The Role of Deconstructive Teaching in the Training of Laparoscopy

Abstract

Background and Objectives: Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying. Methods: Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups. Results: Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs –4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance. Conclusion: Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.

The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression

“…The teaching approach in the control groups was described as traditional Halsted teaching (Balafoutas et al, 2019;Romero et al, 2018), peer teaching or student tutors Notes. a if multiple procedures or assessments were used in the primary studies the included procedures and assessments within this systematics review are underlined.…”

“…The results of these studies are not always consistent. Some trials have reported findings in favour of Peyton's approach (e.g., Balafoutas et al, 2019;Rossettini et al, 2017). Rossettini et al (2017) showed that acquisition of a cervical mobilisation technique was considerable higher in the Peyton group compared to a standard teaching group.…”

Peer Review #2 of "The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression (v0.1)"

“…Four different sub-groups were identified. First, 9 studies compared Peyton's teaching approach against a standard teaching approach (Balafoutas et al 2019;Gradl-Dietsch et al 2016;Jenko et al 2012;Krautter et al 2011;Lapucci et al 2018;Lund et al 2012;Orde et al 2010;Romero et al 2018;Rossettini et al 2017). The analysis showed an effect size of 0.5 SMD (95%CI 0.13 to 0.87) in favour of the Peyton group.…”

“…The study of Herrmann-Werner et al (2013) used a best practice skills laboratory, which consisted of structured individual feedback, performance on manikins and Peyton's teaching approach supervised by student tutors. Three studies (Gradl-Dietsch et al 2019; Gradl-Dietsch et al 2018; Münster et al 2016) used peer or student teachers for the teaching events and Ruesseler et al (2019) used a video 4-step approach.The teaching approach in the control groups was described as traditional Halsted teaching(Balafoutas et al 2019;Romero et al 2018), peer teaching or student tutors teaching(Gradl- Dietsch et al 2019;Gradl-Dietsch et al 2018;Herrmann-Werner et al 2013;Münster et al 2016), 2-stage teaching approach(Jenko et al 2012), Orde's 2-step method(Lapucci et al 2018;Orde et al 2010), standard instructions(Gradl-Dietsch et al 2016;Krautter et al 2011), traditional bedside teaching…”

Peer Review #3 of "The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression (v0.1)"

“…Some trials have reported findings in favour of Peyton's approach (e.g. Balafoutas et al 2019;Rossettini et al 2017). Rossettini et al (2017) showed that acquisition of a cervical mobilisation technique was considerable higher in the Peyton group compared to a standard teaching group.…”