임상술기 교육의 간단한 5단계 모델(Fam Med, 2001)

임상술기 교육의 간단한 5단계 모델(Fam Med, 2001)

A Simple Five-step Method for Teaching Clinical Skills
John H. George, PhD; Frank X. Doto, MS

 

 

 

5단계 방식이 어떻게, 왜 작동하는지를 이해하기 위해서는 정신운동 교육원칙에 대한 빠른 검토가 필요하다. 원리는 사이코모터 영역의 분류법에 기초한다.2 기본원칙은
To understand how and why the five-step method works, a quick review of psychomotor teaching principles is necessary. The principles are based on the taxonomy of the psychomotor domain.2 The fundamental principles are


(1) 개념화—학습자는 기술의 인지적 요소, 즉, 왜 그것이 행해지고 언제 행해지고, 행해지지 않으며, 주의사항은 무엇인지를 이해해야 한다. 학습자는 스킬 수행과 관련된 도구 및 도구를 알아야 합니다.
(1) Conceptualization— the learner must understand the cognitive elements of the skill, that is, why it’s done, when it’s done, when it’s not done, and the precautions involved. The learner must know the instruments and tools involved in the skill’s performance.


(2) 시각화—처음부터 끝까지 그 기술을 전체적으로 보여 주어 예상되는 수행능력의 모델을 갖도록 해야 한다. 이것은 학습자 모방을 초래한다. 
(2) Visualization—the learner must see the skill demonstrated in its entirety from beginning to end so as to have a model of the performance expected. This leads to learner imitation. 


(3) 언어화—학습자는 두 번째 시연과 함께 스킬의 단계에 대한 내레이션을 들어야 한다. 학습자가 시연하기 전에 스킬의 단계를 올바르게 설명할 수 있는 경우, 학습자가 스킬을 올바르게 수행할 가능성이 커집니다. 이는 학습자 조작으로 이어집니다. 
(3) Verbalization— the learner must hear a narration of the steps of the skill along with a second demonstration. If the learner is able to narrate correctly the steps of the skill before demonstrating there is a greater likelihood that the learner will correctly perform the skill. This leads to learner manipulation. 


(4) 연습—학습자가 스킬을 보고, 내레이션을 듣고, 내레이션을 반복한 후, 스킬을 수행합니다. 스킬은 연습을 위해 신중한 단위로 세분될 수 있습니다. 

• 서브 컴포넌트 연습(sub component practice) - 스킬의 일부를 연습, 
• 연계 연습(linking practice) - 작은 부분을 서로 연결
• 연속된 연습(continuous practice) - 전체 스킬을 반복적으로 연습.

이것은 학습자의 정밀도 연습과 궁극적인 표현으로 이어진다.
(4) Practice— the learner having seen the skill, heard a narration, and repeated the narration, now performs the skill. The skill may be broken down into discreet units for practice:

• subcomponent practice—practicing a small portion of the skill,
• linkage practice—practicing small portions linked together,
• contiguous practice— practicing the entire skill repetitively.

This leads to learner precision practice and eventual articulation.


(5) 기술 오류의 수정 및 보강—기술 오류의 즉각적인 수정이 필요하다. 정확한 성능을 강화하기 위해 정적강화를 사용해야 합니다. 
(5) Correction and reinforcement— skill errors need immediate correction. Positive reinforcement should be used to cement correct performance. 

(6) 기술 숙달—실천 상황에서 일련의 기술을 오류 없이 일상적으로 수행할 수 있는 능력. 이는 학습자 설명articulation으로 이어집니다. 

(6) Skill mastery— the ability to routinely perform a sequence of skills in a practice situation without error. This leads to learner articulation. 

 

(7) 기술 자율성—실제 상황에서 오류 없이 일상적으로 기술을 수행할 수 있는 능력. 이는 학습자 자연화naturalization로 이어집니다.

(7) Skill autonomy— the ability to regularly perform the skill as a routine in reallife situations without error. This leads to learner naturalization.

 

 

Step 1

개요: 기술을 배우도록 동기를 부여받으려면, 학습자는 왜 기술이 필요한지, 그리고 그것이 어떻게 의료에 사용되는지를 이해해야 합니다.
Overview: To be motivated to learn a skill, the learner must understand why the skill is needed and how it is used in the delivery of care.

Step 2

 

교사는 말로 설명하지 않고, 정확히 해야 할 기술을 보여줘야 한다. 이 무언의 시연은 학생들이 올바르게 수행되었을 때 그 기술이 어떤 모습인지 마음속에 그려준다. 이 이미지는 학생들이 이 기술을 연습할 때 자신의 수행 능력을 스스로 평가하기 위해 이 그림을 사용하기 때문에 중요합니다.
The preceptor should demonstrate the skill exactly as it should be done without talking through the procedure. This silent demonstration gives students a mental picture of what the skill looks like when it is being done correctly. This image is important since students will use this picture to self-evaluate their own performance when practicing the skill.

 

Step 3

그런 다음, 프리셉터는 절차를 반복하지만 프로세스의 각 단계를 자세히 설명하는 시간을 갖는다. 이를 통해 학생들은 각 단계가 어떻게 최적의 순서에 맞는지 알 수 있으며, 학생들이 질문을 하거나 단계나 절차에 대한 설명을 찾는 시간을 가질 수 있다.
The preceptor then repeats the procedure but takes time to describe in detail each step in the process. This will help students see how each step fits into the optimal sequence and will allow time for students to ask questions or seek clarification of a step or a procedure. 

 

Step 4

학생들은 그 기술을 설명한다. 교수님은 학생들에게 기술을 어떻게 하는지 단계별로 설명해 달라고 함으로써 학생들이 기술을 수행하는 순서의 각 단계를 이해하고 기억하도록 할 것이다. 이것은 또한 학생들이 다음 절차로 이동할 때 단계를 기억할 수 있도록 과정을 기억하는데 도움이 될 것이다.
Students talk through the skill. By asking students to describe step by step how to do the skill, the preceptor will ensure that the students understand and remember each step in the sequence of performing the skill. This will also help the students commit the process to memory so they can recall steps as they move to the next procedure. 

 

Step 5

학생들은 그 기술을 수행한다. 이제 학생들은 교사를 세심하게 관찰하고 필요에 따라 피드백이나 코칭으로 이 기술을 처음 시도할 준비가 되었습니다. 성공적인 시도 후에, 학생들은 원하는 수준의 숙련도에 도달할 때까지 연습을 계속해야 한다.
The students perform the skill. Now students are ready to do their first attempt at the skill with the preceptor carefully observing and providing feedback or coaching as needed. Following a successful attempt, students should continue to practice until they reach the desired level of proficiency. 

 

학생이 스킬을 배우는 데 문제가 있을 경우, 다음 중 어떤 이유로 인해 수행 부족이 발생하는지 확인해야 합니다. 

If students have a problem learning a skill, the preceptor will need to identify which of the following reasons may be underlying their performance deficit. 

 

학습자 특성 능력
Learner Trait Ability

학습자 특성(learner property)은 학습자가 작업을 수행하는 데 필요한 강도, 미세한 모터 조정 또는 미세한 모터 기술을 보유하지 못할 수 있기 때문에 학습자가 작업을 수행할 수 없는 고유의 능력입니다.
Learner trait ability is the inherent inability of the learner to perform the task because the learner may not possess the strength, fine motor coordination, or the fine motor skills necessary to do the task.

 

부적절한/부적절한 작업 설명 및/또는 시연
Inadequate/Inappropriate Task Description and/or Demonstration

학습자는 시연에 주의를 기울이지 않았거나, 데모가 발생한 시점과 과제를 수행하려는 시도 사이에 너무 많은 시간이 있었던 경우 올바른 과제가 어떻게 보이는지 모를 수 있습니다.
Learners may not know what the correct task looks like if they have not paid attention to the demonstration, or there was too much time between when the demonstration took place and his/her attempt to perform the task.

잘못되었거나 오래된 이전 성능 각인
Imprinting of Previous Incorrect or Obsolete Performance

학습자는 이전에 학습한 내용이 잘못되었더라도 자동으로 반복할 수 있습니다. 이는 학생들이 다른 조건에서 절차를 배우려고 시도했지만 적절한 피드백과 수정 조치를 받지 못해 부적절한 기술 적용을 반복하는 사무 기반의 절차에서 종종 발생한다. 
Learners may be automatically repeating what was previously learned even though it was incorrect. This is often the case in officebased procedures where students have attempted to learn a procedure under other conditions and were not given appropriate feedback and corrective action and thus are repeating an inappropriate application of the skill. 

 

부적절한 보정/보강
Improper Correction/ Reinforcement

학습자는 수행이 정확하지 않을 때 수행이 정확했음을 나타내는 피드백을 받았을 수 있습니다. 
Learners may have received what was believed to be feedback indicating the performance was correct when it was not. 

정서적 요인
Affective Factors

정서적 요인에는 두려움, 위협, 산만, 당혹감, 기술의 가치에 대한 믿음 부족, 기술과 무관한 감각 또는 수행 불안 등이 포함될 수 있으며 기술 학습의 결손을 야기할 수 있다. 
Affective factors can include fear, intimidation, distraction, embarrassment, lack of belief in the value of the skill, sense of skill irrelevancy, or performance anxiety and can cause deficits in skill learning. 

부정확한 학습자 성과 인식
Inaccurate Learner Perception of Performance

학습자는 올바르게 수행된 작업과 올바르게 수행되지 않은 작업을 기억하지 못할 수 있습니다.

The learner may not be able to recall what was done and what was not done correctly.

 

---

Fam Med. 2001 Sep;33(8):577-8.

A simple five-step method for teaching clinical skills

J H George 1, F X Doto

Affiliations collapse

Affiliation

• 1Department of Family and Community Medicine, Penn State College of Medicine, Hershey Medical Center, 17033-0850, USA. jgeorge3@psu.edu

• PMID: 11573712