Simulation-Based Basic Life Support Training: A QuasiExperimental Study Comparing Peyton’s Four-Step Approach with Traditional Teaching Among Undergraduate Medical Students

Background: Basic Life Support (BLS) competence is an essential requirement for medical graduates; however, traditional teaching may provide limited opportunities for active learning and structured practice. Peyton's FourStep Approach (PFSA) is a learner-centred method for teaching procedural skills, but evidence regarding its effectiveness in BLS skill acquisition and retention among undergraduate medical students in India remains limited. Objectives: To evaluate the effectiveness of Peyton's Four-Step Approach compared with Traditional Teaching Method (TTM) in improving immediate BLS skill performance and one-month skill retention among undergraduate medical students. Secondary objectives were to assess learner satisfaction and confidence with the two teaching methods. Methods: A quasi-experimental study was conducted among 100 third-year undergraduate medical students at GSL Medical College, Rajahmundry, Andhra Pradesh. Participants were non-randomly allocated into an experimental group receiving BLS training using Peyton's Four-Step Approach (n = 50) and a control group receiving Traditional Teaching Method (n = 50). BLS skills were assessed using a 15-item Objective Structured Clinical Examination (OSCE) checklist before training, immediately after training, and one month after the intervention. Student satisfaction and confidence were also assessed. Data were analysed using independent samples t-test and Chi-square test, with p < 0.05 considered statistically significant. Results: Baseline OSCE scores were comparable between the PFSA and TTM groups (5.82 ± 1.34 vs. 5.68 ± 1.41; p = 0.612). The PFSA group demonstrated significantly higher immediate post-training OSCE scores than the TTM group (12.46 ± 1.18 vs. 10.84 ± 1.47; mean difference: 1.62; p < 0.001). At one-month follow-up, skill retention remained significantly higher in the PFSA group (11.72 ± 1.29 vs. 9.63 ± 1.58; mean difference: 2.09; p < 0.001). Student satisfaction was higher in the PFSA group than in the TTM group (90% vs. 16%; χ² = 54.96; p < 0.001). Similarly, a greater proportion of students in the PFSA group reported confidence in performing BLS skills (88% vs. 10%; χ² = 30.43; p < 0.001). Conclusions: Peyton's Four-Step Approach was more effective than Traditional Teaching Method for improving immediate BLS skill performance and one-month skill retention among undergraduate medical students. The approach was also associated with greater student satisfaction and confidence. Incorporating structured, learnercentred approaches such as PFSA into undergraduate BLS training may enhance the acquisition and retention of essential resuscitation skills.