Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement
Introduction
Tests performed immediately after traditional instructor lead courses in basic life support (BLS) which include lectures, demonstrations, instructor feedback and evaluation, have documented poor skills performance [1], [2], [3], [4]. Tests performed 3–12 months after such a course have also indicated poor retention of core BLS skills [5], [6], [7], [8].
Innovative methods of teaching have been introduced in an attempt to improve the results. Some have used videos with and without student interaction [3], [9], [10]. Eisenburger and Safar [1] concluded that the time required for the acquisition of knowledge and skills vary greatly between students, and that individual practice coached by video has advantages over instructor lead courses. Instructors have been reported to provide poor feedback including correction of skills [11]. In one study the results were better after peer training with the opportunity to practice at a time suitable to the individual compared with a formal instructor led course [2]. Other studies have indicated that there might be an improvement with overtraining (continued training after the individual has performed acceptably) [12], and with the use of audio prompts during the BLS performance [13], [14].
We recently reported an immediate improvement in the performance of BLS core skills by paramedic students when using an automated voice advisory manikin system (VAM) for 3 min [15]. With this system the manikin gives on-line feedback to the student based on accurate measurements of the performance versus set and adjustable limits without any instructor. Their performance remained at the same level when tested again immediately thereafter on the same manikin with the feedback system silenced. All students had attended an instructor led BLS course 11 months earlier.
We were interested in evaluating the retention of skills after a training session with VAM, and whether the retention could be improved by initial overtraining. A group of subjects with previous instructor led BLS training, therefore, were tested immediately after 20 min of individual BLS training with VAM. Forty percent of the subjects thereafter were given 10 extra 3 min training sessions with VAM over a 5 day period. All subjects were brought back for new tests 6 months later.
Section snippets
Materials and methods
The basic chest compressions (CPR) skills mouth-to-mouth ventilation and CPR, of 35 Laerdal Medical employees were studied on a manikin. No subject in the study had any medical background. The manikin used was a standard Skillmeter Resusci Anne (Laerdal Medical, Stavanger, Norway) connected to a laptop computer (Compaq Armada 7770 DMT) running an experimental software, PC Skillmeter VAM version 1.20.6, (Laerdal Medical). No change from the standard Resusci Anne manikin on which all subjects had
Results
Two of the 14 subjects randomised to the overtrained group were unavailable for the 6-month retention test, and three of the 21 randomised to the control group were unavailable for the test with audio feedback from the VAM 1 week thereafter. There were no significant differences between the control group and the overtrained group in age, gender, interval since, or number of previous CPR courses (Table 1) or in the CPR performance at baseline (session 1) or immediately after the 20 min training
Discussion
Before practising with VAM feedback most of the 35 study subjects neither ventilated nor performed CPR in accordance with the 1992 guidelines for CPR under which they had been trained previously [16]. Only one in three compressions and one out of 10 ventilations were correct with 81% having too high an inflation rate even though the maximum flow rate allowed with the old guidelines was as high as 800 ml/s [16]. This is very similar to recent findings using the same methodology in paramedic
Acknowledgements
The study was supported financially by Laerdal Medical AS and Norwegian Air Ambulance.
Portuguese Abstract and Keywords
Objectivo: Avaliar a retenção de conhecimentos após treino de massagem cardı́aca externa e ventilação (RCR) recorrendo a manequim computorizado capaz de fornecer instruções e correcções. Métodos: trinta e cinco voluntários foram expostos a 20 minutos de treino em RCR usando um manequim com capacidade para apoiar o formando com instruções e comentários áudio, mas sem apoio directo de instrutor. As instruções eram fornecidas a partir duma lista pré-gravada e
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Portuguese Abstract and Keywords
Objectivo: Avaliar a retenção de conhecimentos após treino de massagem cardı́aca externa e ventilação (RCR) recorrendo a manequim computorizado capaz de fornecer instruções e correcções. Métodos: trinta e cinco voluntários foram expostos a 20 minutos de treino em RCR usando um manequim com capacidade para apoiar o formando com instruções e comentários áudio, mas sem apoio directo de instrutor. As instruções eram fornecidas a partir duma lista pré-gravada e activadas em função da qualidade dos procedimentos do operador. Além disso, um grupo foi escolhido aleatoriamente para receber 10 sessões de 3 minutos numa semana, no mês seguinte (grupo de sobretreino). As compressões cardı́acas e a ventilação foram quantificadas sem emissão de comentários, antes e após o treino inicial e com comentários nas sessões seguintes e de novo com e sem comentários, 6 meses após a sessão inicial. Resultados: O treino inicial melhorou todas as variáveis. As compressões com a profundidade adequada aumentou de 33 para 77%, e as insuflações, de 9 para 58%. Aos 6 meses os resultados do grupo controlo não foram significativamente diferentes da fase pré treino, á excepção duma maior taxa de insuflações adequadas (18%), enquanto que o grupo com sobretreino revelou uma melhor retenção de competências, incluindo uma correcta profundidade de compressões (média 61%) e insuflações (média 42%). O uso de aviso áudio associou-se a uma melhoria imediata da qualidade das compressões e ventilações, quer no momento, quer aquando da avalialção, na altura e decorridos 6 meses. Conclusão: O ensino com recurso a este tipo de manequim associa-se a melhoria imediata da aprendizagem de RCR, com melhor retenção de conhecimentos a longo prazo quando se associa sobretreino.
Palavras chave: Ressuscitação cardiopulmonar; Educação; Paragem cardı́aca; Ventilação
Spanish Abstract and Keywords
Objetivo: evaluar la retención de destrezas y el posible efecto del sobreentrenamiento inicial, seis meses después del entrenamiento en ventilación y compresión torácica (CPR) en un maniquı́ con retroalimentación con indicaciones de voz. Método: 35 voluntarios tuvieron 20 minutos de entrenamiento provisional en CPR con un maniquı́ con retroalimentación computarizada de indicaciones de voz pero sin instructor. La retroalimentación apropiada fue sacada de una lista pregrabada, dependiendo del desempeño medido con el sistema computarizado del maniquı́, en relación con los lı́mites de variables de ventilación y compresión. Un grupo fue randomizado para recibir 10 sesiones similares, de 3 minutos cada una, durante una semana en el mes siguiente (grupo sobreentrenado). Todas las variables de compresión y ventilación fueron medidas sin retroalimentación antes y después de la sesión inicial, con retroalimentación inmediatamente después, y sin y con retroalimentación seis meses después de la sesión inicial de entrenamiento. Resultados: El entrenamiento inicial mejoró todas las variables. Las compresiones de profundidad adecuada aumentaron de un promedio 33 a 77%, y las insuflaciones correctas de un promedio 9 a 58%. Después de seis meses, los resultados para el grupo control no fueron significativamente diferentes de los pre-entrenamiento, excepto por insuflaciones correctas más frecuentes (18%), mientras que el grupo sobreentrenado tuvo mejor retención de las destrezas, incluyendo correcta profundidad de las compresiones (promedio 61%) e insuflaciones (promedio 42%). Cuando se agregó retroalimentación verbal las ventilaciones y las compresiones mejoraron inmediatamente, tanto cuando fueron evaluadas inmediatamente como 6 meses después del entrenamiento inicial. Conclusiones: El sistema de retroalimentación computarizada con maniquı́ con indicaciones verbales (VAM) puede mejorar el desempeño inmediato de destrezas de soporte vital básico (BLS), con mejor retención a largo plazo con sobreentrenamiento.
Palabras clave: Resucitación cardiopulmonar; Compresiónes torácicas; Educación; Paro cardı́aco; Ventilación