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Teaching of Psychomotor Skills (Additional Notes)

When teaching psychomotor skills, it is important for the educator to remember to

keep skill instruction separate from a discussion of principles underlying the skill
(cognitive component) or a discussion of how the learner feels about carrying out the
skill (affective component).
Psychomotor skill development is very egocentric and usually requires a great
deal of concentration as the learner works toward mastery of a skill. It is easy to interfere
with psychomotor learning if the teacher asks a knowledge (cognitive) question while
the learner is trying to focus on the performance (psychomotor response) of a skill. For
example, while a staff member is learning to suction a patient, it is not unusual for the
teacher to ask, “Can you give me a rationale for why suctioning is important?” or “How
often should suctioning be done for this particular patient?” These questions demand a
cognitive response during the psychomotor performance.
As another example, while the patient is learning to self-administer parenteral
medication, the teacher may simultaneously ask the patient to cognitively respond to the
question, “What are the actions or side effects of this medication?” or “How do you feel
about injecting yourself?” These questions demand cognitive and affective responses
during psychomotor performance. Although a teacher frequently intervenes with
questions in the midst of a learner’s performing, it is definitely an inappropriate teaching
technique. What the educator is doing, in fact, is asking the learner to demonstrate at
least two different behaviors at the same time. This technique can result in frustration and
confusion, and ultimately it may result in failure to achieve any of the behaviors
successfully. Questions related to the cognitive or affective domain should take place
before or after the learner’s practicing of a psychomotor skill (Oermann, 1990).
In psychomotor skill development, the ability to perform a skill is not equivalent
to learning a skill. Performance is a transitory action, while learning is a more permanent
behavior that follows from repeated practice and experience (Oermann, 1990). The actual
learning of a skill requires practice to allow the individual to repeat the performance time
and again with accuracy, coordination, and out of habit. Practice does make perfect, and
so repetition leads to perfection and reinforcement of the behavior. The riding of a
bicycle is a perfect example. When one first attempts to ride a bicycle, movements tend
to be very jerky, and the act requires a great deal of concentration. Once the skill is
learned, bicycle riding becomes a smooth, automatic operation that requires minimal
attention to the details of fine and gross motor movements acting in concert to allow the
learner to achieve the skill of riding a bicycle. Some behaviors that are learned do not
require much reinforcement, even over a long period of disuse, whereas other behaviors,
once learned, need to be rehearsed or relearned to perform them at the level of skill once
achieved.
The amount of practice required to learn any new skill varies with the
individual, depending on many factors. Oermann (1990) and Bell (1991) have addressed
some of the more important variables:

Readiness to learn: The motivation to learn affects the degree of perseverance exhibited
by the learner in working toward mastery of a skill.

Past experience: If the learner is familiar with equipment or techniques similar to those
needed to learn a new skill, then mastery of the new skill may be achieved at a faster
rate. The effects of learning one skill on the subsequent performance of another related
skill is known as transfer of learning (Gomez & Gomez, 1984). For example, if someone
already has experience with downhill skiing, then learning cross-country skiing should
come more easily and with more confidence because the required coordination and
equipment are similar. To use an example in teaching healthcare skills, if a family
member already has experience with aseptic technique in changing a dressing, then
learning to suction a tracheostomy tube using sterile technique should not require as
much time to master.

Health status: Illness state or other physical or emotional impairments in the learner may
affect the time it takes to acquire or successfully master a skill.
Environmental stimuli: Depending on the type and level of stimuli as well as the learning
style (degree of tolerance for certain stimuli), distractions in the immediate surroundings
may interfere with skill acquisition.

Anxiety level: The ability to concentrate can be dramatically affected by how anxious
someone feels. Nervousness about performing in front of someone is particularly a key
factor in psychomotor skill development. High anxiety levels interfere with
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coordination, steadiness, fine muscle movements, and concentration levels when
performing complex psychomotor skills. It is important to reassure learners that they are
not necessarily being “tested” during psychomotor skill performance.
Reassurance and support reduce anxiety levels related to the fear of not meeting
expectations of themselves or of the teacher.

Developmental stage: Physical, cognitive, and psychosocial stages of development all

influence an individual’s ability to master a movement-oriented task. Certainly, a young
child’s fine and gross motor skills as well as cognitive abilities are at a different level
than those of an adult. The older adult, too, will likely exhibit slower cognitive
processing and increased response time (needing longer time to perform an activity)
than younger clients.

Practice session length: During the beginning stages of learning a motor skill, short and
carefully planned practice sessions and frequent rest periods are valuable techniques to
help increase the rate and success of learning. These techniques are thought to be
effective because they help prevent physical fatigue and restore the learner’s attention to
the task at hand.

Performing motor skills is not done in a vacuum. The learner is immersed in a

particu- lar environmental context full of stimuli. Learners must select those
environmental influences that will assist them in achieving the behavior (relevant
stimuli) and ignore those that interfere with a specific performance (irrelevant stimuli).
This process of rec- organizing and selecting appropriate and inappropriate stimuli is
called selective attention (Gomez & Gomez, 1984).
Motor skills should be practiced first in a laboratory setting to provide a safe and
non- threatening environment for the novice learner. Gomez and Gomez (1987) suggest
also arranging for practice sessions to be done in the clinical or home setting to expose
the learner to actual environmental conditions. This technique is known as “open” skills
performance learned under changing and unstable environments. In addition, research
findings indicate that progress in mastery of a psychomotor skill can be accomplished
just as effectively through self-directed study as with teaching in a structured laboratory
situation (Love, McAdams, Patton, Rankin, & Roberts, 1989). Yoder (1993) found that
computer- assisted interactive video (CAIVI) resulted in a greater amount of transfer of
cognitive learning than did linear video for the performance of psychomotor skills in a
clinical setting. Yoder reported that three types of transfer learning occur: self-transfer
(repetition of learning), near transfer (occurs in situations that are very similar), and far
transfer (occurs in situations that are very different). Application of psychomotor skills
in the clinical arena is a type of far transfer.
More recently, Miracle (1999) summarized research findings on educational
strategies and innovations for teaching psychomotor skills to nursing students and
suggested that the limited and mixed findings of research studies warrant further
investigation on methods to teach kinesthetic skills. In any event, contact with the
teacher during practice sessions is an important element for successful psychomotor
learning. Although educator workload necessitates finding cost-effective and time-
efficient ways to teach skill development, mediated instruction should not be used as a
substitute, only a supplement, for instructor input (Baldwin, Hill, & Hanson, 1991).
In addition to using demonstration and return demonstration, mediated instruction, and
self-directed study as teaching methods for psychomotor learning, mental imaging (also
known as mental practice) has surfaced as a viable alternative for teaching motor skills.
Research indicates that learning psychomotor skills can be enhanced through use of
imagery. Mental practice is similar to the type of practice athletes use when preparing to
perform in a sports competition (Eaton & Evans, 1986; Doheny, 1993; Bachman, 1990;
Miracle, 1999).
Another hallmark of psychomotor learning is the type and timing of the feedback
given to learners. Psychomotor skill development allows for immediate feedback such
that learners have an idea on the spot of the results of their performance. During skill
practice, learners receive intrinsic feedback that is generated from within the self, giving
them a sense of or a feel for how they have performed. They may sense that they either
did quite well or that they felt awkward and need more practice. In addition, the teacher
has the opportunity to provide augmented feedback by sharing with learners an opinion
or conveying a message through body language about how well they performed
(Oermann, 1990). The immediacy of the feedback, together with the self-generated and
teacher-supplemented feedback, makes this a unique feature of psychomotor learning.
Performance checklists, which can serve as guides for teaching and learning, are also an
effective tool for evaluat ing the level of skill performance.
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An important point to remember is that it is all right to make mistakes in the
process of teaching or learning a psychomotor skill. If the teacher makes an error when
demonstrating a skill or the learner makes an error during return demonstration, this is
the perfect teaching opportunity to offer anticipatory guidance: “Oops, I made a mistake.
Now what do I do?” Unlike cognitive skill development, where errorless learning is the
objective, in psychomotor skill development a mistake made represents an opportunity
to demonstrate how to correct an error and to learn from the not-so- perfect initial attempts
at performance. The old saying, “You learn by your mistakes,” is most applicable to
psychomotor skill mastery. Thus, learning is a very complex phenomenon. It is clear that
the cognitive, affective, and psychomotor domains, although representing separate
behaviors, are to some extent interrelated. Movement-oriented activities require an
integration of related knowledge and values (Oermann, 1990). For example, the
performance of a psychomotor skill often requires a certain degree of cognitive
knowledge or understanding of information, such as the scientific principles underlying
a practice or why a skill is important to carry out. Also, there may be an affective
component to performing the movement dimension for the psychomotor behavior to be
integrated as part of the learner’s overall experience and ability to attain the ultimate
goal of independence in self-care or practice delivery