Peyton's four-step approach: differential effects of single instructional steps on procedural and memory performance - a clarification study

"Seeing inside out": revealing the effectiveness of otoscopy training in virtual reality enhanced practical exams - a randomized controlled trial

BACKGROUND

The study aimed to assess the impact of different training modalities on otoscopy performance during a practical exam using a high-fidelity simulator and to determine if objective evaluation of otoscopy is feasible using a simulator that records insertion depth and tympanic membrane coverage.

METHODS

Participants were assigned to one of four groups: control and three intervention groups with varying training approaches. Participants received otoscopy training and then were assessed through a practical exam on a high-fidelity simulator that uses virtual reality to visualize the ear canal and middle ear. Performance was evaluated using a modified Objective Structured Assessment of Technical Skills checklist and Integrated Procedural Performance Instrument checklist. Insertion depth, tympanic membrane coverage, and correct diagnosis were recorded. Data were tested for normal distribution using the Shapiro-Wilk test. One-way ANOVA and, for non-normally distributed data, Kruskal-Wallis test combined with Dunn's test for multiple comparisons were used. Interrater reliability was assessed using Cohen's κ and Intraclass correlation coefficient.

RESULTS

All groups rated their training sessions positively. Performance on the OSATS checklist was similar among groups. IPPI scores indicated comparable patient handling skills. The feedback group examined larger tympanic membrane areas and had higher rates of correct diagnosis. The correct insertion depth was rarely achieved by all participants. Interrater reliability for OSATS was strong. IPPI reliability showed good correlation.

CONCLUSION

Regardless of training modality, participants perceived learning improvement and skill acquisition. Feedback improved examination performance, indicating simulator-guided training enhances skills. High-fidelity simulator usage in exams provides an objective assessment of performance.

Comparison of Peyton's Four-Step Approach With the Conventional Bedside Technique in Teaching Clinical Examination Skills to Medical Students

BACKGROUND

 Conventional bedside teaching (CBT) is an integral and classical method for imparting clinical skills to undergraduates in medical schools. It is a traditionally successful approach, especially when it comes to imparting patient-doctor relationship skills and knowledge on clinical management. Peyton's four-step approach (PFSA) is one of the newer structured instructional approaches for teaching-learning, especially for imparting procedural and complex psychomotor skills. The present study compares the application of PFSA in teaching complex systemic examination skills to the CBT technique in teaching the same skill to MBBS students. The impact of the acquisition of this examination skill was assessed statistically to compare PFSA and CBT methodologies.

METHODOLOGY

 The target population was MBBS (Bachelor of Medicine and Bachelor of Surgery) students; for this study, the phase II MBBS students were considered as the study population since they were relatively naïve to clinical bedside examination skills. Students were allotted groups and they were taught clinical skills through CBT and PFSA separately. Using the OpenEpi toolkit Version 3 open-source sample size calculator for comparing two means, the sample size was 30 students in each group. The students were assessed for their competency and were also made to fill out a feedback questionnaire to compare the two methods of education dispensing.  Results: The results of this study showed that PFSA is definitely suitable for teaching clinical examination skills. The acquisition of skills was found non-inferior to CBT while the retention of these skills was found to be equally good or even superior with PFSA than with CBT.  Conclusion: PFSA has already been proven to be a good teaching method for the acquisition of complex procedural skills. This study expands the role of PFSA in teaching clinical bedside examination skills to medical students. Further large-scale studies may clarify the learning impact and outcomes of PFSA in clinical bedside teaching.

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BACKGROUND

This experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.

METHODS

In a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.

RESULTS

Ninety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann-Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).

CONCLUSIONS

The integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.

TRIAL REGISTRATION

University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

Teaching rotary root canal instrumentation using a Peyton teaching approach

INTRODUCTION

The aim of the study was two evaluate the effectiveness of a Peyton teaching approach for rotary root canal instrumentation, in comparison to the traditional "see one-do one" method.

MATERIAL AND METHODS

Forty undergraduate students were randomly divided into two groups (n = 20). Students of the first group (G1) were taught how to use rotary instrumentation using a modified Peyton method, whilst the second group (G2) watched a teaching video (30 min) on the same subject. Both groups instrumented a plastic block and subsequently both mesial canals of an extracted lower molar. The quality of the root canal instrumentation was analysed by 2 blinded observers on video recordings and x-rays.

RESULTS

Interobserver correlation was 0.917 (p < .0005; Pearson) for the assessment of the video recordings; students of G1 received significantly more total points (83.55 ± 6.82 points) compared to G2 (69.76 ± 13.82) (p = .001; t-test), the gender had no significant effect on the overall results (p = .444; two-way ANOVA). Significant differences were detected for the categories "initial scouting," "coronal enlargement," "glide path preparation," "preparation using X2 file," "preparation using X3 file" (p < .05; t-test) as well as for the subcategories "sequence of rinse, recapitulation, rinse" (p = .001; t-test) and "recapitulation" (p < .002; t-test). No differences between groups were observed for the radiographic evaluation with respect to working length and canal straightening.

CONCLUSION

Teaching rotary instrumentation by using the Peyton approach resulted in improved performance of undergraduate students assessed with a checklist-based process analysis. Enhanced implementation of rotary instrumentation could result in better long-term results of students' root canal treatment.

Learning surgical knot tying and suturing technique - effects of different forms of training in a controlled randomized trial with dental students

Objective

The acquisition of surgical skills requires motor learning. A special form of this is intermanual transfer by transferring motor skills from the nondominant hand (NDH) to the dominant hand (DH). The purpose of this study was to determine the learning gains that can be achieved for the DH by training with the DH, the NDH, and by non-surgical alternative training (AT).

Methods

124 preclinical (n=62) and clinical (n=62) dental students completed surgical knot tying and suturing technique training with the DH, with the NDH, and an AT in a controlled randomized trial.

Results

A statistically significant learning gain in knot tying and suture technique with the DH was evident only after training with the DH when compared to training with the NDH (p<0.001 and p=0.004, respectively) and an AT (p=0.001 and p=0.010, respectively). Of those students who achieved a learning gain ≥4 OSATS points, 46.4% (n=32) benefited in their knot tying technique with the DH from training with the DH, 29.0% (n=20) from training with the NDH, and 24.6% (n=17) from an AT while 45.7% (n=32) benefited in their suturing technique with the DH from training with the DH, 31.4% (n=22) from training with the NDH, and 22, 9% (n=16) from an AT.

Conclusions

Training with the DH enabled significantly better learning gains in the surgical knot tying and suturing techniques with the DH.

Deconstructing forearm casting task by videos with step-by-step simulation teaching improved performance of medical students: is making working student's memory work better similar to a process of artificial intelligence or just an improvement of the prefrontal cortex homunculus?

PURPOSE

To compare two teaching methods of a forearm cast in medical students through simulation, the traditional method (Trad) based on a continuous demonstration of the procedure and the task deconstruction method (Decon) with the procedure fragmenting into its constituent parts using videos.

METHODS

During simulation training of the below elbow casting technique, 64 medical students were randomized in two groups. Trad group demonstrated the entire procedure without pausing. Decon group received step-wise teaching with educational videos emphasizing key components of the procedure. Direct and video evaluations were performed immediately after training (day 0) and at six months. Performance in casting was assessed using a 25-item checklist, a seven item global rating scale (GRS Performance), and a one item GRS (GRS Final Product).

RESULTS

Fifty-two students (Trad n = 24; Decon n = 28) underwent both day zero and six month assessments. At day zero, the Decon group showed higher performance via video evaluation for OSATS (p = 0.035); GRS performance (p < 0.001); GRS final product (p < 0.001), and for GRS performance (p < 0.001) and GRS final product (p = 0.011) via direct evaluation. After six months, performance was decreased in both groups with ultimately no difference in performance between groups via both direct and video evaluation. Having done a rotation in orthopaedic surgery was the only independent factor associated to higher performance.

CONCLUSIONS

The modified video-based version simulation led to a higher performance than the traditional method immediately after the course and could be the preferred method for teaching complex skills.

Using an OSCE to Explore the Role of Structured Debriefing and Self-Directed Learning in Simulator-Based Clinical Skill Training in Production Animal Reproductive Medicine

Self-directed learning is associated with several benefits in simulation-based clinical skill training and can be complemented by feedback in the form of post-event debriefing. In this study, final-year veterinary medicine students (n = 111) were allocated into one of three groups and practiced four clinical skills from the domain of production animal reproductive medicine in a clinical skills laboratory. Group 1 completed an instructor-led practice session (I), group 2 completed a self-directed practice session with post-event debriefing (D), and group 3 completed a self-directed practice session without debriefing (control, C). Each practice session included two clinical skills categorized as being directly patient-related (patient) and two clinical skills involving laboratory diagnostics or assembling equipment (technical). Students evaluated the practice session using Likert-type scales. Two days after practice, 93 students took part in an objective structured clinical examination (OSCE). Student performance was analyzed for each learning station individually. The percentage of students who passed the OSCE did not differ significantly between the three groups at any learning station. While the examiner had an effect on absolute OSCE scores (%) at one learning station, the percentage of students who passed the OSCE did not differ between examiners. Patient learning stations were more popular with students than technical learning stations, and the percentage of students who passed the OSCE was significantly larger among students who enjoyed practicing at the respective station (90.9%) than among those who did not (77.8%).

Virtual Deliberate Practice Module for Tracheostomy Change Training: An Application of Educational Design Research

Background

The pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills.

Objective

To develop and evaluate a virtual module prototype grounded in deliberate practice using tracheostomy change as an example.

Methods

After identifying desirable features of a virtual module by surveying stakeholders, we designed a prototype using VoiceThread, a multimedia-based collaborative learning platform. We created an asynchronous module accessible to learners for repeated skill practice and for video upload of individual performance on a tracheostomy task trainer using personal devices. This virtual module provided a four-step coaching (demonstration, deconstruction, formulation, and performance) to practice tracheostomy change. Two instructors reviewed the learners’ performance videos, providing timely feedback for further refinement of skills.

Results

Sixty-four residents completed the module, System Usability Scale, and self-efficacy survey. All residents rated the module, with a mean System Usability Scale score of 68.6 ± 18.4 (maximum score of 100). Two independent instructors rated performance videos using a 12-item checklist with mean interobserver agreement of 88.1% (standard deviation, 9.7) and mean performance checklist score (n = 40) of 10.1 (standard deviation, 1.2) out of 12. After training, residents reported high confidence in their ability to list and perform procedural steps, with improvement in median (interquartile range) comfort levels from 1 (1–2) to 4 (3–4) out of 5 (P < 0.0001).

Conclusion

We developed an asynchronous deliberate practice module on a virtual platform using tracheostomy change as an example. Residents evaluated the module favorably using system usability and learner self-efficacy surveys with improvement of skills.

Teaching fiberoptic-assisted tracheoscopy in very low birth weight infants: A randomized controlled simulator study

OBJECTIVE

We developed a fiberoptic-assisted tracheoscopy (FAST) method to avoid direct laryngoscopy during surfactant replacement therapy and compared two training approaches on a very low birth weight (VLBW) infant simulator.

DESIGN

This prospective randomized controlled study was conducted at the Department of Neonatology and Pediatric Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf, Germany.

PARTICIPANTS

We recruited physicians, trainees, students, and nurses without prior experience in endoscopic techniques.

INTERVENTIONS

Participants were assigned randomly to a group that received instructions according to Peyton's Four-Step Approach and a control group that received standard bedside teaching only.

MAIN OUTCOME MEASURES

Primary endpoints were the total and the component times required to place the bronchoscope and the method success.

RESULTS

We recruited 186 participants. Compared with the control group, the Peyton group had a lower mean (±standard deviation) FAST completion time (33.2 ± 27.5 s vs. 79.5 ± 47.9 s, p < 0.001; d = 1.12) and a higher FAST success rate (95% vs. 84%, p = 0.036, V = 0.18).

CONCLUSION

After standardized training, the vast majority of novices completed FAST successfully. Peyton's four-step approach resulted in faster and more successful performance than standardized training.

Undergraduate Medical Students' Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills

INTRODUCTION

Video-based learning has gained prominence in medical education and, more recently, in musculoskeletal teaching. This study investigated medical students' perceptions of the effectiveness of online video-based learning for musculoskeletal physical examination skills.

METHODS

For one academic year, undergraduate medical students were instructed online through video-based learning before bedside teaching about the physical examination of knee and shoulder joints. At the end of the course, the students participated in a survey to assess their perceptions of the online video-based learning module using a pre-validated questionnaire. The questionnaire consisted of closed-ended and open-ended questions. The closed-ended question responses were assessed using a Likert scale; the open-ended responses were analyzed qualitatively.

RESULTS

In total, 242 out of 310 students who participated in the online video-based learning responded to the survey. Most students found the teaching approach to be satisfactory and preferable to traditional teaching methods. However, they also felt that these modules could not replace hands-on practice. The most helpful aspects of the training modules were a better understanding of the specific tests, technique, and sequence of administering the physical examination. Perceived limitations included the inadequately addressed theoretical basis of the physical examination and the special tests, the need for more time to explain clinical anatomy, and the practical implications of the positive special tests.

CONCLUSION

Undergraduate medical students perceive VBL as helpful for MPES learning. The positive aspects of the VBL approach in teaching MPES are that it is comprehensive, easily accessible, offers standardized teaching, save times, and it includes demonstrations of special tests, examination techniques, and the sequence and organization of the clinical examination. The main perceived limitations were lack of content regarding clinical reasoning and the anatomical basis of the clinical tests.

The 3-D Skills Model: a Randomised Controlled Pilot Study Comparing a Novel 1-1 Near-Peer Teaching Model to a Formative OSCE with Self-regulated Practice

INTRODUCTION

Near-peer teaching is a popular pedagogical teaching tool, with well-recognised benefits for students and tutors. There are multiple existing models to structure these interventions, but it is often unclear how they translate to academic attainment. We designed a novel near-peer teaching model that expands on previous research.

METHODS

Our model was piloted in a formative Objective Structured Clinical Examination (OSCE) setting, trialled on 22 pre-clinical medical students to establish feasibility, acceptability and descriptive outcomes that could inform the design of a larger study. Students were randomly assigned to intervention or control cohorts. Each cohort undertook 5 min formative OSCE assessments with either 3 additional minutes of structured teaching or 3 min of self-regulated practice before reattempting the first OSCE station. Checklist marking sheets for 1^st and 2^nd sittings were collected by independent external markers, in addition to a global assessment rating in which we used the Borderline Regression Method to establish the station pass mark.

RESULTS

A quantitative and qualitative result analysis was performed, demonstrating that students gained on average 3 additional marks after teaching with this model. Students and student-tutors reported increased confidence, high course satisfaction and evidence of reflective practice.

DISCUSSION

We established acceptability and feasibility outcomes. The descriptive outcomes will support the design of a larger, adequately powered study required to demonstrate translation to summative exam performance.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01369-w.

Interprofessional Point-of-Care Ultrasound Training of Resident Physicians by Sonography Student-Coaches

INTRODUCTION

Point-of-care ultrasound (POCUS) education is growing throughout medical education, but many institutions lack POCUS-trained faculty. Interprofessional education offers a strategy for expanding the pool of available teachers while providing an opportunity for collaboration between health professional students.

METHODS

Six students enrolled in the diagnostic medical sonography (DMS) program participated in a case-based, train-the-trainer session to practice a standardized approach for POCUS instruction. They then served as coaches to 25 first-year internal medicine residents learning to perform ultrasound exams of the kidneys, bladder, and aorta. Course assessment included an objective structured exam (OSCE), coaching evaluations, and course evaluations.

RESULTS

Residents scored an average of 81% (71.3 out of 88 points, SD = 7.5) on the OSCE. Residents rated the DMS student-coaches positively on all teacher evaluation questions. Both the residents and DMS student-coaches gave positive course evaluations scores.

DISCUSSION

An interprofessional workshop with DMS students coaching internal medicine residents was an effective strategy for teaching POCUS skills. This approach may offer a solution for programs wanting to implement POCUS training with limited faculty expertise or time.

Curated collections for educators: Six key papers on teaching procedural skills

BACKGROUND

Competence in teaching procedural skills is required for faculty in all specialties. Regardless of involvement in undergraduate medical education (UME) versus graduate medical education (GME), faculty will likely be involved in teaching procedures to novice learners at some point, with the goal of having the learner achieve graduated independence and technical competence in a skill set. A large body of literature exists addressing the best practices for teaching and maintaining procedural skills. We searched for articles that describe the best practices for teaching procedural skills to all levels of learners.

METHODS

We conducted a literature search for papers on procedural skills training and teaching. We also made a call for papers on social media from members of the online #MedEd and #FOAMed communities. Once a list of the articles was compiled, we conducted a three-round modified Delphi process to identify those illustrating best practices for teaching procedural skills by both junior and senior faculty.

RESULTS

We identified 98 relevant articles on the topic of procedural skills training. Six articles were deemed to be highly relevant after three rounds of the modified Delphi. Best practices included using an established educational framework when designing procedural skills teaching sessions, providing positive feedback to learners with opportunities for improvement, and demonstrating the procedure to the learners.

CONCLUSIONS

Medical educators should employ evidence-based practices when designing and delivering procedural skills sessions. Educational frameworks provide faculty developers and facilitators with an organized approach to teaching these sessions. Maintenance of procedural skills over time is key; faculty can utilize simulation-based procedural training and deliberate practice to prevent decay of learned skills.

Face, Content, and Construct Validity of a Virtual Reality Otoscopy Simulator and Applicability to Medical Training

Objective

Otologic diseases are common in all age groups and can significantly impair the function of this important sensory organ. To make a correct diagnosis, the correct handling of the otoscope and a correctly performed examination are essential. A virtual reality simulator could make it easier to teach this difficult-to-teach skill. The aim of this study was to assess the face, content, and construct validity of the novel virtual reality otoscopy simulator and the applicability to otologic training.

Study Design

Face and content validity was assessed with a questionnaire. Construct validity was assessed in a prospectively designed controlled trial.

Setting

Training for medical students at a tertiary referral center.

Method

The questionnaire used a 6-point Likert scale. The otoscopy was rated with a modified Objective Structured Assessment of Technical Skills. Time to complete the task and the percentage of the assessed eardrum surface were recorded.

Results

The realism of the simulator and the applicability to medical training were assessed across several items. The ratings suggested good face and content validity as well as usefulness and functionality of the simulator. The otolaryngologists significantly outperformed the student group in all categories measured (P < .0001), suggesting construct validity of the simulator.

Conclusion

In this study, we could demonstrate face, content, and construct validity for a novel high-fidelity virtual reality otoscopy simulator. The results encourage the use of the otoscopy simulator as a complementary tool to traditional teaching methods in a curriculum for medical students.

[Online Teaching in Surgery]

For quite some time, the development and implementation of online teaching has been a controversial issue in surgical education for the degree in medicine. This has become more important with the progression of digitalisation and not least as a result of the current pandemic. It is becoming increasingly urgent to establish the opportunities and limits of online teaching, which has already proved successful under the current developmental pressure, and there are promising concepts. This article addresses the framework and the various online teaching formats in surgery, and illustrates the interplay between technical feasibility, practical experience, and didactic objectives.

Structured work-based learning in undergraduate clinical radiology immersion experience

BACKGROUND

Practical courses in undergraduate medical training often lack a didactic concept. Active participation and learning success largely depend on chance. This study was initiated to evaluate a novel concept of structured work-based learning (WBL) in the course of students' half-day radiology immersion experience (IE).

METHODS

This prospective, single-centre cohort study included 228 third-year students of the 2019 summer semester who underwent the obligatory radiology IE at a university hospital. The course was based on a novel structured WBL concept that applied established didactic concepts including blended learning, the FAIR principles of feedback, activity, individualization, and relevance, and Peyton's four-step approach. Outcomes of equal weight were student and supervisor satisfaction with the clinical radiology IE assessed by paper-based- and online survey, respectively. Secondary outcome was achievement of intended learning outcomes assessed by means of mini clinical evaluation exercises and personal interviews.

RESULTS

Satisfaction with structured WBL was high in 99.0% of students. Students' expectations were exceeded, and they felt taken seriously at the professional level. Dissatisfaction was reasoned with quality of learning videos (0.6%), little support by supervisors (0.5%), or inadequate feedback (0.6%). Supervising resident physicians rated achievement of intended learning outcomes regarding cognitive and psychomotor competences as excellent for all students. Personal interviews revealed achievement of affective competence in some students. Twelve of 16 (75.0%) supervising physicians were satisfied with focussing on intended learning outcomes and student preparation for IE. Two of 15 (13.3%) supervisors were unsatisfied with time spent, and 4 of 16 (25%) with the approach of assessment.

CONCLUSIONS

This study demonstrated that both students and supervisors were satisfied with the novel concept of structured WBL within the scope of clinical radiology IE. Achievement of intended learning outcomes was promising.

Surgical suture course for dental students with the Peyton-4-step approach versus the PDCA cycle using video assisted self-monitoring

BACKGROUND

In this prospective study the Peyton 4-step approach of demonstration-deconstruction-comprehension (verbalization by the learner), and performance by the learner was compared to the PDCA cycle/Deming-Circle (Plan-Do-Check (video assisted self-monitoring)-Act) as a teaching method for surgical suturing and nodes with end performance as the primary objective.

METHODS

Students of the third clinical semester in dental medicine were randomly selected to one of the two teaching methods. They completed a first course during the third clinical semester and a subsequent course during the fourth clinical semester. The focus was on learning surgical suturing techniques. Before the course started a questionnaire was handed out to both groups to evaluate their initial level of performance. Each course ended with a practical test to review the content of the course. The evaluation followed standardized parameters. Some of the test tasks in test one were repeated in test two to measure a horizontal as well as vertical difference in performance level.

RESULTS

53 students (Peyton: n = 28/18 female, 10 male; PDCA: n = 25/14 female, 11 male) have completed both courses. The evaluation of the subjective questionnaires showed that the members of the PDCA-groups achieved a higher subjective increase in performance. The objective results also indicated higher learning success in the PDCA-groups compared to the Peyton-Group.

DISCUSSION/CONCLUSION

This study demonstrated significant learning success for both groups in their own self-assessment as well as in the results of the practical exercises. Subsequently, the superiority of the PDCA cycle could be shown for almost all criteria for surgical suturing techniques. Several studies prioritize the teaching of practical skills according to Peyton and consider step 3 ("comprehension") to be the essential factor. The PDCA cycle, which has its origins in industrial quality management, and its success can be understood from the perspective of learning theory in terms of Jean Piaget's model of equilibration. The necessity of active reflection on the learning content through practice constitutes the key element for transfer into long-term memory.

Online-rotation in paediatrics - digital live-interaction with children

The two-week block rotation in paediatrics (tenth semester) took place for 62 students purely as online teaching in the summer semester of 2020, at the time of the initial restrictions. As a teaching module, virtual patient presentations including debriefing took place as synchronous teaching. Patients and one parent were broadcast from the wards and outpatient clinics via video conference. Students were able to interact in small groups with 15-22 patients or their parents, respectively, via a doctor and both conduct the case history interview and brief the examination steps. Despite the limitation of not being able to perform the clinical examination themselves, participants rated the block rotation with good marks. They particularly appreciated the ability to interact with the children online as an indispensable compromise in times of suspended classroom teaching during the SARS-CoV-2 pandemic.

The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression

Background

Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a "see one - do one" approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton's teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton's 4-step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher.

Methods

We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions.

Results

An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [-0.09; 1.49]) at retention testing were in favour of Peyton's teaching approach for skill acquisition. The groups using Peyton's teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: -0.8; 95% [CI -2.13 to 1.62]) and retention (SMD: -2.65; 95% CI [-7.77 to 2.47]) testing. The effectiveness of Peyton's teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable.

Conclusion

Peyton's teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton's teaching approach is less clear. Peyton's teaching approach is more effective when small groups with few students per teacher are used.

Confronting the Challenges of Anatomy Education in a Competency-Based Medical Curriculum During Normal and Unprecedented Times (COVID-19 Pandemic): Pedagogical Framework Development and Implementation

BACKGROUND

Anatomy is considered to be one of the keystones of undergraduate medical education. However, recently, there has been drastic reduction, both in gross anatomy teaching hours and its context. Additionally, a decrease in the number of trained anatomists and an increase in the costs associated with procuring human cadavers have been noted, causing a diminution of cadaveric dissections in anatomy education.

OBJECTIVE

To address these challenges, there is an ardent need for a pedagogical framework such that anatomy education can be disseminated through active learning principles, within a fixed time frame, using a small team of anatomists and a small number of cadaveric specimens (for live on-site sessions) as well as collaborative learning principles. The latter is particularly important when anatomy education is delivered through distance learning, as is the case currently during the COVID-19 pandemic.

METHODS

Here, we have blueprinted a pedagogical framework blending the instructional design models of Gagne's 9 events of instruction with Peyton's 4-step approach. The framework's applicability was validated through the delivery of anatomical concepts, using an exemplar from the structure-function course Head and Neck during the normal and COVID-19-mandated lockdown periods, employing the archetype of Frey syndrome. Preliminary evaluation of the framework was pursued using student feedback and end-of-course feedback responses. The efficiency of the framework in knowledge transfer was also appraised.

RESULTS

The blueprinted instructional plan designed to implement the pedagogical framework was successfully executed in the dissemination of anatomy education, employing a limited number of cadaveric specimens (during normal times) and a social media application (SMA)-integrated "interactome" strategy (during the COVID-19 lockdown). Students' response to the framework was positive. However, reluctance was expressed by a majority of the faculty in adopting the framework for anatomy education. To address this aspect, a strategy has been designed using Mento's 12-step change management model. The long-term benefits for any medical school to adopt the blended pedagogical framework have also been explicated by applying Bourdieu's Theory of Practice. Additionally, through the design of an SMA interactome model, the framework's applicability to the delivery of anatomy education and content during the ongoing COVID-19 pandemic was realized.

CONCLUSIONS

In conclusion, the study effectively tackles some of the contemporary key challenges associated with the delivery of anatomy content in medical education during normal and unprecedented times.

A Mixed-Methods Evaluation of Medical Residents' Attitudes Towards Interprofessional Learning and Stereotypes Following Sonography Student-Led Point-of-Care Ultrasound Training

BACKGROUND

Point-of-care ultrasound (POCUS) training is growing across internal medicine graduate medical education, but lack of trained faculty is a barrier to many programs. Interprofessional education (IPE) may offer a solution but must overcome potential biases of trainees.

AIM

To evaluate the impact of an interprofessional POCUS training on residents' attitudes towards interprofessional learning and stereotypes.

SETTING

Midwestern health sciences university.

PARTICIPANTS

Diagnostic medical sonography (DMS) students (n = 13) served as teachers for first-year internal medicine residents (IMR) (n = 49).

PROGRAM DESCRIPTION

DMS students participated in a train-the-trainer session to learn teaching strategies via case-based simulation, then coached IMR to acquire images of the kidneys, bladder, and aorta on live models.

PROGRAM EVALUATION

Mixed-methods evaluation, including pre-/post-surveys and focus group interviews. The survey response rate was 100% (49/49 IMR). Composite survey scores evaluating residents' attitudes towards IPE and stereotyping of sonographers improved significantly following the intervention. Qualitative analysis of focus group interviews yielded four themes: enhanced respect for other disciplines, implications for future practice, increased confidence of DMS students, and interest in future IPE opportunities.

DISCUSSION

Interprofessional POCUS education can improve residents' perceptions towards IPE, increase their level of respect for sonographers, and motivate interest in future interprofessional collaboration.

Randomised simulation trial found an association between rescuers' height and weight and chest compression quality during paediatric resuscitation

AIM

Our aim was to examine the relationship between rescuers' anthropometric data and chest compression quality during paediatric resuscitation training.

METHODS

This study focused on 224 medical students (53% women) who performed 2 minutes of paediatric resuscitation at the Medical University of Vienna, Austria: 116 on a baby manikin and 108 on an adolescent manikin. Skill Reporter software measured chest compression quality by recording compression depth, frequency, hand position and complete recoil. The participants' height, weight and body mass index (BMI) were recorded.

RESULTS

Participants with a lower BMI achieved higher total chest compression scores on both the baby and adolescent manikins than participants with a higher BMI. The latter were more likely to exceed the correct compression depth and not achieve complete chest recoil in the adolescent manikin. When it came to the baby manikin, the female participants achieved better chest recoil and the males achieved a higher number of compressions at the correct rate. Males also achieved better chest recoil with the adolescent manikins. Being tall only correlated with incomplete recoil in the adolescent manikin.

CONCLUSION

The results indicate that anthropometric variables were associated with chest compression quality in paediatric patients and should be considered by future education programmes.

Novel modified Peyton's approach for knowledge retention on newborn life support training in medical students

AIM

We sought to improve retention of neonatal resuscitation skills by modifying step 3 through additional functional verbalisation in Peyton's four-step approach (P4S).

METHODS

Newborn life support (NLS) training was performed in a simulation-based setting. In contrast to the traditional approach, students taught with the modified approach were requested to explain every step of their performance in Peyton's step 3. A total of 123 students were allocated into both experimental groups. Students were then assessed by megacode on day four (initial assessment) and 6 months (follow-up assessment).

RESULTS

Both groups showed similar scorings in the initial, follow-up assessment and in mean change. On initial megacode, time to start with initial inflation and post-resuscitation care was significantly faster in the control group. All showed a significant loss of performance irrespective of modification in step 3 in the follow-up assessment. Only time until start with post-resuscitation care shows a significant group difference in mean change between initial and follow-up with increasing time in the control and decreasing time span in intervention group.

CONCLUSION

Both methods showed equal levels of knowledge acquisition and long-term decline in NLS performances. Verbalisation in step 3 influenced speed of applied NLS performance.

Comparing video-based versions of Halsted's 'see one, do one' and Peyton's '4-step approach' for teaching surgical skills: a randomized controlled trial

BACKGROUND

Teaching complex motor skills at a high level remains a challenge in medical education. Established methods often involve large amounts of teaching time and material. The implementation of standardized videos in those methods might help save resources. In this study, video-based versions of Peyton's '4-step Approach' and Halsted's 'See One, Do One' are compared. We hypothesized that the video-based '4-step Approach' would be more effective in learning procedural skills than the 'See One, Do One Approach'.

METHODS

One-hundred-two naïve students were trained to perform a structured facial examination and a Bellocq's tamponade with either Halsted's (n = 57) or Peyton's (n = 45) method within a curricular course. Steps 1 (Halsted) and 1-3 (Peyton) were replaced by standardized teaching videos. The performance was measured directly (T1) and 8 weeks (T2) after the intervention by blinded examiners using structured checklists. An item-analysis was also carried out.

RESULTS

At T1, performance scores significantly differed in favor of the video-based '4-step Approach' (p < 0.01) for both skills. No differences were found at T2 (p < 0.362). The item-analysis revealed that Peyton's method was significantly more effective in the complex subparts of both skills.

CONCLUSIONS

The modified video-based version of Peyton's '4-step Approach' is the preferred method for teaching especially complex motor skills in a large curricular scale. Furthermore, an effective way to utilize Peyton's method in a group setting could be demonstrated. Further studies have to investigate the long-term learning retention of this method in a formative setting.

Endotracheal intubation training to medical practitioners: Comparison of the modified 4-step Payton's training method and Halsted's training method in a simulated environment

INTRODUCTION

The ability of physicians to perform endotracheal intubation by laryngoscope is one of the essential skills. The purpose of this study was to evaluate the effectiveness of the four-step python training method with the Halsted's "See one, Do one, and Teach one" training method in endotracheal intubation competency in simulated environment.

MATERIALS AND METHODS

This quasi-experimental study was performed on two independent groups with posttest. The statistical society consisted of eighth-semester medical students referred to the emergency medicine unit. The experimental group received a modified four-step python's training method that modified for small groups, and the control group received the Halsted's "See one, Do one, and Teach one" training method. Researcher-made checklist used to rate participant competency as posttest. Data were analyzed using SPSS 19 software.

RESULTS

Sixty-seven students volunteered for the experimental group and 57 students for the control group. In posttest, the experimental group more competent than the control group significantly (P < 0.001). Furthermore, the training course satisfaction of the experimental group was significantly higher than the control group (P < 0.001).

DISCUSSION AND CONCLUSION

Modified python training method for small groups has shown a better effect on student performance. This finding is consistent with previous researches. Modified four-step python's training for small group with an emphasis on peer to peer teaching and receiving feedback from peer can be related to the effectiveness of this training. Further research is recommended in other clinical education settings.

The Role of Deconstructive Teaching in the Training of Laparoscopy

Background and Objectives

Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying.

Methods

Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups.

Results

Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs -4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance.

Conclusion

Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.

Sonography education in the clinical setting: The educator and trainee perspective

INTRODUCTION

Sonography is a complex clinical skill. However, in spite of its complexity, little has been published about how these skills are taught in Australia or internationally. This paper explores Australian sonographer educators' and trainees' perceptions regarding the teaching of sonography skills, with a specific focus on the procedural dimension of the process. A secondary aim is the identification of the Australian sonographer educator workforce and teaching settings.

METHODS

Data were collected from trainee and educator sonographers via an online survey and semi-structured interviews, following ethics approval and informed consent. All data was anonymous or de-identified. Descriptive statistics were generated for quantitative data and qualitative data were analysed using thematic analysis.

RESULTS

The online survey of 72 full responses found that a majority of Australian sonography education occurs in general sonography private practice (52%), with most practices employing up to three trainee sonographers concurrently (78%). Forty-nine per cent of sonographers self-identified as primary clinical supervisors, with the majority (58%) of these holding no teaching qualifications. Fifty per cent of participants reported using a five-step method of teaching the procedural dimension of the process. Qualitative findings revealed four themes related to sonography skills teaching including importance of repeated observation and practice, identification of the teaching model, providing opportunity for feedback and having flexibility to adapt the skill teaching model when applicable.

CONCLUSION

This exploratory mixed-methods study highlights the educator and trainee perspectives of sonography skills teaching. Based on these findings, the authors propose that sonography skills teaching maximise the opportunities for trainees to engage in observation, hands-on learning and obtain constructive feedback. It is also suggested that sonography practices support educators to extend their education skills to ensure high-quality clinical teaching.

Peer-assisted learning (PAL): skills lab tutors' experiences and motivation

BACKGROUND

Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences.

METHODS

We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring.

RESULTS

In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors.

CONCLUSIONS

With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.

Self-directed learning and practice of Italian osteopathic students during summer break: a cross-sectional survey

Background

Self-directed learning is a student-centered approach based on the students’ evaluation about their own learning needs. Self-directed practice is a component of the self-directed learning which focus on achieving manual and practical skills. Given the abundance of manual skills that students need to develop in the osteopathic curriculum, self-directed practice has become an attractive methodology. Most of the Italian osteopathic educational institutions recognize two types of educational curriculum: T1, for students without a healthcare background; and T2 for students who are already healthcare professionals. The aim of the present study is to investigate the attitudes of Italian osteopathic students toward self-directed practice during the summer break highlighting the possible differences between T1 and T2 students.

Methods

A web-based closed-ended survey was administered to the students attending one of the Italian osteopathic educational institutions which accepted to participate in the research.

Results

Two hundred sixty-eight students on 2549 participated to the survey. 64.92% of the students reported to have performed self-directed practice during the summer break. The main difficulty encountered by students in approaching self-directed practice was ‘lack of people to exercise with’. Most of the students performed self-directed practice between 1 to 5 h per week. The most common clinical condition encountered was Low Back Pain. The anatomical area most approached was lumbar spine. The most commonly simulated tests were the articular mobility tests. The techniques in which students trained the most were muscle energy techniques. Significant difference was found in self-engagement to the self-directed practice between T1 and T2 students (p = 0.026), and in the reasons to perform self-directed practice (p = 0.027).

Conclusions

The results of this study could be useful to reveal some aspects of students’ academic education and future clinical practice. Therefore this paper can be a useful tool for the institutions to develop strategies to overcome the reported problems students have towards self-directed practice. For example it should be discussed the possibility for the students to observe some senior osteopaths during their practice or to plan to maintain an open tutored didactic environment during the summer break as an extracurricular activity.

Correlation between students' and trainers' evaluations while learning delegated surgical procedures: A prospective cohort study

BACKGROUND

The delegation of procedures within the medical competence to the nurses can increase the effectiveness of the healthcare provided. The objectives of the study are (1) to assess the quality of training courses for delegated surgical procedures through implementation for graduate scrub nursing ("students") (2) and to evaluate the correlation between the evaluation of this training carried out by students and the self-assessment conducted by the faculty ("trainers").

MATERIALS AND METHODS

We set up a 49-h training for five groups of 10 students from July 2016 to July 2017 in our tertiary academic hospital. The course consisted mostly in simulations based on the "Zwisch" model and focused on acquiring the control of the gesture as well as on the development of critical reasoning. An evaluation of the training by the students but also a self-assessment of trainers were prospectively collected using the SFDP26 questionnaire.

RESULTS

52 active scrub nursing students and 21 trainers were included. 96% of students and 86% of trainers evaluated the training from "good" to "very good". Progress was observed for 41 (79%) of the students and 18 (86%) of the trainers, and 98% of students felt able to put their new skills into clinical practice after training. There was no difference between the total scores of students and teachers (p = 0.153). A statistically significant difference between the evaluations produced by the students and the self-evaluations produced by the trainers was observed for 8 of the 26 items of assessment. In case of inadequacy, the trainers' scores were always lower than those of the students.

CONCLUSIONS

Training in performing delegated surgical procedures by mixed cognitive and motor gestures learning, based on the development of critical thinking and simulations seems to be effective, with a significant improvement in students' knowledge and skills. Expectations of students and trainers are well correlated.

Development of an innovative physical examination course involving handheld ultrasound devices

This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.

Development of an innovative physical examination course involving handheld ultrasound devices

This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.

The Influence of the Instructional Approach on Acquiring Clinical Skills in Surgery: A Comparative Effectiveness Study

OBJECTIVE

The instructional approach used to teach skills and competencies seems to have a critical impact on retaining and performing the learned skills/competencies. However, for most of them, the effect of different instructional approaches as well as evidence for appropriate approaches is unknown. The aim of the present study was to analyze and compare the impact of different instructional approaches in the acquisition of basic skills during undergraduate surgical training.

DESIGN

Randomized controlled cohort study. For the intervention, four instructional approaches ('See one - Do one', 'Video 4-Step Approach', 'Mental Group Mapping', and 'Control') were compared in six basic skills. Students completed a six-station OSCE (one for each skill) during their skills lab training week after the intervention.

SETTING

This study was conducted at the medical faculty of the Goethe University, Frankfurt, Germany.

PARTICIPANTS

Medical students in their fourth year completing their four week of obligatory surgical training.

RESULTS

A total of 151 students were included. The group 'Mental Group Mapping' scored significantly higher in comparison to 'See one - Do one' in four of the six skills and 'Control' in five skills. The group 'Video 4-Step Approach' scored significantly higher in comparison to 'See one - Do one' (three skills) in comparison to 'Control' (two skills). There were no significant differences between the approaches 'Mental Group Mapping' and 'Video 4-Step Approach' as well as between the approaches 'See one - Do one' and 'Control'.

CONCLUSION

Activating instructional approaches such as the '4-Step Approach' and 'Mental Group Mapping' have a significant impact on performing the learned skills and competencies.

Effective teaching of manual skills to physiotherapy students: a randomised clinical trial

CONTEXT

To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited.

OBJECTIVES

Peyton's four-step and the 'See one, do one' approaches were compared for their effectiveness in teaching manual skills.

METHODS

A cluster randomised controlled trial was performed among final-year, right-handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1-C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four-step approach (intervention group) and the 'See one, do one' approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction.

RESULTS

A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms (F_1,111  = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time (F_2,111  = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001).

CONCLUSIONS

Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation.

[Learning how to learn for specialist further education]

The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. The learning process should be voluntary and self-driven with the aim of learning the profession and becoming an expert in a specialist field. Learning is an individual process. Despite this, the constantly cited learning styles are nowadays more controversial. An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e‑learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.

Peyton's four-step approach for teaching complex spinal manipulation techniques - a prospective randomized trial

BACKGROUND

The objectives of this prospective randomized trial were to assess the impact of Peyton's four-step approach on the acquisition of complex psychomotor skills and to examine the influence of gender on learning outcomes.

METHODS

We randomly assigned 95 third to fifth year medical students to an intervention group which received instructions according to Peyton (PG) or a control group, which received conventional teaching (CG). Both groups attended four sessions on the principles of manual therapy and specific manipulative and diagnostic techniques for the spine. We assessed differences in theoretical knowledge (multiple choice (MC) exam) and practical skills (Objective Structured Practical Examination (OSPE)) with respect to type of intervention and gender. Participants took a second OSPE 6 months after completion of the course.

RESULTS

There were no differences between groups with respect to the MC exam. Students in the PG group scored significantly higher in the OSPE. Gender had no additional impact. Results of the second OSPE showed a significant decline in competency regardless of gender and type of intervention.

CONCLUSIONS

Peyton's approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.

Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning external chest compression - a pilot study

INTRODUCTION

The external chest compression is a very important skill required to maintain a minimum of circulation during cardiac arrest until further medical procedures can be taken. Peyton's 4-Steps-Approach is one method of skill training, the four steps being: Demonstration, Deconstruction, Comprehension and Execution. Based on CPR skill training, this method is widely, allegedly predominantly used, although there are insufficient studies on Peyton's 4-Steps-Approach for skill training in CPR in comparison with other methods of skill training. In our study, we compared the medium- term effects on learning external chest compression with a CPR training device in three different groups: PEY (Peyton's 4-Steps-Approach), PMOD (Peyton's 4-Steps-Approach without Step 3) and STDM, the standard model, according to the widely spread method "see one, do one" (this is equal to Peyton's step 1 and 3).

MATERIAL AND METHODS

This prospective and randomised pilot study took place during the summer semester of 2009 at the SkillsLab and Simulation Centre of the University of Cologne (Kölner interprofessionelles Skills Lab und Simulationszentrum - KISS). The subjects were medical students (2(nd) and 3(rd) semester). They volunteered for the study and were randomised in three parallel groups, each receiving one of the teaching methods mentioned above. One week and 5/6 months after the intervention, an objective, structured single assessment was taken. Compression rate, compression depth, correct compressions, and the sum of correct checklist items were recorded. Additionally, we compared cumulative percentages between the groups based on the correct implementation of the resuscitation guidelines during that time.

RESULTS

The examined sample consisted of 134 subjects (68% female; age 22±4; PEY: n=62; PMOD: n=31; STDM: n=41). There was no difference between the groups concerning age, gender, pre-existing experience in CPR or time of last CPR course. The only significant difference between the groups was the mean compression rate (bpm): Group 1 (PEY) with 99±17 bpm, Group 2 (PMOD) with 101±16 bpm and Group 3 (STDM) with 90±16 bpm (p=0,007 for Group 3 vs. Group 1 and Group 3 vs. Group 2, Mann-Whitney- U-Test). We observed no significant differences between the groups after the second assessment.

CONCLUSION

Our study showed that there are no essential differences in external chest compression during CPR performed by medical students dependent on the teaching method (Peyton vs. "Non-Peyton") implemented with regard to the medium-term effects. The absence of benefits could possibly be due to the simplicity of external chest compression.

Practical Clinical Training in Skills Labs: Theory and Practice

Today, skills laboratories or "skills labs", i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method's effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training.

Basic practical skills teaching and learning in undergraduate medical education - a review on methodological evidence

OBJECTIVE

Practical skills are an essential part of physicians' daily routine. Nevertheless, medical graduates' performance of basic skills is often below the expected level. This review aims to identify and summarize teaching approaches of basic practical skills in undergraduate medical education which provide evidence with respect to effective students' learning of these skills.

METHODS

Basic practical skills were defined as basic physical examination skills, routine skills which get better with practice, and skills which are also performed by nurses. We searched PubMed with different terms describing these basic practical skills. In total, 3467 identified publications were screened and 205 articles were eventually reviewed for eligibility.

RESULTS

43 studies that included at least one basic practical skill, a comparison of two groups of undergraduate medical students and effects on students' performance were analyzed. Seven basic practical skills and 15 different teaching methods could be identified. The most consistent results with respect to effective teaching and acquisition of basic practical skills were found for structured skills training, feedback, and self-directed learning. Simulation was effective with specific teaching methods and in several studies no differences in teaching effects were detected between expert or peer instructors. Multimedia instruction, when used in the right setting, also showed beneficial effects for basic practical skills learning.

CONCLUSION

A combination of voluntary or obligatory self-study with multimedia applications like video clips in combination with a structured program including the possibility for individual exercise with personal feedback by peers or teachers might provide a good learning opportunity for basic practical skills.