Development Of Procedural Skills Research Articles

Improving assessment of procedural skills in health sciences education: a validation study of a rubrics system in neurophysiotherapy

BackgroundThe development of procedural skills is essential in health sciences education. Rubrics can be useful for learning and assessing these skills. To this end, a set of rubrics were developed in case of neurophysiotherapy maneuvers for undergraduates. Although students found the rubrics to be valid and useful in previous courses, the analysis of the practical exam results showed the need to change them in order to improve their validity and reliability, especially when used for summative purposes. After reviewing the rubrics, this paper analyzes their validity and reliability for promoting the learning of neurophysiotherapy maneuvers and assessing the acquisition of the procedural skills they involve.MethodsIn this cross-sectional and psychometric study, six experts and 142 undergraduate students of a neurophysiotherapy subject from a Spanish university participated. The rubrics’ validity (content and structural) and reliability (inter-rater and internal consistency) were analyzed. The students’ scores in the subject practical exam derived from the application of the rubrics, as well as the rubrics’ criteria difficulty and discrimination indices were also determined.ResultsThe rubrics´ content validity was found to be adequate (Content Validity Index > 0.90). These showed a unidimensional structure, and an acceptable internal consistency (α = 0.71) and inter-rater reliability (Fleiss’ ƙ=0.44, ICC = 0.94). The scores of the subject practical exam practically covered the entire range of possible theoretical scores, showing all the criterion medium-low to medium difficulty indices - except for the one related to the physical therapist position-. All the criterion exhibited adequate discrimination indices (rpbis > 0.39), as did the rubric as a whole (Ferguson’s δ = 0.86). Students highlighted the rubrics´ usefulness for learning the maneuvers, as well as their validity and reliability for formative and summative assessment.ConclusionsThe changed rubrics constitute a valid and reliable instrument for evaluating the execution quality of neurophysiotherapy maneuvers from a summative evaluation viewpoint. This study facilitates the development of rubrics aimed at promoting different practical skills in health-science education.

Simulation-Based Education in Acute and Chronic Pain Training.

The use of simulation-based education (SBE) in medical training has expanded greatly and has grown to include high fidelity and task simulation along with hybrid models using patient actors to enhance education and training of critical events as well as technical skills. In the field of anesthesiology, SBE has been particularly useful for crisis resource management and rare critical scenarios and new research into the use of SBE using task simulation for procedural skill development has been done highlighting the benefits to subspecialty procedural training. Medical simulation has become a common practice in medical training and research. SBE has demonstrated positive outcomes in improving technical skills, knowledge, comfort, and clinical performance. The widespread implementation of SBE in regional anesthesia and chronic pain training varies, with cost and availability being factors. Nonetheless, SBE has shown great potential in enhancing education and preparing physicians in subspecialties of anesthesia.

Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa

BackgroundIn 2021, South Africa introduced a 6-month internship rotation in family medicine, in the second year of a 2-year internship programme for newly qualified doctors. This was a major change from the previous 3-months training in family medicine, and expanded the training platform to smaller district hospitals and primary health care (PHC) facilities, many of which had never had interns. The medical disciplines in South Africa needed to know if this change in the internship programme was worthwhile and successful. The aim of this study was to assess the new family medicine rotation for medical interns at district health facilities in the Western Cape Province.MethodsDescriptive exploratory qualitative research included six intern programmes across the province. Purposeful sampling identified a heterogeneous group with maximum variation in experience. Overall, eight interns, four managers, four supervisors and four intern curators were included. Individual semi-structured interviews were audio-recorded and the transcripts were thematically analysed using the framework method and Atlas-ti software.ResultsFour major themes emerged around the varied structure and organisational characteristics of the rotations, the orientation and arrival of interns, their learning during the rotation, and impact on health services. A programme theory was developed that defined the key inputs (i.e. infrastructure, communication, orientation, preparation, prior learning and guidelines), processes (i.e. model of the rotation, clinical training and supervision, clinical teaching), outputs (i.e. more independent decision making, approach to undifferentiated problems, approach to chronic care and continuity, development of procedural skills, approach to sequential coordination of care and referrals, working in a multidisciplinary team and inter-professional learning, integration of multiple competencies, as well as becoming more person and community orientated).ConclusionsThe new rotation in family medicine was positively experienced by most interns, supervisors and managers. It should lead to improved quality of care, better preparation for obligatory community service, and an increased likelihood of considering a career in district level health services. This study will form part of an exploratory sequential mixed methods study that incorporates the key issues into a questionnaire for a descriptive survey of all interns in a subsequent study.

Moral disengagement mechanisms in interactions of human drivers with autonomous vehicles: Validation of a new scale and relevance with personality, driving style and attitudes

The introduction of autonomous vehicles (AVs) in the road transportation systems raises questions with respect to their interactions with human drivers’, especially during the early stages. Issues such as unfamiliarity or false assumptions regarding the timid and safe behaviour of AVs could potentially result in undesirable human driver behaviours, for instance “testing” AVs or being aggressive towards them. Among other factors, morality has been determined as a source of aggressive driving behaviour. Following previous approaches on moral disengagement, the current paper argues that moral standards during interactions of human drivers with AVs could potentially blur, leading to the disengagement of self-regulation mechanisms of moral behaviour. The study investigates the impact of moral disengagement on the intention of human drivers to be aggressive towards AVs. To that end, an online survey was conducted including a newly developed survey of moral disengagement, adapted to the context of AVs. Moreover, measures of personality, driving style, attitudes towards sharing the road with AVs and perceived threats were collected. A confirmatory factor analysis provided support for the concept of moral disengagement in the context of AVs. Moreover, relationships between personality, driving style and attitudes towards sharing the road with AVs were found, via a structural equation modelling approach (SEM). The results could have implications in the future driver training and education programmes, as it might be necessary to not only focus on driving skills but also on the development of procedural skills that will improve the understanding of AVs’ capabilities and ensure safer interactions. Efforts on improving attitudes towards AVs may also be necessary for improving human driver behaviour.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents’ procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development.

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

OA03 Impact of the COVID-19 pandemic on rheumatology training: results of the regional survey from the North West of England

Abstract Background/Aims The COVID-19 pandemic has disrupted healthcare delivery and provision of medical education and training worldwide. We assessed the impact of the COVID-19 pandemic on rheumatology training experience in the Northwest and Merseyside deaneries of England. Methods Rheumatology trainees from the Northwest and Merseyside deaneries were issued links to an anonymous web-based survey on their training experience between August 2020 to April 2021, during the 2nd wave of the Covid-19 pandemic. Results 34 of 42 trainees completed the survey. 31 were in clinical training: 13 (42%) in a pure rheumatology post and 18 (58%) in a dual post with general medicine. Most trainees attended 3-4 clinics per week (58%), with 23% attending ≤2 clinics and 19% attending 5 clinics. The proportion of face-to-face clinics ranged from 20% to 100% (median 60%). The reduced face-to-face clinical experience was not due to trainees’ needs to shield. The range of proportion of phone consultations was 0% to 80% (median 40%). Remote consultations were conducted by telephone only for 26 (84%) trainees and by video or phone for 3 (10%). The durations for both face-to-face and virtual consultations were ranged similarly at 15 to 45 minutes (median 30minutes) for new cases and 15 to 30 minutes (median 20 minutes) for follow-ups. Only 5 (16%) trainees felt confident with assessing new patients by remote consultation. 8 (26%) trainees had some form of formal training in a virtual consultation. However, only 4 (13%) reported being “aware” of how to guide a patient through self-examination of the joints, 17 (55%) trainees were “somewhat aware”, and 10 (32%) were “not aware”. 20 (65%) trainees reported reliance on radiological and serological investigations rather than clinical skills during remote consultations. Development of skills for patient communication, joint injections, time management, and prescribing immune-suppressive medications were mainly hampered. The majority of trainees agreed that virtual educational programs had improved opportunities for attendance at structured deanery teaching sessions. Conclusion The impact of the COVID-19 pandemic on rheumatology training has been significant both in terms of current rheumatology education programme delivery and training requirements. Our regional survey shows less than a third of trainees had formal training in conducting remote consultations resulting in low levels of confidence in assessing patients remotely. Less face-to-face patient contact negatively impacted clinical and procedural skills development. Restructuring the rheumatology curricula to include training in rheumatology-specific remote consultations and ensuring clinical and procedural competencies by including novel support modalities like simulation sessions may be options for consideration going forwards. Delivery of some structured teaching sessions through the virtual platform is here to stay. Disclosure E.P. Chua: None. Y. Tan: None. L.K. Mercer: None. S. Wig: None.

Percepción sobre clases virtuales de estudiantes de odontología de la Universidad Nacional de Concepción durante el COVID-19, 2020

COVID-19 generated the need to apply virtual education. This work aims to evaluate the development of virtual classes of the Faculty of Dentistry of the National University of Concepción during the isolation by covid-19 from the perspective of the students, year 2020, with a quantitative, descriptive, non-experimental approach, sample for convenience, being n=55. Self-administered electronic forms were applied, which was validated by expert judgment. The conclusions were reached: the students are satisfied with the teaching/learning process for the development of theoretical or conceptual virtual classes, but affirm that these cannot replace face-to-face classes, claim to generate new knowledge and are not very satisfied with the development of procedural skills. Saving time is the most outstanding advantage, among the disadvantages it was observed, due to the multiple distractors that are generated. The factors that affect the development of virtual classes are the lack of motivation to learn more about the different subjects, and for the participation of virtual classes by teachers; as well as the poor Internet connection and the lack of management for the use of Blogs as a form of collaborative work and analysis.

Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis.

Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = -1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = -0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = -0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = -0.78 to 0.87)], attitude change [SMD = -0.09 (95% CI = -0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = -0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills.

Application of the «Alexander Technique» in violin and viola classrooms. Analysis of its impact through audiovisual materials

The teaching and learning process of a musical instrument is intrinsically related to the development of procedural skills, where the acquisition of control in the execution of the actions occupies a highly significant place. From this point we turn our gaze towards the Alexander Technique (AT), where the mind-body is assumed to function in an integrated way. In the present study we examine the impact of its implementation in violin and viola classrooms, in relation to the modeling of specific behaviors to the performance and musical interpretation through a recording technology. To do this, we use the qualitative methodological paradigm, which conforms both to the objectives of our research as well as to the theoretical-practical foundation of AT, characterized by a holistic vision. The study starts from a specific course in this subject for elementary and professional teachers of violin and viola. After its completion, different teachers videotaped their pedagogical practices implementing the TA, which we analyzed through our proposed analytical model of classroom praxis. Using the Atlas.ti software for the treatment of the data from the audiovisual records, the results revealed that the professors subject to research incorporate various aspects of the AT in their pedagogical-didactic classroom action. The conclusions point to a set of potentialities that the application of AT presents in relation to the instrumental teaching-learning process.

Turning The Tables On Tradition: Flipped High-Fidelity Simulation To Potentiate Learning.

Innovative teaching modalities are more popular than ever within medical education. Examples include the flipped classroom model, incorporation of digital media and use of high-fidelity simulation technology. Our novel flipped simulation curriculum proposes the use of the flipped teaching method within the simulation lab for undergraduate and graduate medical education. With a focus on case-based learning, procedural skill development, and clinical excellence, flipped simulation incorporates many of the most important facets of medical education.

Computer-Based Video Instruction for Training Medical Students on Skin Biopsies.

The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills. This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology. Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention. In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p < .001, respectively). Approximately 33.3% of the students stated that the experience increased their interest in the field of dermatology. Incorporation of CBVI into the dermatology curriculum augments medical students' procedural skills. The CBVI group performed significantly better in all 7 grading categories for shave biopsy and in 5 of 7 categories for punch biopsy. Integration of procedural laboratory tests raises students' interest in dermatology.

Pilot Test of a Collaborative "Helping Hands" Tele-Assistance System for the Development of Clinical Skills.

The development and acquisition of clinical skills take time and practice. Access to expertise and guidance to perform clinical (patient care) procedures can be difficult, especially in real-world clinical settings. We developed an innovative, collaborative tele-assistance system that provided remote guidance to nursing students in the development of procedural skills. Proof of concept was demonstrated. Instructors were able to guide learners in undertaking procedures remotely using the helping hands technology. Such technology has the potential to improve health professional education in the workplace.

The Evaluation of the Problem Solving in Mathematics Course According to Student Views

This study was conducted to determine the problem solving skills of the third grade students studying at the department of elementary school mathematics teaching. The study was conducted in the second semester of the academic year of 2015-2016. The study group consists of 47 third year student who study at Ondokuz Mayis University, Faculty of Education Elementary School Mathematics Teaching ad take the selective course of Problem Solving in Mathematics. Within the scope of this course, the researchers explained subjects related to problem and problem solving, problem solving skills and solved problems during the first 4 weeks of the course. For the rest of the weeks, the students were divided into groups. They have solved two non-routine problems each week for 8 weeks. The method of study is the interview method, which is one of the qualitative research methods. In light of the retrieved findings, the answers given by the students have been thematized as the stages of problem solving, understanding the problem, implementing the problem, evaluation of the problem, reasons for taking the courses, association problems, ways of finding different solutions, development of procedural skills, creating formulas, mathematical thinking, use of mathematical language, suitability of the course, views on problem solving, and the contribution of the course.

Establishing the effectiveness, cost-effectiveness and student experience of a Simulation-based education Training program On the Prevention of Falls (STOP-Falls) among hospitalised inpatients: a protocol for a randomised controlled trial

IntroductionSimulation-based education (SBE) is now commonly used across health professional disciplines to teach a range of skills. The evidence base supporting the effectiveness of this approach for improving patient health...

Beyond learning by doing: an exploration of critical incidents in outdoor leadership education

This paper argues that outdoor leader education and training is characterized by the development of procedural skills at the expense of crucial but usually ignored non-technical skills (e.g. contextualized decision-making and reflection). This risks producing practitioners with a potentially unsophisticated awareness of the holistic outdoor environment impeding the development of links between theory and practice. This paper analyses the application of critical incident theory to a study of undergraduates in a UK outdoor leadership degree programme in order to examine the processes of developing non-technical reflective skills in the students. The study examines a range of critical incidents in a purposive homogeneous sample of students who were asked to identify and reflect on critical incidents in practice settings of their own choice. These settings spanned from the United Kingdom to remote locations overseas. Qualitative data analysis was carried out using interpretative phenomenological analysis. The findings indicated that outdoor leadership programmes need to develop a broader and holistic skills base rather than concentrate on primarily physical and technical skills. A focus on the critical incident method early in education has the potential to equip practitioners with the holistic and complex set of skills required in the contemporary outdoor workplace.

Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

Simulation - the need for a paradigm shift in urological training.

Surgical training based on the Halstedian principle of apprenticeship has not really changed for over a century now. Educationists endeavor constantly to reduce the time taken for students/trainees to achieve competency while meeting safety standards. This is due to the constraints of time, economics, facilities, teachers, regulations, governance and the need to fill manpower gaps in the healthcare system. The increasing demand for clinical productivity from senior physicians, for example, in the United Kingdom has seen a paradigm shift – from the ‘consultant led’ care a decade ago to the ‘consultant delivered’ care provided now. Therefore, experts are able to allocate only a limited time to train students and residents. In addition to the skills required to practise as a physician, surgeons need to achieve competency in various surgical procedures. Training that encompasses development of both technical and non-technical skills such as knowledge acquisition, team work, communication and interpersonal skills (conveniently grouped under the umbrella of crisis resource management – CRM) can be simulated in a stress-free and safe environment (as there is no ‘live’ patient) [1]. In this issue of the journal, Preece has provided a concise review of the currently available simulation tools in urology [2]. Individual procedural skill development simulators have not had a wider audience to test their construct and content validities nor have there been comparative studies using large volumes of participants to assess the superiority of individual models. Further studies are required especially in this area so that the curricula that are integrating simulation into their surgical training programs can make cost-effective investments. While integration of simulation in surgical training is inevitable, the use of simulation in assessments of trainees may be a leap of faith given that this field is still relatively in its infancy [3]. It is worth remembering that the goal of simulation in surgical training is to alter the slope of the learning curve. It cannot make the curve disappear. Simulation is here to remain and will be an important adjunct to clinical apprenticeship in urological training. Systematic integration into mainstream urological training needs careful planning and uniform implementation in the domains of training, assessment and certification.

How much training is required to implant and manage CRT?

The number of patients receiving cardiac resynchronization therapies (CRTs) is increasing at a substantial rate. The implant, however, is not always performed effectively and the complication rates are considerable. The training and accreditation to perform CRT need to be evaluated to optimize procedural and patient outcomes. The relationship between higher procedural volumes and reduced procedural complications is evident and consistent across a range of surgical specialties and procedures. Present guidelines recommend that training in CRT can be achieved with five to 25 cases. The limited studies in this area suggest that this is inadequate, with complication rates of CRT reducing significantly with procedural experience well beyond 100 cases.There is increasing evidence that the development of procedural skills is dependent not only on cognitive factors, but also on a number of intrinsic visuospatial factors and fine motor dexterity. These factors can be tested objectively and the validity of adopting these techniques for the selection and training of operators is being evaluated. Ongoing evaluation of the training requirements and accreditation is required to optimize the implantation of CRT.

Physical Fidelity Versus Cognitive Fidelity Training in Procedural Skills Acquisition

The current study examined whether training simulators for the acquisition of procedural skills should emphasize physical fidelity or cognitive fidelity of the task. Simulation-based training for acquiring and practicing procedural skills is becoming widely established. Generally speaking, these simulators offer technological sophistication but disregard theory-based design, leaving unanswered the question of what task features should be represented in the simulators.The authors compared real-world training and two alternative virtual trainers, one emphasizing physical fidelity and the other cognitive fidelity of the task. Participants were randomly assigned to one of four training groups in a LEGO assembly task: virtual-physical fidelity, cognitive fidelity, real world, and control. A posttraining test to assess the development of procedural skills was conducted. Both the virtual-physical fidelity and cognitive fidelity training methods produced better performance time than no training at all, as did the real-world training. The cognitive fidelity training was inferior in terms of test time compared to the real-world training, whereas the virtual-physical fidelity training was not. In contrast, only the real-world and the cognitive fidelity groups, and not the virtual-physical fidelity group, required significantly less time than the control group for error correction. The two training methods have complementary advantages. Combining physical fidelity and cognitive training methods can enhance procedural skills acquisition when real-world training is not practicable.