Emergency departments offer a unique educational setting where housestaff can be exposed to and learn a variety of procedural skills. However, procedural skills are often overlooked as an assumed activity without a formal educational context. The clinical educator's understanding of the educational principals of teaching and learning procedural skills is minimal. This review offers further insight. The "psychomotor domain," which represents a hierarchy of learning motor skills, and relevant motor learning theory extracted from the educational psychology literature are reviewed. These theoretical considerations can be adapted to and provide useful information relevant to procedural medicine. Issues of curriculum content, methods of teaching and learning, and issues of competence relevant to the creation of a procedural skill program are reviewed and discussed.