Gaps in practice

January/February 2011


Teaching procedural skills in general practice

Volume 40, No.1, January/February 2011 Pages 63-67

Susan M Wearne


General practitioners need the skills to perform a core set of procedures. The increase in community based medical education gives GPs more opportunity and responsibility to facilitate medical students and junior doctors’ acquisition of these core skills.


This article summarises how procedural skills are learned and describes a practical framework for constructing a supportive learning environment that is safe for patients and learners.


Procedural skills are learned in stages starting with a ‘big picture’ concept of the skill and its place in clinical care. Next the skill becomes fixed through deliberate practice with specific, constructive feedback based on observation. Autonomous practice is reached after further practice and exposure to increased complexity. General practitioners can facilitate skill development by using a staged learning cycle, building on their learner’s prior knowledge and skill.

‘See one, do one, teach one’ and its variant ‘do one, teach one’ were the historical approaches to learning procedural skills in medicine. But who would fly with an airline that used this method to teach their pilots? ‘See one, do one, teach one’ may produce a doctor who knows how to do a procedure in one setting (procedural knowledge).1 But it fails to provide extensive practise in learning manual tasks with varying contexts and complications,2 or engender the wisdom to know when to do what (strategic knowledge)3 or promote the acquisition of the appropriate values and attitudes of a professional (dispositional knowledge).1 In the past, procedural skills were learnt in hospitals. The increase in community based medical education4 brings with it an increasing role for general practitioners to teach procedural skills.

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