Suturing in Small Group Teaching Settings: a Modification to Peyton’s Four-Step Approach

Raymond Yap, Alayne Moreira, Simon Wilkins, Fairleigh Reeves, Michele Levinson, Paul McMurrick

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2 Citations (Scopus)


Objective: Suturing is a fundamental skill of medical professionals. Although Peyton’s four-step approach (demonstration, deconstruction, comprehension, and performance) has been tested and validated for numerous skills, one of its major limitations is its requirement for 1:1 instructor/student ratio. This study aimed to investigate the feasibility of modifying Peyton’s approach for small group teaching in the setting of suturing. Design: Students were randomized into two groups, with one group taught using a modified Peyton’s approach, where students acted as the instructor for step 3, while another group was taught using a standard teaching approach. Suturing technique was assessed using an objective structured assessment of technical skill instrument and student feedback elicited through a Likert-type scale survey. Setting: The study was conducted at Cabrini Hospital (Melbourne, Australia), a private tertiary-level hospital with an attached clinical school. Participants: Twenty-three first clinical year students (third year) were invited to participate. Twenty-two students gave consent, and 12 students were allocated to group 1 (modified Peyton’s approach), and 10 students in group 2 (standard approach). Results: Although the two groups were similar in their mean suturing scores and satisfaction, there was more consistency in suturing steps in group 1 versus group 2. Conclusions: A modified Peyton’s approach using students only in step 3 was feasible in small group settings. Further studies, including comparison with Peyton’s original approach, are planned.

Original languageEnglish
Pages (from-to)575-580
Number of pages6
JournalMedical Science Educator
Issue number4
Publication statusPublished - 1 Dec 2016


  • Clinical skills
  • Peyton’s four-step approach
  • Procedural skills
  • Simulation
  • Small group teaching
  • Suturing
  • Undergraduate medical education

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