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

Gertraud Gradl-Dietsch,Melanie Simon,Ali Modabber,Tolga T Sönmez,Sven Nebelung,Cavan Lübke,Klemens Horst,Matthias Knobe,Ralf Münker

doi:10.1186/s12909-016-0804-0

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.

Highlights

The 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
Participant selection Based on previous literature on the effect of Peyton’s four-step approach an effect size of 0.7 was expected
Theoretical instruction did not differ between groups and there were no differences between groups with respect to the results of the multiple choice exam

Summary

Introduction

The 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. The need of a medical expert with a strong didactical background to transfer these complex psychomotor skills was shown [1]. The mastery of complex psychomotor skills is a prerequisite for chiropractic treatments. Students typically acquire these skills through observation of their teachers demonstrating specific procedures and through. Step 1 – “Demonstrate”: The trainer demonstrates the skill at a normal pace and without additional comments. Step 2 – “Talk the trainee through”: The trainer demonstrates the respective skill while describing each procedural substep in detail

Methods

Results

Discussion

Conclusion