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Gastroenterology and Hepatology From Bed to Bench.

MEDICAL EDUCATION
©2011 RIGLD, Research Institute for Gastroenterology and Liver Diseases

How to use Gagne’s model of instructional design in teaching


psychomotor skills
Kayvan Khadjooi¹, Kamran Rostami², Sauid Ishaq²
¹Hull York Medical School, UK
²Dudley Group of Hospitals, NHS Foundation Trust, UK

ABSTRACT
Gagne’s model of instructional design is based on the information processing model of the mental events that occur
when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific
instructional events to achieve those outcomes. Applying Gagne's nine-step model is an excellent way to ensure an
effective and systematic learning program as it gives structure to the lesson plans and a holistic view to the teaching. In
this paper, we have chosen a routine practical procedure that junior doctors need to learn: insertion of a peritoneal
(ascitic) drain and we use Gagne’s “events of instruction” to design a lesson plan for this subject.
Keywords: Gagne’s model, Information processing model, Instructional design, Teaching.
(Please cite as: Khadjooi K, Rostami K, Ishaq S. How to use Gagne’s model of instructional design in teaching
psychomotor skills. Gastroenterol Hepatol Bed Bench 2011;4(3):116-119).

Introduction Gagne’s model of instructional


1
Instructional events refer to actions of both design
teacher and learners during the teaching session. Robert Gagne is considered to be one of the
Selecting appropriate events and planning them foremost contributors to the systematic approach
in the right format and the right sequence is to instructional design and his theory has provided
crucial in a successful lesson design. A lesson a great number of valuable ideas for trainers and
design is a plan showing the type of teachers. Gagne’s model of instructional design is
instructional events, their order and the kind of based on the information processing model of the
activity taking place in each event. In designing mental events that occur when adults are presented
a lesson plan, there are 2 important factors: the with various stimuli and focuses on the learning
objectives and the learners. outcomes and how to arrange specific instructional
In this paper, we have chosen a routine events to achieve those outcomes. Gagne’s theories
practical procedure that junior doctors need to have been applied to the design of instruction in
learn: insertion of a peritoneal (ascitic) drain. several domains, such as the military, flying,
We use Gagne’s “events of instruction” to leadership, engineering and healthcare.
design a lesson plan for this subject. Essential to Gagne's ideas of instruction are
what he calls “conditions of learning”: internal
conditions deal with what the learner knows prior
Received: 29 March 2011 Accepted: 28 May 2011
Reprint or Correspondence: Kayvan Khadjooi, MD, MRCP,
to the instruction, external conditions deal with the
CertMedEd. Hull York Medical School, UK
E-mail: kayvan@nhs.net

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Khadjoo K. et al 117

stimuli that are presented to the learner, e.g. with ascites can be presented together with
instructions provided by the teacher. relevant investigations/images, asking the learners
The first step in Gagne’s theory is specifying the about the case. There is no doubt that curiosity
kind of outcomes to be achieved. He categorised motivates students to learn.
these outcomes into five types: verbal information,
intellectual skills, cognitive strategies, attitudes, and (II) Informing the learner of the
motor skills.
objective
The second step is to organise appropriate
instructional events. Gagne’s “Events of Early in each lesson students should encounter
Instruction” consist of the following: a list of learning objectives. This initiates the
1. Gaining attention internal process of expectancy and helps motivate
2. Informing the learner of the objective the learner to complete the lesson.
3. Stimulating recall of prerequisite learning A direct statement can be used in our session:
4. Presenting the stimulus material “upon completing this lesson you will be able to”:
5. Providing learning guidance  Consent the patient for insertion of a
6. Eliciting the performance peritoneal drain
7. Providing feedback  Identify the correct anatomical point
8. Assessing the performance  Identify the equipment required
9. Enhancing retention and transfer  Prepare, position and monitor the patient
Inserting a peritoneal drain is a motor skill,  Understand and perform the correct
which corresponds to affective and psychomotor technique for insertion of a peritoneal
skill outcomes. The ideal number of learners for drain under fully aseptic condition
this kind of session is 4 or 5. The following  Understand the principles of securing,
instructional events can be organised for a lesson dressing and connecting the drain
to teach insertion of a peritoneal drain:  Understand the importance of appropriate
analgesia post procedure
(I) Gaining attention  Complete the appropriate documentation
When students arrive at class, their attention in patient’s medical notes
can be directed toward many other things, so in
order for any learning to take place, first their (III) Stimulating recall of
attention must be captured and their interest prerequisite learning
should be aroused. Here are some examples:
Associating new information with prior
1) An abrupt stimulus change, such as
knowledge and personal experience and getting
gesturing or speaking loudly
the learners to think about what they already know
2) Starting the lesson with a thought-provoking
can facilitate the learning process.
question or interesting fact.
In our session, 20-30 minutes should be
3) Providing an interesting visual or sound
allocated for interactive discussion of the
stimulus. Depending on the audience, multimedia
following:
(like PowerPoint slides) can be used to combine
Asking questions about previous observations
photographs, pictures, and sound.
and experiences, indications of inserting a
In our session, combining items 2 and 3 is a
peritoneal drain, relevant anatomy, findings on
good starting point: a case scenario of a patient
examination and relevant tests before the

Gastroenterology and Hepatology From Bed to Bench 2011;4(3): 116-119


118 How to use Gagne’s model of instructional design in teaching psychomotor skills

procedure to confirm the diagnosis (e.g. abdominal understanding, and the repetition further increases
ultrasound) the likelihood of retention.
In our session, each one of the learners should
(IV) Presenting the stimulus get familiar with the equipment, demonstrate the
sterile technique and perform the procedure on the
material
dummy under direct supervision.
This event is where the new content is actually
presented to the learner. Content should be
(VII) Providing feedback
organised meaningfully, and explained and
demonstrated using a variety of media. While observing each learner performing the
In our session, different steps of the procedure procedure, individual and immediate feedback and
should be explained: guidance can be provided and any questions can
How to consent the patient, monitoring, be answered. In addition, feedback from other
equipment needed, positioning the patient, the learners observing the performance is very
technique of peritoneal drain insertion and how to helpful.
secure the drain. Finally, tests needed after the
procedure (biochemistry, cytology and (VIII) Assessing the performance
microbiology tests on the fluid sample), and At this point, the students demonstrate what
appropriate analgesia should be explained. they have learned without receiving additional
coaching or hints. However, a single performance
(V) Providing learning guidance does not ensure that the new capability has been
This event means showing what appropriate reliably stored and additional practice is needed.
actions constitute correct performance, plus In our session, this will constitute demonstration
additional suggestions, including use of examples, of the whole procedure by the learner without
case studies, graphical representations, and prompt or guidance. The main issue here is time
mnemonics to help learners encode information and resources. If there is enough time, or if an
for long-term storage, or in simple terms, “make additional session is organised, they can practice
the stimulus as meaningful as possible”. the procedure a few times and at the end
As this is a practical procedure, if learners first demonstrate their performance. It is not possible to
observe the procedure they are in a better position assess the desired outcome, insertion of a
to perform it themselves. The teacher shows the peritoneal drain on “a real patient” in the same
equipment and performs the procedure on a session but during on-calls and on the wards, the
dummy, including the sterile technique, explaining learners get a chance of performing the procedure.
it step by step. While performing the procedure, Due to invasive nature of the procedure, they
useful tips and hints can be provided. “must” be supervised and assisted initially and
after practicing a few times, they will be able to
perform it independently.
(VI) Eliciting the performance
(practice) (IX) Enhancing retention and
The action now turns to learners. In this event,
transfer
the learner is required to practice the new skill or
behaviour. Eliciting performance provides an Once we are reasonably sure that the new
opportunity for learners to confirm their correct capabilities are reliably stored, we can increase the

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Khadjoo K. et al 119

likelihood that they will be retained over a long time systematic learning program as it gives structure to
period by providing practice and spaced reviews. the lesson plans and a holistic view to the teaching.
The repetition of learned concepts is an effective
We need to keep in mind that the exact form of these
mean of enhancing retention, although often disliked
by students. Additionally, transfer of knowledge and events is not something that can be specified in
skills to new problems and situations is a goal of general for all lessons, but rather must be decided for
most instruction, but classroom time constraint each learning objective.
makes it more difficult to achieve.
The performance most frequently required of
To enhance retention, the learners should practice
the procedure on a dummy a few times. More students is to remember, while our intent is most
frequent practice broken by rest periods is more often to help them understand, and by putting more
effective. The transfer of knowledge constitutes structure into the objectives of the lesson plans we
applying their skills in a clinical setting, while
will be able to achieve this aim. As Gagne himself
initially being supervised. The session can be closed
by reviewing the key points, answering the questions says, “organisation is the hallmark of effective
and asking for learners’ feedback. instructional materials”.
In designing a session like this, several
factors need to be considered, including the
References
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Conclusions
Gagne's theories provide a great deal of valuable
information to teachers. Applying Gagne's nine-step
model is an excellent way to ensure an effective and

Gastroenterology and Hepatology From Bed to Bench 2011;4(3): 116-119