Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Surg Educ. 2022 Sep-Oct;79(5):1228-1236. doi: 10.1016/j.jsurg.2022.04.003. Epub 2022 May 14.
Several motor learning models have been used to teach highly complex procedural skills in medical education. Two approaches are often employed amongst health care professionals: Halsted's "See one - do one - teach one" concept and Peyton's Four-step approach. Peyton's deconstruction of the learning process into 4 sub-steps was reported to be preferable for learning/acquiring/teaching complex clinical skills. However, a new increasingly popular technique is known as the spaced learning method. In a previous study, we were able to confirm that the spaced learning concept is superior for laparoscopic suturing and knot tying compared to conventional training curricula, this current study aimed to assess the influence of spaced learning in combination with Halsted's and Peyton's tutoring approaches on laparoscopic knot tying of medical students.
After randomization, 20 medical students were either assigned to Halsted's or Peyton's teaching approach and trained one-on-one (teacher-student). Additionally, all subjects were trained according to the spaced learning concept, containing 40 minutes of content-blocks, followed by a 20-minute break involving coordinated, standardized physical activity. This was repeated three times. Primary endpoints were time, knot quality, precision, knot strength, as well as overall laparoscopic knotting performance and competency. To evaluate the motivation of the subjects, an 18-item questionnaire was utilized to measure four motivational factors (anxiety, probability of success, interest, and challenge).
All trainees significantly improved after training in all knot attributes. Trainees assigned to Halsted's method were able to significantly outperform the Peyton group in knot quantity within 30 minutes (p = 0.013), time/knot (p = 0.033), performance score (p = 0.009), and precision (p = 0.032). No significant difference between Halsted and Peyton was found for knot strength and quality. Furthermore, no significant difference was identified comparing motivation pre- and post-training. However, subjects in the Peyton appeared to be significantly more anxious after training.
Combining spaced learning technique with Halsted's "see one - do one - teach one" appears to be superior to Peyton's Four-step approach in conjunction with spaced learning in surgical naïve students. We recommend further studies evaluating the combination of spaced learning with Halsted and Peyton's instructional methods.
在医学教育中，已经有几种运动学习模型被用于教授高度复杂的程序性技能。两种方法在医疗保健专业人员中经常被采用：Halsted 的“看一次、做一次、教一次”的概念和 Peyton 的四步方法。Peyton 将学习过程分解为 4 个亚步骤，据报道，这种方法更适合学习/获得/教授复杂的临床技能。然而，一种新的、越来越流行的技术被称为间隔学习法。在之前的一项研究中，我们能够证实，与传统的培训课程相比，间隔学习法在腹腔镜缝合和打结方面具有优越性，本研究旨在评估间隔学习法与 Halsted 和 Peyton 的辅导方法相结合对医学生腹腔镜打结的影响。
随机分组后，20 名医学生被分配到 Halsted 或 Peyton 的教学方法中，进行一对一的培训（教师-学生）。此外，所有学生都按照间隔学习的概念进行培训，包含 40 分钟的内容块，然后休息 20 分钟，包括协调的、标准化的身体活动。这重复了三次。主要终点是时间、结的质量、精度、结的强度，以及整体腹腔镜打结的表现和能力。为了评估受试者的动机，使用了一个包含 18 个项目的问卷来衡量四个动机因素（焦虑、成功的可能性、兴趣和挑战）。
所有的受训者在所有的结属性方面都在训练后显著提高。在 30 分钟内，采用 Halsted 方法的受训者在结的数量上明显优于 Peyton 组（p=0.013），在时间/结（p=0.033）、表现评分（p=0.009）和精度（p=0.032）方面也明显优于 Peyton 组。在结的强度和质量方面，Halsted 和 Peyton 之间没有显著差异。此外，培训前后的动机没有显著差异。然而，Peyton 组的受试者在培训后似乎明显更加焦虑。
将间隔学习技术与 Halsted 的“看一次、做一次、教一次”结合起来，似乎比 Peyton 的四步方法与间隔学习结合起来更适合于没有手术经验的学生。我们建议进一步研究评估间隔学习与 Halsted 和 Peyton 教学方法的结合。
