RESUMO
Introduction: Although overloaded curricula; the increasing student to educator ratio; limited resources; insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency; the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods : A randomised controlled trial design was used to compare the efficacy of the traditional; Peyton's four-stage; and a modified five-step method. Regarding the latter; George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught 'manual defibrillation'. Subsequent to the teaching session as well as at two months later; students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results: None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion: Considering that the three instructional approaches were similar in terms of skill acquisition and retention; incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment