The Effectiveness of Peyton’s 4-Step Approach to Teach Resuscitation Skills: A Randomized Controlled Clarification Study

Abstract

Objectives The aim of this study was to compare the effectiveness of the Peyton approach with the traditional 2-step approach instruction and to clarify if a possible superiority can be attributed to specific skill domains. The primary and secondary outcome were the quality of resuscitation, reflected by technical (TS)- and nontechnical skills (NTS). The tertiary outcome were the subjective learning gains of the undergraduates. Methods In a randomized controlled simulation study, second year medical undergraduates participated in compulsory Advanced Cardiac Life Support training (ACLS). The control group received the 2-step approach and the intervention group Peyton’s 4 step approach as a training instruction. Results N = 290 second year medical undergraduates participated in the study. There were no relevant differences between both groups in purely haptically skills like chest compression. The intervention group showed significantly better procedural skills of ACLS skill domains, resulting in lower no-flow time during the scenarios ( t (120) = 2.132, P = .035)). NTS of both groups did not differ ( t (150) = 1.694, P = .092)). Undergraduates of the intervention group reported significant higher learning gains for procedural ACLS skills, like performing the algorithm ( P < .001). Conclusion Integrating Peyton's 4-step approach into structured ACLS training enhances procedural cardiopulmonary resuscitation skills, adherence to the ACLS algorithm, and skill retention in advanced stages of medical education, especially when undergraduates have prior resuscitation experience. While the method shows limited benefit for teaching discrete tactile skills in earlier stages, its strategic inclusion in later phases can optimize curriculum design by aligning advanced teaching methods with learners’ developmental needs. These findings highlight the importance of tailoring ACLS education to maximize training effectiveness and improve resuscitation outcomes.