Multimodal Large Language Models (MLLMs)show strong medical visual understanding,however their capability for continuous per-ception in procedural clinical workflows re-mains underexplored. We present Perceive-and-Plan, a decomposed in-context learningparadigm for clinical skill keyframe reorder-ing. The method separates visual perceptionfrom temporal planning via two stages: (1)structured visual perception with saliency-guided Picture-in-Picture (PiP) compositionthat magnifies critical regions (head, chest)as color-coded insets, and (2) temporal rea-soning with chain-style self-verification viafresh conversation reset and visual-evidenceanchoring (BLS Rules R1-R11). Withoutparameter updates, our system scores 71.43overall (2nd place, ClinSkill QA 2026), with0.86 pairwise accuracy and 1.0 rationale cover-age. Structured prompting with visual saliencyguidance measurably improves MLLMs’ pro-cedural understanding.Our code is pub-lished at https://github.com/NanceTide/clinskillqa-perceive-and-plan.