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Simulation-based neonatal resuscitation training of medical students: is Peyton’s 4-stage approach more effective than traditional 2-stage technique?

  • Erol Tutdibi1,
  • Ludwig Gortner1,
  • Thomas Volk2 and
  • Erik Reus2
Molecular and Cellular Pediatrics20141(Suppl 1):A4

Published: 11 September 2014


Medical StudentObjective Structure Clinical ExaminationNeonatal ResuscitationTraditional GroupTheoretical Part

Resuscitation of newborns is a critical procedure and requires refined skills. The contents of resuscitation guidelines and their implementation should be crucial in education of medical students. The traditional 2-stage (“see one, do one”) instruction is theory-loaded and does not provide sufficient hands-on training needed to give trainees the necessary practical experience or confidence in clinical skills. We aimed to evaluate whether simulation-based skill training by Peyton’s 4-step approach can improve the performance of medical students in neonatal resuscitation compared to traditional front-side 2-step teaching. In a prospective trial design, 49 fourth-year medical students were randomized in traditional and 4-stage groups. According to the “see one, do one” principle in the traditional group the teacher at first explained the ERC-algorithm and demonstrated the neonatal resuscitation procedure before the practitioners could train on manikins. In the “Peyton” group students were divided in small-groups with 4 trainees each and received 4-step approach training. Three days after the initial neonatal resuscitation training all students passed a standardized simulation-based scenario with newborn manikins to assess the effect of both teaching methods by an objective structured clinical examination (OSCE) and binary checklist. We modified the OSCE with a practical (pOSCE, maximal score 118) and a theoretical part (tOSCE, maximal score 74). Students in 4-stage group scored significantly higher than traditional trained participants: 113±5 vs. 68±23 (pOSCE) and 66±5 vs. 40±23 (tOSCE), all p<0.001. In conclusion, our study demonstrates that simulation-based training by Peyton’s 4-stage approach is effective to increase the performance of medical students in neonatal resuscitation.

Authors’ Affiliations

Department of Pediatrics and Neonatology, Intensive Care Medicine and Pain Therapy, University of Saarland, Homburg/Saar, Germany
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University of Saarland, Homburg/Saar, Germany


© Tutdibi et al; licensee Springer 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.