Basic life support training for health care students

Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system

BACKGROUND

Bristol Medical School has adopted a near peer-led teaching approach to deliver Basic Life Support training to first year undergraduate medical students. Challenges arose when trying to identify early in the course which candidates were struggling with their learning, in sessions delivered to large cohorts. We developed and piloted a novel, online performance scoring system to better track and highlight candidate progress.

METHODS

During this pilot, a 10-point scale was used to evaluate candidate performance at six time-points during their training. The scores were collated and entered on an anonymised secure spreadsheet, which was conditionally formatted to provide a visual representation of the score. A One-Way ANOVA was performed on the scores and trends analysed during each course to review candidate trajectory. Descriptive statistics were assessed. Values are presented as mean scores with standard deviation (x̄±SD).

RESULTS

A significant linear trend was demonstrated (P < 0.001) for the progression of candidates over the course. The average session score increased from 4.61 ± 1.78 at the start to 7.92 ± 1.22 at the end of the final session. A threshold of less than 1SD below the mean was used to identify struggling candidates at any of the six given timepoints. This threshold enabled efficient highlighting of struggling candidates in real time.

CONCLUSIONS

Although the system will be subject to further validation, our pilot has shown the use of a simple 10-point scoring system in combination with a visual representation of performance helps to identify struggling candidates earlier across large cohorts of students undertaking skills training such as Basic Life Support. This early identification enables effective and efficient remedial support.

Learning by teaching basic life support: a non-randomized controlled trial with medical students

BACKGROUND

Cardiopulmonary resuscitation is usually taught in universities through theoretical lectures and simulations on mannequins with low retention of knowledge and skills. New teaching methodologies have been used to improve the learning, placing the student at the center of the process. Likewise, the outside community knows next to nothing about cardiopulmonary resuscitation. Patients who have an out-of-hospital cardiac arrest will die if the effective maneuvers are not promptly done. Learning by teaching could be a way to answer both requirements. It was therefore decided to evaluate whether the medical students' cardiopulmonary resuscitation performance would improve when they teach other people, and if those people could learn with them effectively.

METHODS

A non-randomized controlled trial was designed to assess whether teaching Basic Life Support would increase students' learning. Socially engaged, seeking to disseminate knowledge, 92 medical students were trained in Basic Life Support and who subsequently trained 240 community health professionals. The students performed theoretical and practical pre- and post-tests whereas the health professionals performed theoretical pre- and post-tests and one practical test. In order to assess the impact of teaching on students' learning, they were divided into two groups: a case group, with 53 students, reassessed after teaching health professionals, and a control group, with 39 students, reassessed before teaching.

RESULTS

The practical students' performance of the case group went from 13.3 ± 2.1 to 15.3 ± 1.2 (maximum = 17, p < 0.001) and theoretical from 10.1 ± 3.0 to 16.4 ± 1.7 (maximum = 20, p < 0.001) while the performance of the control group went from 14.4 ± 1.6 to 14.4 ± 1.4 (p = 0.877) and from 11.2 ± 2.6 to 15.0 ± 2.3 (p < 0.001), respectively. The theoretical performance of the health professionals changed from 7.9 ± 3.6 to 13.3 ± 3.2 (p < 0.001) and the practical performance was 11.7 ± 3.2.

CONCLUSIONS

The students who passed through the teaching activity had a theoretical and practical performance superior to that of the control group. The community was able to learn from the students. The study demonstrated that the didactic activity can be an effective methodology of learning, besides allowing the dissemination of knowledge. The University, going beyond its academic boundaries, performs its social responsibility.

Professionalizing peer instructor skills in basic life support training for medical students: A randomized controlled trial

Background:

The Radboud university medical center designed an obligatory basic life support and first-aid course for first-year medical students.

Objectives:

We evaluated the value of an additional train-the-trainer course following European Resuscitation Council guidelines, which focuses on practical basic life support training and providing feedback, in comparison with standard in-service instructor training.

Methods:

This study was a prospective randomized controlled trial. A total of 10 intervention instructors, 14 control instructors, and 337 first-year medical students participated in the study. Students, blinded for the type of instructor, completed questionnaires evaluating the quality of the basic life support training (theoretical and practical) and provided feedback. The secondary endpoint was the basic life support examination to assess whether the instructors’ training influenced the quality of the participants’ basic life support.

Results:

The response rate of the questionnaire was 82% on average. No differences were found between intervention and control group concerning theoretical basic life support training. The intervention instructors scored significantly higher on practical basic life support training according to student evaluations ( p < 0.001). The pass rate on basic life support examinations did not differ significantly ( p = 0.669). Appreciation of given feedback was independent of instructors’ educational training.

Conclusion:

This study is the first to establish that the 12-h train-the-trainer course following European Resuscitation Council guidelines improves students’ appreciation of practical basic life support training. The additional course did not influence appreciation of theoretical basic life support training or perceived feedback.

Peers versus professional training of basic life support in Syria: a randomized controlled trial

BACKGROUND

Peer training has been identified as a useful tool for delivering undergraduate training in basic life support (BLS) which is fundamental as an initial response in cases of emergency. This study aimed to (1) Evaluate the efficacy of peer-led model in basic life support training among medical students in their first three years of study, compared to professional-led training and (2) To assess the efficacy of the course program and students' satisfaction of peer-led training.

METHODS

A randomized controlled trial with blinded assessors was conducted on 72 medical students from the pre-clinical years (1st to 3rd years in Syria) at Syrian Private University. Students were randomly assigned to peer-led or to professional-led training group for one-day-course of basic life support skills. Sixty-four students who underwent checklist based assessment using objective structured clinical examination design (OSCE) (practical assessment of BLS skills) and answered BLS knowledge checkpoint-questionnaire were included in the analysis.

RESULTS

There was no statistically significant difference between the two groups in delivering BLS skills to medical students in practical (P = 0.850) and BLS knowledge questionnaire outcomes (P = 0.900). Both groups showed statistically significant improvement from pre- to post-course assessment with significant statistical difference in both practical skills and theoretical knowledge (P-Value < 0.001). Students were satisfied with the peer model of training.

CONCLUSION

Peer-led training of basic life support for medical students was beneficial and it provided a quality of education which was as effective as training conducted by professionals. This method is applicable and desirable especially in poor-resource countries and in crisis situation.

Improvement in Confidence Levels for the Management of Paediatric Cardiac Arrests in Medical Students Following a Training Course

BACKGROUND

Newly qualified doctors lack competency in handling a cardiopulmonary resuscitation. The ability to recall CPR fundamentals have been shown to be inadequate. Of greater concern is that medical students over - estimate their ability to deliver such aid in a real - world setting. As most medical students are only taught adult BLS they are often unskilled and/or unhelpful in managing paediatric specific emergencies. This fact is supported by the poor outcomes demonstrated in delivering successful Paediatric Basic Life Support (PBLS).

OBJECTIVES

Our aim was to evaluate the baseline confidence levels of medical students in dealing with a paediatric cardiac arrest (PCA) and the improvement seen following a PBLS training course.

METHODS

A prospective study was conducted on 51 medical students who attended an established one - day PBLS and first aid course at one UK medical school. Participants were requested to complete a questionnaire directly prior to and after the course.

RESULTS

Following the delivery of the training, the cohort reported a statistically significant (P < 0.05) increase in mean confidence with PCA from 2.2/10 (2.2 out of 10) to 7.5/10. A pre - training mean confidence score of 2.6/10 was observed for Year 4 and 5 students who are close to graduating.

CONCLUSIONS

Our findings clearly demonstrate very poor confidence among medical students with PCA at all stages of their training. We would strongly advocate the inclusion of a PBLS component in medical school curriculums so that future doctors are adequately prepared to deliver PBLS with confidence.

A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students

Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training.

Knowledge and Attitudes Towards Basic Life Support Among Health Students at a Saudi Women's University

OBJECTIVES

Awareness of basic life support (BLS) is paramount to ensure the provision of essential life-saving medical care in emergency situations. This study aimed to measure knowledge of BLS and attitudes towards BLS training among female health students at a women's university in Saudi Arabia.

METHODS

This prospective cross-sectional study took place between January and April 2016 at five health colleges of the Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. All 2,955 students attending the health colleges were invited to participate in the study. Participants were subsequently asked to complete a validated English-language questionnaire which included 21 items assessing knowledge of BLS and six items gauging attitudes to BLS.

RESULTS

A total of 1,349 students completed the questionnaire (response rate: 45.7%). The mean overall knowledge score was very low (32.7 ± 13.9) and 87.9% of the participants had very poor knowledge scores. A total of 32.5% of the participants had never received any BLS training. Students who had previously received BLS training had significantly higher knowledge scores (P <0.001), although their knowledge scores remained poor. Overall, 77.0% indicated a desire to receive additional BLS training and 78.5% supported mandatory BLS training.

CONCLUSION

Overall knowledge about BLS among the students was very poor; however, attitudes towards BLS training were positive. These findings call for an improvement in BLS education among Saudi female health students so as to ensure appropriate responses in cardiac arrest or other emergency situations.

Basic life support knowledge of first-year university students from Brazil

We aimed to evaluate knowledge of first aid among new undergraduates and whether it is affected by their chosen course. A questionnaire was developed to assess knowledge of how to activate the Mobile Emergency Attendance Service - MEAS (Serviço de Atendimento Móvel de Urgência; SAMU), recognize a pre-hospital emergency situation and the first aid required for cardiac arrest. The students were also asked about enrolling in a first aid course. Responses were received from 1038 of 1365 (76.04%) new undergraduates. The questionnaires were completed in a 2-week period 1 month after the beginning of classes. Of the 1038 respondents (59.5% studying biological sciences, 11.6% physical sciences, and 28.6% humanities), 58.5% knew how to activate the MEAS/SAMU (54.3% non-biological vs 61.4% biological, P=0.02), with an odds ratio (OR)=1.39 (95%CI=1.07-1.81) regardless of age, sex, origin, having a previous degree or having a relative with cardiac disease. The majority could distinguish emergency from non-emergency situations. When faced with a possible cardiac arrest, 17.7% of the students would perform chest compressions (15.5% non-biological vs 19.1% biological first-year university students, P=0.16) and 65.2% would enroll in a first aid course (51.1% non-biological vs 74.7% biological, P<0.01), with an OR=2.61 (95%CI=1.98-3.44) adjusted for the same confounders. Even though a high percentage of the students recognized emergency situations, a significant proportion did not know the MEAS/SAMU number and only a minority had sufficient basic life support skills to help with cardiac arrest. A significant proportion would not enroll in a first aid course. Biological first-year university students were more prone to enroll in a basic life support course.

Peer-led training and assessment in basic life support for healthcare students: synthesis of literature review and fifteen years practical experience

BACKGROUND

In 1995, the University of Birmingham, UK, School of Medicine and Dentistry replaced lecture-based basic life support (BLS) teaching with a peer-led, practical programme. We present our 15-yr experience of peer-led healthcare undergraduate training and examination with a literature review.

METHODS

A literature review of healthcare undergraduate peer-led practical skills teaching was performed though Pubmed. The development of the Birmingham course is described, from its inception in 1995-2011. Training methods include peer-led training and assessment by senior students who complete an European Resuscitation Council-endorsed instructor course. Student assessors additionally undergo training in assessment and communication skills. The course has been developed by parallel research evaluation and peer-reviewed publication. Course administration is by an experienced student committee with senior clinician support. Anonymous feedback from the most recent courses and the current annual pass rates are reported.

RESULTS

The literature review identified 369 publications of which 28 met our criteria for inclusion. Largely descriptive, these are highly positive about peer involvement in practical skills teaching using similar, albeit smaller, courses to that described below. Currently approximately 600 first year healthcare undergraduates complete the Birmingham course; participant numbers increase annually. Successful completion is mandatory for students to proceed to the second year of studies. First attempt pass rate is 86%, and close to 100% (565/566 students, 99.8%) following re-assessment the same day. 97% of participants enjoyed the course, 99% preferred peer-tutors to clinicians, 99% perceived teaching quality as "good" or "excellent", and felt they had sufficient practice. Course organisation was rated "good" or "excellent" by 91%. Each year 3-4 student projects have been published or presented internationally. The annual cost of providing the course is currently £15,594.70 (Eur 18,410), or approximately £26 (Eur 30) per student.

CONCLUSIONS

This large scale, peer-led BLS course demonstrates that such programmes can have excellent outcomes with outstanding participant satisfaction. Peer-tutors and assessors are competent, more available and less costly than clinical staff. Student instructors develop skills in teaching, assessment and appraisal, organisation and research. Sustainability is possible given succession-planning and consistent leadership.

First aid and basic life support: a questionnaire survey of medical schools in the Netherlands

PURPOSE

Adequate education in first aid and basic life support (BLS) should be considered as an essential aspect of the medical curriculum. The objective of this study was to investigate the current medical training in first aid and BLS at all 8 medical schools in the Netherlands.

SUMMARY

An evaluation was made, by sending a questionnaire to all medical schools, regarding whether the medical training was performed in accordance with the national Dutch guidelines for medical education. The response was 100%. Seven of the eight medical schools train their students in first aid and BLS during the medical curriculum. An average of only 38% of the clinical pictures and diseases and 69% of the skills were mastered at the level-defined national Dutch guidelines.

CONCLUSION

The medical education in the Netherlands does not meet the required objectives as stated in the national Dutch guidelines concerning first aid and BLS.

Peer assessment of resuscitation skills

INTRODUCTION

Peer tuition has been identified as a useful tool for delivering undergraduate healthcare training in basic life support. The aim of this study was to test the expansion of the peer tuition model to include peer assessment of performance. The study also sought to establish the attitudes towards peer assessment among the course students and tutors.

METHODS

Students undergoing an end-of-course test in basic life support were simultaneously assessed by peer and faculty assessors, and the reliability of assessment results was measured. Students' and peer assessors' attitudes to peer assessment were also measured, by questionnaire.

RESULTS

In all 162 candidates were assessed by 9 sets of peers and faculty examiners. Inter-observer agreement was high (>95%) for all assessment domains apart from chest compressions (93%). Agreement on the final pass/fail decision was less consistent at 86%, because of the lower pass rate of 71% (115/162) afforded by peer assessors compared with 82% (132/162) by faculty assessors (p=0.0008). Peer assessor sensitivity and specificity were 85% was 90%, respectively, with positive predictive value of 97% and negative predictive value of 57%.

CONCLUSION

Senior healthcare students can make reliable assessments of their peers' performance during an end-of-course test in basic life support. Students preferred peer assessment, and the peer assessment process was acceptable to the majority of students and peer assessors.

First aid: level of knowledge of relatives and bystanders in emergency situations

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16+/-3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver's license were considered to be more successful.

An evaluation of objective feedback in basic life support (BLS) training

BACKGROUND

Studies show that acquisition and retention of BLS skills is poor, and this may contribute to low survival from cardiac arrest. Feedback from instructors during BLS training is often lacking. This study investigates the effects of continuous feedback from a manikin on chest compression and ventilation techniques during training compared to instructor feedback alone.

MATERIALS AND METHODS

A prospective randomised controlled trial. First-year healthcare students at the University of Birmingham were randomised to receive training in standard or feedback groups. The standard group were taught by an instructor using a conventional manikin. The feedback group used a 'Skillreporter' manikin, which provides continuous feedback on ventilation volume and chest compression depth and rate in addition to instructor feedback. Skill acquisition was tested immediately after training and 6 weeks later.

RESULTS

Ninety-eight participants were recruited (conventional n=49; Skillreporter n=49) and were tested after training. Sixty-six students returned (Skillreporter n=34; conventional n=32) for testing 6 weeks later. The Skillreporter group achieved better compression depth (39.96mm versus 36.71mm, P<0.05), and more correct compressions (58.0% versus 40.4%, P<0.05) at initial testing. The Skillreporter group also achieved more correct compressions at week 6 (43.1% versus 26.5%, P<0.05).

CONCLUSIONS

This study demonstrated that objective feedback during training improves the performance of BLS skills significantly when tested immediately after training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.

Medical students teaching basic life support to school children as a required element of medical education: a randomised controlled study comparing three different approaches to fifth year medical training in emergency medicine

OBJECTIVES

Basic life support (BLS) by doctors has been shown to be of poor quality. To improve medical education training should be simplified, and simultaneously the learner should be involved more actively. To combine both ideas we trained medical students to give BLS courses and sent them to teach school children. This was a requirement for their emergency medicine course. Our model was compared to conventional teaching.

DESIGN

Medical students were assigned at random to one of three groups. Group 1 ("university") attended a conventional university BLS/ALS course. Group 2 ("EMS") accompanied a BLS vehicle of the emergency medical service (EMS) after suitable preparation. Group 3 ("school") was instructed to teach BLS and then sent to teach at schools.

MAIN OUTCOME MEASURES

Clinically significant BLS skills, and overall BLS skills, each assessed by structured clinical examination (SCE). Theoretical knowledge assessed by written (open question) test.

RESULTS

Clinically relevant mistakes were seen in 37.5% in group 1 ("university"), compared to 28.8% in group 2 ("EMS"), and 11.3% in group 3 ("school"). Highly significant differences were shown between "school" and "EMS" (p=0.011), and between "school" and "university" (p<0.001). In practical testing for overall performance the "university" group reached a median of 78.8% (25th-75th percentile 69.2-84.6%), group "EMS" reached 76.9% (69.2-88.5%), and group "school" 84.6% (76.9-90.0). Group "school" showed significant advantages over "university" (p=0.015) and "EMS" (p=0.010). Written test results did not differ statistically.

CONCLUSION

Medical students teaching BLS to school children as a compulsory element of their own medical training showed superior practical skills as compared to conventional teaching. Theoretical knowledge was equivalent to the control groups, although their course contained less theoretical information.

No model of clinical education for physiotherapy students is superior to another: a systematic review

QUESTION

Which models of undergraduate/entry-level clinical education are being used internationally in allied health disciplines? What is the effect and, from the perspective of stakeholders, what are the advantages, disadvantages, and recommendations for successful implementation of different models of undergraduate/entry-level clinical education?

DESIGN

Systematic review with data from quantitative and qualitative studies synthesised in a narrative format.

PARTICIPANTS

Undergraduates/entry-level students from five allied health disciplines undergoing clinical education.

INTERVENTION

Six broad models of clinical education: one-educator-to-one-student (1:1); one-educator-to-multiple-students (1:2); multiple-educators-to-one-student (2:1); multiple-educators-to-multiple-students (2:2); non-discipline-specific-educator and student-as-educator.

OUTCOME MEASURES

Models were examined for productivity; student assessment; and advantages, disadvantages, and recommendations for implementation.

RESULTS

The review found few experimental studies, and a large amount of descriptive research and opinion pieces. The rigour of quantitative evidence was low, however qualitative was higher. Evidence supporting one model over another was largely deficient with few comparative studies available for analysis. Each model proffered strengths and weaknesses, which were unique to the model.

CONCLUSION

There is currently no 'gold standard' model of clinical education. The perception that one model is superior to any other is based on anecdotes and historical precedents, rather than on meaningful, robust, comparative studies.

Basic life support skills training in a first year medical curriculum: six years' experience with two cognitive-constructivist designs

RATIONALE

Although the Basic Life Support (BLS) ability of a medical student is a crucial competence, poor BLS training programs have been documented worldwide. Better training designs are needed. This study aims to share detailed descriptions and the test results of two cognitive-constructivist training models for the BLS skills in the first year of medical curriculum.

METHOD

A BLS skills training module was implemented in the first year curriculum in the course of 6 years (1997-2003). The content was derived from the European Resuscitation Council Guidelines. Initially, a competence-based model was used and was upgraded to a cognitive apprenticeship model in 2000. The main performance-content type that was expected at the end of the course was: competent application of BLS procedures on manikins and peers at an OSCE as well as 60% achievement in a test consisting of 25 MCQ items. A retrospective cohort survey design using exam results and a self-completed anonymous student ratings' questionnaire were used in order to test models.

RESULTS

Training time for individual students varied from 21 to 29 hours. One thousand seven hundred and sixty students were trained. Fail rates were very low (1.0-2.2%). The students were highly satisfied with the module during the 6 years.

CONCLUSION

In the first year of the medical curriculum, a competence-based or cognitive apprenticeship model using cognitive-constructivist designs of skills training with 9 hours theoretical and 12-20 hours long practical sessions took place in groups of 12-17 students; medical students reached a degree of competence to sufficiently perform BLS skills on the manikins and their peers. The cognitive-constructivist designs for skills training are associated with high student satisfaction. However, the lack of controls limits the extrapolation of this conclusion.

First aid and basic life support of junior doctors: A prospective study in Nijmegen, the Netherlands

According to the Dutch medical education guidelines junior doctors are expected to be able to perform first aid and basic life support. A prospective study was undertaken to assess the level of first aid and basic life support (BLS) competence of junior doctors at the Radboud University Nijmegen Medical Centre (RUNMC), the Netherlands. Fifty-four junior doctors (18%), of the medical students in their final years, were submitted to a theoretical test, composed of multiple-choice questions concerning first aid and basic life support. This test was followed by a practical test consisting of two out-of-hospital first aid and basic life support scenarios including cardiopulmonary resuscitation (CPR). In total, 19% of the junior doctors passed the theoretical test. The first scenario was performed correctly in 11%. The CPR situation was correctly performed by 30% of the students as observed by the examiners but when assessed by the checklists of Berden only 6% of the students performed correct CPR. It is concluded that the level of first aid and basic life support of the junior doctors at the RUNMC is low and does not meet the required level as stated in the guidelines for practice of medical education in the Netherlands.

Training of ???first-aid??? trainers: a medical school example in Turkey

OBJECTIVE

A student-oriented basic life support and first-aid training is practical to enlarge the number of qualified people in the field. In this study, we aimed to describe and discuss the training process of a group of medical students at Hacettepe University, School of Medicine and their assessment as basic life support and first-aid trainers.

METHODS

A '6-hour' 'Training the Trainers' course was conducted and participants' demonstration and coaching skills were evaluated by using a 3-point scale (1 - needs improvement; 2 - competently performed; 3 - proficiently performed). In total, 31 students out of 45 volunteers were certified as trainers.

RESULTS

All of the students proficiently performed 'explain the aim of the demonstration', 'motivate participants to use checklists', and 'motivate the participants to ask questions' for demonstraton skills. Similarly, they all got the maximum grade for 'answer the questions of the participant', 'discuss the coach role of the participant', 'apply the skills', and 'follow up with the participant by using the checklist' as steps of coaching skills. None of the skills within the checklists needed improvement for any of the candidates.

CONCLUSION

Although there are limitations, we hope that our experience of the Training the Trainers course will be useful for readers to highlight the importance of skill-based peer education on a very important public health concern, especially for the developing countries.

The evaluation of first aid and basic life support training for the first year university students

In Turkey, the first aiders are few in quantity and yet they are required in many settings, such as earthquakes. It was thought that training first year university students in first aid and basic life support (FA-BLS) techniques would serve to increase the number of first aiders. It was also thought that another problem, the lack of first aid trainers, might be addressed by training medical students to perform this function. A project aimed at training first year university students in FA-BLS was conducted at Hacettepe University. In the first phase, medical student first aid trainers (MeSFAT) were trained in FA-BLS training techniques by academic trainers and in the second phase, first year university students were trained in FA-BLS techniques by these peer trainers under the academic trainers' supervision. The purpose of this study was to assess the participants' evaluation of this project and to propose a new program to increase the number of first aiders in the country. In total, 31 medical students were certified as MeSFATs and 12 of these trained 40 first year university students in FA-BLS. Various questionnaires were applied to the participants to determine their evaluation of the training program. Most of the participants and the authors considered the program to be successful and effective. This method may be used to increase the number of first aid trainers and first aiders in the community.

CPREzy™: an evaluation during simulated cardiac arrest on a hospital bed

CPREzy is a new adjunct designed to improve the application of manual external chest compressions (ECC) during cardiopulmonary resuscitation (CPR). The aim of this study was to determine the effect of using the CPREzy device compared to standard CPR during the simulated resuscitation of a patient on a hospital bed. Twenty medical student volunteers were randomised using a cross over trial design to perform 3 min of continuous ECC using CPREzy and standard CPR. There was a significant improvement in ECC depth with CPREzy compared to standard CPR 42.9 (4.4) mm versus 34.2 (7.6): mm, P = 0.001; 95% CI d.f. 4.4-12.9 mm. This translated to a reduction in the percentage of shallow compressions (<38 mm) with CPREzy 16 (23)% compared to standard CPR 59 (44)%, P = 0.003. There was a small increase in the percentage of compression regarded excessive (>51 mm): CPREzy 6.5 (19)% versus standard CPR 0 (0.1)%. P = 0.012). There was no difference in compression rate or duty cycle between techniques. Equal numbers of participants (40% in each group) performed one of more incorrectly placed chest compression. However the total number of incorrect compressions was higher for the CPREzy group (26% versus 3.9% standard CPR, P < 0.001). This was due to a higher number of low compressions (26% of total compressions for CPREzy versus 1% for standard CPR, P < 0.001). In conclusion, CPREzy was associated with significant improvements in ECC performance. Further animal and clinical studies are required to validate this finding in vivo and to see if it translates to an improvement in outcome in human victims of cardiac arrest.

A comparison between over-the-head and standard cardiopulmonary resuscitation

BACKGROUND

Standard cardiopulmonary resuscitation (CPR) is performed by kneeling adjacent to the side of the casualty. In certain circumstances it may be difficult or impossible to perform CPR in this position, for example in confined spaces such as a narrow corridor, aircraft or train gangway. The aim of this study was to investigate the technique of over-the-head CPR (OTH CPR), where the CPR provider kneels above the casualty and performs chest compressions OTH of the casualty.

METHODS

Twenty volunteers were randomised to a cross over trial where they performed standard and OTH CPR at a 7-day interval. Compression and ventilation variables were recorded on the Laerdal Resusci Annie VAM system.

RESULTS

Chest compression depth and ventilation volume declined over time (0-3 min P < 0.001). There was no difference in compression rate, depth, duty cycle or ventilation rate, inflation rate and ventilation volume between techniques. Hand position was incorrect more frequently in the standard compared to the OTH group (incorrect compressions 300 versus 76, respectively, P < 0.001) due principally to a greater proportion of low positioned compressions in the standard CPR group.

CONCLUSION

OTH CPR appears equally effective as standard CPR with some marginal advantages in correct hand placement. We suggest that in situations where it is not possible to perform standard CPR, OTH CPR may be considered as a suitable alternative.

Challenges in the care of the acutely ill

Health care providers, hospital administrators, and politicians face competing challenges to reduce clinical errors, control expenditure, increase access and throughput, and improve quality of care. The safe management of the acutely ill inpatient presents particular difficulties. In the first of five Lancet articles on this topic we discuss patients' safety in the acute hospital. We also present a framework in which responsibility for improvement and better integration of care can be considered at the level of patient, local environment, hospital, and health care system; and the other four papers in the series will examine in greater detail methods for measuring, monitoring, and improving inpatient safety.

Cardiac arrest management

Approximately 1,000 people in the United States suffer cardiac arrest each day, most often as a complication of acute myocardial infarction (AMI) with accompanying ventricular fibrillation or unstable ventricular tachycardia. Increasing the number of patients who survive cardiac arrest and minimizing the clinical sequelae associated with cardiac arrest in those who do survive are the objectives of emergency medical personnel. In 1990, the American Heart Association (AHA) suggested the chain of survival concept, with four links--early access, cardiopulmonary resuscitation (CPR), defibrillation, and advanced care--as the way to approach cardiac arrest. The recently published International Resuscitation Guidelines 2000 of the AHA have addressed advances in our understanding of the chain of survival. While the chain of survival concept has withstood a decade of scrutiny, there are only a few scientifically rigorous research studies that support changes in prehospital patient care. Additional research efforts carried out in the prehospital setting are needed to support the concepts included in the chain of survival for cardiac arrest patients. Participants at the second Turtle Creek Conference, a meeting of experts in the field of emergency medicine held in Dallas, Texas, on March 29-31, 2000, discussed these and other issues associated with prehospital emergency care in the cardiac arrest patient. This paper addresses a number of the issues associated with each of the links of the chain of survival, the evidence that exists, and what should be done to achieve the clinical evidence needed for true clinical significance. Also included in this paper are the consensus statements developed from small discussion groups held after the main presentation. These comments provide another perspective to the problems and to possible approaches to deal with them.

First aid and basic life support skills training early in the medical curriculum: curriculum issues, outcomes, and confidence of students

BACKGROUND

The importance of training physicians and other health care professionals in first aid and basic life support (BLS) is now widely recognized. The Faculty of Medicine and Health Sciences of the United Arab Emirates University have been offering formal training in these skills to 1st-year medical students since 1989. The aim of this study was to determine the efficacy of the program and the extent to which it provides students with confidence to perform skills on their own after training.

DESCRIPTION

165 of 180 male and female students comprising 3 cohorts (91.7% response rate) completed a self-administered anonymous questionnaire. The questionnaire contained open- ended and Likert-type questions regarding course organization, content, strengths and weaknesses, teaching--learning approaches, and skills development and confidence. The authors analyzed assessment outcomes and associations between self-perceived levels of confidence and ability to practice.

EVALUATION

Students were uniformly enthusiastic and highly motivated by the program. Self-assessed confidence in ability to perform skills on their own after completing the program was moderately correlated with perceived frequency of opportunity to practice many skills. There was nevertheless a consistent desire for more practice time.

CONCLUSIONS

The results suggest that the program provides students with sound basic knowledge and adequate practical skills in first aid and BLS and that adequacy of time and physical and human resources are important prerequisites to facilitate practice and engender confidence in skills.

Role of anaesthesiologists in undergraduate medical education

Although anaesthesia and intensive care medicine are postgraduate subjects, few would deny the value of exposing medical undergraduates to clinical training in these areas. The present review addresses developments in medical undergraduate training curricula, and the specific benefits that can be provided for medical students, at all stages of training, by anaesthesiologists working in operating theatres, intensive care units and pain clinics.

Cardiopulmonary resuscitation training for students of odontology: skills acquisition after two periods of learning

INTRODUCTION

Although life threatening emergencies in dental practice are not frequent, dentists have to be competent in providing basic life support (BLS).

OBJECTIVES

The aim of this work was to study the level of skills acquisition among dentistry students in two different periods of one rescuer-BLS training, a first short practice training of 2 h followed by 8 h of practice over a period of 2 months.

METHODS

One hundred and sixteen second-year undergraduate students of Anesthesiology at the Dental School of the Complutense University in Madrid were tested at the end of the two periods of learning using a recording manikin with a validated scoring system (Laerdal Resusci-Anne). This manikin recorded the percentage of adequate chest compressions and insuflations, rate of chest compressions and the causes of error in each case.

RESULTS

Final global results were, 51.66+/-3.0% adequate chest compressions; and 54.44+/-3.61% adequate insuflations. The kinds of errors where different in both tests were, wrong hand position (26.92+/-2.96 vs. 12.29+/-2.40%, P<0.001); excessive compressions (27.71+/-2.90 vs. 16.02+/-2.33%, P<0.05); and weak compressions (23.28+/-3.24 vs. 16.77+/-2.57%, P<0.05). Regression analysis found a positive correlation among excessive compression, height and weight (P<0.001) and a negative correlation between weak compression, height and weight (P<0.001).

CONCLUSIONS

The poor overall results, although similar to those shown in the literature, have made us question the validity of our methods of teaching BLS. We were able to establish a correlation between demographic and sociocultural variables with the typical errors, and to begin the process of improving our teaching methods.