Elsevier

Resuscitation

Volume 52, Issue 3, March 2002, Pages 273-279
Resuscitation

Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement

https://doi.org/10.1016/S0300-9572(01)00476-2Get rights and content

Abstract

Aim: To evaluate the retention of skills 6 months after training in ventilation and chest compressions (CPR) on a manikin with computer based on-line voice advisory feedback and the possible effects of initial overtraining. Methods: Thirty five volunteers had 20 min provisional CPR training on a manikin with computer based voice advisory feedback but without an instructor. The appropriate feedback was taken from a pre-recorded list depending on performance measured by the manikin–computer system versus set limits for ventilation and compression variables. One group in addition was randomised to receive 10 similar 3 min training sessions during 1 week in the following month (overtrained group). All ventilation and compression variables were measured without feedback before and after the initial training session, with feedback immediately thereafter, and both without and with feedback 6 months after the initial training session. Results: The initial training improved all variables. Compressions with correct depth increased from a mean of 33 to 77%, and correct inflations from a mean of 9 to 58%. After 6 months, the results for the controls were not significantly different from pre-training, except for a higher of correct inflations (18%), while the overtrained group had better retention of skills including the correct compression depth (mean 61%) and inflations (mean 42%). When verbal feedback was added both the compressions and ventilations immediately improved both when tested immediately and 6 months after the initial training session. Conclusions: The computer-based voice advisory manikin (VAM) feedback system can improve immediate performance of basic life support (BLS) skills, with better long-term retention with overtraining.

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

References (32)

  • W Kaye et al.

    Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public

    Crit. Care Med.

    (1986)
  • L Curry et al.

    Effects of training in cardiopulmonary resuscitation on competence and patient outcome

    Can. Med. Assoc. J.

    (1987)
  • R Broomfield

    A quasi-experimental research to investigate the retention of basic cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development

    J. Adv. Nurs.

    (1996)
  • D.K Moser et al.

    Recommendations for improving cardiopulmonary resuscitation skills retention

    Heart Lung

    (1992)
  • J.B Oxendine

    Effect of mental and physical practice on the learning of three motor skills

    Res. Q.

    (1969)
  • L.M Starr

    Electronic voice boosts CPR responses

    Occup. Health Saf.

    (1997)
  • Cited by (148)

    • External Cardiac Massage Training of Medical Students: A Randomized Comparison of Two Feedback Methods to Standard Training

      2020, Journal of Emergency Medicine
      Citation Excerpt :

      Being confronted with CA in a clinical situation is rare and unpredictable, and therefore questioning about the retention of technical skills is important. Wik et al. showed that skills acquired after initial training of naive trainees were maintained at 6 and 12 months, while a French study showed no effect on retention at 4 months in learners who were trained with the feedback device (9,13,14). Additional information is therefore necessary to determine if using a feedback training method is associated with improved long-term performance and when deterioration of retention starts to occur.

    • Wilderness First Responder: Are Skills Soon Forgotten?

      2018, Wilderness and Environmental Medicine
      Citation Excerpt :

      Studies examining the skill and knowledge retention of CPR, ACLS, neonatal resuscitation, and advanced trauma life support revealed that skills deteriorated, usually declining more rapidly than knowledge, where both were assessed.6,46−54 Confidence ratings exceeded performance by residents in a number of pediatric resuscitation techniques.48 Frequent refresher courses to review critical skills and knowledge were recommended.

    View all citing articles on Scopus

    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

    View full text