The Monday Memo
June 18, 2018 PITT DPT STUDENTS
Clicker Training and Task Analysis
A few weeks ago, 2nd-year president Jim Tersak wrote about learning a new skill and the ways in which we can break down practice to learn that skill. Not long after reading Jim’s memo, I heard an interesting podcast discussing the ways in which we learn. I highly recommend checking it out. The episode focused on the importance of the learning environment during the cognitive stage of motor learning, and the effect of an instructor’s feedback upon the learner. First, let’s talk about some basic principles of skill acquisition.
Table 1 outlines the principles of experience-dependent plasticity as taught in Neuromuscular PT. As clinicians, we help our patients acquire new skills and refine their movement patterns. It is imperative for us to carefully design the environment in which our patients learn, and control as many aspects of that environment as possible to avoid interference. Whether caused by environment, the student, or the instructor, interference can occur in response to a single experience during skill acquisition and negatively impact future training. In the podcast, Dr. Martin Levy discusses the role that feedback plays when training surgical residents. He explains how external feedback may be misconstrued by students early in the learning process, and that this negative emotional association can impede the ability to learn that skill in the future.
To remedy this issue, Dr. Levy has adopted a style of teaching which has long been used by animal trainers: a clicker. He uses a clicker to provide objective, external feedback when instructing orthopedic residents in various skills required for surgery. He prefers the technique because it removes the learner’s desire to be rewarded by the instructor. Instead, the students are rewarded by perfecting the movement. As soon as they perform the task correctly, Levy simply clicks and they move on to the next step. The system is binary: either the learner correctly performed the task or they did not. This allows the student to focus on intrinsic feedback (aka the information received from visual, motor, and somatosensory systems) when completing the training, which is then verified by the external feedback of Levy’s click. This emphasis on intrinsic feedback enables the students to correctly perform surgical tasks under a variety of conditions.
The key to appropriately utilizing this technique is to first perform an extensive task analysis on the skill being taught; the clinician must be able to break down the whole task into its smallest components, just like Jim discussed in his memo. Levy teaches each component until it becomes highly skilled, then manipulates his students’ environment to prepare them for real OR scenarios. We must be able to do the same for our patients and for ourselves as we learn. For example, when learning to perform joint mobilizations, our body mechanics are absolutely critical. We can effectively master this technique by breaking down the task into steps:
- Patient positioning
- Table height
- Clinician foot placement
- Clinician hand placement
- Direction of mobilization, force of mobilization, etc.
If we are able to effectively analyze a task to promote our own learning, then we can apply similar logic to educating our patients. By coaching a patient through the foot placement, then ankle, knee, hip, and trunk movement, we can effectively help them master a lateral step-down task.
Clickers may not be ideal in a physical therapy setting, and some patients could potentially be offended at the thought of using one. However, we can utilize the key principle that the clicker provides by simplifying our feedback and optimizing our patient’s environment. This allows our patients to focus more fully on the task at hand, so that you can make the environment increasingly more functional after they’ve mastered the basics. A simple ‘yes’ or ‘no’, or even a click, can go a long way.
-Joe Dietrich, SPT, ATC