Appendix E: Training Techniques

TeamSTEPPS Course Management Guide

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

Training Techniques

Presentation Skills

Presenting effective classes takes a combination of technical competence, knowledge of the material, and practice. Being an effective presenter is a learned skill. Even when the presenter has an in-depth knowledge of the material, it is important to practice the delivery for maximum impact.

Speaker Attributes

  • Speech — Speak naturally, using the same mannerisms as during a personal conversation.
  • Vocabulary — Use terms the audience will understand.
  • Enthusiasm — Demonstrate enthusiasm for teamwork. Enthusiasm is infectious and will help to overcome obstacles to learning.
  • Sincerity — Course content has serious implications for the staff. That said, it is possible to be serious and still have fun.
  • Knowledge and experience — Use your understanding of the subject matter and applied experience to guide the students through the learning process.
  • Credibility — As a leader in the department, sharing your personal commitment to teamwork will lend credibility to the course.
  • Attitude/self-confidence — A positive attitude about the importance of the subject matter and confidence in your ability to present the material will ensure an effective class session.
  • Eye contact — Maintain eye contact with the audience, referring to your teaching guide and audio-visual aids as necessary to ensure accuracy.
  • Dress — Dress in a manner appropriate to your instructor role and establishes an environment conducive to learning.
  • Gestures/Mannerisms — Natural is better. Avoid behaviors that create a distraction to learning, such as putting your hands in your pockets and jingling your change.
  • Movement — The best way to move around the class is to walk naturally, and keep the pace slow. Too much movement can become a distraction for students.

Presentation Aids

Several aids are available to assist with the delivery of the TeamSTEPPS Course. These include:

  • Slides — These require a computer and a projection device.
  • TeamSTEPPS Course Videos — These are included on the DVD and embedded in the slides.
  • White board or flipchart — These training aids provide the user with the ability to jot down ideas and thoughts from participants during the presentation.

Managing Difficult Situations

A number of situations may arise in the classroom that can derail the training session. It is important that the instructor be prepared to manage these when they occur.

  • Non-communicative group/individual:
    • Ask direct questions.
    • Ask "yes/no" questions, then ask for an explanation.
    • Call individuals by name.
    • Restate or rephrase or reword questions to focus attention.
  • Controlling, persistent talker
    • Ask direct "yes/no" questions, thank the trainee, and move back to your presentation.
    • Offer to follow-up with the trainee after the presentation.
    • Take the trainee aside during a break and discuss the effect they are having on the class. Be tactful, but firm.
    • Interrupt with: "That's an interesting point.let's see what others in the group think about it."
  • You lose control of the presentation
    • Re-establish eye contact.
    • Change your position.
    • Redirect the group to the visual aids.
    • Ask direct questions to the more disruptive group members.
    • Change the tone or volume of your voice.
    • Call a break.
  • The group gets off topic.
    • Restate your objective.
    • Summarize.
    • Ask "yes/no" questions, then ask for an explanation that relates to the topic.
    • Refer to your visual aids.

Side Conversation

  • Call individual(s) by name and ask an easy question.
  • If you are in the habit of moving around the room, stand casually behind the members who are talking. This should not be made obvious to the group.

Adult Learning Model

One of the keys to being an effective instructor is to tailor the presentation to the audience. TeamSTEPPS classes will include a mix of students from different positions and educational backgrounds (e.g., medical technicians, nurses, physicians, and clerks). However, there is one constant in this mixture; all of the students are adults. Research has shown that certain teaching techniques enhance training provided to adults. Adults learn best when they are involved in the learning process. The following characteristics are common to adult students.

  • Adult learners are self-directed.
  • The adult's orientation to learning tends to be task or problem—centered.
  • Adult learners are motivated by internal incentives.
  • Adults learn best in a climate that is relaxed, collaborative, and mutually respectful.
  • Adults learn best through experiential activities that have immediate application to life tasks.

The CPR Approach (Pike 1994)

Training expert Bob Pike uses the acronym CPR to address the importance of content relevancy, learner participation, and reinforcement in classroom training. This approach meets the needs of the adult learner and ensures the transfer of training.


  • Link goals of the TeamSTEPPS Course to local problems (This answers the question, "What's in it for me?")
  • Introduce locally defined and fully endorsed internal support structures at appropriate points during teamwork training.
  • Use personal vignettes to exemplify teaching points.
  • All vignettes and examples should be from events that actually happened.


  • Foster interaction through appropriate classroom layout.
  • Encourage learners to share their personal experiences.
  • Engage learners in practical exercises.
  • Allow time for questions and discussion.


  • Instruct participants to mark central concepts in their notes.
  • Reinforce key teamwork actions at the end of each module.
  • Clarify the objectives of each practical exercise during facilitation.
  • Reinforce behaviors depicted in the videotape.

Facilitation Skills

Facilitation is a method of instruction that utilizes the principles of the adult learning model. Unlike didactic instruction in which the instructor leads the discussion step-by-step and summarizes each topic, a facilitation approach promotes student learning through a process of inquiry in which the instructor asks questions that generate discussion relative to principles taught in the course.

Facilitation Basics

An effective presentation applies the facilitation basics listed below:

  • Encourage student participation. The adult learning model is built around the concept of self-learning. One way to ensure that students are involved in the learning process is to encourage participation in the discussions.
  • Adapt the level of facilitation to the students. It is important to know the audience. Depending upon the subject and the students' experiences, it is possible to use varying degrees of facilitation during a training session.
  • Ensure all critical topics are covered. Keep in mind the objectives of the class; if the discussion goes off on a tangent, guide it back on track.
  • Integrate instructional points as needed. Make sure the discussions stay focused on the subject. Use questions and statements to emphasize instructional points.

Facilitation Techniques

A skilled facilitator encourages student participation through:

  • Non-verbal feedback — Body language provides instant feedback to the speaker. Use it to your advantage; show the speaker that you are receptive to his/her opinion/idea.
  • Short interjections — Use short statements to affirm discussion points or guide the discussion toward a learning objective.
  • Echoing — Restate the point to ensure other class members were able to hear.
  • Reflecting — Direct the point back to the student or class.
  • Expanding — Expound upon the student's point.

Asking Questions

Questions are one of the most important tools available to the facilitator. Used correctly, questions provide immediate feedback about training effectiveness, are a means of assessing students' knowledge, and can be used to guide discussions. When used incorrectly, questions can stifle student participation and the learning process.

Questioning techniques:

  • Direct question — In this questioning technique, the facilitator identifies the person who will answer the question before it is stated. This action may create anxiety unless a supportive and trusting environment has been firmly established.
  • General address question — When using this questioning technique, the facilitator will first state the question, pause, and then call upon an individual to answer the question. This technique is better than the direct question because it tends to create less anxiety and students have time to formulate a response.
  • Return question — This technique is similar to the reflecting technique discussed in the previous section. Instead of answering a student's question, the facilitator returns the question to the student for an answer.
  • Relay — Instead of answering a student's question, the facilitator chooses another student to answer. This is most effective when combined with the general address questioning technique.

Questions should focus students' attention on the training objective and involve them in the learning process. The following question set is one method of doing this.

  • What has happened up to this point?
  • What do you think about what happened?
  • What would you do differently, if anything?

What does the instructor do if there is no response to a question? The answer depends upon the level of facilitation being employed.

  • High-level facilitation — Use silence or pauses to elicit responses. It will normally take only a short period of time before the participants will feel obligated to speak.
  • Intermediate-level facilitation — Re-word the question to ensure understanding, prompt the participants with bits of information, and try to avoid answering the question.
  • Low-level facilitation — Answer the question, but confirm that the class understands and agrees with the answer.

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Page last reviewed October 2014
Page originally created September 2012
Internet Citation: Appendix E: Training Techniques. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.