Intended for healthcare professionals

Practice Teaching Rounds

Teaching procedural skills

BMJ 2008; 336 doi: (Published 15 May 2008) Cite this as: BMJ 2008;336:1129
  1. Teodor P Grantcharov, assistant professor 12,
  2. Richard K Reznick, R S McLaughlin professor and chair of the department of surgery1
  1. 1University of Toronto
  2. 2Division of General Surgery, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
  1. Correspondence to: T P Grantcharov grantcharovt{at}

“See one, do one” is not the best way to teach the complex technical procedures needed in many hospital based specialties

For many patients, a successful clinical outcome depends on having a well performed technical procedure. Crucial for surgeons, technical competence is becoming an important element of training for many hospital based specialists: interventional radiologists, cardiologists, gastroenterologists, endovascular therapists, and others. “See one, do one” is no longer appropriate for educating health professionals to perform complex procedures. Graduated independence, the hallmark of the approach to teaching procedural skills, is being challenged by concerns for patients’ safety, the skyrocketing complexity of procedures, and a diminishing work week for trainees. Finding the balance between patients’ safety and doctors’ training will require a more structured approach to our skills curriculum, including continuous assessment of skills, constructive feedback, and provision of opportunities for deliberate practice in the teaching environment.

This paper aims to provide an evidence based algorithm for procedural skills training. It focuses on teaching technical skills, which are just one component of a successful procedure—others are clinical judgment, communication, and team work.

What do we know about current teaching of procedural skills?

Currently, training in technical procedures is often unsystematic and unstructured. Educational tools that have been validated are often underutilised,1 and evidence is growing that adjunctive methods for procedural teaching, such as the use of virtual reality, have not been translated into clinical practice. Teaching communities worldwide would benefit from standardised validated curriculums that use proved technology for teaching technical competence effectively, minimise wasted time, and focus on the breadth of skills needed for a specific practice.

Pre-patient training

Pretraining for technical skills should involve three major components, which should be done outside the clinical setting:

  • The cognitive knowledge surrounding the specific medical conditions, the steps of a procedure, and the function and operation of equipment;

  • Instruction in basic, generic enabling …

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