Authors: Wei B et al.
Journal of Cardiothoracic and Vascular Anesthesia, February 11, 2026.
Comparing Modified Peer-Assisted and Traditional Instructor-Led Approaches in Defibrillation Training.
This randomized controlled study evaluated whether a modified peer-assisted teaching approach could improve defibrillation training compared with the traditional instructor-led method used in basic life support (BLS) education for surgical residents.
The study was based on Peyton’s four-step teaching method, a widely used approach for teaching procedural skills in medical education. Traditionally, this method involves four sequential steps: demonstration by the instructor, deconstruction of the procedure, guided practice, and independent performance by the learner. In this study, the investigators modified the method by shifting the instructor’s role toward facilitation and emphasizing peer-assisted learning, allowing trainees to guide and teach each other during practice.
The trial was conducted at the simulation training center of a university-affiliated tertiary hospital in China. Eighty-four surgical residents participating in American Heart Association basic life support training between 2019 and 2023 were enrolled and randomly assigned to one of two groups:
• Experimental group (42 residents): training using the modified peer-assisted Peyton four-step approach
• Control group (42 residents): traditional instructor-led teaching
Training effectiveness was evaluated through theoretical knowledge testing, practical skill assessments, and participant questionnaires measuring satisfaction and engagement.
Theoretical knowledge test scores were very high in both groups and did not significantly differ. The experimental group achieved an average score of 99.3 ± 2.6 compared with 98.3 ± 4.4 in the traditional training group.
However, several clinically relevant performance measures favored the peer-assisted training approach. Residents in the modified Peyton group demonstrated higher accuracy in recognizing shockable rhythms (92.9% vs 76.2%) and more appropriate administration of resuscitation medications (92.9% vs 76.2%). In addition, the number of deviations from the standard defibrillation algorithm was lower in the peer-assisted group.
Learner experience also differed between groups. Questionnaire responses showed that residents trained with the modified Peyton method reported greater satisfaction with the teaching process, higher interest in learning, and a stronger willingness to perform defibrillation promptly in real clinical situations.
These findings suggest that shifting the instructor’s role from a purely directive position to a facilitator while incorporating peer-assisted learning may enhance procedural training outcomes. The collaborative environment may help reinforce skill acquisition and confidence while maintaining equivalent theoretical knowledge acquisition.
The authors conclude that the modified Peyton four-step approach may be a valuable strategy for clinical skills education, particularly in simulation-based resuscitation training programs.
Key Points
• Peyton’s four-step method is a commonly used framework for teaching procedural medical skills.
• This study compared a modified peer-assisted version of the method with traditional instructor-led teaching.
• Eighty-four surgical residents undergoing BLS training were randomized to the two approaches.
• Knowledge test scores were similar between groups.
• The peer-assisted group showed better recognition of shockable rhythms and more appropriate resuscitation drug use.
• Residents trained with the modified method reported higher satisfaction and greater learning engagement.
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