Effectiveness of Peyton’s Four-Step Approach with Real-Time Feedback Versus Traditional Teaching Methods in Training Undergraduate Medical Students in Male Urinary Catheterization: A Randomized Controlled Trial

Abstract

Background

The acquisition of procedural competence is a fundamental component of undergraduate medical education, particularly within competency-based medical education (CBME) frameworks. Conventional apprenticeship-based teaching methods often lack standardization and structured feedback, potentially limiting effective skill acquisition and compromising patient safety. Peyton’s Four-Step Approach (PFSA), a structured and learner-centered instructional model, has emerged as a promising strategy for procedural skills training, especially when supplemented with real-time feedback.

Objective

To compare the effectiveness of Peyton’s Four-Step Approach with real-time feedback versus traditional teaching methods in improving procedural skill acquisition, retention, learner confidence, and satisfaction among undergraduate medical students performing male urinary catheterization.

Methods

This prospective randomized controlled trial was conducted in a simulation-based skills laboratory at a tertiary care teaching institution. A total of 150 final-year MBBS students were randomized into two groups: PFSA with real-time feedback (n = 75) and traditional teaching method approach (TTMA) (n = 75). The primary outcome was procedural skill proficiency assessed using Objective Structured Clinical Examination (OSCE) scores immediately post-training and at 1-month follow-up. Secondary outcomes included learner confidence, satisfaction, and retention of procedural steps. Statistical analysis was performed using SPSS version 26.0, with significance set at p < 0.05.

Results

The PFSA group demonstrated significantly higher OSCE scores than the TTMA group both immediately after training (mean difference: 3.19; p < 0.001) and at 1-month follow-up (mean difference: 3.47; p < 0.001). A higher proportion of Grade A performers and no Grade D performers were observed in the PFSA group at follow-up. Learner confidence, satisfaction, and procedural step retention were significantly greater in the PFSA group (p < 0.001).

Conclusion

PFSA with real-time feedback is significantly more effective than traditional teaching methods for training undergraduate medical students in male urinary catheterization, improving skill acquisition, retention, confidence, and satisfaction.