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Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Sawyer, T. et al. Acad Med 90, 1025–1033 (2015).


Acquisition of competency in procedural skills is a fundamental goal of medical training. Based on a review and critical synthesis of the literature, the authors propose an evidence-based pedagogical framework rooted in adult learning theory for procedural skill training.


Teaching and learning procedural skills can be divided into two phases: cognitiveand psychomotor. The cognitive phase is devoted to learning about the procedure and developing an understanding of what is involved (Learn and See). The psychomotor phase involves practicing the skill and completing the procedure on a patient in the clinical setting (Practice, Prove, and Do). Learn: this step focuses on conceptualization using cognitive learning strategies (such as lectures, assigned readings, etc.) and verifications such as MC tests. See: this step involves an instructor demonstrating and modeling the procedure for the learner. Educators and instructors must come to a consensus on the best way to perform the procedure and to identify key steps. Practice: the learner is allowed deliberate practice in a safe learning environment on a partial-task trainer, mannequin, or virtual reality trainer. Evaluation is formative and dedicated to areas for improvement and maximizing performance.

Prove: the learner undergoes competency-based assessment on a simulator prior to performing the skill on a patient to demonstrate mastery and ensure patient safety.

Do: the learner continues the process of procedural skill development on real patients, initially with formative and direct supervision coupled with assessment and refinement of the skill.

Maintain: once achieved, mastery of a skill will degrade over time if not practiced (“de-skilling”). Simulation-based retraining can allow for needed practice with an infrequently performed procedure.


The use of an EHR system can be contextualized as a procedural skill, requiring the ability to quickly and accurately perform a manual task (navigating the EHR and entering information), as well as to modify movement to fit a unique situation (interacting with each particular patient with the computer as the “third party”; entering diverse sources of information and effectively using decision aids; etc.). This evidence-based framework can potentially be adapted to a curriculum of EHR use. It is very elegant, based in accepted learner theory, and suited for learning across the medical lifespan. Other than reliance on simulation, this framework is also quite adaptable to curricula. 5/5 Checks.