Summary: Teaching medical procedures is one of the most rewarding aspects of medical education. Physicians-in-training place a high value on mastering clinical procedures and often link their confidence to their procedural skills. It is important to provide an opportunity for the student to prepare to learn a new procedure. This phase of learning should occur in a more didactic format, aside from the laboratory or patient bedside where the actual mechanics of the procedure will be performed. The goal of this preparatory time is to ensure that the student understands the large amount of prerequisite information needed to perform the procedure appropriately. This information includes a review of the indications and contraindications for the procedure, the human anatomy involved, the tools used to perform the procedure, and the expected outcome of the procedure. Students are often able to uncover and retain more information if they consult multiple sources, including colleagues, texts, nurses, and Web-based media. The prospect of learning and performing a new procedure typically serves as adequate motivation for this active learning to occur. Furthermore, many teaching institutions have developed and evaluated computer-assisted modules that incorporate images, short video clips, and instructional texts for this phase of learning. While students prepare to learn a procedure, the instructor must prepare to teach it. This involves task analysis, a skill in which the instructor breaks down the procedure into small, more digestible components for teaching purposes. For example, when teaching the placement of a central line, one of the microskills that needs to be acquired before attempting the procedure is the ability to draw back on a syringe using a single-handed method. Without accomplishing this smaller component of the motor skill, the physician will never learn to place a central line independently. As this example demonstrates, instructor preparation can be challenging because many of the microskills required to perform procedures are taken for granted once the procedure is mastered. Therefore, instructors must take the time to deconstruct the components of the procedure in preparation for the learning session and create a task analysis. The long-standing tenet “see one, do one, teach one” does not provide an optimal framework for the learner or the instructor to ensure mastery of a procedure. Instead, a multistep process of learning the procedure and then practicing it with a declining level of supervision and guidance is more effective: Steps in the process of learning a procedure Conceptualization—understanding the reasons for performing a procedure, the overall process, the tools involved, and the risks/benefits. Visualization—observing a demonstration of the procedure, performed in a fluid and competent manner by the master teacher Verbalization—reviewing a verbal deconstruction of the procedure while it is performed by the expert, with opportunity for interruptions and clarifications. Guided practice—performing the sequential steps of the procedure under the supervision of an expert physician. When an error is identified, it is best to have the instructor place his or her hand on the trainee’s hand to stop the incorrect action and physically redirect the student to the correct motor action while providing verbal instruction regarding the proper method. It is important that learners be told that this will happen and for them to expect this hand-on-hand contact. One common pitfall is allowing learners to perform procedures with errors and then providing feedback regarding those errors after the procedure has been completed. The idea is to stop the error before it is imprinted in the learner’s motor memory. Practice without guidance can precipitate errors and result in imprinting of inappropriate actions, which is dangerous to patients and a disservice to the learner. Immediate feedback,
