N582 Module 3 assignment: psychomotor domain lesson plan using deliberate practice and mastery learning, a full sample

Practice Until Mastery: A Deliberate Practice Lesson Plan for Teaching Open Tracheostomy Suctioning

Student Name

Master of Science in Nursing Program, Aspen University

N582: Teaching Strategies in Nursing Education

Instructor Name

Month Day, Year

Practice Until Mastery: A Deliberate Practice Lesson Plan for Teaching Open Tracheostomy Suctioning

Suctioning a tracheostomy is a skill that nursing students may perform only once or twice during their clinical rotations, often under pressure and with a patient who is coughing and anxious. In a composite baccalaureate program, faculty noticed that students who had watched a demonstration and practiced once in the skills laboratory still hesitated at the bedside, forgot to preoxygenate or suctioned too long. A single demonstration followed by a single return demonstration was producing exposure, not competence.

This paper presents a psychomotor lesson plan built on deliberate practice and mastery learning. It states the objectives, describes the lesson's sequence, explains why the design rests on evidence and describes how competence will be assessed before students perform the skill on patients.

Principles Behind the Design

Ericsson (2004) described deliberate practice as practice that is focused on a well-defined task, performed at an appropriate level of difficulty, accompanied by immediate informative feedback and repeated with opportunities to correct errors. Expert performance, in his account, comes from sustained deliberate practice rather than from experience alone. Mastery learning adds a standard: every learner must meet a defined level of performance before moving on, and time, not the standard, is what varies.

The combination has strong support for clinical skills. In a meta-analysis of 14 studies comparing simulation-based education with deliberate practice to traditional clinical education, McGaghie et al. (2011) found an overall effect size of 0.71 in favor of simulation with deliberate practice for achieving specific clinical skill goals, while noting the small number of studies and calling for careful implementation and evaluation.

Deliberate practice also depends on the feedback source. Peer feedback during guided practice is useful for procedural steps that can be checked against a list, but the instructor's feedback is needed for subtler judgments, such as recognizing that a patient's color and oxygen saturation call for stopping and reoxygenating. For this reason, the lesson pairs structured peer checking early in the session with instructor-led deliberate practice later, when errors are fewer and more consequential.

Learning Objectives and Content Standard

By the end of the lesson, each student will be able to identify indications for suctioning, such as audible or visible secretions or a sawtooth pattern on a ventilator waveform; perform open tracheostomy suctioning using sterile technique with preoxygenation, a catheter of appropriate size, suction applied only while withdrawing and each pass limited in duration; assess the patient's oxygenation and respiratory status before, during and after the procedure; and document the procedure and the character of secretions. The technical steps follow current clinical practice guidelines on artificial airway suctioning, which recommend preoxygenation before suctioning in adults and children, generally avoiding normal saline instillation and using sterile technique during open suctioning (Blakeman et al., 2022).

The Lesson Sequence

The table summarizes the 120-minute laboratory session for groups of eight students with one instructor.

Two design choices deserve explanation. First, the deliberate practice cycles focus on one error at a time. A student who forgets to preoxygenate and also suctions too long corrects the first error in the next attempt, then the second, rather than receiving a long list of feedback at once. Second, the mastery check introduces a realistic complication, a drop in oxygen saturation during suctioning, so that students practice stopping, reoxygenating and reassessing rather than completing a memorized routine regardless of the patient's response.

Assessment of Competence

Competence is assessed with a checklist of critical and noncritical steps developed from the practice guideline and reviewed by the course faculty. Critical steps include hand hygiene, preoxygenation, sterile technique, applying suction only on withdrawal, limiting pass duration and assessing the patient afterward. The mastery standard is that the student completes every critical step correctly and at least 90% of all steps. Students who do not meet the standard receive specific feedback, practice again and retest; there is no penalty for needing more than one attempt, which is central to mastery learning. The checklist score is recorded, and only students who have met the standard perform the skill on patients, under supervision.

To check whether the skill is retained, students repeat a brief version of the mastery check before their critical care rotation. Skills decay without use, and a short refresher with deliberate practice before the rotation is more efficient than discovering the decay at the bedside.

Resources and Feasibility

Mastery learning takes more laboratory time than a single return demonstration, and some students will need extra sessions. The program can manage this by scheduling open laboratory hours staffed by trained teaching assistants, recording the demonstration for review, and using peer coaching with the checklist during guided practice, which frees the instructor to focus on students who are struggling. The cost of the extra time is modest compared with the risk of a student suctioning a patient incorrectly, and the same structure can be reused for other infrequent, high-risk skills such as central line dressing changes.

Conclusion

Infrequent, high-risk psychomotor skills are poorly served by a single demonstration and return demonstration. A lesson built on deliberate practice, with focused repetition, immediate feedback and a mastery standard every student must meet, produces the competence students need before they suction a real patient's airway. The evidence supports the approach, and the design can be sustained with peer coaching and open laboratory time. For students who once hesitated at the bedside, practice until mastery replaces exposure with confidence grounded in performance.

References

Blakeman, T. C., Scott, J. B., Yoder, M. A., Capellari, E., & Strickland, S. L. (2022). AARC clinical practice guidelines: Artificial airway suctioning. Respiratory Care, 67(2), 258-271. https://doi.org/10.4187/respcare.09548

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10 Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022

McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706-711. https://doi.org/10.1097/ACM.0b013e318217e119