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In this study, conducted with 64 students from the Gülhane Midwifery Department, the impact of the Peyton model on prenatal examination training was investigated. The students, randomly assigned to two groups, received theoretical and skills training; their knowledge, skills (blind assessor), self-efficacy, anxiety, and satisfaction levels were measured in laboratory and clinical settings 1 and 8 weeks after the training.
This thesis study included 64 second-year students enrolled in the Midwifery Department at the Gülhane Faculty of Health Sciences, University of Health Sciences, who had not previously received any training in prenatal care. The participating students were asked to complete the "Student Demographic Information Form," the "Prenatal Examination Knowledge Test," and the "Clinical Performance Self-Efficacy Scale." The students were randomly assigned to two groups: the Peyton Group and the Standard Group. Both groups first received theoretical instruction in a classroom setting, followed by skill training tailored to their respective groups in a laboratory setting one week later. One week after the completion of both theoretical and practical training, the students were invited to the laboratory for the initial assessment. At this stage, participants were asked to complete the "Prenatal Examination Knowledge Test," the "Clinical Performance Self-Efficacy Scale," and the "State Anxiety Inventory" prior to the practical assessment. Practical skills were assessed by a blind evaluator through observation using the "Prenatal Examination Skills Checklist" on a mannequin. Eight weeks after the initial assessment, students were invited to the Prenatal Care Clinic at Gülhane Training and Research Hospital for the clinical practice assessment. Prior to the clinical evaluation, the students were asked to complete the "State Anxiety Inventory." The clinical prenatal examination was evaluated in the same manner by a blind evaluator using the "Prenatal Examination Skills Checklist." At the conclusion of the study, the students were asked to complete the "Satisfaction Survey on Teaching Methods" to determine their opinions regarding the teaching methods employed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Peyton Group | Experimental | Midwifery students receiving prenatal care training based on the Peyton Model |
|
| Standart Group | Active Comparator | Midwifery students receiving standard prenatal care training |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Peyton Model Training | Other | A four-step instructional method (Demonstration, Deconstruction, Comprehension, and Performance) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Prenatal Examination Skill Scores | The Prenatal Care Skills Checklist was developed by the researchers and consists of 84 items within 4 subscales (Communication, History Taking, Physical Examination, and Evaluation/Planning/Documentation). The checklist uses a 2-point Likert scale and is evaluated on a 100-point system, where higher scores indicate an increased level of skill. Its content validity was validated by CVI. | 1 week and 8 weeks post-training |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Performance Self-Efficacy Scale | The Self-Efficacy in Clinical Performance Scale (SECPS) was developed by Cheraghi et al. (2009) and adapted into Turkish by Pozam and Zaybak (2013). It consists of 37 items and 4 subscales (Data Collection, Nursing Diagnosis/Planning, Implementation, and Evaluation). The scale uses an 11-point Likert-type format ranging from 0% to 100%. Evaluation is based on mean item scores (0-100), where higher scores indicate an increased level of clinical self-efficacy. The Cronbach's alpha coefficient was .98 |
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Inclusion Criteria:
Exclusion Criteria:
In Turkey, according to national regulations, only female students are admitted to midwifery undergraduate programs. Therefore, the study population consists only of female students
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| Name | Affiliation | Role |
|---|---|---|
| Nazan Karahan, Professor, Ph.D. | Saglik Bilimleri Universitesi | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Health Sciences, Gulhane Faculty of Health Sciences, Department of Midwifery | Ankara | keçiören | 06010 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37679958 | Background | Heriwardito A, Ramlan AAW, Basith A, Aristya L. Effectiveness of endotracheal intubation and mask ventilation procedural skills training on second-year student using modified Peyton's Four-Step approach during COVID-19 pandemic. Med Educ Online. 2023 Dec;28(1):2256540. doi: 10.1080/10872981.2023.2256540. | |
| 41098552 | Background |
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| ID | Term |
|---|---|
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
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A randomized parallel-group study design was used. Participants were divided into two groups: the intervention group receiving prenatal care training based on the Peyton Model, and the control group receiving standard training.
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Statistician
| Standard Training | Other | Traditional lecture and demonstration-based training |
|
| Before training, 1 week and 8 week post-training |
| State Anxiety Levels | The State-Trait Anxiety Inventory (STAI-S) was developed by Spielberger (1970) and adapted into Turkish by Öner and Le Compte (1983). For this study, the State Anxiety subscale (STAI-S) is used, consisting of 20 items that evaluate the individual's anxiety level at a specific moment. It is scored on a 4-point Likert scale, with total scores ranging from 20 to 80. Higher scores indicate an increased level of anxiety. The Cronbach's alpha coefficient for this subscale ranges from 0.94 to 0.96. | 1 week and 8 weeks post-training |
| Prenatal Care Knowledge Scores | The Knowledge Test, developed by the researchers, consists of 25 items. Total scores range from 0 to 100, where higher scores indicate greater knowledge levels. The content validity was confirmed by experts using the Content Validity Index (CVI). | Before training, 1 week and 8 week post-training |
| Satisfaction with Teaching Methods | The Educational Methods Satisfaction Questionnaire, developed by Gürpınar (2005), aims to evaluate participants' satisfaction with the educational method. It consists of 16 items scored on a 5-point Likert scale (1: Strongly disagree - 5: Strongly agree). The total score ranges from 16 to 80, where higher scores indicate an increased level of satisfaction. The internal consistency of the scale was validated with a Cronbach's alpha of 0.84. | 8 weeks post-training (at the end of the study) |
| Zhang X, Sun Z, Lan Q, Xu M, Guo X, Wei B. Enhancing Maternal ACLS Training: Evaluating the Effectiveness of a Modified Peyton's Four-Step Teaching Approach. Adv Med Educ Pract. 2025 Oct 10;16:1837-1845. doi: 10.2147/AMEP.S542286. eCollection 2025. |
| 40904337 | Background | Matschl J, Ploger R, Wittek A, Walter A, Gembruch U, Strizek B, Recker F. Developing and Assessing an Integrated Comprehensive Obstetric Ultrasound Training Program for Undergraduate Medical Students - the Fetal Assessment in Medical Education Study (FAME study). Geburtshilfe Frauenheilkd. 2025 Mar 3;85(9):976-986. doi: 10.1055/a-2531-2707. eCollection 2025 Sep. |
| 40735144 | Background | Cenaj D, Schulte-Uentrop L, Laura Kroger LF, Kullmei J, Haus JM, Moll-Khosrawi P. The Effectiveness of Peyton's 4-Step Approach to Teach Resuscitation Skills: A Randomized Controlled Clarification Study. J Med Educ Curric Dev. 2025 Jul 24;12:23821205251358090. doi: 10.1177/23821205251358090. eCollection 2025 Jan-Dec. |
| 31285653 | Background | Balafoutas D, Joukhadar R, Kiesel M, Hausler S, Loeb S, Woeckel A, Herr D. The Role of Deconstructive Teaching in the Training of Laparoscopy. JSLS. 2019 Apr-Jun;23(2):e2019.00020. doi: 10.4293/JSLS.2019.00020. |
| 37560044 | Background | Dasci S, Schrem H, Oldhafer F, Beetz O, Kleine-Dopke D, Vondran F, Beneke J, Sarisin A, Ramackers W. Learning surgical knot tying and suturing technique - effects of different forms of training in a controlled randomized trial with dental students. GMS J Med Educ. 2023 Jun 15;40(4):Doc48. doi: 10.3205/zma001630. eCollection 2023. |
| 33380320 | Background | Leitmann A, Reinert S, Weise H. Surgical suture course for dental students with the Peyton-4-step approach versus the PDCA cycle using video assisted self-monitoring. BMC Oral Health. 2020 Dec 30;20(1):365. doi: 10.1186/s12903-020-01309-x. |
| 39664508 | Background | Smith CJ, Rohlfsen C, Wardian J, Sahak K. Teaching Procedural Skills: Integrating Educational Theory Into Practice. MedEdPORTAL. 2024 Dec 11;20:11476. doi: 10.15766/mep_2374-8265.11476. eCollection 2024. |
| 39624958 | Background | Schmidt M, Schauwinhold MT, Loeffler LAK, Klasen M, Lambert SI, Sopka S, Vogt L. Safety management within the scope of teaching practical clinical skills: framing errors for cardiopulmonary resuscitation training - a multi-arm randomized controlled equivalence trial. Ann Med. 2024 Dec;56(1):2408458. doi: 10.1080/07853890.2024.2408458. Epub 2024 Oct 7. |
| 40229639 | Background | Abbasi M, Taghadosi M, Atoof F, Hosseiniara R. A quasi-experimental comparison of Kolb and Peyton educational approaches on CPR knowledge and performance among nurses. BMC Med Educ. 2025 Apr 14;25(1):530. doi: 10.1186/s12909-025-06996-0. |
| 40823457 | Background | Briones-Zamora KH, Briones-Claudett KH, Diaz Mora P, Berrus Zhumi E, Polanco Montero A, Serrano Torres WE, Benites Solis J, Briones-Zamora AD, Briones-Marquez DC. Comparison of Peyton's Four-Step Approach and Rapid Cycle Deliberate Practice in Basic and Advanced Airway Management: A Simulation-Based Study. Cureus. 2025 Aug 14;17(8):e90113. doi: 10.7759/cureus.90113. eCollection 2025 Aug. |
| 41217693 | Background | Breunig M, Kingsley R, Schroeder D, Kraus J, Plooster C, Galush T, Boldenow L, Ragaisis T, Regan H, Schouten WM, Shafay R, Issa M, T Kashiwagi D. The effect of Peyton's four-step method for teaching point-of-care ultrasound psychomotor skills: an experimental study. Ultrasound J. 2025 Nov 11;17(1):58. doi: 10.1186/s13089-025-00466-w. |
| 33083149 | Background | Giacomino 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. |
| 41621188 | Background | Sahin M, Dogu O. The effect of Halsted and Peyton teaching approaches on objective performance, self-regulated learning and satisfaction in nursing skills education: A randomized controlled trial. Nurse Educ Pract. 2026 Mar;92:104726. doi: 10.1016/j.nepr.2026.104726. Epub 2026 Jan 27. |