gms | German Medical Science

Question: While the Peyton-4-Step-Approach is widely employed throughout clinical technical skills education, its effectiveness has barely been subject to systematic investigation. To assess effects of the Peyton-4-Step-Approach with respect to students’ objective performance, we performed a randomised controlled trial, to evaluate the hypotheses that the Peyton-4-Step-Approach leads 1) to a significantly enhanced technical skills performance in a skills laboratory setting, and 2) to a significantly better patient-physician communication.

Methods: 34 volunteer third year medical students were randomly assigned to one of two groups participating in videotaped skills laboratory sessions on the topic gastric tube application using a manikin. The intervention group (IG) received skills training using the Peyton-4-Step-Approach instruction with the following steps:

1.

trainer demonstrates,

2.

trainer talks the learner through,

3.

trainee talks the trainer through,

4.

trainee does.

The control group (CG) received skills training using a standard instruction:

1.

trainer demonstrates,

2.

trainer talks the learner through,

3.

trainee does.

Two independent video assessors scored the last step of IG and CG using binary checklists (13 yes / no items) and IPPI (Integrated Procedural Performance Instrument) rating form to evaluate technical skills performance (8 items; six-point Likert scale ranging from 1 = low competence to 6 = high competence) as well as global ratings to assess patient-physician communication (4 items; six-point Likert scale ranging from 1 = low competence to 6 = high competence).

Results: While the time needed to instruct participants did not differ between IG and CG (IG 605 ± 66 seconds vs. CG 572 ± 79 seconds; p<.195), IG was significantly faster in performing the gastric tube application (IG 187 ± 30 seconds vs. CG 242 ± 53 seconds; p<.001). IG and CG as well did not differ in binary checklist assessment (IG 88.1 ± 7.5% vs. CG 85.3 ± 11.4%; p<.400), indicating that both groups considered all important sub-steps of gastric tube application. However IG scored significantly better on IPPI rating form (IG 4.36 ± 0.58 vs. CG 3.08 ± 1.04; p<.001) and global ratings (IG 4.63 ± 0.59 vs. CG 2.48 ± 1.71; p<.001) reflecting a more fluently and professional performance and the facility to integrate patient-physician communication more easily.

Conclusion: Introducing the Peyton-4-Step-Approach into technical skills training leads to superior technical skills performance and better patient-physician communication. We conclude that the Peyton-4-Step-Approach is an indispensable method in introducing technical skills.