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News|Articles|April 25, 2025

Show, Tell, Teach: Elevating EVS Training Through Cognitive Science and Performance Coaching

Training EVS workers for hygiene excellence demands more than manuals—it requires active engagement, motor skills coaching, and teach-back techniques to reduce HAIs and improve patient outcomes.

Hygiene performance involves cleaning and maintaining indoor environments to achieve desired hygienic outcomes—high-performance hygiene—to minimize exposures and health care-associated infections (HAIs).

Cognitive science and motor skills research in performance fields such as education, health care, and athletics can offer many lessons to those training environmental service (EVS) workers.

Education, Health Care

Learning involves active use of the mind and body. Since students who passively read and then re-read material do not learn it better than those who read it just once1 but are more engaged with the material, providing a task list and description or even a task manual for EVS workers to read/re-read does not convey the correct procedure without engagement and field application.

Cognitive studies show an effective way to teach involves guided practice—distributed and repeated over time2—plus a 2-way show and tell (ST) process in which a teacher or coach demonstrates the correct method, the student demonstrates it back to the teacher, gets more instruction or coaching, then the cycle repeats until mastered. The emphasis is on action and interaction—engagement—for mastery.3

“There has been a wealth of motor learning research over the years on the use and value of demonstrations (show) and verbal instructions (tell) to facilitate learning a new task,” said physical education expert Jane Shimon,3 citing the 2017 work of Magill and Anderson.4

ST uses “teach-back” —originally where patients explained back in their own words what doctors said to show they understood what doctors intended5 —when EVS staff teach other healthcare workers (HCW) based on the “teach once, learn twice” concept. (Figure 1)

Effective training in hygiene performance transitions the process from passive to active and interactive modes.

Athletics

In performance swimming, would you prepare for a swim meet by repeatedly studying the pool's dimensions and the water's aspects (the learning equivalent of passively re-reading material)? Of course not. You take the plunge, get wet, get coached, and practice: Steps might include practicing swimming the length of the pool several times each day, alternating endurance with speed, counting the number of strokes required each way so you know when to execute a turn, and practicing different strokes to see how they affect your progress—all guided by a 2-way ST approach to hone your skills and train your mind and muscles.

In competitive swimming, using a 2-way ST approach involves watching video of champion swimmers and/or a skilled coach demonstrating a stroke (showing) and explaining why it works (telling), trainees practicing it back, and video recording their swim to review and share with others (showing and telling); then repeating until learned.

Performance Hygiene

If technique matters in performance athletics, then it matters even more in performance hygiene, where lives may be at stake. For example: proper disinfection of hard surfaces requires more than reading and rereading the product label or even a how-to guide, but ideally a video-driven and -recorded stepped process of active-practice including: 1) clear notice to bystanders that an area is being treated, 2) application of the product in the right way to avoid aerosolizing the product but enabling enough liquid volume to the surface to enable proper dwell time, 3) moving to other activities while proper dwell or set time occurs, 4) removing the solution ideally by a squeegee for flat surfaces or otherwise by microfiber, and 5) rinsing the surfaces to prevent leaving skin-irritating residues or soil-attracting buildup. (There are times, of course, when disinfectants are left to air-dry on surfaces, a practice that may be the lesser of 2 evils: While it may increase chemical exposures/buildups, it more effectively prevents disease transmission.)

Another example is proper handwashing technique, which may be achieved by an ST handwashing certification, a credential offered by the Indoor Health Council.

Regardless of the endgame, using a 2-way ST video-recorded process or practice saved to the Learning Management System or Training Management System provides solid evidence and a video record that the teacher has taught and the learner has learned.

Learning Sustained

Training is learning. Learning requires effort. (Sidebar) Effort is only sustainable when there is a reward or benefit for the work invested.

HCW Training benefits include:

  • Better regulatory compliance
  • Job satisfaction
  • Career opportunities
  • Credentialing and recognized achievement, eg, CHESP (Certified Health Care Environmental Services Professional)6
  • Greater HCW skills, knowledge, and confidence
  • Better patient care
  • Fewer HAIs
  • Lower operational costs
  • Higher employee retention
  • More teamwork between departments (eg, infection prevention and control and EVS)

A Word About Manuals

Think of a procedure’s manual as an action guide or template, not as passive reading material. Achieving consistent results requires a consistent process; a task manual helps serve this purpose. For example, the US Training Within Industry (TWI) program developed during World War II and later adopted by Toyota, required the trainer to know the manual completely, “like a director would know every line in a play’s script (and how the performance is intended to be received), and then deliver them like an actor…” and “It was decided that a [training] manual should be readable from a distance of from four to five feet [with oversized fonts and images], and that a glance should be enough to show the exact kind of thing that the trainer should be doing—what he must put on the board and the few parts which were to be stated verbatim.” 7 [brackets inserted by authors]

EVS training manuals should follow suit.

Sidebar: Core Truths About Learning and Training

Core Truths About Learning and Training

  1. “Training” encompasses all forms, whether virtual or otherwise, as research shows that the principles of effective training transcend delivery methods and are founded on core truths.
  1. Humans may have unlimited ability to learn, but there are effective and ineffective ways to do it.
  1. Learning is effortful, difficult, challenging, and not easy.
  1. Learning is a mindset; trainees must decide to learn, just as we must decide to teach.
  1. Learning or training involves gaining the knowledge and skills necessary to understand and address the opportunities and challenges we face.
  1. Learning or training is effective to the extent it engages the mind and body in effortful work that involves hard pulling information from memory (knowledge retrieval) and is a matter of degree; For example, a multiple-choice quiz is a form of knowledge retrieval but is not as effective as hard pulling information solely from memory, or practicing, spacing and interleaving* steps/processes and engaging muscle memory.
  1. Associated Retrieval Training with Spacing (ARTS) is the most effective way to learn long-term, as it involves spaced knowledge retrieval that is interleaved from related or unrelated topics over time; a method that may not be intuitive, but research shows it is the most effective way to learn a concept or physical process.
  1. Per the book, Make It Stick: "If learners spread out their study of a topic, returning to it periodically over time, they remember it better.... Similarly, if they interleave the study of different topics, they learn each better than if they had studied them one at a time in sequence."8

Cognitive research shows that interleaving or studying diverse, smaller topics over time is more effective than studying a single, large topic in depth in one sitting.

References

  1. Callender A, McDaniel M. The limited benefits of rereading educational texts. 2009.
  2. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving students' learning with effective learning techniques: promising directions from cognitive and educational psychology. Psychol Sci Public Interest. 2013;14(1):4-58. doi:10.1177/1529100612453266
  3. Shimon J. Show and tell: A teaching strategy. Phys Health Educ Am. 2022.
  4. Magill RA, Anderson DI. Motor Learning and Control: Concepts and Applications. 11th ed. McGraw-Hill Education; 2017.
  5. Anderson KM, Leister S, De Rego R. The 5Ts for teach back: an operational definition for teach-back training. Health Lit Res Pract. 2020;4(3):e148-e156. doi:10.3928/24748307-20200617-01
  6. Association for the Health Care Environment (AHE). Accessed April 19, 2025. https://www.ahe.org/
  7. Dinero D. Training Within Industry: The Foundation of Lean. Taylor & Francis; 2005.
  8. Brown PC, Roediger HL III, McDaniel MA. Make It Stick: The Science of Successful Learning. Harvard University Press; 2014.

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