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. 2015 May 27:6:399-406.
doi: 10.2147/AMEP.S81923. eCollection 2015.

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

Markus Krautter  1 , Ronja Dittrich  2 , Annette Safi  2 , Justine Krautter  1 , Imad Maatouk  2 , Andreas Moeltner  2 , Wolfgang Herzog  2 , Christoph Nikendei  2
Affiliations

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

Markus Krautter et al. Adv Med Educ Pract. .

Abstract

Background: Although Peyton's four-step approach is a widely used method for skills-lab training in undergraduate medical education and has been shown to be more effective than standard instruction, it is unclear whether its superiority can be attributed to a specific single step.

Purpose: We conducted a randomized controlled trial to investigate the differential learning outcomes of the separate steps of Peyton's four-step approach.

Methods: Volunteer medical students were randomly assigned to four different groups. Step-1 group received Peyton's Step 1, Step-2 group received Peyton's Steps 1 and 2, Step-3 group received Peyton's Steps 1, 2, and 3, and Step-3mod group received Peyton's Steps 1 and 2, followed by a repetition of Step 2. Following the training, the first independent performance of a central venous catheter (CVC) insertion using a manikin was video-recorded and scored by independent video assessors using binary checklists. The day after the training, memory performance during delayed recall was assessed with an incidental free recall test.

Results: A total of 97 participants agreed to participate in the trial. There were no statistically significant group differences with regard to age, sex, completed education in a medical profession, completed medical clerkships, preliminary memory tests, or self-efficacy ratings. Regarding checklist ratings, Step-2 group showed a superior first independent performance of CVC placement compared to Step-1 group (P<0.001), and Step-3 group showed a superior performance to Step-2 group (P<0.009), while Step-2 group and Step-3mod group did not differ (P=0.055). The findings were similar in the incidental free recall test.

Conclusion: Our study identified Peyton's Step 3 as being the most crucial part within Peyton's four-step approach, contributing significantly more to learning success than the previous steps and reaching beyond the benefit of a mere repetition of skills demonstration.

Keywords: Peyton’s four-step approach; procedural skills; skills-lab training.

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Figures

Figure 1
Figure 1
Study design: All four participating groups underwent skills-lab training with the topic of central venous catheterization (CVC), which was completed after different sub-steps of Peyton’s four-step approach, followed by an immediate video assessment of their first independent performance of CVC. In order to evaluate the differential effect specifically attributed to Step 3, a Step-3mod group was added, which received a mere repetition of step 2. One day after skills-lab training, participants underwent an incidental free recall test to evaluate memory performance.
Figure 2
Figure 2
Checklist ratings and memory performance for substeps of central venous catheter (CVC) placement reached by different participating groups. Notes: (A) Results of video rating using binary checklists for first independent performance of CVC placement after training sessions. Percentage of correctly performed procedural substeps (39 items) reached by participating groups. (B) Number of correctly recalled substeps by participating groups in incidental recall test 1 day after training sessions (39 items); mean; t-test results.
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