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