Novice
Deliberate
Practice
Expert
• Cognitive
Ignition
Master
Coaching
• Spaced Learning
• Skills
• 4-Step Coaching
“Imitatsiya”
Imitate
Myelin
1. Every movement, thought,
or feeling is a precisely
timed electrical signal
in a circuit of nerve fibers.
2. Myelin is the nerve fiber
insulation to increase signal
strength, speed & accuracy
3. The more we fire the circuit,
the more myelin optimizes the performance
Myelin sheath
Chang, Y (2014)
John, V 2014
The hippocampus showed
an increase in gray matter
during the learning period
and more pronounced in
the scan after the learning
period.
 A goal-oriented, highly
targeted, error-focused,
repetitive, effortful
practice
 Focus on the process as
opposed to the outcome
 Prompt feedback from
knowledgeable people
 Apply it immediately
Module 1: Cognitive
 Spaced Repetition Learning
Module 2: Clinical/Procedural skills
 4-Step procedural coaching (Walker & Peyton)
Module 1
What is it?
 Learning that is spaced out over time
involving repetition to increase learning
 Particularly beneficial when retention is the
goal
 Difference between rote memorization and
revisiting a topic over time
Input #1
Topic A
Break #1
wait, topic B, activity, etc
Input 2
Topic A
(Different angles, examples, formats)
Break 2
wait, topic C, activity, etc
Final input #3
Topic A
(Different angles, examples, formats)
 Divide into groups
 Select a topic for your Spaced Learning
Educational Session
 Create Learning objectives
 Design Session using Spaced Learning
Content—Break—Recall—Break—
Understanding
Module 2
10,000 hr
 Motivation, focus and concentration
 Designed specifically to improve performance
 Design of task takes into account pre-existing
knowledge
 Must repeatedly perform same or similar task
 Individual supervision
 Immediate and informative feedback
Peyton JWR. Teaching and learning in medical practice. 1998
Reflective
Observation
Concrete
Experience
Abstract
Conceptualization
Active
Experimentation
• Demonstration
• Deconstruction
• Unconsciously
incompetent
• Consciously incompetent
experience
reflection
experiment
conceptualize
• Performance
• Formulation
• Unconsciously competent
• Consciously competent
We are what we repeatedly do.
Excellence, then, is not an act but a habit.
Aristotle
 Deconstruct the steps for skill in question
 Discuss Practical Steps for Implementation
 Resources needed (e.g. Task Trainer vs.
Patient)
 Frequency and location of training
 Trial Technique
Master coach
Struggling leaner
Locate
the impaired circuits
Deliver
repetitive HD signals to fire
the particular skill circuits
“Human delivery system of signals that fuel skill circuits”
Deep knowledge
Deep and broad
principles,
strategies and
practiced instinct
Perceptiveness
Always learn about learners
Create customized teaching
GPS reflex
Deliver small, highly
targeted and
specific
adjustments
Theatrical honesty
Very dramatic
Full of characters
Authentic connections
Cognitive
Noncognitive
Knowledgeable
Enthusiastic
Demonstrates clinical skills
Stimulating
Well organized
Encouraging
Excellent communication skills
Creates a positive, supportive
learning environment
Provides feedback
Models professional
characteristics
Explains concepts clearly
Focuses on learner’s needs
Sets goals and expectations
Interacts positively with
students
Provides direct supervision
Listens
Bannister SL, et al, Pediatrics, 2010
Gifford KA and Fall LH, Acad Med,
2014
Novice
Deliberate
Practice
Ignition
Master
Coaching
Expert
Sierra 2006