What can I do?

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  1. Use video-recordings of demonstrations to provide feedback [1]
  2. Demonstrate a skill, then do it again breaking down each part, then do it again while students describe what’s happening, then get students to do it themselves [2]
  3. Have students mentally rehearse skills [3]

What is this about?

In a health setting, demonstrations are a teaching method in which the educator shows the student how to perform a task or procedure, usually through a hands-on demonstration or through the use of visual aids. Demonstrations can be used to introduce new material, to reinforce or clarify existing material, or to provide students with the opportunity to observe and learn from the educator or from their peers.

Part of this summary is informed by Peyton’s teaching approach:

  • Peyton’s teaching approach is a stepwise teaching approach and consists of the following four steps: (i) step 1 refers to the demonstration of the whole procedure in real time (‘‘demonstration’’); (ii) in step 2 the teacher repeats the demonstration but this time all procedural sub-steps are described (‘‘deconstruction’’); (iii) during step 3 the student talks the teacher through the procedure. The teacher performs the procedure under the guidance of the student (‘‘comprehension’’) and (iv) in step 4 the students carry out the procedure on their own initiative (‘‘performance’’) (2, p. 2)

Another part is informed by research on mental practice:

  • Mental practice is a method for learning a procedure without actually physically performing it. Mental practice relates to mental rehearsal in this review. This doesn’t cover other practice conditions such as relaxation or meditation exercises. Mental practice may involve exercises such as thinking about the procedure and its parts but mental practice may also include different imagery techniques (with the purpose to maximise equivalence with physical practice, e.g. instruction mode or position of the learner) (3, p. 3)

What's the evidence say?

Compared to standard ‘see one, do one’ approaches, using Peyton’s teaching approach (i.e., demonstration-deconstruction-comprehension-performance) had a larger effect on procedural skill development ➕ ➕ ➕ ➕  [2]. This effect was reversed when peers - instead of educators - were the teachers ➖ ➖ [2]. The student-to-teacher ratio was also important. The impact of using Peyton’s teaching approach decreases as student numbers increase [2]. Using video-recordings - where possible and appropriate - has been shown to have a large effect on learning procedural skills ➕ ➕ ➕ ➕  [1]. Mental rehearsal also had a large effect on procedural skill development ➕ ➕ ➕ ➕  [3]. There’s no compelling evidence that either practicing the whole skill or parts of the skill influences skill development, both are as effective as each other [3]. Similarly, the effects of providing feedback throughout an attempt of waiting until the attempt has finished are equivocal [3].

What's the underlying theory?

  1. Social Cognitive Theory suggests that demonstrations can influence learning by providing students with information about the standards and expectations of the learning environment, and by providing opportunities for social comparison. Demonstrations can also provide a sense of social support and encouragement, which can enhance motivation and learning.
  2. Constructivist Theory suggests that demonstrations can facilitate learning by providing students with the opportunity to construct their own understanding of the material through hands-on experience and reflection. Demonstrations can provide a concrete and experiential context for learning, which can help students to make connections between the material and their own lives and experiences.
  3. Self-Regulation Theory suggests that demonstrations can facilitate learning by providing students with the opportunity to take responsibility for their own learning and to monitor and regulate their own progress. Demonstrations can provide students with a structured and supportive environment in which to practice and reflect on their learning, and to develop strategies for self-regulation. This process can help students to become more self-directed and motivated learners.

Where does the evidence come from?

This evidence summary is based on three meta-analyses. The first [1] explored the use of video feedback in education settings and included studies that principally focused on improving effective communication in professional practice. The 33 studies included in this paper were mostly controlled (over half were randomised controlled trials) and represented a variety of health and non-health professions. The authors reported significant heterogeneity, but no publication bias ➕➕➕ . The second study [2] explored the use of Peyton’s 4-step teaching approach. This meta-analysis consisted of 14 randomised controlled studies and covered a variety of different procedural skills. The heterogeneity was large and no information was provided regarding publication bias ➕➕➕ . The final meta-analysis [3] investigated the evidence behind four motor learning principles (i.e., part v. whole practice, random v. blocked practice, mental practice, terminal v concurrent feedback) in health education. The paper included 15 primary studies (all were randomised controlled trials). Heterogeneity scores were within acceptable limits, but no publication bias was included ➕➕➕➕ .


  1. Fukkink, R. G., Trienekens, N., & Kramer, L. J. C. (2011). Video Feedback in Education and Training: Putting Learning in the Picture. Educational Psychology Review, 23(1), 45-63.
  2. Giacomino, K., Caliesch, R., & Sattelmayer, K. M. (2020). The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ, 8, e10129.
  3. Sattelmayer, M., Elsig, S., Hilfiker, R., & Baer, G. (2016). A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education. BMC Medical Education, 16, 15.

Additional Resources