Efficiency of short individualised CPR self-learning sessions with automated assessment and feedback

doi:10.1016/j.resuscitation.2013.02.020

Resuscitation

Volume 84, Issue 9, September 2013, Pages 1267-1273

https://doi.org/10.1016/j.resuscitation.2013.02.020 Get rights and content

Abstract

Introduction

Regular assessments are recommended to identify individuals requiring additional resuscitation training. We developed a strategy of short CPR self-learning sessions followed by automated assessment with feedback and investigated its efficiency to achieve a pre-defined level of compression skills.

Methods

Four hundred and four students in pharmacy and educational sciences participated. Initial training (max. 40 min) consisted of a 15 min learning-while-watching video followed by manikin exercises with computer voice feedback. At baseline and after training, performance was measured using an automated test. To be judged competent participants had to achieve ≥70% compressions with depth ≥50 mm and ≥70% compressions with complete release (<5 mm) and a compression rate between 100 and 120 min⁻¹ within a two month period. Automated feedback was provided and failed participants had to retrain within two weeks. Retraining (max. 20 min and max. three times) was done with voice feedback exercises. Before retraining, the previous test result was displayed together with feedforward. After five months all participants were invited for a retention test.

Results

After one to four sessions, 99% (401/404) of all participants achieved competency. After five months 48% (137/288) of the students participating in the retention test was still competent. The percentage competent participants was 80% (230/288) for compression depth, 97% (279/288) for complete release and 60% (172/288) for mean rate.

Conclusions

One or multiple short self-learning sessions were highly efficient to successfully train 99% of participants. After five months, retention of compression depth and complete release was very high. However, only 48% still achieved a 70% combined score for compression skills, highlighting the importance of regular assessment and retraining.

Introduction

According to the European Resuscitation Council (ERC) 2010 guidelines, cardiopulmonary resuscitation (CPR) training should be tailored to the needs of different types of learners to ensure acquisition and retention of skills.¹ CPR skills are, however, poorly acquired and retention deteriorates in as little as three to six months.¹ The use of frequent assessments can identify those individuals requiring refresher training to help maintain their knowledge and skills.2, 3, 4, 5, 6, 7 Providing feedback on a trainee's skill level is also known to have great impact on acquisition and retention of skills.8, 9, 10, 11

Previous research demonstrated that for training in a self-learning (SL) station, a combined instructional strategy consisting of a Mini Anne™ video (Laerdal, Norway) followed by refinement with voice feedback exercises in the Resusci Anne Skills Station™ (Laerdal, Norway) was non-inferior for acquisition of chest compression skills compared to instructor-led (IL) training.¹² Video alone showed not to be sufficient to acquire CPR skills.¹³ To retrain CPR skills in a SL station adequately, voice feedback exercises appeared to be more effective than a video.¹⁴

To report clinical competence the proportion of successful participants should be assessed against a predefined pass level.¹⁵ In 1995 the Royal College of General Practitioners already suggested a 70% level for adequate chest compressions as a lower limit for effective circulatory support.¹⁶ Our previous research explored the possibility to implement such a 70% level in a combined score for compression skills based on 70% compression with correct depth, 70% compressions with complete release and with correct compression rate.13, 14 The choice for a 70% cut-off value for a combined assessment score is, however, at this stage not based on clear-cut empirical evidence. Since no specific CPR related research is available to propose a benchmark, we build on general principles as derived from Mastery Learning research indicating that a high attainment level has to be pursued before moving to the next learning goal and that formative assessment should be adopted to give immediate feedback to foster the high attainment level of the goals being pursued. In this context, Hattie reports that Mastery Learning approaches result in high effect sizes when considering the impact on learning performance (ES = .58).⁹ The development of an automated testing method in combination with such a combined assessment score now allows the introduction of automated feedback and feedforward on the test result.¹⁷

However, a lack of knowledge remains about the optimal learning strategy for each individual to acquire and maintain a sufficient CPR skill level. We hypothesised that for some people multiple training sessions incorporating testing and feedback/feedforward would be necessary to achieve competency, while others can reach a similar level of skill acquisition with only a single successful training session. Therefore, we investigated the efficiency of a strategy comprising additional short CPR self-learning sessions followed by automated assessment and feedback to achieve a pre-defined level of compression skills. In addition, the retention after five months was assessed.

Section snippets

Methods

The study was approved by the Ethics Committee of Ghent University Hospital. Our study population comprised 428 of 431 eligible students (pharmacy and educational sciences) giving informed consent. During a two month study period a SL station, as described previously, was made available in a small room accessible 24 h a day and seven days a week.12, 13, 14 In Google Calendar participants had to book a first training session (limited to a maximum of 40 min) and up to three additional sessions

Results

During the academic year 2011–2012, 404 participants (155 pharmacy students and 249 educational sciences’ students) completed the training (Fig. 2). This group of 404 students consisted of 87% females and the mean age was 20 years (SD 2.5). One hundred and two participants (25%) had followed a CPR course in the past, with a mean time of 27 months ago (SD 26).

Of all participants 307/404 performed a valid pre-test (>120 compressions). The 70% combined assessment score at T0 was achieved by 16/307

Discussion

Our results demonstrate that after one or multiple short training sessions followed by assessment and feedback 99% of all participants were able to achieve a predefined 70% combined score for compression skills. Retention testing showed that 48% of the participants still achieved this pass level after five months and as shown in Fig. 4 some of the participants were even able to maintain a higher level than the predefined 70%. Although this combined score for compression skills shows important

Conclusions

One to maximum four short SL sessions led to compression skills competency in 99% of the participants. After five months, retention of compression depth and complete release was very high. However, only 48% of the participants still achieved a 70% combined score for compression skills, indicating the importance of regular assessment and retraining in almost half of the participants.

Conflict of interest statement

We received an unrestricted grant from the Laerdal Foundation. Laerdal (Stavanger, Norway) provided the manikin, the face shields and the Resusci Anne Skills Station™ licenses for the study. Laerdal has taken no part in designing the study, analysing data or writing of the manuscript.

Acknowledgements

We are grateful to the management of Ghent University Hospital, to Francis Dewandel from the IT department for computer support, to Charlotte Vankeirsbilck for administrative support and to all the students who participated in the study. We are especially grateful to Bram Gadeyne for the software development.

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2022, Intensive and Critical Care Nursing
Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors.
Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50–60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100–120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%.
In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037–0.479; p = 0.002].
Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.
Cardiopulmonary resuscitation retention training for hospital nurses by a self-learner skill station or the traditional instructor led course: A randomised controlled trial
2021, Resuscitation Plus
Intrahospital cardiac arrest has a steep mortality and high-quality cardiopulmonary resuscitation (CPR) is essential for favourable outcome. Instructor led (IL) CPR training is resource demanding and instructor free, feedback providing CPR skill stations (SS) could provide a means to enable the needed frequent retraining. The main objective of this study was to test the hypothesis that there was no difference between IL and SS training.
A total of 129 hospital nurses were randomised to CPR retraining in three groups; skill station with retraining at 2 months (SS-R), skill station without retraining (SS) and instructor led training (IL). Participants were tested at baseline, 2 and 8 months. The skill station groups were combined (c-SS) for analysis at baseline and 2 months when comparing to IL.
Baseline characteristics for the three groups differed significantly, however c-SS and IL groups performed equally at baseline and testing at 2 months. At 8 months the SS group performed 71% correct ventilations compared to 54% in the IL group (p = 0.04), but CPR quality was otherwise equal. Longitudinal analysis showed SS-R performed 3.4 mm deeper compressions at final evaluation compared to baseline (p = 0.02) and 2.8 mm deeper compared to 2-month test (p = 0.02). No effects of retraining at 2 months could be detected at final comparison of SS-R and SS groups.
CPR training using a skill station led to equal performance at 2 and 8 months compared to instructor led training. Feedback-providing skill stations could be a feasible tool for required frequent retraining.
Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial
2019, Resuscitation
Spaced training programs employ short, frequent CPR training sessions to improve provider skills. The optimum training frequency for CPR skill acquisition and retention has not been determined. We aimed to determine the training interval associated with the highest quality CPR performance at one year.
Participants were randomized to 1-month, 3-month, 6-month, and 12-month CPR training intervals over the course of a 12-month study period. Practice sessions included repeated two-minute CPR practice sessions with visual feedback and verbal coaching until Excellent CPR was achieved, to a maximum of three attempts. Excellent CPR was defined as a two-minute CPR session with ≥90% of compressions with a depth of 50–60 millimeters, a rate of 100–120 per minute, and with complete chest recoil. CPR performance was assessed in all groups at 12 months. The primary outcome was the proportion of participants able to perform Excellent CPR in each group.
A total of 167 participants were included in the analysis. Baseline assessment showed no difference in CPR performance (p = 0.38). Participants who were trained monthly had a significantly higher proportion of Excellent CPR performance (58%) than those in all other groups (26% in the 3-month group, p = 0.008; 21% in the 6-month group, p = 0.002; and 15% in the 12-month group, p < 0.001).
Short-duration, distributed CPR training on a manikin with real-time visual feedback is effective in improving CPR performance, with monthly training more effective than training every 3, 6, or 12 months.
Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers – A randomized controlled trial
2018, Resuscitation
Citation Excerpt :
The use of real-time feedback during CPR training has been shown to improve CPR performance in healthcare providers [10,26]. Some studies have shown that short CPR self-learning sessions with feedback during CPR training improved CPR skill acquisition [10,26–29] as well as perception of CPR quality [19]. However, the use of real-time feedback was not incorporated into distributed practice educational designs in these studies.
Guideline compliant CPR is associated with improved survival for patients with cardiac arrest. Conventional Basic Life Support (BLS) training results in suboptimal CPR competency and skill retention. We aimed to compare the effectiveness of distributed CPR training with real-time feedback to conventional BLS training for CPR skills in pediatric healthcare providers.
Healthcare providers were randomized into receiving annual BLS training (control) or distributed training with real-time feedback (intervention). The intervention group was asked to practice CPR for 2 min on mannequins while receiving real-time CPR feedback, at least once per month. Control group participants were not asked to practice CPR during the study period. Excellent CPR was defined as 90% guideline-compliance for depth, rate and recoil of chest compressions. CPR performance of participants was assessed (on infant and adult-sized mannequins) every 3 months for a duration of 12 months. CPR performance was compared between the 2 groups.
A total of 87 healthcare providers were included in the analyses (control n = 41, intervention n = 46). Baseline assessment showed no significant difference in CPR performance across the 2 groups. The intervention group has a significantly greater proportion of participants with excellent CPR compared with the control group on an adult sized mannequin (14.6% vs. 54.3%, p < 0.001) and infant-sized mannequin (19.5% vs. 71.7%, p < 0.001) at the end of the study. In the intervention group, all CPR metrics except infant depth were improved and retained over the course of the study.
Distributed CPR training with real-time feedback improves the compliance of AHA guidelines of quality of CPR.
Brief training in automated external defibrillation use for persons with down syndrome
2017, Resuscitation
Cardiopulmonary Resuscitation Quality by Helicopter Rescue Swimmers While Flying
2016, Air Medical Journal
Our objective was to assess the cardiopulmonary resuscitation (CPR) quality by helicopter rescue swimmers (HRSs) while flying.
Twenty HRSs from the Spanish Maritime Safety took part in this study. The research protocol included 2 phases: a baseline test (5 minutes of CPR on land) and a challenge test (5 minutes of CPR on a Sikorsky S-61N helicopter in-flight). A Laerdal Resusci Anne mannequin with Laerdal PC Skill Reporting (Stavanger, Norway) was used to register CPR variables.
CPR quality on land versus in-flight was not significantly different. The mean chest compression (CC) depth (52.6 mm on land vs. 51.9 mm in-flight) was inside the recommended range, but mean CC rate (133 vs. 132 per minute), tidal volume (752 vs. 888 mL), and hands-off time (9 per cycle in both tests) were above the 2015 recommended goal. Incomplete chest re-expansion was observed in 19% of on land and 26% in-flight CCs. CPR quality was maintained throughout the 5-minute challenges.
HRSs are able to perform CPR in a flying helicopter with similar quality to CPR on land. They need additional training to avoid excessive CC rates, tidal volumes, and hands-off times and to permit chest re-expansion.

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^☆: A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.02.020.

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Simulation and educationEfficiency of short individualised CPR self-learning sessions with automated assessment and feedback☆

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Lancet

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Confidence vs competence: basic life support skills of health professionals

Br J Nurs

Cardiopulmonary resuscitation

BMJ

Pre-training evaluation and feedback improve medical students’ skills in basic life support

Med Teach

Visible learning: a synthesis of over 800 meta-analysis relating to achievement

Simulation and education
Efficiency of short individualised CPR self-learning sessions with automated assessment and feedback☆