Teaching a psychomotor skill Orla OReilly

Learning outcomes To explain what is meant by the term psychomotor skill To review the phases involved in teaching a psychomotor skill.

Psychomotor Skill A psycho-motor skill is “ an observable performance that requires some degree of neuromuscular co-ordination”. (Mosby’s Medical, Nursing and Allied Health Dictionary 1994)

What are Psychomotor skills Psychomotor skills are an extremely important aspect of the practice of nursing;-nursing science is largely a practical endeavour (Quinn 2007). Although it is possible to teach some psychomotor skills in a skills laboratory/centre, such learning still needs to be consolidated in practice (Quinn 2007). Teaching a skill is largely a task of simplification (Higgins 2002).

A psychomotor skills has both a cognitive and motor component A skill should bring together theory and practice. It is not just about being able to do something, but it is about understanding the rationale that underpins it. (Quinn 2000)

Practice Motor skills require practice in order to be learned. Practice is required in order that the student receive kinaesthetic feedback from their own body e.g. learning to ride a bike/bandaging/ IM injection/ washing hands. Feedback from the teacher is also critical. Practice must be physical and mental, there must be ample opportunities for practice;- simulation provides students with opportunities to practice in a safe environment, the use of technology can enhance this. (Quinn 2007)

Phases in motor skill acquisition 1.Cognitive phase: learner intellectualises the skill and develops a cognitive map (Theory). The more complex the skill the longer this period will take. 2.Associated phase: skill is performed in various sections (almost separately). As the learner progresses the sections are chained together taking on the characteristics of a skilled performance. Feedback is imperative at this stage.

Autonomous 3.Autonomous phase: the various aspects are performed uninterrupted and without that the learner has to think about it. The skill becomes automatic and is resistant to external factors such as stress/workload and interferences. (Fitts and Posner 1967 cited in Quinn 2000)

Phases of teaching a psychomotor skill 1.Preparative phase 2.Constructive phase 3.Coaching phase 4.Fading phase 5.Practice phase 6.Reflective phase (Quinn 2000, Higgins 2002)

Preparative Phase Formulate intended learning outcomes of the session use e.g. Blooms taxonomy (1954) Formulate plan for: Self Environment Teaching materials Sequencing of teaching, timing, length of lesson

Consider Skill – what exactly needs to be addressed in this session. Audience – age, culture, education, timing, environment Assess the entry behaviour or the learners level of knowledge, ask questions.

Consider also Venue – privacy, space, seating etc. Time – check ward schedule, workload, availability of family/parents/child Equipment – available, aids and appliances must be current and in working order Potential problems – venue, time, equipment, questions that may arise Analysis of skill – divide into sub-skills

Skills analysis Consists of breaking the skill down to its component parts. Identifying the sub-skills that comprise the total motor skill. Break down the sub-skills into elements. Determine the sequence of the procedure. (Quinn 1995)

Preparative phase contd. Assess entry behaviour of learner, ask questions Benner (1984) ‘From novice to expert’ In relation to skills: Novice: no experience of the situation, rule-governed behaviour, performance of skill. Advanced beginner: some prior experience. However not confident nor competent enough to perform skill.

Preparative phase contd Competent: demonstrates competence in performance (more technically, not necessarily holistically). Proficient: Performs skills on the basis of principles (holistic understanding) which may be applied in various situations.

Preparative phase contd Expert: deep understanding and seamless performance of simple and complex skills. Also demonstrates an ability to consider the wider aspects of health care. Demonstrates precision, efficiency, smoothness, adaptability, timing and ease when performing a skill.

Constructive phase Create the motivational set by: Outlining learning outcomes Emphasise importance of the skill Set skill in the context of current programme/study Demonstrate the entire skill slowly in appropriate sequence Model appropriate behaviour Avoid variations and negative examples

Constructive phase contd Demonstrate skill at slower pace Break skill into component parts, so that the learner can observe the stages of the process Stress important aspects of skill – use as cues (highlight rationale, underlying concepts) Encourage learner to state what they observe

Coaching phase While the learner practices sub-skills: Observe their performance in sequence Encourage them to explain what they are doing (talking aloud through steps) Use cues to prompt, if necessary (types of prompting) Help them ‘chaining’ sub-skills into fluent psychomotor skill Provide constructive feedback (Quinn 2000)

Fading phase Gradually withdraw prompts and feedback Student moves from dependent to independent (novice to competent)

Practice phase Allow time for practice as: …without practice, kinaesthetic feedback is missing and skill cannot be learned (Quinn 2000). Learner (not teacher) should pace the learning Cognitive learning faster than motor learning (avoid taking over) Take individual differences of learners into account (i.e. learning styles)

Reflective Phase Returning to the experience: Opportunity to self-assess Learner may articulate knowledge, reasoning and critical thinking skills Opportunity for feedback (Dewey 1963, Quinn 2000)

Expand Psychomotor skills Increase complexity (simple to complex) Increase diversity (various contexts)

References Reece, I 7&Walker S. (2003) Teaching Training and Learning: a practical guide. Sunderland: Business Education PublishersLtd. Rose M. & Best D (2005) Transforming Practice through Clinical Education, Professional Supervision and Mentoring.Oxford: Elsevier Ltd. Quinn, F (2007) The Principles and Practice of Nurse Education. 5 th edition Cheltenham: Nelson Thornes Quinn, F (2000) The Principles and Practice of Nurse Education. 4 th edition Cheltenham: Nelson Thornes