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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsThere 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.ConclusionsPeyton’s approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.

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

“…However, the group using Peyton's four‐step approach demonstrated better performance than the ‘See one, do one’ group after both 1 week and 1 month. Among medical students, similar findings on the effectiveness of Peyton's approach, in both the short and long terms, have been reported . By contrast, the superiority of the approach was not confirmed recently in cardiopulmonary resuscitation chest compression .…”

“…identification and fixation of cervical spine level) that require high levels of sensory and motor coordination . However, in neither group did participants achieve completely correct performance during the skills laboratories, possibly because joint mobilisation is not included among the learning outcomes expected at undergraduate level and the participating students were being exposed to the acquisition of this complex competence for the first time …”

“…The primary and secondary outcome assessments were performed by three evaluators . Each was experienced in both manual therapy and teaching (average of 11 years of experience).…”

“…However, to date, only six studies have compared the ‘See one, do one’ and Peyton's four‐step approaches as teaching methods in the learning of medical procedures by adopting a randomised controlled trial design. Four of these, involving, respectively, 94, 34, 84 and 95 medical students and using gastric tube insertion, intravenous cannulation and spinal manipulations, documented Peyton's approach as being more effective and better able to enhance performance, communication skills and skill speeds . By contrast, two studies using chest compression in cardiopulmonary resuscitation involving samples of, respectively, 126 and 134 medical students documented no differences in terms of performance, but significantly higher skill speed in the groups that used the Peyton approach …”

“…The approach consists of four teaching steps: demonstration; deconstruction; comprehension, and performance . The ‘comprehension’ step represents the specific value of both the Doto and Peyton models in that students are encouraged to: (i) reflect on information acquired in the previous step; (ii) organise their thoughts before actively verbalising them, and (iii) facilitate the integration of new knowledge with that already acquired …”