A Controlled Study on the Application of Modified Internet-based Peyton Teaching Method in Clinical Skills Training

doi:10.21203/rs.3.rs-3558016/v1

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Research Article

A Controlled Study on the Application of Modified Internet-based Peyton Teaching Method in Clinical Skills Training

https://doi.org/10.21203/rs.3.rs-3558016/v1

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Objective

To compare the effects of the modified Internet-based Peyton teaching method and the traditional teaching method on clinical skills training.

Methods

Fourth-year medical students at Shenzhen University were randomly divided into two groups, the intervention group and the control group. The intervention group were trained using the modified internet-based Peyton method while the control group were trained in a traditional way. Their learning outcomes were assessed through student questionnaires and their final OSCE scores.

Results

Four items on the questionnaires showed staistical significance (P < 0.05) between the two groups, namely "I think the course helped me learn skills", "The course achieved my expected results", "I accept the format of the course", and "I think the class time is sufficient". The final OSCE results also showed statistical difference (P < 0.05) between the groups.

Conclusion

The application of the modified internet-based Peyton teaching method in clinical skills training can promote students' learning interest, stimulate their initiative for active learning, reduce their brain load to understand the in-class information, and increase the cooperation and mutual evaluation among students. It enriches the traditional teaching content and teaching modes, improving the students’ learning efficiency and skills retention.Therefore, the method is a beneficial tool for basic clinical skills training in the new era.

Modified Internet-based Peyton Method

Clinical Skills Training

Traditional Teaching Method

Learning Outcomes

OSCE Scores

Medical Education

Most medical schools do not have a uniform teaching mode on clinical skills training. Teachers have different understanding about how to teach clinical skills. The teaching methods still stay in traditional ways such as video and Powerpoint slides presentation, personal demonstration of procedures, and bedside teaching. In this teaching mode, teachers usually first explain the relevant theoretical knowledge of a clinical skill, then demonstrate the skill, and finally only have a few students practice the skill. This teaching method places too much emphasis on the teacher's explanation, occupying most of the in-class time and seriously compressing students' practice time. At the same time, students are passively learning, which makes it difficult to stimulate their learning interest or awaken their awareness of actively participating in the class.

With the development of 5G Internet online courses, we began to introduce scenario case simulation exercises on the Internet teaching platform since 2021 to improve the traditional Peyton teaching method and apply it in clinical skills training (Saeed et al., 2023). This study adopts a randomized controlled method to explore the application effect of the modified Internet-based Peyton teaching method in clinical skills training courses. We aim to find an effective teaching method to stimulate students' interest in learning, improve their active thinking and independent operation abilities, and reduce their cognitive load of digesting the in-class information.

2.1 Sample population

This study selected fourth year medical students from Shenzhen University as research subjects according to voluntary principles.This study received ethical approval from the Ethics Committee of Huazhong University of Science and Technology Union Shenzhen Hospital, China. Informed consent was obtained from all participants before their enrolment. All selected subjects volunteered to participate in the study. A total of 60 students were enrolled and all of them signed the informed consent form. Then they were randomly divided into two groups, with 30 students in each group. In the intervention group, there were 9 male and 21 female students, with an average age of 22.4 ± 0.724years old. The average score of each subject at the end of the third academic year was 81.07 ± 7.506. In the control group, there were 10 male and 20 female students, with an average age of 22.2 ± 0.761 years old. The average score of each subject at the end of the third academic year was 80.5 ± 8.669. The two groups were comparable in terms of gender ratio, age and GPA at the end of the third academic year (see Table 1).

Table 1

Enrollment of the experimental and control groups
	intervention group	Control group	P
Male	9	10	1
Female	21	20	1
Age	22.4 ± 0.724	22.2 ± 0.761	0.338
Average scores at the beginning of the research	81.07 ± 7.506	80.5 ± 8.669	0.994

2.2 Training methods

2.2.1 Preparation before training

There were two teachers preparing clinical skills training course together for all participants. Teacher A taught the intervention group and teacher B taught the control group. Clinical Skill Operation Guidelines for Medical Students in China, 3rd edition, edited by Jiang Baoguo and Chen Hong (People’s Medical Publishing House, 2020) was adopted as the textbook. Incision and drainage was selected as the training skill. The course duration was 135 minutes. The teachers prepared the course according to the syllabus.

2.2.2 Research design

(1) The intervention group were trained by the improved Internet-based Peyton teaching model, which encompassed five steps. Step One: Demonstration. Before class, the instructor recorded a 10-minute demonstration video and prepared a checklist of standard operating procedures for students’ self-learning. The operation video was pushed through the "Colleague Bar" or "Study Tong" learning platform on enterprise WeChat, allowing students to learn standardized operation and communicate with their peers and tutors online at any time. After the self-learning, students should take pre-class test online; Step Two: Deconstruction. In class, the instructor used two past exam cases (superficial abscess and deep abscess) as guides to demonstrate the skills and perform the necessary sub-steps with detailed descriptions and explanations; Step Three: Understanding. Fifteen students were divided into four groups, each of three or four members. Student A performed superficial abscess on the task trainer, while Student B took the checklist to guide the partner’s operation and also acted as a patient. StudentS C and D took the checklist to verify the operation details. The instructor observed the operation of each group in turn and corrected the students' operation in a timely manner; Step Four: Re-understanding. Students exchanged their roles. For example, student B operated on the simulator. Student A played the role of patient with the checklist while C and D acted as observers. The instructor still observed and corrected each student’s operation. Then the case was changed to deep abscess. The two observers who did not have hand-on practice before tooks turns to operate. Step Five: Demonstration / Execution. Each group randomly selected one student to perfrom part of deep abscess independently on the task trainer, and the four members completed the entire procedure consecutively. At the end of each part of the procedure, all studnets gave feedback firstly, and the instructor gave feedback secondly. Finally, students provided feedback, shared their knowledge gains and difficulties encountered, and received feedback from the instructor.

(2) The control group were trained in a traditional way, where students previewed the textbook and watched the operation video before class. During the class, key concepts related to skills and operations were presented through PPT and video, followed by a demonstration of the operation. Fifteen students were divided into four groups, who took turns performing skills and operations on the task trainer for "superficial abscess" and"deep abscess". One student took the standardized patient quantitative form and played the role of patient, while the other two students acted as observers, taking the checklist for evaluation. The instructor observed the operation of one group at a time and provided feedback at the end. Finally, students provided feedback, shared their knowledge gains and difficulties encountered, and received feedback from the instructor.

2.3 Learning outcome assessment

2.3.1 Skill test

The final-semester skill test adopted the OSCE format, with "incision and drainage" as one of the exam stations. The full mark for all skills was 100. All examiners underwent training on examination procedures and scoring consistency before the examination, and attending physicians or above served as examiners.

2.3.2 Questionnaire survey

The assessment was conducted through a survey using a "Questionnaire Star" QR code to collect quantitative data on teaching quality with reference to the modified WISER learning assessment tool of the University of Pittsburgh Medical Center (Phrampus et al., 2016). The questionnaire adopted the Likert scale (1–5 points) for scoring, with 1–2 points indicating very poor or poor, 3 points indicating general, 4–5 points indicating good or very good. The questionnaire included 13 assessment items, which were: 1. I think the course is helpful for my skill learning; 2. This course has achieved my expected results; 3. Before the course, I had confidence in my incision and drainage skills; 4. After the course, I have more confidence in my incision and drainage skills; 5. I believe I can complete the incision and drainage surgery for patients under the supervision of the instructor at present; 6. I have watched the demonstration video in advance; 7. I have learned the operation process of incision and drainage in advance; 8. Pre-class preparation is helpful for me; 9. I can understand the content of the class; 10. I accept the form of the class; 11. I think the explanations in class are detailed and practical; 12. I think there is sufficient time in class; 13. Under the guidance of the instructor, my problems were resolved in a timely manner.

2.4 Statistical analysis

Data were analyzed using SPSS26. Measurement data were expressed as x ± s. Comparison between groups was analyzed by nonparametric test, and P < 0.05 was considered statistically significant,as shown in Fig. 1.

[insert Fig. 1 near here]

3.1 Questionnaire results

There were 13 items in the questionnaire. The results showed that there was statistical difference between the training methods in “I think the course has helped me learn skills”, “the course has met my expectations”, “I accept the form of the course”, and “I think there is enough time in the class” (P < 0.05). The other items did not show statistical significance as Table 2 shows.

Table 2

Results of the questionnaire stars
Item	Intervention group	Control group	P
1. I think the course is helpful for my skill learning;	4.83 ± 0.38	4.57 ± 0.50	0.025^*
2. This course has achieved my expected results;	4.80 ± 0.48	4.50 ± 0.51	0.01^*
3. Before the course, I had confidence in my incision and drainage skills;	3.97 ± 1.03	3.83 ± 1.02	0.596
4. After the course, I have more confidence in my incision and drainage skills; .	4.60 ± 0.56	4.37 ± 0.67	0.161
5. I believe I can complete the incision and drainage surgery for patients under the supervision of the instructor at present;	4.73 ± 0.45	4.43 ± 0.68	0.074
6. I have watched the demonstration video in advance;	4.13 ± 1.17	3.63 ± 1.22	0.073
7. I have learned the operation process of incision and drainage in advance;	4.23 ± 1.07	3.77 ± 1.14	0.070
8. Pre-class preparation is helpful for me;	4.53 ± 0.73	4.30 ± 0.75	0.139
9. I can understand the content of the class;	4.73 ± 0.45	4.53 ± 0.51	0.111
10. I accept the form of the class;	4.80 ± 0.41	4.50 ± 0.57	0.027^*
11. I think the explanations in class are detailed and practical;	4.80 ± 0.41	4.60 ± 0.50	0.094
12. I think there is sufficient time in class;	4.67 ± 0.71	4.43 ± 0.57	0.035^*
13. Under the guidance of the instructor, my problems were resolved in a timely manner.	4.77 ± 0.50	4.57 ± 0.57	0.107

3.2 Results of the final exam

The average score of the intervention group was 74.25 ± 13.28,and the average score of the control group was 65.00 ± 18.48. The difference in the skills test results between the two groups was statistically significant (P < 0.05). The performance of the students in the intervention group was significantly better than that of the traditional teaching group, as shown in Fig. 2.

[insert Fig. 2 near here]

4.1 The Internet-based teaching method can facilitate unifying pre-class knowledge reserve

In the medial education system of China, fourth-year medical students have acquired self-learning ability. By providing demonstration videos and operation checklists, the Internet platform enables students to effectively preview the course according to their personal level and learning state in their spare time (Zhao et al., 2008). The modified Peyton method shifts demonstration, which is the first step of the original Peyton method in class, forward to pre-class and provides videos that can be paused, replayed, or fast-forwarded on the learning platform for students’ self-learning. In the preview stage, students can communicate with their peers and instructors online at any time to solve the problems they encounter; at the same time, they need to complete the online pre-class test questions (Nourkamiet al., 2020).

All participants in the program came from the same class and were randomly divided into two groups. They watched the same videos and used the same checklists before class. They also shared the same clinical cases in class. Thus the intervention group and the control group were comparable. The questionnaire survey results showed that there was no statistical difference between the two groups in terms of the degree of acceptance of the course, such as "I have confidence in my incision and drainage skills", "I have watched the demonstration video in advance", "I have learned the operation process of incision drainage in advance", and "pre-class preparation is helpful for me" (P > 0. 05). This indicates that the improved Peyton teaching method based on the Internet platform can achieve consistent pre-class knowledge reserve, and students have the same acceptance, which lays a solid foundation for the follow-up classroom teaching (Holland et al., 2013).

4.2 The modified Peyton teaching method centers on students and activates students’ interest points

In traditional teaching of clinical skills, teachers use slides to teach relevant knowledge and concepts of skill operation, highlight key points and difficulties, demonstrate operations, and finally allow a small number of students to practice. The teaching method causes teachers to spend most of the time imparting knowledge, leaving less time for students to practice, which prevents everyone from receiving effective training. At the same time, it also puts students in a passive state and leads to low participation rate ( (Seifert et al, 2020)). According to the Miller's triangle theory, knowledge can only be effectively grasped and the forgetting rate can be reduced if it is applied to specific clinical cases (Miller, 1990).

The modified Peyton method can provide more learning resources and practical opportunities to help students better master the knowledge of skill operation and apply the skills in the clinical setting. In the improved Peyton teaching paradigm, instructors and students exchange their roles. Except for the instructor explaining the details of operation, the rest of the time is reserved for training and feedback between students. Students take turns to be the operator, the standardized patient, and the observer. With the assistance of checklists, each student can play the major role in class, making the theory of peer learning practical. Everyone acts as a different role in each operation drill, which stimulates personal learning potential. This teaching method is conducive to activating students’ subjective initiative (Lund et al., 2012). Meanwhile, given the high volume and deep complexity of medical knowledge, the modified Peyton teaching method gradually breaks down the knowledge points and reduces the brain load, so that students can gradually master and apply the basic skills and deepen their understanding of theoretical knowledge (Gradl-Dietsch et al., 2016). The improved method emphasizes hand-on practice and group collaborative learning to encourage students’ participation and increase their interest (Geletu, 2022), thus improving learners' motivation and cognition. As a result, learners will focus on higher-order cognitive activities and maintain knowledge and memory depth (Gholami et al., 2021).

According to the questionnaire results, the intervention group outperformed the control group in terms of "I think the course is helpful for my skill learning", "This course has achieved my expected results", "I think there is sufficient time in class", and "I accept the form of the class", and the difference between the groups was statistically significant (p < 0.05). The final exam results suggest that the modified Internet-based Peyton model has significantly improved the students' skill level, which provides strong evidence for validity of the teaching method.

4.3 The improved Peyton teaching model facilitates providing timely feedback and answering questions at any time

Based on progressive and differentiated clinical cases, students are guided to effectively communicate with patients before operation and conduct comprehensive operation, evaluation and cooperation with each other to strengthen the learned knowledge and solve related problems (Nikendei et al., 2005). The cases are gradually upgraded from simple to complex to stimulate students’ interest and avoid boring repetition (Gordon et al., 2000). At the same time, students should learn how to give feedback and solve their own problems in different cases (Ker & Bradley, 2013), which stimulates the learners’ subjective initiative and encourages their participation in the course. When constructing corresponding medical solutions for different clinical cases, teachers become facilitators of case operation, promoting students to apply their knowledge to solve different clinical problems, thereby improving teaching effectiveness (Burgess et al., 2021).

The results of this study show that applying Internet-based Peyton teaching method in clinical skills training can promote students' learning interest, stimulate their initiative for active learning, reduce their brain load to understand the in-class information, and increase the cooperation and mutual evaluation among students. It enriches the traditional teaching content and teaching modes, improving the students’ learning efficiency and reducing the forgetting rate of knowledge.

There are still some limitations in this study. It is not a multi-center study and the number of participants is small. The teaching model based on the self-learning platform is different from the traditional classroom teaching. The former is featured with small class and high quality while the latter targets a large number of learners. The specific number of students suitable for the new teaching paradigm still needs further research. Under the premise of ensuring teaching quality and classroom effect, resources such as teachers and classrooms should be fully utilized and relevant research and experiments are needed to seek the possible solutions. How to combine the improved Peyton teaching method with other modern educational means (such as virtual reality, artificial intelligence, etc.) needs to be further explored to improve the effect of medical student skills training.

This study is limited to a single skill operation, and the evaluation of complex medical team cooperation projects has not been involved.

Competing interests

The authors declare there are no competing interests.

Funding

This research was funded by the 2021 Teaching Reform Research Project of Guangdong Clinical Teaching Base (Grant No.2021JD089), 2021 Shenzhen University Teaching Reform Research Project (Grant No.JG2021171), 2022 Shenzhen Nanshan District Technology R&D and Creative Design Project Sub-funding for Education (Health) Science and Technology Project (Grant No. 2022057), and 2022 Guangdong Quality Engineering Project (Specialized Talent Training Program for Medical Innovation and Complexity for Intelligent Healthcare).

Author contributions

CHC and ZMW designed the study and performed the experiments; ZLH and TPCperformed the experiments, WSW and ZQC analyzed the data,CHC,ZHC,PJX and YHK wrote the manuscript.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

No new software or custom code was created for this study. The modified internet-based Peyton teaching method implemented in this study utilized existing, publicly available digital tools and platforms.

Ethics approval

The ethical approval for this study was provided by the Ethic Committee of Huazhong University of Science and Technology Union Shenzhen Hospital, China(full name of ethics committee).

Consent for participate

Informed consent was obtained from every subject before the enrollment. All selected subjects volunteered to participate in the study.

Consent for publish

Participants were made aware that anonymized quotes may be used in publications prior to giving consent.

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No competing interests reported.

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Version 1

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You are reading this latest preprint version

A Controlled Study on the Application of Modified Internet-based Peyton Teaching Method in Clinical Skills Training

Status:

Version 1

Abstract

Objective

Methods

Results

Conclusion

Figures

1 Introduction

2 Sample population and methods

2.1 Sample population

2.2 Training methods

2.2.1 Preparation before training

2.2.2 Research design

2.3 Learning outcome assessment

2.3.1 Skill test

2.3.2 Questionnaire survey

2.4 Statistical analysis

3 Results

3.1 Questionnaire results

3.2 Results of the final exam

4 Discussion

4.1 The Internet-based teaching method can facilitate unifying pre-class knowledge reserve

4.2 The modified Peyton teaching method centers on students and activates students’ interest points

4.3 The improved Peyton teaching model facilitates providing timely feedback and answering questions at any time

5 Conclusion

Declarations

References

Additional Declarations

Status:

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