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


METHODS
We 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.


RESULTS
There 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.


CONCLUSIONS
Peyton's approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.
Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Gertraud
G
Gradl-Dietsch
Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Cavan
C
Lübke
Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Klemens
K
Horst
Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Melanie
M
Simon
Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Ali
A
Modabber
Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Tolga T
TT
Sönmez
Department of Orthopaedics and Trauma Surgery, Bethlehem Hospital Stolberg, 5 Steinfeldstreet, 52222, Stolberg, (Rheinland), Germany.
Ralf
R
Münker
Department of Radiology, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
Sven
S
Nebelung
Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany. mknobe@ukaachen.de.
Matthias
M
Knobe
D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D009048:Motor Skills; D011446:Prospective Studies; D012737:Sex Factors; D013663:Teaching; D055815:Young Adult
Gender differences; Instructional method; Medical education; Peyton’s four-step approach; Spinal manipulation