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.