Trainee questions? Flip “ASK” into “KSA”

A recent supervisors workshop has made me think about how I structure teachjng sessions – often a medical student or registrar will come along and say ‘teach me something’ – My teaching is often shaped by what I am interested in, by events that have happened recently or by the desire to finish teaching ASAP and get to the pub.

Even when the subject matter seems clear, it may be hard to give structure to teaching rather than ‘winging it’.

This week I was exposed to the KSA approach. We’re all familiar with the ‘flipped classroom’ – as well as pre-teaching preparation, if you are bailed up on the run or in the corridor then:

“flip the trainee’s ASK to KSA”

Consider these three domains relevant to any topic :

  • ‘knowledge’
  • ‘skills’
  • ‘attitude’

…or KSA.

Then consider what you wish to impart :

  • the learning objectives
  • the desired competencies that need to be reached
  • how you will achieve this (strategies).

Then apply them across each of the KSA domains.


Screen Shot 2013-11-28 at 6.04.24 pm


As an example, let’s say we sit down to have a chat after dealing with an emergency psychiatric presentation requiring intravenous sedation, detention and transfer.

Knowledge might include

  • assessment of the acute psychiatric patient
  • focused history & examination of agitated patient
  • pharmacology and rationale selection of ‘take down’ medications
  • understanding risks of procedural sedation inc psychiatric risk vs anaesthetic risk
  • knowledge of appropriate mental health criteria for detention

Skills might include

  • confidence with assessment and history
  • ability to consider IN-IM-IV-PO routes of drug administration, pros/cons
  • use of ETCO2 in monitoring sedated patient
  • completion of appropriate mental health paperwork
  • use of Richmond Agitation Sedation Scale
  • use of appropriate suicide risk scores

Attitude might include

  • understanding how to manage own feelings towards psychiatric emergency
  • human factors in emergency team work
  • interagency attitudes with police, ambulance, retrieval, mental health teams

Using this matrix has helped me consolidate my teaching approach.

Thanks to Adelaide-to-Outback for suggesting this tool.


1 thought on “Trainee questions? Flip “ASK” into “KSA””

  1. This is a very useful post. I have used a simpler “template” of 2 components. Teaching the mindset and then teach the skill. Similar to what u have discussed. My particular bias is towards the mindset. My philosophy is that if u get the mindset right then the “how” and the “what” will come easier. Dr Vin @

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