• Philipp Romero, Patrick Günther, Karl-Friedrich Kowalewski, Mirco Friedrich, Mona W Schmidt, Sarah M Trent, Javier R De La Garza, Beat P Müller-Stich, and Felix Nickel.
• Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany.
• J Surg Educ. 2018 Mar 1; 75 (2): 510-515.

BackgroundThis 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).MethodsLaparoscopically 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.ResultsPerformance 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.ConclusionsPeyton's Four-Step Approach is the preferable method for learning complex laparoscopic skills like ICKT.Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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