Using Gagne’s instructional model in phlebotomy education

Figures & data

Table 1 Gagne’s nine events of instruction

Instructional event	Cognitive process
1. Gaining attention	Reception
2. Informing learner of objectives	Expectancy
3. Stimulate recall of prior learning	Retrieval
4. Presenting stimulus	Selective perception
5. Providing learning guidance	Semantic encoding
6. Eliciting performance	Responding
7. Providing feedback	Reinforcement
8. Assessing performance	Retrieval
9. Enhancing retention and transfer	Generalization

Note: Adapted from Gagne RM, Wager WW, Golas KG, Keller JM. Principles of Instructional Design. 5th ed. © 2005 South-Western, a part of Cengage Learning, Inc. ISBN: 9780534582845 (0534582842).¹

Table 2 The preanalytical variables associated with blood specimen collection

Patient variables	Variables in technique	Transportation variables	Specimen variables
Age Sex Special needs Diet Smoking Drugs/alcohol Exercise Stress Diurnal/circadian variations Altitude Dehydration	Patient identification Tourniquet application Site selection Decontamination Equipment/supplies	Delivery (by hand, pneumatic tube) Temperature/light Timing	Identification and labeling Equipment/supplies Anticoagulants Specimen processing (centrifugation) Storage prior to testing

Notes: Adapted from Garza, Diana; Becan-McBride, Kathleen, Phlebotomy Handbook, 9th, © 2015. Adapted by permission of Pearson Education, Inc., New York, New York.²³ Data from McCall and Tankersley.²⁴

Table 3 Role-play scenario

Place:	The phlebotomy room in a medical laboratory
Characters:	1) Phlebotomist, 2) adult patient; Ms Tan Lee Lee (or) Mr Tan Sin How
Equipment:	Two chairs and a table Prelabeled laboratory requisition form Unlabeled prefilled blood tubes
Background:	The medical laboratory is a facility that analyses clinical specimens for the purpose of health and disease management. Blood is a body fluid that is commonly used for such investigational purposes. Upon the order of a medical doctor, the patient will turn up at the medical laboratory with the prefilled laboratory requisition form for the blood tests. It is the role of the phlebotomist to ensure correct patient identification and rightful specimen collection, while paying attention to the quality of specimen collected. Depending on the role-play pair, the adult patient can be a female (Ms Tan Lee Lee) or a male (Mr Tan Sin How). Adult patients are told what their names are and they are to carry the stapled prelabeled laboratory form to the phlebotomist. The laboratory requisition form is purposely labeled wrongly as Ms Tan Lily or Mr Tan Sing Howe. All other patient identifiers remain correct. As lipid profile is ordered, a fasting status is required. Fasting is defined as no caloric intake for at least 8 hours.
Scenario:	An adult patient has been scheduled to go for a blood test. Holding a prelabeled laboratory requisition form, the patient enters the medical laboratory and requests for the blood testing service. The patient is directed to the phlebotomy room by the counter receptionist. You are a phlebotomist and you are going to approach the patient.
Objectives:	• To uphold the positive first impression of a professional phlebotomist • To ensure positive patient identity (using two unique patient identifiers) • To ensure proper blood specimen identification (labeling) • To ensure quality of blood specimen collected (mindful of preanalytical variables; fasting)
The student should:	• Greet patient with a smiling face and in a friendly tone, and maintain comfortable eye contact • Identify the patient by using at least two unique patient identifiers (eg, name [to spell out] and NRIC number) • Check the status of dietary restriction (fasting; “Have you taken any food or drink for the past 8 hours?”) • Label the blood tube immediately after blood collection using simulated prefilled blood tube • Send the labeled blood tube to the laboratory using mock pneumatic tube

Abbreviation: NRIC, National Registry Identification Card.

Figure 1 Phlebotomy checklist.

GagneRMWagerWWGolasKGKellerJMPrinciples of Instructional Design5th edMason, OHSouth-Western2005

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GarzaDBecan-McBrideKPhlebotomy Handbook: Blood Specimen Collection from Basis to AdvancedUpper Saddle River NJPearson Education Inc2015

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McCallRETankersleyCMPhlebotomy EssentialsPhiladelphiaWolters Kluwer2016

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