Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Mixed methods approach to understanding the influence of changes in successive versions of the advanced trauma life support training program on student performance

BACKGROUND

The Advanced Trauma Life Support course is the American College of Surgeons' standard of care for physicians who provide initial care to trauma victims. In addition to content updates, Advanced Trauma Life Support version 10 adopted contemporary learning theory and practice into the format and conduct of the training.

METHODS

The study used a mixed-methods approach wherein a one-group post-test-only study of student and student refresher exam score differences was followed up with a faculty survey to qualitatively explore the quantitative findings. Mann-Whitney U tests were used to test the null hypotheses that student and student refresher test scores on version 9 (2018) and version 10 (2019) were the same. χ² tests of independence were conducted to test the null hypotheses that student and student refresher initial assessment pass rates under versions 9 and 10 were the same. Faculty survey responses were analyzed descriptively.

RESULTS

For the student written tests, the null hypothesis was retained. For the student refresher written tests the null hypothesis was rejected; the 2019 cohort performed worse than the 2018 cohort. Student initial assessment and student refresher initial assessment pass rates in 2018 and 2019 were statistically the same. The majority of faculty reported less motivation for teaching version 10.

CONCLUSION

Although a quadrennial review of the format and conduct of Advanced Trauma Life Support courses above and beyond content updates is appropriate, it may be prudent to require strong evidence of improved student performance and value before implementing changes to the training.

Impact of training in Advanced Cardiac Life Support (ACLS) in the professional career and work environment

We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

Medical students teaching cardiopulmonary resuscitation to middle school Brazilian students

BACKGROUND

Diseases of the circulatory system are the most common cause of death in Brazil. Because the general population is often the first to identify problems related to the circulatory system, it is important that they are trained. However, training is challenging owing to the number of persons to be trained and the maintenance of training.

OBJECTIVES

To assess the delivery of a medical-student led cardiopulmonary resuscitation (CPR) training program and to assess prior knowledge of CPR as well as immediate and delayed retention of CPR training among middle school students.

METHODS

Two public and two private schools were selected. CPR training consisted of a video class followed by practice on manikins that was supervised by medical students. Multiple choice questionnaires were provided before, immediately after, and at 6 months after CPR training. The questions were related to general knowledge, the sequence of procedures, and the method to administer each component (ventilation, chest compression, and automated external defibrillation). The instructors met in a focus group after the sessions to identify the potential problems faced.

RESULTS

In total, 147 students completed the 6-month follow-up. The public school students had a lower prior knowledge, but this difference disappeared immediately after training. After the 6-month follow-up period, these public school students demonstrated lower retention. The main problem faced was teaching mouth-to-mouth resuscitation.

CONCLUSIONS

The method used by medical students to teach middle school students was based on the see-and-practice technique. This method was effective in achieving both immediate and late retention of acquired knowledge. The greater retention of knowledge among private school students may reflect cultural factors.