Q: Did you see one, before doing one?

A: See one, do one, teach one. This is an age-old phrase in medical education. I can write about the pros and cons of this teaching approach, but here I wanted to primarily write about the importance of seeing one.

A few months ago, I was orienting our newest residents using simulation. We asked our residents to conduct a rapid sequence induction (RSI). The team of CA-1s came up with a plan and proceeded with induction. Despite getting caught up a couple of times, our scenario reached an end and all went well. At the end of the session, we asked learners for their feedback on how effective our teaching strategy was. All of them enjoyed being immersed in the simulator, but more than one stated that it would have been helpful to have seen an expert do a RSI before they did one. They sought a role model.

The feedback resonated with me. I reflected on my teaching practices and discovered that I often ask students to perform a task, with my specifications, under my guidance. However, the student had rarely watched me do it my way. For example, I enjoy teaching ultrasound-guided vascular access. I often coached residents through the steps of placing an ultrasound-guided arterial line; they are doing not seeing. Part of me did not want to take away their opportunity to place the line. However, I have since changed my teaching practices. Now, I demonstrate the procedure myself, describing in detail each step and pausing for questions. The students report that they learn a lot of my nuances by seeing an expert. They then model their behaviors to reflect the entire task from beginning to end. This confirms aspects of Albert Bandura’s social learning theory developed in the 1960s.

As an educator, serving as a role model extends to all aspects of patient care, teamwork, professionalism, and more; it likely extends outside the workplace. Learners are watching and modeling. For this reason, I now stress that students see me do at least one, before doing one.

Dr. Ankeet UdaniQ: Did you see one, before doing one?
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Q: Did you see one, before doing one?

A: See one, do one, teach one. This is an age-old phrase in medical education. I can write about the pros and cons of this teaching approach, but here I wanted to primarily write about the importance of seeing one.

A few months ago, I was orienting our newest residents using simulation. We asked our residents to conduct a rapid sequence induction (RSI). The team of CA-1s came up with a plan and proceeded with induction. Despite getting caught up a couple of times, our scenario reached an end and all went well. At the end of the session, we asked learners for their feedback on how effective our teaching strategy was. All of them enjoyed being immersed in the simulator, but more than one stated that it would have been helpful to have seen an expert do a RSI before they did one. They sought a role model.

The feedback resonated with me. I reflected on my teaching practices and discovered that I often ask students to perform a task, with my specifications, under my guidance. However, the student had rarely watched me do it my way. For example, I enjoy teaching ultrasound-guided vascular access. I often coached residents through the steps of placing an ultrasound-guided arterial line; they are doing not seeing. Part of me did not want to take away their opportunity to place the line. However, I have since changed my teaching practices. Now, I demonstrate the procedure myself, describing in detail each step and pausing for questions. The students report that they learn a lot of my nuances by seeing an expert. They then model their behaviors to reflect the entire task from beginning to end. This confirms aspects of Albert Bandura’s social learning theory developed in the 1960s.

As an educator, serving as a role model extends to all aspects of patient care, teamwork, professionalism, and more; it likely extends outside the workplace. Learners are watching and modeling. For this reason, I now stress that students see me do at least one, before doing one.

Chris KeithQ: Did you see one, before doing one?
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Q: What is the simulation experience during residency?

A: Simulation-based education at Duke has three main functions during residency training. First, orientation. All anesthesia residents spend their first week at Duke in small groups practicing the basics of anesthesia preparation, induction, maintenance and emergence. Orientation allows students to ask questions in a controlled, safe environment so they are well prepared when they are in the clinical setting. The second feature is offering a consistent curriculum to all residents. New this year, we are implementing a three-year, graduated simulation curriculum covering all important events identified by faculty and residents as must-manage cases. The cases will cover general, vascular, transplant, pediatric, cardiac anesthesia and more. The goal is to make sure all residents learn and manage common and rare events in simulation, regardless of their clinical exposure. Finally, the third function of simulation is to verse our residents in principles of crisis resource management. Similar to the training aviation pilots receive, the CRM-simulation curriculum spans all three years of residency with increasing complexity. The course prepares our residents to be effective leaders and team members in times of crisis in the perioperative environment. We have additional exciting aspects of simulation including gaming and patient safety efforts that are currently being studied and will be implemented into the residency curriculum in the future.

Dr. Ankeet UdaniQ: What is the simulation experience during residency?
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