and don’ts Workshop held before every final practical Beal (1991)

Standardizing training/ assessment Rapacciuolo, Channell & Cooley (2013)

Evaluate subjects, discuss findings and reach consensus Consensus training significantly improved inter-observer reliability Consensus training Degenhardt, Snider, Snider & Johnson (2005)

References & resources Aubin, A., Gagnon, K., & Morin, C. (2013). The seven-step palpation method: A proposal to improve palpation skills. International Journal of Osteopathic Medicine, doi: /j.ijosm Beal, M. (1991). The principles of palpatory diagnosis and manipulative technique. Newark, Ohio: American Academy of Osteopathy. Browning, S. (2010). Teaching osteopathic students technique: using research to identify good teaching practice. International Journal of Osteopathic Medicine, 13, Degenhardt, B., Snider, K., Snider, E., & Johnson, J. (2005). JAOA, 105 (10), George, J., & Doto, F. (2001). A simple five-step method for teaching clinical skills. Family Medicine, 33(8), Kaufman, H., Wiegand, R., & Tunick, R. (1987). Teaching surgeons to operate – Principles of psychomotor skills training. Acta Neurochir (Wien), 87(1-2):1-7. Rapacciuolo, J., Channell, M., & Cooley, D. (2013). Standardizing the osteopathic practical. International Journal of Osteopathic Medicine, doi: /j.ijosm Sullivan, M., & Baker, C. (2010). Employ a structured approach to teaching psychomotor skills to enhance learner performance. American College of Surgeons Residency Assist Page,