Comparison of Peyton's Four-Step Approach and Halsted's 'See One, Do One' Method for Teaching Basic Surgical Skills: A Randomised Study Assessing Long-Term Retention in a Pakistani Medical School

Skills-lab training as a procedural teaching approach is nowadays part of the training programs of almost all medical faculties. Certain components like observation, clinical skills, practice and decision-making have been shown to contribute to a successful learning experience in skills labs. It offers a safe, "mistake-forgiving" training environment that allows students to practice procedures on mannequins, with standardised patients or with each other before performing procedural skills on real patients,

The positive effect of skills-lab training sessions on learning outcomes and transfer of acquired skills to clinical practice has been shown in a variety of different settings. It has become a necessity for every undergraduate medical student/teacher to be aware of the basic methodologies taught through skills lab training, which should be practised in every medical institution.

In the studies, a lot of instructional techniques that include various steps to convey clinical technical skills to learners have been described. It includes some established teaching techniques, for example, Halsted's traditional teacher-centred "See one do one" approach. In this form of teaching, students learn only by observing an experienced surgeon explaining and demonstrating the skill. This can later be practised on artificial skin models. It's a process of active learning in a continual cycle. Another instructional approach that is becoming increasingly pervasive in medical studies is "Peyton's Four-Step Approach" This methodology was established based on the work of Peyton and was readily adapted in the last decade by medical institutes throughout the world.

It consists of four clearly defined instructional steps:

• Step 1 - "Demonstrate": The trainer demonstrates the skill without adding any comments.
• Step 2 - "Talk the trainee through": The trainer demon¬strates the respective skill while explaining each proce¬dural sub step in detail.
• Step 3 - "Trainee talks trainer through": The trainer performs the skill for a third time, based on the sub steps described to him/her by the trainee.
• Step 4 - "Trainee does": The trainee performs the skill on his/her own