Structured teaching methods enhance skill acquisition but not problem-solving abilities: an evaluation of the 'silent...

We aimed to evaluate whether a structured teaching technique (the silent run through) was of benefit in the learning of a skill sequence, and whether it would affect students' ability to improve their problem-solving skills or ability to make judgements.

Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills, by raters blind to the teaching techniques the students had received.

School of Medicine, University of Leeds, UK.

Medical students.

Students who received the structured teaching were significantly better at reproducing a complex, sequential clinical skill (examination of a squint). There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station. Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills.

This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning. In particular, a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal 'commentary' may be an effective way of teaching the sequential motor components of complex clinical skills.