BackgroundAlthough Peyton’s four-step approach is a widely used method for skills-lab training in undergraduate medical education and has been shown to be more effective than standard instruction, it is unclear whether its superiority can be attributed to a specific single step.PurposeWe conducted a randomized controlled trial to investigate the differential learning outcomes of the separate steps of Peyton’s four-step approach.MethodsVolunteer medical students were randomly assigned to four different groups. Step-1 group received Peyton’s Step 1, Step-2 group received Peyton’s Steps 1 and 2, Step-3 group received Peyton’s Steps 1, 2, and 3, and Step-3mod group received Peyton’s Steps 1 and 2, followed by a repetition of Step 2. Following the training, the first independent performance of a central venous catheter (CVC) insertion using a manikin was video-recorded and scored by independent video assessors using binary checklists. The day after the training, memory performance during delayed recall was assessed with an incidental free recall test.ResultsA total of 97 participants agreed to participate in the trial. There were no statistically significant group differences with regard to age, sex, completed education in a medical profession, completed medical clerkships, preliminary memory tests, or self-efficacy ratings. Regarding checklist ratings, Step-2 group showed a superior first independent performance of CVC placement compared to Step-1 group (P<0.001), and Step-3 group showed a superior performance to Step-2 group (P<0.009), while Step-2 group and Step-3mod group did not differ (P=0.055). The findings were similar in the incidental free recall test.ConclusionOur study identified Peyton’s Step 3 as being the most crucial part within Peyton’s four-step approach, contributing significantly more to learning success than the previous steps and reaching beyond the benefit of a mere repetition of skills demonstration.

The reproducibility of the clinical skin tests was substantial to good, apart from the consistency measurements. We suggest that skin consistency is withdrawn as a diagnostic criterion. The upper level for normal skin extensibility should be 3 cm. SC and STSM are promising para-clinical methods, but their diagnostic sensitivity and specificity need to be determined.

Therapist variables have received growing attention in the context of psychotherapy research. The presented study aims at expanding the knowledge about professional development by examining motives of career choice and choice of therapeutic orientation in psychotherapy candidates. Twenty-four master's-level psychologists, who had just begun either a cognitive-behavioral (CBT; n ϭ 12, all female, mean age 29.4 years) or psychodynamic (PDT; n ϭ 12, 8 female, 4 male, mean age 31.8 years) therapy training program, were interviewed about their motivation to start training. Participants represented 60% of the PDT and 67% of the CBT cohort. Verbatim transcripts were analyzed based on qualitative content analysis using MaxQDA 10 software. The authors revealed that CBT candidates tended to strive for socioeconomic security and to rely on the method's scientific foundation and manual-guided processes. PDT candidates regarded biographical aspects to be more meaningful for their choice of psychotherapy training. The 2 groups differed mainly in terms of categories of biographical and personality aspects, as well as regarding the importance of research aspects. Findings suggest that different therapeutic orientations not only match the different needs of patients but also match the different therapeutic characters.