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

Objectives We aimed to evaluate whether a structured teaching technique (th e silent run through) was of benefit in the learning of a skill sequence, a nd whether it would affect students' ability to improve their problem-solvi ng skills or ability to make judgements. Design Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of comple x tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compar ed with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clini cal Examination on the two skills, by raters blind to the teaching techniqu es the students had received. Setting School of Medicine, University of Leeds, UK. Subjects Medical students. Results Students who received the structured teaching were significantly be tter 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 level s of satisfaction with learning skills in such a structured way and reporte d increased confidence in their examination skills. Conclusions This study provides some evidence to support the hypothesis tha t different teaching techniques may be more effective far improving differe nt elements of skills learning. In particular, a highly structured techniqu e involving breaking complex tasks down into smaller components and utilizi ng an internal 'commentary' may be an effective way of teaching the sequent ial motor components of complex clinical skills.