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Teaching and learning practical skills

For many years, medical students and trainees learnt clinical skills by the principle of ‘see one, do one, teach one’. However, there are few redeeming features of this model and nobody in the 21st century, whether patient, trainer or trainee, should be exposed to its dangers. For the novice, skills should first be attempted in the secure environment of the skills or simulation centre and then practised until such time as they or their trainers feel they are competent to perform the skills on real patients. This is not to ignore the fact that simulation should augment, and not replace, real clinical practice, and one must be careful to reinforce this message in any assessment programme.

Thinking points

  • Think about the way you commonly teach a trainee/student a new procedure or skill. ist the important steps, as if you were teaching someone else this method of delivery.
  • How could you augment this method to ensure a large cohort of students all received similar instruction?


Peyton (1998), a general surgeon, describes an excellent and widely advocated model for teaching skills in simulated and other settings, known as the ‘four-stage approach’.

Four stage approach

This model may be expanded or reduced depending on the background skills of the learner. Video may be used in Stages 1 and 2. As with all teaching, the learner must be given constructive feedback and allowed time for practice of the skills.

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