Undergraduate Curricular Training in Musculoskeletal Ultrasound by Student Teachers: The Impact of Peyton's Four-Step Approach.

Abstract

The aim of this study was to assess the impact of Peyton's 4-step approach on musculoskeletal ultrasound skills in a peer-teaching environment as compared to traditional "see one, do one" training and to evaluate students' acceptance of the training strategy. A total of 491 second year medical students (342 women, 149 men) completed a compulsory curricular course on musculoskeletal ultrasound. We randomly assigned students to receive traditional peer teaching or peer teaching using Peyton's four-step approach in small groups. All groups received theoretical and practical hands-on training of selected views of the knee and shoulder. We assessed differences in practical skills (objective structured practical examination, OSPE) and evaluation results with respect to teaching strategy. There were no relevant differences between the two teaching interventions regarding the OSPE results. Students scored significantly higher in the knee view (knee 6.5 ± 1.7 points, shoulder 6.0 ± 1.9 points; p < 0.001), needed less time to display the required image (knee 36 ± 21 s, shoulder 43 ± 20 s; p < 0.001) and more students obtained the cut-off mark of 60% to pass the exam (knee 73%, shoulder 61%; p < 0.001). Acceptance of the peer-teaching concept was high, and the overall rating of the instructors was good. The majority of students enjoyed the course and rated it highly. Traditional teaching and Peyton's 4-step approach seem to be equally effective for teaching basic musculoskeletal ultrasound skills to undergraduate medical students. Qualitative analysis revealed high acceptance of both peer teaching strategies. Differences in course content complexity and degree of difficulty need to be addressed in future courses.