Halsted's "See One, Do One, and Teach One" versus Peyton's Four-Step Approach: A Randomized Trial for Training of Laparoscopic Suturing and Knot Tying

Abstract

Background: This study aimed to compare the effectiveness of Halsted's method "see one, do one, and teach one" with Peyton's Four-Step Approach for teaching intracorporal suturing and knot tying (ICKT).

Methods: Laparoscopically naïve medical students (n = 60) were randomized to teaching of ICKT with either Halsted's (n = 30) or Peyton's method (n = 30) for 60 minutes. Each student's first 3 and final sutures were evaluated using Objective Structured Assessment of Technical Skills (OSATS), procedural implementation, knot quality, total time, and suture placement accuracy.

Results: Performance score and OSATS-PSC always differed significantly in favor of Peyton's group (p = 0.001). OSATS-GRS (p = 0.01) and task time (p = 0.03) differed only in the summary of the first 3 sutures in favor of Peyton's group. There were no significant intergroup differences in knot quality and accuracy.

Conclusions: Peyton's Four-Step Approach is the preferable method for learning complex laparoscopic skills like ICKT.

Keywords: Halsted; Interpersonal and Communication Skills; Peyton; Practice-Based Learning and Improvement; education; knot tying; laparoscopy; minimally invasive surgery.