A comparison of multimedia and standard advanced cardiac life support learning

E-learning in advanced cardiac life support: Outcome and attitude among healthcare professionals

Background:

Advanced cardiac life support provides healthcare professionals with knowledge and skills needed in dealing with cardiac emergencies. By incorporating e-learning in advanced cardiac life support courses, it allows for easier accessibility of learning materials and a more personalized learning schedule at a lower overall cost.

Objectives:

This study aims to compare the outcome of e-learning advanced cardiac life support versus conventional advanced cardiac life support among healthcare professionals and determine their attitude on e-learning.

Methods:

A total of 96 candidates attending advanced cardiac life support courses in Hospital Universiti Sains Malaysia between January 2016 and May 2017 were included in the study. In total, 48 candidates were enrolled on each arm. Candidates in conventional advanced cardiac life support undertook a 2-day face-to-face course. Participants in e-learning advanced cardiac life support completed 6 h of online lecture videos prior to 1-day modified face-to-face course. All candidates were assessed by pre- and post-course multiple-choice questions and practical cardiac arrest simulation test. Only post-course and cardiac arrest simulation test marks contribute to the passing or failure of the candidates.

Results:

Candidates in e-learning advanced cardiac life support courses had higher mean scores on the pre-course multiple-choice questions (69.1, SD: 19.1) compared to those in conventional advanced cardiac life support courses (58.6, SD: 16.6, p < 0.001). The cardiac arrest simulation test pass rate on e-learning advanced cardiac life support was higher than conventional advanced cardiac life support courses although statistically not significant (95.8% vs 87.5%; p = 0.134). The overall pass rate was 93.8% for e-learning advanced cardiac life support versus 83.3% in conventional advanced cardiac life support (p = 0.099). A majority of the candidates had positive attitude towards e-learning.

Conclusion:

E-learning advanced cardiac life support courses demonstrated better results in terms of knowledge compared to conventional advanced cardiac life support, with equivalent skill scores. Shorter course duration, lesser cost and participants’ satisfaction were the added benefits. Further study can be done to explore the utilization of e-learning materials among healthcare professionals and its other advantages.

E-learning in advanced life support--an evaluation by the Resuscitation Council (UK)

AIM

To descriptively analyse the outcomes following the national roll out of an e-Learning advanced life support course (e-ALS) compared to a conventional 2-day ALS course (c-ALS).

METHOD

Between 1st January 2013 and 30th June 2014, 27,170 candidates attended one of the 1350 Resuscitation Council (UK) ALS courses across the UK. 18,952 candidates were enrolled on a c-ALS course and 8218 on an e-ALS course. Candidates participating in the e-ALS course completed 6-8h of online e-Learning prior to attending the 1 day modified face-to-face course. Candidates participating in the c-ALS course undertook the Resuscitation Council (UK) 2-day face-to-face course. All candidates were assessed by a pre- and post-course MCQ and a practical cardiac arrest simulation (CAS-test). Demographic data were collected in addition to assessment outcomes.

RESULTS

Candidates on the e-ALS course had higher scores on the pre-course MCQ (83.7%, SD 7.3) compared to those on the c-ALS course (81.3%, SD 8.2, P<0.001). Similarly, they had slightly higher scores on the post-course MCQ (e-ALS 87.9%, SD 6.4 vs. c-ALS 87.4%, SD 6.5; P<0.001). The first attempt CAS-test pass rate on the e-ALS course was higher than the pass rate on the c-ALS course (84.6% vs. 83.6%; P=0.035). The overall pass rate was 96.6% on both the e-ALS and c-ALS courses (P=0.776).

CONCLUSION

The e-ALS course demonstrates equivalence to traditional face-to-face learning in equipping candidates with ALS skills when compared to the c-ALS course. Value is added when considering benefits such as increased candidate autonomy, cost-effectiveness, decreased instructor burden and improved standardisation of course material. Further dissemination of the e-ALS course should be encouraged.

Randomized trial of a novel ACLS teaching tool: does it improve student performance?

Introduction

Mounting evidence suggests that high-fidelity mannequin-based (HFMBS) and computer-based simulation are useful adjunctive educational tools for advanced cardiac life support (ACLS) instruction. We sought to determine whether access to a supplemental, online computer-based ACLS simulator would improve students’ performance on a standardized Mega Code using high-fidelity mannequin based simulation (HFMBS).

Methods

Sixty-five third-year medical students were randomized. Intervention group subjects (n = 29) each received a two-week access code to the online ACLS simulator, whereas the control group subjects (n = 36) did not. Primary outcome measures included students’ time to initiate chest compressions, defibrillate ventricular fibrillation, and pace symptomatic bradycardia. Secondary outcome measures included students’ subjective self-assessment of ACLS knowledge and confidence.

Results

Students with access to the online simulator on average defibrillated ventricular fibrillation in 112 seconds, whereas those without defibrillated in 149.9 seconds, an average of 38 seconds faster [p<.05]. Similarly, those with access to the simulator paced symptomatic bradycardia on average in 95.14 seconds whereas those without access paced on average 154.9 seconds a difference of 59.81 seconds [p<.05]. On a subjective 5-point scale, there was no difference in self-assessment of ACLS knowledge between the control (mean 3.3) versus intervention (mean 3.1) [p-value =.21]. Despite having outperformed the control group subjects in the standardized Mega Code test scenario, the intervention group felt less confident on a 5-point scale (mean 2.5) than the control group. (mean 3.2) [p<.05]

Conclusion

The reduction in time to defibrillate ventricular fibrillation and to pace symptomatic bradycardia among the intervention group subjects suggests that the online computer-based ACLS simulator is an effective adjunctive ACLS instructional tool.

A human cadaver fascial compartment pressure measurement model

BACKGROUND

Fresh human cadavers provide an effective model for procedural training. Currently, there are no realistic models to teach fascial compartment pressure measurement.

OBJECTIVES

We created a human cadaver fascial compartment pressure measurement model and studied its feasibility with a pre-post design.

METHODS

Three faculty members, following instructions from a common procedure textbook, used a standard handheld intra-compartment pressure monitor (Stryker(®), Kalamazoo, MI) to measure baseline pressures ("unembalmed") in the anterior, lateral, deep posterior, and superficial posterior compartments of the lower legs of a fresh human cadaver. The right femoral artery was then identified by superficial dissection, cannulated distally towards the lower leg, and connected to a standard embalming machine. After a 5-min infusion, the same three faculty members re-measured pressures ("embalmed") of the same compartments on the cannulated right leg. Unembalmed and embalmed readings for each compartment, and baseline readings for each leg, were compared using a two-sided paired t-test.

RESULTS

The mean baseline compartment pressures did not differ between the right and left legs. Using the embalming machine, compartment pressure readings increased significantly over baseline for three of four fascial compartments; all in mm Hg (±SD): anterior from 40 (±9) to 143 (±44) (p = 0.08); lateral from 22 (±2.5) to 160 (±4.3) (p < 0.01); deep posterior from 34 (±7.9) to 161 (±15) (p < 0.01); superficial posterior from 33 (±0) to 140 (±13) (p < 0.01).

CONCLUSION

We created a novel and measurable fascial compartment pressure measurement model in a fresh human cadaver using a standard embalming machine. Set-up is minimal and the model can be incorporated into teaching curricula.

Annual resuscitation competency assessments: a review of the evidence

BACKGROUND

Australian critical care nurses generally undertake assessment of resuscitation competencies on an annual or biannual basis. International resuscitation evidence and guidelines released in 2010 do not support this practice, instead advocating more frequent retraining.

AIM

To review the evidence for annual assessment of resuscitation knowledge and skills, and for the efficacy of resuscitation training practices.

METHODS

A search of the Medline and CINAHL databases was conducted using the key search words/terms 'resuscitation' 'advanced life support' 'advanced cardiac life support' 'assessment' 'cardiac arrest', 'in-hospital cardiac arrest', 'competence', 'training', 'ALS', 'ACLS' 'course' and 'competency'. The search was limited to English language publications produced during the last 10 years. The International Liaison Committee On Resuscitation worksheets were reviewed for key references, as were the reference lists of articles from the initial search.

RESULTS

There is little evidence to support the current practice of annual resuscitation competency assessments. Theoretical knowledge has no correlation with resuscitation performance, and current practical assessment methods are problematic. Both knowledge and skills decline well before the 12-month mark. There is emerging support in the literature for frequent practice sessions using simulation technology.

CONCLUSION

The current practice of annual assessments is not supported by evidence. Emerging evidence for regular resuscitation practice is not conclusive, but it is likely to produce better outcomes. Changing practice in Australia also represents an opportunity to generate data to inform practice further.

An exploratory study of factors influencing resuscitation skills retention and performance among health providers

INTRODUCTION

Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention.

METHODS

A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers.

RESULTS

Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate.

DISCUSSION

The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales.

School nurse online emergency preparedness training: an analysis of knowledge, skills, and confidence

The objective of this study was to evaluate the effectiveness of a computer-assisted emergency preparedness course for school nurses. Participants from a convenience sample (52) of school nurses from New Mexico were randomly assigned to intervention or control groups in an experimental after-only posttest design. Intervention group participants completed 15 online emergency preparedness training modules followed by posttests, and control group participants completed the posttests without taking the training modules. Tests measured emergency preparedness with written exams, confidence surveys, and skills performance in videotaped scenarios; the videotaped scenarios were scored by Pediatric Emergency Medicine physicians blinded to whether the participants were in the intervention or control group. The intervention group participants scored significantly higher in tests of knowledge and skills than control group participants. Confidence Survey scores did not differ significantly. The online training modules are a valuable resource for improving school nurse emergency preparedness knowledge and skills but may not affect participants' confidence.

They just don't get enough! Variable intern experience in bedside procedural skills

BACKGROUND

Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures.

METHODS

Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined.

RESULTS

For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44-84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation (beta = 0.17, 95% confidence interval (CI) 0.02-0.21, P = 0.03) and age >30 years on commencing internship (beta = 8.44, 95%CI 3.03-14.06, P = 0.003. Adjusted R(2) = 0.08, P = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme (beta = 0.48, 95%CI 0.34-0.62, P < 0.001), intern experience with patient procedures (beta = 0.34, 95%CI 0.21-0.47, P < 0.001) and a clear decision to enter a postgraduate training programme (beta = 0.13, 95%CI 0.04-0.22, P = 0.007, Adjusted R(2) = 0.50, P < 0.001).

CONCLUSION

Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.

Undergraduate training in the care of the acutely ill patient: a literature review

OBJECTIVE

To characterise the problem of teaching acute care skills to undergraduates and to look for potential solutions.

DESIGN

Systematic literature review including Medline, EMBASE, CINAHL. Eligible studies described education and training issues focusing on caring for acutely ill patients. Articles were excluded if they did not address either educational or clinical aspects of acute care and resuscitation.

MEASUREMENT AND RESULTS

We identified and reviewed 374 articles focusing on training or clinical aspects of caring for the acutely ill patient. Undergraduates and junior physicians lack knowledge, confidence and competence in all aspects of acute care, including the basic task of recognition and management of the acutely ill patient. There is wide variability both between and within countries regarding the amount of teaching in critical care offered to undergraduate medical students. Many centres are starting to use an integrated approach to acute care teaching, with early exposure to basic life support and clinical skills, coupled with later exposure to more complex acute care topics. Clinical attachments remain a popular method for training in acute care. Acute care courses are increasingly being used to standardise delivery of practical skills and patient management training.

CONCLUSION

The training of healthcare staff in the care of acutely ill patients is suboptimal, adding to patient risk. Improvements in training should start at undergraduate level for maximal effect, should be integrated with postgraduate education, and are likely to enhance current efforts to improve patient safety in acute care.

Evaluation of the Clinical Assessment project: a computer-based multimedia tool to assess problem-solving ability in medical students

OBJECTIVE

The purpose of this work was to describe Clinical Assessment, a computer-based multimedia patient simulation used to assess the problem-solving abilities of medical students and to evaluate its capacity to guide the assignment of course grade.

METHODS

This was a multisite reviewer-blinded comparison of course grades, National Board of Medical Examiners pediatric examination score, and Clinical Assessment scores at 3 pediatric clerkship sites of the Harvard Medical School. Participants included 470 students completing their pediatric clerkships. Each student's performance on < or = 4 Clinical Assessment patient case simulations was compared with National Board of Medical Examiners pediatric examination scores and course grades assigned by clerkship directors based on overall ward performance.

RESULTS

Data from both the National Board of Medical Examiners pediatric "shelf" examination and the course grade were available for 411 students who completed > or = 1 Clinical Assessment case. There was a strong correlation between Clinical Assessment score and course grade when comparing students receiving honors versus satisfactory category course grades. Students who ordered more expensive or greater numbers of laboratory tests did not achieve greater diagnostic accuracy on Clinical Assessment. Clinical Assessment had a high positive predictive value for course grade: 95% of students scoring > or = 90% on Clinical Assessment achieved an honors category course grade.

CONCLUSIONS

Because nearly all of the students who scored very well on Clinical Assessment received honors category course grades, future high scorers on this examination merit consideration for assigning a high course grade. A computer-based multimedia patient simulation assessment tool provides objective information that can complement a student's National Board of Medical Examiners score and course grade and may assist in evaluating clinical problem-solving ability.

Learning about screening using an online or live lecture: does it matter?

OBJECTIVE

To determine the impact of an online lecture versus a live lecture on screening given to medical students who are participating in an outpatient clerkship.

DESIGN

Prospective, randomized, controlled study.

PARTICIPANTS AND SETTING

Ninety-five senior medical students in a primary care medicine clerkship based at university and distant clinic sites.

INTERVENTION AND MEASUREMENTS

Forty-eight medical students were randomized to the live lecture on screening (live lecture group), and forty-seven medical students were randomized to the online lecture on screening (online lecture group). Outcome measures included students' knowledge, use of time, and satisfaction with the lecture experience.

RESULTS

Compared to students in the live lecture group, students in the online lecture group demonstrated equal post-intervention knowledge of screening (P =.91) and expended 50 minutes less time to complete the lecture. Online lecture students who used the audio feed of the lecture were equally satisfied with the lecture as the live lecture students. Without the audio feed, online lecture students were less satisfied.

CONCLUSIONS

An online lecture on screening is a feasible, efficient, and effective method to teach students on outpatient clerkships about principles of screening.

A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course

BACKGROUND

Critical pediatric illness or injury occurs infrequently in out-of-hospital settings, making it difficult for paramedics to maintain physical assessment, treatment, and procedure skills.

OBJECTIVES

To document the ability of paramedics to retain clinical knowledge over a one-year interval after completing a pediatric resuscitation course and to determine whether clinical experience or retesting improves retention.

METHODS

This was a randomized controlled study assessing retention of knowledge in pediatric resuscitation soon after, six months after, and 12 months following completion of a pediatric advanced life support course. Forty-three paramedics participated in pre- and post-pediatric resuscitation course testing and were randomly assigned to one of four groups. Group 1 received a knowledge examination (KE) and mock resuscitation scenarios (MR) at six months. Group 2 received only the KE at six months. Group 3 received the MR only at six months. Group 4 received no intermediate testing. All groups were reassessed at 12 months.

RESULTS

Pediatric clinical knowledge (as measured by KE) rose sharply immediately after the course but returned to baseline levels within six months. There was no difference between the groups in knowledge scores at 12 months, despite the interventions at six months.

CONCLUSIONS

Although intensive out-of-hospital pediatric education enhances knowledge, that knowledge rapidly decays. Emergency medical services programs need to find novel ways to increase retention and ensure paramedic readiness.