Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

doi:10.1016/j.resuscitation.2005.08.020

Resuscitation

Volume 69, Issue 3, June 2006, Pages 443-453

https://doi.org/10.1016/j.resuscitation.2005.08.020 Get rights and content

Summary

Objective

To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills.

Methods

We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003–04. We examined two new instructional methods: [1] interactive-computer training and [2] interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group.

We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0–100%.

Results

For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students’ positive outcomes for AED pad placement.

Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups.

Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%.

The pattern of results was similar after 2 months.

Conclusions

We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.

Introduction

Training middle and high school students in cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) represents an opportunity to increase the number of laypersons who can apply CPR¹ and use an AED. Efforts to engage older adults in CPR training have been discouraging,2, 3 whereas high school students are an accessible population that may be interested in learning CPR.4, 5 Many high schools, however, do not provide CPR training due to barriers such as lack of classroom time, and lack of time for teacher training in CPR and AED instruction, or for implementing the training in the classroom.⁶

In order to address these barriers, less instructor-dependent modalities, such as interactive computer, video, film, and self-training methods have been explored. Several studies indicate that adults trained with video self-instruction7, 8, 9 or an automated manikin¹⁰ may be able to achieve similar or better CPR performance than those trained with the traditional American Heart Association's classroom training method. In randomized, controlled studies of computer software for CPR training, results have been mixed. One study showed improvement in behavior and assessment skills, but not in the motor skills needed to adequately provide CPR,¹¹ while another showed improved performance of some skills, such as bag mask ventilation.¹² However, neither study included training in the use of an AED, and no study has evaluated CPR and AED training of high school students without the use of instructors. There are two relevant AED studies, but neither focused on high school students. One indicated that students in the sixth grade were capable of learning how to use an AED,¹³ and the other that AED use can be taught to senior citizens without an instructor.¹⁴

Section snippets

Study design

We conducted a cluster-controlled trial of three instructional interventions among high school students with random allocation based on classrooms. Within each participating high school we assigned at random participating classrooms to one of the three instructional methods or to the control group, and assessed student knowledge and skills 2 days and 2 months later.

Setting

The study took place in urban and suburban public high schools in the Seattle, Washington region, during the 2003–2004 school year.

Interventions

Characteristics of study subjects

The initial post-training knowledge test was completed by 784 students, but 5 could not be included in any analysis because of missing data of important information (e.g., prior AED use, grade in school). The number of students who took the skills tests ranged from 623 to 752. Participation in each of the interventions and the control group ranged from 75 to 80%.

Previous CPR training ranged from 66 to 73% by the trial arm (Table 2). Of the students reporting previous CPR training, 22% received

Discussion and conclusions

Computer-based CPR and AED training for high school students is appealing because it requires little classroom time (about 45 min), and does not require the classroom teacher to take time to be trained in CPR and AED instruction or to prepare to teach students CPR and AED knowledge and skills.

Other studies have found video self-instruction to be more effective in teaching CPR performance than the traditional American Heart Association's classroom training method, but none of these studies

Acknowledgements

The authors thank all the school nurses, health educators, computer lab coordinators, principals, classroom teachers and high school students, without whose participation the study would not have been possible. We also thank the University of Washington first year medical students who provided the hands-on CPR and AED training to the high school students. Finally, we give special thanks to the evaluators and evaluation coordinator who showed ongoing flexibility and resourcefulness in

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^☆: A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2005.08.020.

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Training and educational paperComparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students☆

Summary

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Study design

Setting

Interventions

Characteristics of study subjects

Discussion and conclusions

Acknowledgements

Resuscitation

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Ann Emerg Med

Resuscitation

Resuscitation

Resuscitation

Ann Emerg Med

Resuscitation

J Clin Epidemiol

CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation

Resuscitation

Training and educational paper
Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students☆