A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

Medicine and dentistry
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Interrogating practice
• How does the NHS of today influence the way students observe and learn
clinical skills?
• How does the learning environment of the clinical skills centre differ from
that of the clinical arena?
providing the teacher with a regulated, reproducible teaching arena. The simulated
element will most commonly refer to materials, actors and role play.
A clinical skills centre or laboratory is incorporated into the infrastructure of most
medical and dental schools in the Western world. Most now incorporate high-fidelity
and virtual reality simulators, as well as SDL and CAL facilities. We found (at a medical
school at which we both worked) that the employment of a dedicated skills teacher
revolutionised the use and potential of the centre, as have others (e.g. at the University
of Leeds Medical School (Stark et al., 1998)).
Peyton, a general surgeon, describes an excellent, and widely advocated, model
for teaching skills, in simulated settings and otherwise, known as the ‘four-stage
approach’.
Stage 1
Demonstration of the skill at normal speed, with little or no explanation.
Stage 2
Repetition of the skill with full explanation, encouraging the learner to ask questions.
Stage 3
The demonstrator performs the skill for a third time, with the learner providing the cue
and explanation of each step and being questioned on key issues. The demonstrator
provides necessary corrections. This step may need to be repeated several times until the
demonstrator is satisfied that the learner fully understands the skill.
Interrogating practice
If you are not already using it, how could you adapt Peyton’s four-stage
approach to your own (simulated or non-simulated) clinical teaching?