Group Instruction Research Articles

Differentiated Spelling: Using Small Group Instruction

Spelling instruction is often overlooked by many teachers during reading and language arts. The purpose of this study was to implement a manageable differentiated word study instruction program, drawn from the Words Their Way (WTW) program, to determine how it affected students’ spelling accuracy and how the participants perceived its effect on students’ daily journal writing time in a fourth-grade self-contained classroom. Students were placed into small groups based on their spelling pre-test scores. Data was collected through field notes, student and teacher interviews, a pre- and post-test, and a survey. Qualitative data was analyzed using the constant comparative method, and quantitative data was analyzed using descriptive statistics. Four major themes emerged including benefits and drawbacks of the WTW program, WTW program’s perceived impact on students’ journal writing, and WTW program helping improve students’ spelling accuracy. The researcher also found that most of the participants showed growth on the post-assessment.

Counselors in Training Value of Experiential Learning Experiences: An Exploratory Analysis

Counselor education pedagogy entails multiple unique instructional modalities, including supervision, group counseling, and skills instruction. Counseling programs often include courses such as practicum and internship, which embed experiential learning throughout the curriculum. However, little is known about the motivations and perceptions counselors-in-training hold for experiential learning. Thus, there is a need to explore learners' perceptions of an experiential learning experience on their knowledge and skills and to identify the learners' motivation to participate in experiential learning activities. Twelve counselors-in-training were surveyed after volunteering at a month-long STEM summer camp for middle school students. The Experiential Learning Survey was used to assess counselors-in-training's perception of experiential learning. A modified version of the Self-Regulation Questionnaire was also used to determine motivations for volunteering for experiential learning activities. Based on the findings, counselors-in-training had a favorable perception of experiential learning and reported intrinsic motivation as the main factor influencing volunteerism.

What Makes Study Abroad Transformative? Comparing Linguistic and Cultural Contacts and Learning Outcomes in Virtual vs In-Person Contexts

To what extent can the transformative power and language learning affordances provided by the study abroad experience be virtualized? The large-scale shift away from on-site study abroad to online learning in 2020-2021, caused by the COVID pandemic, has made it possible to compare data for in-person immersion learning versus digitally mediated forms of direct instruction and second language (L2) community engagement of otherwise similarly prepared L2 learner cohorts. The present study compares measured proficiency outcomes, as well as other performance-based data of late-adolescent and young adult U.S. participants in a group of federally sponsored overseas intensive immersion study programs for Arabic, Chinese, and Russian operating abroad for the period 2017-2019 and as virtual programs in 2020-2021 (in-person N=1388 and virtual N=770). Program data for early-stage learners, mid-level learners, and advanced learners are analyzed separately by target language, initial proficiency levels, and program durations. As a result of the COVID pandemic, all programs shifted from in-person format to virtual instruction, provided by the existing overseas partner faculties, who adapted core curricula, group instruction, direct enrollment courses and tutorials for use in both synchronous and asynchronous forms of online instruction. Similarly, organization of homestay visits, internship programs and cultural programming was also shifted to virtual format. Given the importance of language contact and L2 interactions, this study provides comparisons of both aggregate and activity-specific L2 time-on-task levels for both cohorts, documenting comparable levels of instructional time available within the two formats (18 hours/week), but less than half the available hours to the virtual student for informal L2 contact and community engagement activities. Comparisons of the speaking proficiency outcomes by language and training levels revealed a relatively consistent gap in mean gain levels across languages, with participants in the virtual groups attaining on average one proficiency sub-level lower in speaking gains than their respective face-to-face counterparts. Comparisons of reading, listening, and writing outcomes, however, showed smaller differences, sometimes none at all. Intercultural Development Index (IDI) and other data related to participants’ cultural competencies, including cultural referencing, self-presentation (Identity Competence), socio-pragmatic strategy selection, lexical and collocational choices, and other markers were observed generally to fall short of the standards set in previous years by students enrolled in the in-person versions of the same programs. Finally, the study takes note of curricular and technological interventions introduced during the COVID period which have been recommended for adoption in the new cycle of in-person programs in 2022-2023 and beyond.

Developing intercultural competence through a cultural metacognition-featured instructional design in English as a foreign language classrooms.

The soaring demand for intercultural competence (IC) in the globalized world has made it a key concern in foreign language education. Most existing training on IC has often focused on providing immersive intercultural experiences, equipping learners with cultural knowledge, and simulating intercultural situations. However, some of these approaches may not be feasible in English as a foreign language (EFL) classrooms, nor are they effective to prepare learners to cope with the complexities and uncertainties in novel intercultural situations unless there specifically involves higher-order thinking. Thus, this study took a perspective of cultural metacognition and examined whether and how could an instructional design that highlighted cultural metacognition facilitate learners' IC development in an EFL classroom at the tertiary level in Chinese mainland. Fifty-eight undergraduate students enrolled in an English Listening, Viewing, and Speaking course were involved in the instruction, and questionnaires and focus groups were employed for the data collection. A paired sample t-test revealed that there was a significant enhancement in students' intercultural competence in terms of affective, metacognitive, and behavioral dimensions, but not in the knowledge dimension. Thematic analysis indicated that the instructional design was effective in supporting students' intentional knowledge acquiring, developing positive intercultural attitudes, and promoting the translation of cognition into actions. The findings thus confirmed that the instructional design featuring cultural metacognition can be used in domestic EFL contexts, such as College English classrooms at the tertiary level in Chinese mainland, as an effective way of enhancing learners' IC. This study also offered additional evidence of how students' IC development was achieved through a range of metacognitive processes, which may provide implications for teachers to design their IC instructions in similar EFL educational settings.

Digital divide and teaching modality: It's role in technology and instructional strategies.

This quantitative study aimed to better understand how teachers implement technology in a variety of teaching modalities to enhance content delivery and student engagement. More specifically, it aimed to investigate the digital divide of technology usage based upon school setting and usage frequency.Responses were collected using a random sampling method of full-time K-12 public school teachers in a Mid-Atlantic state. The instrument was developed from prior research and examined educator usage frequency of instructional technology in urban, rural, and suburban schools dependent upon teaching modality. A total of 423 participants responded to the researcher-created questionnaire and yielded practical implementations for further study. The findings uncovered significant differences in usage frequency of rural, urban, and suburban teachers utilizing technology dependent upon modality (ex. cooperative learning, small group instruction, student-led research, problem-solving). Results of this investigation contribute to the field through an attempt to foster a discussion of disparities between the integration of technology and school setting. The purpose of this discussion is to identify gaps in the digital divide, apply frameworks geared toward equity, and create professional development opportunities for all educators to differentiate technology usage across multiple teaching modalities.

Simulating Ovariohysterectomy: What Type of Practice Promotes Short- and Long-Term Skills Retention?

Simulation-based surgical training allows students to learn skills through deliberate practice without the patient risk and stress of operating on a live animal. This study sought to determine the ideal distribution of training sessions to improve short- and long-term retention of the skills necessary to perform a simulated ovariohysterectomy (OVH). Fourth-semester students (n = 102) were enrolled. Students in the weekly instruction group (n = 57) completed 10 hours of training on the OVH simulator, with sessions held at approximately weekly intervals. Students in the monthly instruction group (n = 45) completed the same training with approximately monthly sessions. All students were assessed 1 week (short-term retention test) and 5 months following the last training session (long-term retention test). Students in the weekly instruction group scored higher on their short-term assessment than students in the monthly instruction group (p < .001). However, students' scores in the weekly instruction group underwent a significant decrease between their short- and long-term assessments (p < .001), while the monthly group did not experience a decrease in scores (p < .001). There was no difference in long-term assessment scores between weekly and monthly instruction groups. These findings suggest that if educators are seeking maximal performance at a single time point, scheduling instructional sessions on a weekly basis prior to that time would be superior to monthly sessions, but if educators are concerned with long-term retention of skills, scheduling sessions either on a weekly or monthly basis would accomplish that purpose.

The Effect of Tablet App with Different Learning Content on Preschoolers’ Implicit Memory Development: Numbers and Literacy

With the development of new technology, products such as tablets have begun playing an increasingly important role in early childhood education. This study investigated the effect of an educational tablet app based teaching method and a conventional teaching method on young children’s implicit memory. Participants (N = 123) aged between aged three to five from a preschool were divided into four groups, the number cognition and reading comprehension experimental and control groups. The experimental groups underwent using the educational tablet apps for 2 months, while the control group followed regular teaching activities. Participants’ implicit memory were analyzed before and after the training. Among the four groups, the implicit memory of children in the number cognition tablet instruction group improved significantly, followed by the reading comprehension conventional group. The result reinforces previous findings that learning contents presented by different teaching methods could promote young children’s implicit memory development.

Examining the Remote Learning Experiences of Children Born Very Preterm During the COVID-19 Pandemic

This study examined the remote learning activities children born very preterm (VPT; gestational age ≤ 30 weeks) received, compared with children born full term (FT; gestational age ≥ 37 weeks), during the COVID-19 pandemic. Parents of 5- to 6-year-olds born VPT ( n = 33) and FT ( n = 33) reported on the provision, frequency, and duration of teacher-provided live instruction, educational materials, and homework; and parent-provided educational materials. More kindergarten children born VPT received small group instruction and fewer received large group instruction than FT children. Preschoolers born VPT engaged in parent-provided learning apps, educational videos, and reading activities less frequently or for shorter durations than FT children. Findings suggest that while teachers generally implemented remote learning similarly for children born VPT and FT, parents did not. Children born VPT are at higher risk for educational problems and may benefit from more intensive school- and home-based educational interventions to help offset the impact of school closures.

Effects of cardiopulmonary resuscitation instructions on the outcomes of out-of-hospital cardiac arrest: An analysis of the JAAM-OHCA registry.

To determine whether dispatcher-provided cardiopulmonary resuscitation (CPR) instructions improve the outcomes of out-of-hospital cardiac arrest (OHCA). Cases registered in the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry between June 2014 and December 2019 were included. Cases in which the dispatcher provided CPR instructions to the bystander were included in the "Instructions" group", and cases without CPR instructions were included in the "No Instructions" group. The primary outcome was the proportion of patients with a favorable neurological outcome, defined as a Glasgow-Pittsburgh cerebral performance category scale of 1 to 2 at 1 month after OHCA. Overall, 51,199 patients with OHCA were registered in the JAAM-OHCA Registry during the study period. Of these, 33,745 were eligible for the study, with 16,509 in the Instructions group and 17,236 in the No Instructions group. The proportion of patients with a favorable neurological outcome at 1 month after OHCA was inferior in the Instructions group than in the No Instructions group (2.3% versus 3.0%, p < 0.001). After adjustment for patient background characteristics, no association was found between CPR instructions provided by a dispatcher and favorable neurological outcomes at 1 month after OHCA (adjusted odds ratio, 1.000; 95% confidence interval, 0.869-1.151, p = 0.996). The present study found no clear clinical benefit of dispatcher-provided CPR instructions on the neurological outcomes of cases with OHCA.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory.

Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG ("International Cognitive") 2014 clinical practice guidelines were updated. An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice. The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual's functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation. These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory.

THE CONSTRUCTION OF MASCULINITIES AT CHICHEN ITZA: A FUNCTIONAL INTERPRETATION OF STRUCTURE 2D6

AbstractThe structure of power underlying the hegemonic control Chichen Itza held over the Northern Maya Lowlands has been debated for decades. In this article, we present the idea of a dominant discourse on masculinities, which played a fundamental role in both practice and on a symbolic level among the strategies designed to support this emblematic pre-Columbian capital. Our discussion of archaeological evidence will focus on spaces where men are represented, where they would meet and carry out rituals. We contend that gallery-patios such as Structure 2D6 served as instruction and socialization locales for groups of warriors. The architectural configuration of this building is very similar to a series of venues at Chichen Itza and other Mesoamerican cities. In these spaces, associated iconography depicts male individuals in processions and ritual practice, including sacrifice and self-sacrifice. We argue that the gallery of Structure 2D6 was a semi-public, performative space, whose theatricality combined the central alignment of a sacrificial stone and a throne or altar with the presence of several patolli boards carved into the building's plaster floor. Chemical analyses of plastered surfaces testify to intense activities taking place around all three of these features.

Facilitating and Complicating Factors in Distance Language Teaching: Instructors’ Views

The present paper employed instructors’ views to address the facilitating and complicating factors in distance teaching of Turkish. The data were collected through a semi-structured interview form consisting of five questions. The questions were designed by the author and reviewed by two Turkish language teaching specialists. The data were collected through one-on-one online interviews with the participants over Microsoft Teams. To increase the reliability, the participants’ responses, deciphered by the author one Turkish language teaching specialist were explored for interrater consistency. According to the formula proposed by Miles and Huberman, the consistency was found to be 0.94. Accordingly, the difficulties in distance teaching of Turkish were addressed within two themes: technical and teaching-oriented problems. Yet, the participants brought positive remarks on personal, technological, and financial aspects of distance Turkish teaching. Besides, the emerging views regarding educational materials were grouped under distance education platforms and digital tools. The measurement and evaluation problems were also discussed under the reliability of exams and types of language skills assessment. Finally, the recommendations brought by the instructors for distance Turkish teaching were themed under three headings: recommendations for technology, materials, and practice. Overall, future comparative research may employ a larger sample of instructors working in other Turkish language centers and compare the findings. Moreover, further research may seek the attitudes of larger groups of instructors within a quantitative design to suggest more generalizable results. Or, the subject may be addressed by mixed-design research to bring a more comprehensive understanding of the phenomenon.

Automatic Compilation of CNN on Reconfigurable Array Processor Based on Scalable Instruction Group Library

Automatic Compilation of CNN on Reconfigurable Array Processor Based on Scalable Instruction Group Library

Building Preservice Teacher Resiliency with Trauma-Informed Case Based Instruction

At least one in four children in the United States has experienced one or more traumatic events (National Child Traumatic Stress Network Schools Committee [NCTSN], 2008). Children exposed to trauma bring a host of psychological and physical stressors to the classroom. Teachers can positively impact a student's ability to cope with these events and develop resilience (Brooks, 1994), but not without a physical and emotional toll on their well-being. This paper investigates one teacher education program's attempt to better support preservice teachers (PTs) in meeting these challenges by examining the impact of trauma-informed case-based instruction on PTs self-reported resilience and efficacy with Trauma Informed Instructional Practices (TIIP). Before partaking in a teacher education summer study abroad program, 26 PTs completed both the Conner-Division Resilience Scale-10 (CD-RISC) and Teacher Self-Efficacy Scale (TSES) to determine baselines for resilience and efficacy. During the program, eight PTs participated in a special topics course on trauma-informed practices utilizing case-based instruction (treatment group). At the completion of the program, all 26 PTs were reassessed on both scales. Results indicated that PTs made significant gains on both measures, but those who were in the trauma-informed case-based instruction group had significantly greater gains in resiliency than the control group. The findings support the use of case-based instruction for enhancing PTs’ resiliency. Implications are provided for embedding resiliency scaffolds for case-based reasoning through a trauma-informed lens.

Recalibrating Negative Weighting Biases through Risk-Taking Manipulation in College Students with High Rejection Sensitivity: Focusing on Instruction Type

Background: This study aimed to examine negative weighting biases in risk-taking situations and recalibrate the negative weighting biases using Bean Fest training among college students with high levels of rejection sensitivity. Methods: Participants were college students who were randomly assigned to one of three groups: an implicit instruction group, an integrated instruction group, and a control group. In the recalibration condition, participants were informed whether each classification was correct or not, thus recalibrating the valence weighting bias. The integrated instruction group was given a strategic message to recalibrate the negative weighting bias explicitly, while the implicit instruction group was given a message that allowed them to determine the more effective method based on their own response.Results: Both treatment groups recalibrated the negative weighing bias effectively. In addition, the level of rejection sensitivity in the integrated instruction group was significantly reduced compared to that of the implicit instruction group. Conclusions: This result suggests that Bean Fest training is effective in recalibrating the negative weighting bias and reducing rejection sensitivity among college students. The limitations of this study and suggestions for subsequent research are discussed.

Discourse-based grammar instruction in ESL academic writing: a mixed methods study

The present study examined the relative effects of discourse-based and sentence-level grammar instruction on the learning of English present perfect in academic writing, using a sequential explanatory mixed-methods design. Participants were 37 multilingual graduate students enrolled in different sections of an ESL-writing course at a U.S. university. Prior to two 35-minute instruction sessions, the participants completed a pretest composed of acceptability-judgment, forced-choice, and fill-in-the-blank tasks. The same tasks, with different but comparable items, were administered immediately after and four weeks after the completion of the instructions. Retrospective verbalizations were elicited after completion of the delayed post-test to elicit the learners’ awareness of the target form and other related tenses in academic writing. While results of the acceptability-judgment and forced-choice tasks show non-significant differences among the treatment and control groups on the pre-post-delayed post-tests, the discourse-based, fill-in-the-blank task results reveal that the discourse-based instruction group outperformed the other groups immediately after instruction. Results from the retrospective interviews corroborate these findings. Implications for discourse-based grammar instruction are discussed.

Video-based technical feedback and instruction improves tackling technique of community rugby union players

ABSTRACT The aims of this study were to test the change and retention of player’s overall tackling technique and technical components following a player-specific video-based technical feedback and instruction intervention on both their dominant and non-dominant shoulders. Twenty-four (n = 24) rugby union players participated in a non-randomized control-intervention, which consisted of a video-based technical feedback and instruction group (video-based technical feedback) and a no video-based technical feedback and instruction group (control). During 3 sessions (baseline, intervention, retention) separated by one week, participants in each group performed six tackles (3 tackles on each shoulder) on a tackle simulator. In total, 432 tackles (video-based technical feedback = 216, control = 216) were analysed. Each tackle was analysed using a standardized list of technical criteria (arbitrary units, AU). For the dominant shoulder, tackling technique scores significantly improved from baseline to intervention for both groups. For the non-dominant shoulder, only the video-based technical feedback group improved their tackling technique from baseline to intervention (baseline 6.89 [6.33–7.45] AU vs. intervention 7.72 [7.35–8.10] AU p = .001, ES = 0.60 moderate). For the retention session, the video-based technical feedback group scored significantly higher than the control group, for dominant (video-based technical feedback 8.00 [7.60–8.40] AU vs. control 7.22 [6.83–7.62] AU p = .014, ES = 0.66 moderate) and non-dominant (video-based technical feedback 8.11 [7.81–8.41] AU vs. control 7.22 [6.90–7.55] p = .004, ES = 0.96 moderate) tackles. This study demonstrates the efficacy of video-based technical feedback as a method to optimize tackle training for player safety and performance. HIGHLIGHTS Video-based technical feedback can improve tackling technique in both dominant and non-dominant shoulders. Video-based technical feedback group continued to improve following a retention interval of one week. The video-based technical feedback group showed a significant (with a moderate effect size) improvement from baseline for two techniques – namely, “body position – upright to low” and “drive through contact with legs and shoulders”. Video-based technical feedback can be used as a method to optimize tackle training for injury prevention and performance.

Investigating the impact of explicit and implicit instruction on the use of interactional metadiscourse markers

The current study aimed to compare the influence of explicit versus implicit instruction on EFL learners’ use of interactional metadiscourse markers in their writing. The study also aimed to explore the perceptions of EFL learners on the instruction of these markers in their writing classes. 120 female undergraduates who are Arab EFL learners took part in the investigation. A mixed-methods research design was adopted with an explicit instruction group, an implicit instruction group and a control group. The experimental groups were introduced to a set of interactional metadiscourse markers as per Hyland’s (2005) interaction model in two 70-minute sessions. Additionally, the experimental groups completed two post-experimental questionnaires. The results of analysis of variance showed a positive, albeit very limited, influence for the explicit/implicit teaching with the markers of self-mentions, appeals to shared knowledge, directives and questions. As for the participants’ perception of the instructional intervention, the participants viewed both explicit and implicit instruction as helpful but could not always apply what they had learned due to task demands. The results are discussed in light of the existing literature and the specific context in which the study was implemented. Furthermore, implications for writing pedagogy are proposed.

Effectiveness of Combined Flipped and Classroom-based Instruction in Teaching Pulmonary Ultrasound to First-year Medical Students

Background and Objectives of the Study The study aimed to determine the effectiveness of combining flipped classroom on pulmonary ultrasound instruction in first-year medical students with traditional classroom-based instruction and compared it to traditional classroom-based instruction alone. The insights of the teachers and the students on the implementation of both interventions were also evaluated. Research Methodology This is a mixed qualitative (concurrent triangulated) and quantitative research. Baseline procedural knowledge and skills of a total of 282 students on the lung ultrasound scanning using pre-test 20-item summative test, multiple-choice question type of examination, and a pre-test narrative test on lung ultrasound were obtained. A post-intervention summative assessment and narrative test were administered. Statistical analyses were done to compare the scores. A thematic analysis was done to evaluate the responses to the survey. Results 138 students were randomly assigned to the classroom-based instruction group, while 144 students in the combined flipped and classroom-based instruction group. The number of students who passed the summative (MCQ) test and were given flipped classroom and classroom-based instruction increased (6.3% to 79.9%; p&lt;0.001) and the number of students given classroom-based instruction only, significantly increased (4.3% to 79.9%; p&lt;0.001). The number of students who passed the narrative test and were given flipped classroom and classroom-based instructions increased (2.1% to 84.0%; p&lt;0.001) and the number of students given the classroom-based instruction only, also significantly increased (3.6% to 84.2%; p&lt;0.001). The students appreciated the classroom-based instruction because of the knowledgeable facilitators, the very concise approach, that is understandable and done in real-time. In addition, the flipped classroom was likewise helpful and a good introduction before the classroom-based instruction. The facilitators have noticed that the ease in instruction was influenced by the student’s enthusiasm and willingness to learn. Conclusion Flipped classroom in addition to classroom-based instruction, and classroom based instruction were effective in teaching pulmonary ultrasound to First-year medical students Key words: flipped classroom, lung ultrasound, pulmonary ultrasound, medical school, medical students, medical education, blended classroom, classroom-based instruction, ultrasound, ultrasound medical education, video-based instruction

Evaluation of Metered Dose Inhaler Use Technique and Response to Educational Training

Prescribing inhalers without imparting adequate education regarding proper technique of their usage may result in suboptimal clinical improvement and wastage of medication. Training interventions using a standard check-list may help improve faulty techniques and enhance drug efficacy. Patients using metered dose inhaler (MDI) were included in the study. Inhaler technique was first evaluated at baseline using a standard check-list of recommended steps (National Institute of Health guidelines; see Table) and scores were given for each step correctly performed. Those who could not perform all steps correctly were given training intervention. The patients were assigned to two methods of educational intervention; one group was trained by providing written material giving step-wise instructions while the other group was given an actual physical demonstration using a placebo device. The technique was re-evaluated and scored following each educational session, and continued till the patient achieved a full score, or for a maximum of 3 sessions, whichever occurred earlier. Median score was calculated after each session and was compared between the two groups. Each patient was followed up after two months and the re-evaluated the same way. One hundred and seventeen subjects were enrolled in the study (59 in the written group and 57 in the practical demonstration group). At baseline, only 1 of the 117 subjects could perform all the steps of inhaler usage correctly. This patient was, therefore, not provided the inhaler technique education. The overall median (range) score of the whole group was 3 (range 1-8). This score rose to 6, 7 and 8 after each of the three subsequent educational intervention sessions. At one-month follow-up, the median score dropped to 7 and improved with a repeat educational session as previously done. A significant difference was observed in the median score improvement achieved in the practical demonstration group compared with the written instruction group (3.0 versus 2.0 respectively, p < 0.001). Inhalation technique of patients improves after imparting systematic educational intervention. A practical demonstration of all the steps proved more effective than simple verbal/written advice. In view of increasing errors being committed over a period of time, repeated demonstration of the proper technique using a standard check-list significantly improves the errors committed during inhaler use.