Modification of Peyton’s four-step approach for small group teaching – a descriptive study

BMC Medical Education

Markus Krautter³  Jana Jünger¹  Wolfgang Herzog¹  Jan Lauter¹  Daniel Huhn¹  Jan Stiepak²  Julia Huber¹  Christoph Nikendei¹ 

[1] Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany;Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Heidelberg, Germany;Department of Nephrology, University of Heidelberg, Heidelberg, Germany

关键词: Small group teaching;    Peyton;    Instructional approach;    Simulation;    Catheter insertion;    Clinical skills;    Undergraduate medical education;   

Others  :  1118089
DOI  :  10.1186/1472-6920-14-68

 received in 2013-11-29, accepted in 2014-03-26,  发布年份 2014

【 摘 要 】

Background

Skills-lab training as a methodological teaching approach is nowadays part of the training programs of almost all medical faculties. Specific ingredients have been shown to contribute to a successful learning experience in skills-labs. Although it is undoubted that the instructional approach used to introduce novel clinical technical skills to learners has a decisive impact on subsequent skills performance, as yet, little is known about differential effects of varying instructional methods. An instructional approach that is becoming increasingly prevalent in medical education is “Peyton’s Four-Step Approach”. As Peyton’s Four Step Approach was designed for a 1:1 teacher : student ratio, the aim of the present study was to develop and evaluate a modified Peyton’s Approach for small group teaching.

Methods

The modified Peyton’s Approach was applied in three skills-lab training sessions on IV catheter insertion, each with three first- or second year medical students (n = 9), delivered by three different skills-lab teachers. The presented descriptive study investigated the practicability and subjective impressions of skills-lab trainees and tutors. Skills-lab sessions were evaluated by trainees’ self-assessment, expert ratings, and qualitative analysis of semi-standardized interviews conducted with trainees and tutors.

Results

The model was well accepted by trainees, and was rated as easy to realize, resulting in a good flow of teaching and success in attracting trainee’s attention when observed by expert raters. Qualitative semi-standardized interviews performed with all of the trainees and tutors revealed that trainees valued repeated observation, instruction of trainees and the opportunity for independent performance, while tutors stressed that trainees were highly concentrated throughout the training and that they perceived repeated observation to be a valuable preparation for their own performance.

Conclusion

The modified Peyton’s Approach to instruct small groups of students in skills-lab training sessions has revealed to be practicable, well accepted by trainees, and easy for tutors to realize. Further research should address the realization of the model in larger skills-lab training groups.

【 授权许可】

   
2014 Nikendei et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ziv A, Ben-David S, Ziv M: Simulation based medical education: an opportunity to learn from errors. Med Teach 2005, 27(3):193-199.
• [2]Barrows HS: An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med 1993, 68(6):443-451. discussion 451–443
• [3]Bradley P, Postlethwaite K: Setting up a clinical skills learning facility. Med Educ 2003, 37(Suppl 1):6-13.
• [4]Nikendei C, Zeuch A, Dieckmann P, Roth C, Schafer S, Volkl M, Schellberg D, Herzog W, Jünger J: Role-playing for more realistic technical skills training. Med Teach 2005, 27(2):122-126.
• [5]Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ: Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005, 27(1):10-28.
• [6]Jiang G, Chen H, Wang S, Zhou Q, Li X, Chen K, Sui X: Learning curves and long-term outcome of simulation-based thoracentesis training for medical students. BMC Med Educ 2011, 11:39. BioMed Central Full Text
• [7]Khan K, Pattison T, Sherwood M: Simulation in medical education. Med Teach 2011, 33(1):1-3.
• [8]Lynagh M, Burton R, Sanson-Fisher R: A systematic review of medical skills laboratory training: where to from here? Med Educ 2007, 41(9):879-887.
• [9]Lund F, Schultz JH, Maatouk I, Krautter M, Moltner A, Werner A, Weyrich P, Junger J, Nikendei C: Effectiveness of IV cannulation skills laboratory training and its transfer into clinical practice: a randomized, controlled trial. PloS One 2012, 7(3):e32831.
• [10]McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D: Evaluating the impact of simulation on translational patient outcomes. Simul Healthc 2011, 6(Suppl):S42-S47.
• [11]Ericsson KA, Krampe RT, Teschromer C: The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993, 100(3):363-406.
• [12]Kneebone R, Bello F, Debra N, Neville M, Andrew C, Faranak Y, Tanya T, David W, Ara D: Learner-centred feedback using remote assessment of clinical procedures. Med Teach 2008, 30(8):795-801.
• [13]Veloski J, Boex JR, Grasberger MJ, Evans A, Wolfson DB: Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME guide no. 7. Med Teach 2006, 28(2):117-128.
• [14]Krautter M, Weyrich P, Schultz JH, Buss SJ, Maatouk I, Junger J, Nikendei C: Effects of Peyton’s four-step approach on objective performance measures in technical skills training: a controlled trial. Teach Learn Med 2011, 23(3):244-250.
• [15]Abusrewil F, Cameron M, JC J, SG S, BCJ BC, Wallace D: Advanced trauma life support skills training: a controlled trial. In Sixth Ottawa Conference on Medical Education: 1994. Ottawa: University of Toronto Bookstores; 1994:715.
• [16]American College of Surgeons Committee on Trauma: Advanced trauma life support program for doctors: ATLS. Chicago: American College of Surgeons; 1997.
• [17]Benjamin L: Selection, teaching and training in ophthalmology. Clin Experiment Ophthalmol 2005, 33(5):524-530.
• [18]Lake FR, Hamdorf JM: Teaching on the run tips 5: teaching a skill. Med J Aust 2004, 181(6):327-328.
• [19]Walker M, Peyton JWR: Teaching in the theatre. In Teaching and learning in medical practice. Edited by Peyton JWR. Rickmansworth: Manticore Publishers Europe Ltd; 1998:171-180.
• [20]Bullock I: Skill acquisition in resuscitation. Resuscitation 2000, 45(2):139-143.
• [21]Bullock I, Davis M, Lockey A, Mackway-Jones K: Pocket Guide to Teaching for Medical Instructors, 2nd Edition, vol. 2nd. Oxford: Blackwell Publishing; 2008.
• [22]Cummins R: Instructor’s manual: advanced cardiovascular life support. Dallas: American Heart Association; 2001.
• [23]Nolan J, Baskett P, Gabbott D: Resuscitation Council (UK). London: Advanced life support course provider manual; 2001.
• [24]Jawhari J, Krautter M, Dittrich R, Junger J, Nikendei C: Instruktion im Skills-Lab: Differentielle Effekte der Peyton-Schritte auf die Gedächtnisleistung. In Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA). Aachen: Düsseldorf: German Medical Science GMS Publishing House; 2012.
• [25]Dubrowski A, MacRae H: Randomised, controlled study investigating the optimal instructor: student ratios for teaching suturing skills. Med Educ 2006, 40(1):59-63.
• [26]Shanks D, Wong RY, Roberts JM, Nair P, Ma IW: Use of simulator-based medical procedural curriculum: the learner’s perspectives. BMC Med Educ 2010, 10:77. BioMed Central Full Text
• [27]Weyrich P, Celebi N, Schrauth M, Möltner A, Lammerding-Köppel M, Nikendei C: Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ 2009, 43(2):113-120.
• [28]Weyrich P, Schrauth M, Kraus B, Habermehl D, Netzhammer N, Zipfel S, Jünger J, Riessen R, Nikendei C: Undergraduate technical skills training guided by student tutors–analysis of tutors’ attitudes, tutees’ acceptance and learning progress in an innovative teaching model. BMC Med Educ 2008, 8:18. BioMed Central Full Text
• [29]Wu EH, Elnicki DM, Alper EJ, Bost JE, Corbett EC Jr, Fagan MJ, Mechaber A, Ogden PE, Sebastian JL, Torre DM: Procedural and interpretive skills of medical students: experiences and attitudes of third-year students. Acad Med 2006, 81(10 Suppl):S48-S51.
• [30]Wu EH, Elnicki DM, Alper EJ, Bost JE, Corbett EC Jr, Fagan MJ, Mechaber AJ, Ogden PE, Sebastian JL, Torre DM: Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students. Acad Med 2008, 83(10 Suppl):S63-S67.
• [31]Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19(6):349-357.
• [32]Flick U: Qualitative research in psychology: A textbook. London: SAGE Publications Ltd; 2002.
• [33]Hill CE, Knox S, Thompson BJ, Nutt Williams E, Hess SA: Consensual qualitative research: an update. J Couns Psychol 2005, 52(2):196-205.
• [34]Knox S, Burkard AW: Qualitative research interviews. Psychother Res 2009, 19(4–5):566-575.
• [35]Helfferich C: Die Qualität qualitativer Daten: Manual für die Durchführung qualitativer Interviews, vol. 2. Wiesbaden: VS Verlag für Sozialwissenschaften; 2005.
• [36]Strauss AL, Corbin JM: Basics of qualitative research: techniques and procedures for developing grounded theory. Qual Sociol 1990, 13(1):3-21.
• [37]Wulf G, Shea C, Lewthwaite R: Motor skill learning and performance: a review of influential factors. Med Educ 2010, 44(1):75-84.
• [38]Sopka S, Biermann H, Rossaint R, Knott S, Skorning M, Brokmann JC, Heussen N, Beckers SK: Evaluation of a newly developed media-supported 4-step approach for basic life support training. Scand J Trauma Resusc Emerg Med 2012, 20(1):37. BioMed Central Full Text
• [39]Lehmann R, Bosse HM, Simon A, Nikendei C, Huwendiek S: An innovative blended learning approach using virtual patients as preparation for skills laboratory training: perceptions of students and tutors. BMC Med Educ 2013, 13:23. BioMed Central Full Text