Comparison of Peyton's Four-Step Approach and Halsted's 'See One, Do One' Method for Teaching Basic Surgical Skills

Overview

This study aimed to compare Halsted's "See One, Do One" method with Peyton's Four-Step Approach for teaching basic surgical skills to undergraduate medical students in a simulated skills-laboratory setting at Department of Surgery, Dow University of Health Sciences \& Dr. Ruth K. M. Pfau Civil Hospital Karachi. Medical students were randomised to Halsted and Peyton Arms and were taught Four Surgical Skills i-e Gloving by open method, Incision Making, Interrupted suturing, One-handed reef knot. After three months, all participants were recalled to perform the same set of skills. Each participant performed individually in a controlled setting while being video recorded. The recordings were later evaluated by an independent assessor(academic surgeon) blinded to the participants' group allocation. Skill performance was assessed using a six-point Likert scale, where 1 = unsatisfactory, 2 = satisfactory with mistakes, 3 = satisfactory, 4 = average, 5 = good, and 6 = perfect.

Skills-lab training as a procedural teaching approach is nowadays part of the training programs of almost all medical faculties. Certain components like observation, clinical skills, practice and decision-making have been shown to contribute to a successful learning experience in skills labs. It offers a safe, "mistake-forgiving" training environment that allows students to practice procedures on mannequins, with standardised patients or with each other before performing procedural skills on real patients, The positive effect of skills-lab training sessions on learning outcomes and transfer of acquired skills to clinical practice has been shown in a variety of different settings. It has become a necessity for every undergraduate medical student/teacher to be aware of the basic methodologies taught through skills lab training, which should be practised in every medical institution. In the studies, a lot of instructional techniques that include various steps to convey clinical technical skills to learners have been described. It includes some established teaching techniques, for example, Halsted's traditional teacher-centred "See one do one" approach. In this form of teaching, students learn only by observing an experienced surgeon explaining and demonstrating the skill. This can later be practised on artificial skin models. It's a process of active learning in a continual cycle. Another instructional approach that is becoming increasingly pervasive in medical studies is "Peyton's Four-Step Approach" This methodology was established based on the work of Peyton and was readily adapted in the last decade by medical institutes throughout the world. It consists of four clearly defined instructional steps: * Step 1 - "Demonstrate": The trainer demonstrates the skill without adding any comments. * Step 2 - "Talk the trainee through": The trainer demon¬strates the respective skill while explaining each proce¬dural sub step in detail. * Step 3 - "Trainee talks trainer through": The trainer performs the skill for a third time, based on the sub steps described to him/her by the trainee. * Step 4 - "Trainee does": The trainee performs the skill on his/her own Probable benefits of the technique include the grouping of several learning theories. Especially step three, when the trainee instructs the trainer, seems to be an important step in student learning. The student first has to analyse the first two steps, which are based on a social-cognitive approach to learning theory, i.e. thinking and sharing. This gives the student time to organise their thoughts before actively saying it. In addition, the reasoning process called self-explanation seems to facilitate the integration of new knowledge into existing knowledge. We know it is no question that the instructional methods used to develop better grip of new clinical skills have huge impact in developing skill performance, but the contrasting results of different instructional methods for different surgical skills including both basic and advance surgical skills, require further evaluation. This study aims to determine the better approach of teaching surgical skills, so that the same would be employed in future to impart surgical skills to junior surgeons, postgraduate trainees, interns and undergraduate students in skills lab.