Retention of Basic Surgical SkillsNCT07735026
Comparison of Peyton's Four-Step Approach and Halsted's 'See One, Do One' Method for Teaching Basic Surgical Skills
A study testing Halsted's approach and Peyton's approach in people with Retention of Basic Surgical Skills and Surgical Skills Performance Score, run by Dow University of Health Sciences at 1 site in Pakistan.
Trial summary
This study aimed to compare Halsted's "See One, Do One" method with Peyton's Four-Step Approach for teaching basic surgical skills to undergraduate medical students in a simulated skills-laboratory setting at Department of Surgery, Dow University of Health Sciences \& Dr. Ruth K. M. Pfau Civil Hospital Karachi. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Retention of Basic Surgical Skills, Surgical Skills Performance Score
- What is being tested?
- Halsted's approach and Peyton's approach
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 sitePakistan
- Study dates
- 9 Jan 2025to 23 Mar 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Medical students of DMC with no prior exposure to surgical skills.
Who cannot join
- Students who had previously attended any basic surgical skills workshop.
- Students who had participated in surgical camps or had prior hands-on surgical experience.
Trial locations and contacts
1 site in 1 country.
Pakistan1 site
Dow University of Health Sciences & Dr. Ruth K. M. Pfau Civil Hospital Karachi
Karachi, Sindh, 74200
About this study
Official title: Comparison of Peyton's Four-Step Approach and Halsted's 'See One, Do One' Method for Teaching Basic Surgical Skills: A Randomised Study Assessing Long-Term Retention in a Pakistani Medical School
This study aimed to compare Halsted's "See One, Do One" method with Peyton's Four-Step Approach for teaching basic surgical skills to undergraduate medical students in a simulated skills-laboratory setting at Department of Surgery, Dow University of Health Sciences \& Dr. Ruth K. M. Pfau Civil Hospital Karachi. Medical students were randomised to Halsted and Peyton Arms and were taught Four Surgical Skills i-e Gloving by open method, Incision Making, Interrupted suturing, One-handed reef knot. After three months, all participants were recalled to perform the same set of skills. Each participant performed individually in a controlled setting while being video recorded. The recordings were later evaluated by an independent assessor(academic surgeon) blinded to the participants' group allocation.
Skill performance was assessed using a six-point Likert scale, where 1 = unsatisfactory, 2 = satisfactory with mistakes, 3 = satisfactory, 4 = average, 5 = good, and 6 = perfect.
Read the detailed description
Skills-lab training as a procedural teaching approach is nowadays part of the training programs of almost all medical faculties. Certain components like observation, clinical skills, practice and decision-making have been shown to contribute to a successful learning experience in skills labs. It offers a safe, "mistake-forgiving" training environment that allows students to practice procedures on mannequins, with standardised patients or with each other before performing procedural skills on real patients,
The positive effect of skills-lab training sessions on learning outcomes and transfer of acquired skills to clinical practice has been shown in a variety of different settings. It has become a necessity for every undergraduate medical student/teacher to be aware of the basic methodologies taught through skills lab training, which should be practised in every medical institution.
In the studies, a lot of instructional techniques that include various steps to convey clinical technical skills to learners have been described. It includes some established teaching techniques, for example, Halsted's traditional teacher-centred "See one do one" approach. In this form of teaching, students learn only by observing an experienced surgeon explaining and demonstrating the skill. This can later be practised on artificial skin models. It's a process of active learning in a continual cycle. Another instructional approach that is becoming increasingly pervasive in medical studies is "Peyton's Four-Step Approach" This methodology was established based on the work of Peyton and was readily adapted in the last decade by medical institutes throughout the world.
It consists of four clearly defined instructional steps:
- Step 1 - "Demonstrate": The trainer demonstrates the skill without adding any comments.
- Step 2 - "Talk the trainee through": The trainer demon¬strates the respective skill while explaining each proce¬dural sub step in detail.
- Step 3 - "Trainee talks trainer through": The trainer performs the skill for a third time, based on the sub steps described to him/her by the trainee.
- Step 4 - "Trainee does": The trainee performs the skill on his/her own
Probable benefits of the technique include the grouping of several learning theories. Especially step three, when the trainee instructs the trainer, seems to be an important step in student learning. The student first has to analyse the first two steps, which are based on a social-cognitive approach to learning theory, i.e. thinking and sharing. This gives the student time to organise their thoughts before actively saying it. In addition, the reasoning process called self-explanation seems to facilitate the integration of new knowledge into existing knowledge.
We know it is no question that the instructional methods used to develop better grip of new clinical skills have huge impact in developing skill performance, but the contrasting results of different instructional methods for different surgical skills including both basic and advance surgical skills, require further evaluation.
This study aims to determine the better approach of teaching surgical skills, so that the same would be employed in future to impart surgical skills to junior surgeons, postgraduate trainees, interns and undergraduate students in skills lab.
- Being tested
- Halsted's approach, Peyton's approach
- Keywords
- Surgical skills, peyton's method, Halsted's Method
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Halsted's approachBehavioural
Participants in Halsted group were taught the following four skills employing Halsted 'see one do one' approach:
- Gloving by open method.
- Incision Making
- Interrupted suturing
- One-handed reef knot
Peyton's approachBehavioural
Participants in this group were taught the following four skills employing Peyton's Four-step approach:
- Gloving by open method.
- Incision Making
- Interrupted suturing
- One-handed reef knot
| Study group | Role | What they receive |
|---|---|---|
| Halsted | Active comparator | Skills taught using Halsted's 'See one, do one' approach Receives: Behavioral: Halsted's approach |
| Peyton | Experimental | Skills taught using Peyton's Four-Step Approach Receives: Behavioral: Peyton's approach |
What is being measured
The primary outcome is the main question the study is designed to answer.
Skill Performance score
After three months, all participants in both arms were recalled to perform the same set of skills. Each participant performed individually in a controlled setting while being video recorded. The recordings were later evaluated by independent assesor blinded to the participants' group allocation.
Skill performance was assessed using a six-point Likert scale, where 1 = unsatisfactory, 2 = satisfactory with mistakes, 3 = satisfactory, 4 = average, 5 = good, and 6 = perfect.
Measured: 3 months
Secondary outcomes (1)
Time to Teach skill
The time required to teach each of the four skills was recorded in both arms.
Measured: 1 day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jul 2026
- Study start9 Jan 2025
- Primary completion23 Mar 2026
- Study completion23 Mar 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Retention of Basic Surgical SkillsStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 50 participants (actual)
Sponsor and investigators
- Lead sponsor
- Dow University of Health Sciences
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Syed Ali Haider, Dow University of Health Sciences
- Investigators
- Syed Ali Haider, FCPS,F.MAS, FACS, Principal investigator, Dow University of Health Sciences & Dr. Ruth K. M. Pfau Civil Hospital Karachi
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07735026
- Sponsor's protocol ID
- IRB-1784/DUHS
- Status last verified
- Aug 2026
- First submitted
- 24 Jul 2026
- Last updated
- 10 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: All of the individual participant data collected during the trial, after deidentification.
Publications
Romero P, Gunther P, Kowalewski KF, Friedrich M, Schmidt MW, Trent SM, De La Garza JR, Muller-Stich BP, Nickel F. Halsted's "See One, Do One, and Teach One" versus Peyton's Four-Step Approach: A Randomized Trial for Training of Laparoscopic Suturing and Knot Tying. J Surg Educ. 2018 Mar-Apr;75(2):510-515. doi: 10.1016/j.jsurg.2017.07.025. Epub 2017 Aug 8.
PubMed 28801083Seifert LB, Schnurr B, Stefanescu MC, Sader R, Ruesseler M, Sterz J. Comparing video-based versions of Halsted's 'see one, do one' and Peyton's '4-step approach' for teaching surgical skills: a randomized controlled trial. BMC Med Educ. 2020 Jun 17;20(1):194. doi: 10.1186/s12909-020-02105-5.
PubMed 32552805Krautter M, Weyrich P, Schultz JH, Buss SJ, Maatouk I, Junger J, Nikendei C. Effects of Peyton's four-step approach on objective performance measures in technical skills training: a controlled trial. Teach Learn Med. 2011 Jul-Sep;23(3):244-50. doi: 10.1080/10401334.2011.586917.
PubMed 21745059Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ. 2020 Oct 9;8:e10129. doi: 10.7717/peerj.10129. eCollection 2020.
PubMed 33083149Kotsis SV, Chung KC. Application of the "see one, do one, teach one" concept in surgical training. Plast Reconstr Surg. 2013 May;131(5):1194-1201. doi: 10.1097/PRS.0b013e318287a0b3.
PubMed 23629100
Study at a glance
From the registry record, last updated by the sponsor on 10 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Peyton's Four-Step Approach and Halsted's 'See One, Do One' Method for Teaching Basic Surgical Skills: A Randomised Study Assessing Long-Term Retention in a Pakistani Medical School
- ClinicalTrials.gov ID
- NCT07735026
- Acronym / sponsor ID
- IRB-1784/DUHS
- Keywords
- Surgical skills, peyton's method, Halsted's Method
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 50 participants (actual)
- Lead sponsor
- Dow University of Health SciencesUniversity, hospital or other
- Study start
- 9 Jan 2025 (actual)
- Primary completion
- 23 Mar 2026 (actual)
- Study completion
- 23 Mar 2026 (actual)
- First posted
- 29 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aimed to compare Halsted's "See One, Do One" method with Peyton's Four-Step Approach for teaching basic surgical skills to undergraduate medical students in a simulated skills-laboratory setting at Department of Surgery, Dow University of Health Sciences \& Dr. Ruth K. M. Pfau Civil Hospital Karachi. Medical students were randomised to Halsted and Peyton Arms and were taught Four Surgical Skills i-e Gloving by open method, Incision Making, Interrupted suturing, One-handed reef knot. After three months, all participants were recalled to perform the same set of skills. Each participant performed individually in a controlled setting while being video recorded. The recordings were later evaluated by an independent assessor(academic surgeon) blinded to the participants' group allocation.
Skill performance was assessed using a six-point Likert scale, where 1 = unsatisfactory, 2 = satisfactory with mistakes, 3 = satisfactory, 4 = average, 5 = good, and 6 = perfect.
Detailed description
Skills-lab training as a procedural teaching approach is nowadays part of the training programs of almost all medical faculties. Certain components like observation, clinical skills, practice and decision-making have been shown to contribute to a successful learning experience in skills labs. It offers a safe, "mistake-forgiving" training environment that allows students to practice procedures on mannequins, with standardised patients or with each other before performing procedural skills on real patients,
The positive effect of skills-lab training sessions on learning outcomes and transfer of acquired skills to clinical practice has been shown in a variety of different settings. It has become a necessity for every undergraduate medical student/teacher to be aware of the basic methodologies taught through skills lab training, which should be practised in every medical institution.
In the studies, a lot of instructional techniques that include various steps to convey clinical technical skills to learners have been described. It includes some established teaching techniques, for example, Halsted's traditional teacher-centred "See one do one" approach. In this form of teaching, students learn only by observing an experienced surgeon explaining and demonstrating the skill. This can later be practised on artificial skin models. It's a process of active learning in a continual cycle. Another instructional approach that is becoming increasingly pervasive in medical studies is "Peyton's Four-Step Approach" This methodology was established based on the work of Peyton and was readily adapted in the last decade by medical institutes throughout the world.
It consists of four clearly defined instructional steps:
- Step 1 - "Demonstrate": The trainer demonstrates the skill without adding any comments.
- Step 2 - "Talk the trainee through": The trainer demon¬strates the respective skill while explaining each proce¬dural sub step in detail.
- Step 3 - "Trainee talks trainer through": The trainer performs the skill for a third time, based on the sub steps described to him/her by the trainee.
- Step 4 - "Trainee does": The trainee performs the skill on his/her own
Probable benefits of the technique include the grouping of several learning theories. Especially step three, when the trainee instructs the trainer, seems to be an important step in student learning. The student first has to analyse the first two steps, which are based on a social-cognitive approach to learning theory, i.e. thinking and sharing. This gives the student time to organise their thoughts before actively saying it. In addition, the reasoning process called self-explanation seems to facilitate the integration of new knowledge into existing knowledge.
We know it is no question that the instructional methods used to develop better grip of new clinical skills have huge impact in developing skill performance, but the contrasting results of different instructional methods for different surgical skills including both basic and advance surgical skills, require further evaluation.
This study aims to determine the better approach of teaching surgical skills, so that the same would be employed in future to impart surgical skills to junior surgeons, postgraduate trainees, interns and undergraduate students in skills lab.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Halsted | Active comparator | Behavioral: Halsted's approachSkills taught using Halsted's 'See one, do one' approach |
| Peyton | Experimental | Behavioral: Peyton's approachSkills taught using Peyton's Four-Step Approach |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- Medical students of DMC with no prior exposure to surgical skills.
Key exclusion criteria (2 listed)
- Students who had previously attended any basic surgical skills workshop.
- Students who had participated in surgical camps or had prior hands-on surgical experience.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Halsted's approachParticipants in Halsted group were taught the following four skills employing Halsted 'see one do one' approach: 1. Gloving by open method. 2. Incision Making 3. Interrupted suturing 4. One-handed reef knot | Behavioural | Halsted |
| Peyton's approachParticipants in this group were taught the following four skills employing Peyton's Four-step approach: 1. Gloving by open method. 2. Incision Making 3. Interrupted suturing 4. One-handed reef knot | Behavioural | Peyton |
Primary outcome
Skill Performance score
Time frame: 3 months
After three months, all participants in both arms were recalled to perform the same set of skills. Each participant performed individually in a controlled setting while being video recorded. The recordings were later evaluated by independent assesor blinded to the participants' group allocation. Skill performance was assessed using a six-point Likert scale, where 1 = unsatisfactory, 2 = satisfactory with mistakes, 3 = satisfactory, 4 = average, 5 = good, and 6 = perfect.
1 secondary outcome
Time to Teach skill
Time frame: 1 day
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Aug 2026.
- Background: PubMed 28801083Romero P, Gunther P, Kowalewski KF, Friedrich M, Schmidt MW, Trent SM, De La Garza JR, Muller-Stich BP, Nickel F. Halsted's "See One, Do One, and Teach One" versus Peyton's Four-Step Approach: A Randomized Trial for Training of Laparoscopic Suturing and Knot Tying. J Surg Educ. 2018 Mar-Apr;75(2):510-515. doi: 10.1016/j.jsurg.2017.07.025. Epub 2017 Aug 8.
- Background: PubMed 32552805Seifert LB, Schnurr B, Stefanescu MC, Sader R, Ruesseler M, Sterz J. Comparing video-based versions of Halsted's 'see one, do one' and Peyton's '4-step approach' for teaching surgical skills: a randomized controlled trial. BMC Med Educ. 2020 Jun 17;20(1):194. doi: 10.1186/s12909-020-02105-5.
- Background: PubMed 21745059Krautter M, Weyrich P, Schultz JH, Buss SJ, Maatouk I, Junger J, Nikendei C. Effects of Peyton's four-step approach on objective performance measures in technical skills training: a controlled trial. Teach Learn Med. 2011 Jul-Sep;23(3):244-50. doi: 10.1080/10401334.2011.586917.
- Background: PubMed 33083149Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ. 2020 Oct 9;8:e10129. doi: 10.7717/peerj.10129. eCollection 2020.
- Background: PubMed 23629100Kotsis SV, Chung KC. Application of the "see one, do one, teach one" concept in surgical training. Plast Reconstr Surg. 2013 May;131(5):1194-1201. doi: 10.1097/PRS.0b013e318287a0b3.
- Individual participant dataSharing planned: Yes. All of the individual participant data collected during the trial, after deidentification.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Syed Ali Haider, FCPS,F.MAS, FACS principal investigator
Dow University of Health Sciences & Dr. Ruth K. M. Pfau Civil Hospital Karachi
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Halsted's approach and Peyton's approach in people with Retention of Basic Surgical Skills and Surgical Skills Performance Score, run by Dow University of Health Sciences at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 10 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Skill Performance score (time frame: 3 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07735026, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Aug 2026.