Effectiveness of digital resuscitation training in improving knowledge and skills: A systematic review and meta-analysis of randomised controlled trials

The effectiveness of serious games in nursing education: A meta-analysis of randomized controlled studies

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize the effects of randomized controlled trials using serious gaming in nursing education on knowledge, skills, and confidence.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

Randomized controlled trials published in English in PubMed, CINAHL, Web of Science, Scopus, Cochrane Library databases between 2000 and 2023.

REVIEW METHODS

Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Tool for Assessment of Risk of Bias for Randomized Controlled Trials and the review was reported according to the PRISMA-2020 protocol. The review was conducted by two independent reviewers.

RESULT

As a result of the database review, a total of 1886 studies were found and 8 studies were included in the meta-analysis. The use of serious games was found to have a low to moderate effect on the knowledge levels of nursing students (Hedge's g = 0.492; 95 % CI = -0.094-1.078), and a moderate effect on their skill (Hedge's g = 0.756; 95 % CI = 0.505-1.003) and self confidence levels (Hedge's g = 0.698; p = 0.362, 95 % CI = -0.801-2.196). The heterogeneity of the studies was found to be high for knowledge (I2 = 92 %), skill (I2 = 71.5 %) and self confidence (I2 = 95.9 %), and low for knowledge (p = 0.90; p = 0.29) and skill (p = 0.75; p = 0.69) in terms of bias analyses egger regression test and begg and mazumdar test, respectively.

CONCLUSION

The reviewed studies revealed that the use of serious games in nursing education has positive effects on knowledge, skills and self-confidence. In order to increase the reliability of the evidence, there is a need to increase the number of welldesigned randomized controlled trials using serious games and to examine the effects of these results in clinical practice with larger sample groups.

Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos

AIMS

To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS.

BACKGROUND

Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed.

DESIGN

A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education.

METHODS

The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting.

RESULTS

Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point.

CONCLUSION

Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.

Comparing the effects of blended learning and traditional instruction on basic life support for laypersons: A randomized controlled trial

BACKGROUND/PURPOSE

Blended learning offers the advantages of both instructor-led and self-instruction methods in basic life support (BLS). Our study aims to compare the effects of blended learning with those of traditional instructor-led methods on the performance of laypersons taking BLS courses.

METHODS

A total of 108 participants were randomly assigned to three groups: traditional instruction (group A, n = 36), blended learning with two rounds of practice (group B, n = 36), and blended learning with three rounds of practice (group C, n = 36). Group A received a 90-min lecture and a 30-min hands-on practice session using a manikin and a metronome. Participants in groups B and C received 18-min standardized online video lessons and performed hands-on practice twice and thrice, respectively. The primary outcome was chest compression at a correct speed (100-120 compressions per min) after the training course. Secondary outcomes included knowledge test scores, attitudes and confidence, and individual skill performance after training.

RESULTS

Patient characteristics were similar between the groups. Blended learning with practicing thrice resulted in the highest compressions at a correct speed (group A vs. B vs. C, 68.09 vs 80.03 vs 89.42, p = 0.015) and the shortest average hands-off time (group A vs. B vs. C, 1.12 vs 0.86 vs 0.17 s, p = 0.015). Both blended groups performed better in confirming environmental safety (p < 0.001). No differences in scores of the knowledge test, attitude, or confidence were noted among the three groups.

CONCLUSION

Blended learning with three rounds of hands-on practice may be considered an alternative teaching method.

The Effects of Serious Games on Cardiopulmonary Resuscitation Training and Education: Systematic Review With Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Serious games have emerged as an innovative educational strategy with the potential to significantly enhance the quality and effectiveness of cardiopulmonary resuscitation (CPR) training. Despite their promise, there remains a degree of controversy when comparing the advantages of serious games with traditional CPR training methods. This study seeks to provide a comprehensive assessment of the impact of serious games on CPR training and education by systematically analyzing the results of previous research.

OBJECTIVE

This study aimed to assess the effect of serious games on CPR training and education by summarizing and pooling the results of previous studies.

METHODS

We conducted a thorough and systematic search across 9 prominent web-based databases, encompassing the period from the inception of these databases until April 1, 2023. The databases included in our search were PubMed, Cochrane Library, Wiley Online Library, EBSCO (PsycInfo), SpringerLink, Chinese Biology Medicine Disc, Vip Journal Integration Platform, Wanfang Database, and Chinese National Knowledge Infrastructure. The studies selected adhered to the following criteria: (1) being a randomized controlled trial comparing serious games and traditional methods for CPR training; (2) having participants aged 12 years or older in CPR; (3) having an experimental group using serious games and a control group using nongame methods for CPR instruction; and (4) having outcomes including theoretical and skill assessments, compression depth, and rate. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. Data analysis was performed using RevMan (version 5.3; Cochrane Training), and mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables.

RESULTS

A total of 9 articles were included, involving 791 study participants, of whom 395 in the experimental group taught CPR training using serious games and 396 in the control group taught CPR training using traditional methods. The results of our meta-analysis indicate that the use of serious games in CPR training yields outcomes that are comparable in effectiveness to traditional training methods across several key areas. Specifically, serious games demonstrated equivalence to traditional formats in theory assessment (SMD -0.22, 95% CI - 0.96 to 0.51; P=.55), skill assessment (SMD -0.49, 95% CI -1.52 to 0.55; P=.36), compression depth (MD -3.17, 95% CI -0.18 to 6.53; P=.06), and compression rate (MD -0.20, 95% CI -7.29 to 6.89; P=.96).

CONCLUSIONS

In summary, serious games offer a viable and effective CPR education approach, yielding results comparable to traditional formats. This modality is a valuable addition to CPR training methodologies. However, caution is warranted in interpreting these findings due to limited controlled trials, small sample sizes, and low-quality meta-analyzed evidence.

Effectiveness of breastfeeding educational interventions to improve breastfeeding knowledge, attitudes, and skills among nursing, midwifery, and medical students: A systematic review and meta-analysis

BACKGROUND

Breastfeeding education programs are necessary to prepare healthcare students to address the breastfeeding needs of families. Various breastfeeding educational modules have been used in academic settings; however, the effectiveness of breastfeeding educational interventions remains unclear.

OBJECTIVES

To examine the effectiveness of educational interventions to improve the breastfeeding knowledge, attitudes, and skills of nursing, midwifery, and medical students.

METHODS

A systematic review was conducted searching academic databases from inception to December 22, 2022. Searches were carried out by two authors independently in PubMed, MEDLINE, Web of Science, Scopus, CINAHL Plus, Embase, Cochrane Library, and ERIC. Joanna Briggs Institute critical appraisal checklist was used. The data were extracted for a random-effects meta-analysis to estimate the standardized mean differences (SMDs) with 95 % confidence interval (CI). Subgroup analyses were performed to identify potential moderators.

RESULTS

Thirty-three quasi-experimental studies (12 two-group studies and 21 one-group studies), which included 1313 nursing students, 204 midwifery students, and 1066 medical students, were identified. The students who received educational interventions had significantly higher scores in breastfeeding knowledge (SMD: 0.67, 95 % CI: 0.46, 0.87 for two-group studies; SMD: 1.42, 95 % CI: 0.91, 1.94 for one-group studies), more positive attitudes toward breastfeeding (SMD: 0.43, 95 % CI: 0.22, 0.63 for two-group studies; SMD: 0.98, 95 % CI: 0.32, 1.63 for one-group studies), and higher scores for breastfeeding skills (SMD: 1.52, 95 % CI: 0.46, 2.58 for two-group studies; SMD: 1.33, 95 % CI: 0.43, 2.23 for one-group studies) than the control groups. As a teaching method, clinical practicums were a significant moderator of both breastfeeding knowledge (p = .035) and skills (p < .001). Few studies (n = 5) described the educational framework underpinning the program development.

CONCLUSIONS

Breastfeeding educational interventions effectively improve the breastfeeding knowledge, attitudes, and skills of undergraduate nursing, midwifery, and medical students. Incorporating clinical practicums in interventions is important. Future studies to examine useful teaching strategies for enhancing learning outcomes are warranted.

Augmented reality training in basic life support with the help of smart glasses. A pilot study

Introduction

Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support.

Aim

To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication.

Methods

Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario.

Results

After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training.

Conclusions

A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

The Effectiveness of Technology-Based Cardiopulmonary Resuscitation Training on the Skills and Knowledge of Adolescents: Systematic Review and Meta-analysis

BACKGROUND

Cardiopulmonary resuscitation (CPR) training for adolescents is a prominent strategy to increase the number of community first responders who can recognize cardiac arrest and initiate CPR. More schools are adopting technology-based CPR training modalities to reduce class time and reliance on instructor availability and increase their capacity for wider training dissemination. However, it remains unclear whether these technology-based modalities are comparable with standard training.

OBJECTIVE

This study aimed to systematically review and perform meta-analyses to evaluate the effectiveness of technology-based CPR training on adolescents' CPR skills and knowledge.

METHODS

Searches were conducted in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL, PsycINFO, Education Resources Information Center, ProQuest Dissertations and Theses Global, and Scopus from inception to June 25, 2021. Eligible randomized controlled trials (RCTs) compared technology-based training with standard training for adolescents aged 12 to 18 years. Studies were appraised using the Cochrane risk-of-bias tool. Random-effects meta-analyses were performed using Review Manager (The Cochrane Collaboration). Subgroup analyses were conducted to explore sources of heterogeneity. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Seventeen RCTs involving 5578 adolescents were included. Most of the studies had unclear risks of selection bias (9/17, 53%) and high risks of performance bias (16/17, 94%). Interventions that included instructor guidance increased the likelihood of adolescents checking the responsiveness of the person experiencing cardiac arrest (risk ratio 1.39, 95% CI 1.19-1.63) and calling the emergency medical services (risk ratio 1.11, 95% CI 1.00-1.24). Self-directed technology-based CPR training without instructor guidance was associated with poorer overall skill performance (Cohen d=-0.74, 95% CI -1.02 to -0.45). Training without hands-on practice increased mean compression rates (mean difference 9.38, 95% CI 5.75-13.01), whereas real-time feedback potentially yielded slower compression rates. Instructor-guided training with hands-on practice (Cohen d=0.45, 95% CI 0.13-0.78) and the use of computer programs or mobile apps (Cohen d=0.62, 95% CI 0.37-0.86) improved knowledge scores. However, certainty of evidence was very low.

CONCLUSIONS

Instructor-guided technology-based CPR training that includes hands-on practice and real-time feedback is noninferior to standard training in CPR skills and knowledge among adolescents. Our findings supported the use of technology-based components such as videos, computer programs, or mobile apps for self-directed theoretical instruction. However, instructor guidance, hands-on practice, and real-time feedback are still necessary components of training to achieve better learning outcomes for adolescents. Such a blended learning approach may reduce class time and reliance on instructor availability. Because of the high heterogeneity of the studies reviewed, the findings from this study should be interpreted with caution. More high-quality RCTs with large sample sizes and follow-up data are needed. Finally, technology-based training can be considered a routine refresher training modality in schools for future research.

How to evaluate first aid skills after training: a systematic review

Background

To be able to help and save lives, laypersons are recommended to undergo first aid trainings. The aim of this review was to explore the variety of the elements of the measuring systems to assess the effects of first aid trainings on different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.

Methods

This systematic literature review used Scopus and PubMed databases and searched for studies published between January, 2000, and December, 2020. Out of 2,162 studies meeting the search criteria, 15 studies with quantitative and repeatable evaluation methods to assess first aid skills after first aid training for adults were included in the final analysis.

Results

Practical skills, especially on the ability to perform cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator, were the most studied first aid skills after first aid training. This evaluation was based on several standardized measurements and assessed often with the help of a combination of resuscitation manikin and observer. Evaluation methods of performance in other emergency situations are not well standardized. Questionnaires used to assess knowledge of first aid, though seemingly based on guidelines, were also not standardized, either. Emotional aspects of first aid (willingness or self-confidence) were evaluated by highly simplified questionnaires, and answers were graded by five-point Likert scale.

Conclusion

According to our review, the focus of evaluation methods after first aid training has been on practical skills and especially on CPR. Though the evaluation of first-aid knowledge seems to be straightforward, it is not performed systematically. Evaluation methods for emotional aspects are highly simplified. Overall, standardized measurements and evaluation methods to assess all aspects of first aid skills are needed.

Development of an intervention to facilitate dissemination of community-based training to respond to out-of-hospital cardiac arrest: FirstCPR

Background and aim

Out-of-hospital cardiac arrest (OHCA) is a significant public health issue with low survival rates. Prompt bystander action can more than double survival odds. OHCA response training is primarily pursued due to work-related mandates, with few programs targeting communities with lower training levels. The aim of this research was to describe the development process of a targeted multicomponent intervention package designed to enhance confidence and training among laypeople in responding to an OHCA.

Methods

An iterative, three-phase program development process was employed using a mixed methods approach. The initial phase involved establishment of a multidisciplinary panel that informed decisions on key messages, program content, format, and delivery modes. These decisions were based on scientific evidence and guided by behavioural theories. The second phase comprised the development of the intervention package, identifying existing information and developing new material to fill identified gaps. The third phase involved refining and finalising the material via feedback from panel members, stakeholders, and community members.

Results

Through this approach, we collaboratively developed a comprehensive evidence-based education and training package consisting of a digital intervention supplemented with free access to in-person education and training. The package was designed to teach community members the specific steps in recognising and responding to a cardiac arrest, while addressing commonly known barriers and fears related to bystander response. The tailored program and delivery format addressed the needs of individuals of diverse ages, cultural backgrounds, and varied training needs and preferences.

Conclusion

The study highlights the importance of community engagement in intervention development and demonstrates the need of evidence-based and collaborative approaches in creating a comprehensive, localised, relatively low-cost intervention package to improve bystander response to OHCA.

Blended learning for accredited life support courses - A systematic review

Aim

To evaluate the effectiveness on educational and resource outcomes of blended compared to non-blended learning approaches for participants undertaking accredited life support courses.

Methods

This review was conducted in adherence with PRISMA standards. We searched EMBASE.com (including all journals listed in Medline), CINAHL and Cochrane from 1 January 2000 to 6 August 2021. Randomised and non-randomised studies were eligible for inclusion. Study screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I tools), and certainty of evidence evaluation (using GRADE) were all independently performed in duplicate. The systematic review was registered with PROSPERO (CRD42022274392).

Results

From 2,420 studies, we included data from 23 studies covering fourteen basic life support (BLS) with 2,745 participants, eight advanced cardiac life support (ALS) with 33,579 participants, and one Advanced Trauma Life Support (ATLS) with 92 participants. Blended learning is at least as effective as non-blended learning for participant satisfaction, knowledge, skills, and attitudes. There is potential for cost reduction and eventual net profit in using blended learning despite high set up costs. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity across studies precluded any meta-analysis.

Conclusion

Blended learning is at least as effective as non-blended learning for accredited BLS, ALS, and ATLS courses. Blended learning is associated with significant long term cost savings and thus provides a more efficient method of teaching. Further research is needed to investigate specific delivery methods and the effect of blended learning on other accredited life support courses.

Deliberate practice in resuscitation training using a feedback device, and the effects of the physical characteristics of the rescuer on the acquisition and retention of cardiopulmonary resuscitation skills: Randomized clinical trial

BACKGROUND

Cardiopulmonary resuscitation (CPR) skills decline rapidly and rescuers' physical characteristics could impact on their performance. Our aim was to analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students prior to, immediately after, and three months after training, considering their physical characteristics.

METHOD

Sixty nursing students participated in this randomized clinical trial (control group n = 28; training group n = 32). Their physical characteristics (weight, height, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)% index, handgrip strength, and CPR position strength) were measured before starting the trial. The training group followed a CPR training programme based on deliberate practice, providing feedback on their performance using an FD. All participants were evaluated during two-minute CPR compression/ventilation cycles.

RESULTS

The training group showed an improved ability to perform chest compressions (F_{(2, 115.2)} = 13.3; p < .001; ω²_p = 0.17) and ventilations (F_{(2, 115.3)} = 102.1; p < .001; ω²_p = 0.63), improving their overall quality of CPR (F_{(2, 115.2)} = 40.1; p < .001; ω²_p = 0.40). The physical characteristics of the participants did not affect CPR performance in any study phase.

CONCLUSIONS

A structured training programme based on deliberate practice using an FD had a positive effect on the acquisition of CPR skills by participants, while their physical characteristics had no impact on performance.

Self-Management Micro-Video Health Education Program for Hemodialysis Patients

Self-management in hemodialysis patients is critical; however, is generally low. This study aimed to examine the effects of a theory-based micro-video health education program on the improvement of self-management, hemodialysis knowledge, and self-efficacy in hemodialysis patients. A pre-test post-test control group quasi-experimental design was used to recruit 80 hemodialysis patients in a dialysis center. The participants were assigned in a 1:1 ratio to receive routine care or a 3-month micro-video health education program. Between-group comparison showed that patients in the intervention group had significantly greater improvement in hemodialysis knowledge than those in the control group (p < .05). However, no significant group differences were observed in terms of self-management and self-efficacy. Within-group comparison showed that the overall self-management level of patients in both groups improved significantly, particularly in problem-solving skills and self-care dimensions. Therefore, micro-video health education can improve the self-management and hemodialysis knowledge in Chinese patients undergoing hemodialysis.Trial Registration: Registered at ClinicalTrials.gov with study number (ChiCTR1800018172; http://www.chictr.org.cn/index.aspx).

[Education for resuscitation]

Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.

Efficacy and knowledge of conducting CPR through online learning during the COVID-19 pandemic: A literature review

The COVID-19 pandemic has made it difficult to carry out face-to-face training activities in various higher institutions. This has led to a negative impact on the skills and abilities of nursing students in performing cardiopulmonary resuscitation (CPR) and the cessation of their clinical practice programs in hospitals. Therefore, the aim of this study is to determine the efficacy and knowledge of nursing students in performing CPR by implementing a blended learning program, through online learning platforms. The search for full-text articles was carried out in May 2020 and were reviewed to know whether they fit the theme using the ProQuest, ScienceDirect and PubMed databases with the keywords "BLS", "CPR", "Blended learning", "Knowledge" and "Self-efficacy". In addition, there were 15 articles that matched the criteria. The application of a blended learning program that integrates video and face-to-face lectures through online learning platforms in conducting effective CPR, increases the efficacy and knowledge of nursing students. The effectiveness of online learning greatly affects the efficacy and knowledge of nursing students in conducting CPR. Therefore, it was highly recommended during the COVID-19 pandemic.

Effectiveness of a serious game addressing guideline adherence: cohort study with 1.5-year follow-up

BACKGROUND

Patients presenting with acute shortness of breath and chest pain should be managed according to guideline recommendations. Serious games can be used to train clinical reasoning. However, only few studies have used outcomes beyond student satisfaction, and most of the published evidence is based on short-term follow-up. This study investigated the effectiveness of a digital simulation of an emergency ward regarding appropriate clinical decision-making.

METHODS

In this prospective trial that ran from summer 2017 to winter 2018/19 at Göttingen Medical University Centre, a total of 178 students enrolled in either the fourth or the fifth year of undergraduate medical education took six 90-min sessions of playing a serious game ('training phase') in which they managed virtual patients presenting with various conditions. Learning outcome was assessed by analysing log-files of in-game activity (including choice of diagnostic methods, differential diagnosis and treatment initiation) with regard to history taking and patient management in three virtual patient cases: Non-ST segment elevation myocardial infarction (NSTEMI), pulmonary embolism (PE) and hypertensive crisis. Fourth-year students were followed up for 1.5 years, and their final performance was compared to the performance of students who had never been exposed to the game but had otherwise taken the same five-year undergraduate course.

RESULTS

During the training phase, overall performance scores increased from 57.6 ± 1.1% to 65.5 ± 1.2% (p < 0.001; effect size 0.656). Performance remained stable over 1.5 years, and the final assessment revealed a strong impact of ever-exposure to the game on management scores (72.6 ± 1.2% vs. 63.5 ± 2.1%, p < 0.001; effect size 0.811). Pre-exposed students were more than twice as likely to correctly diagnose NSTEMI and PE and showed significantly greater adherence to guideline recommendations (e.g., troponin measurement and D-dimer testing in suspected PE).

CONCLUSIONS

The considerable difference observed between previously exposed and unexposed students suggests a long-term effect of using the game although retention of specific virtual patient cases rather than general principles might partially account for this effect. Thus, the game may foster the implementation of guideline recommendations.

European Resuscitation Council Guidelines 2021: Education for resuscitation

These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.

A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation

Our study aimed to compare the effect of self-instruction with manikin feedback to that of instructor-led method on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skill performance. In our randomized non-inferiority trial, 64 non-healthcare providers were randomly allocated into self-instruction and instructor-led groups. Both groups watched a 27-min standardized teaching video. Participants in the self-instruction group then performed hands-on practice on the Resusci Anne QCPR with a device-driven feedback, while those in the instructor-led group practiced manikins; feedback was provided and student's questions were answered by instructors. Outcomes were measured by blinded evaluators and SkillReporter software. The primary outcome was the pass rate. Secondary outcomes were scores of the knowledge test and items of individual skill performance. The baseline characteristics of the two groups were similar. The pass rates were 93.8% in both group (absolute difference 0%, p = 0.049 for noninferiority). The knowledge test scores were not significantly different. However, the self-instruction group performed better in some chest compression and ventilation skills, but performed worse in confirming environmental safety and checking normal breathing. There was no difference in AED skills between the two groups. Our results showed the self-instruction method is not inferior to the instructor-led method.

Guess it (SVUAL): An app designed to help nursing students acquire and retain knowledge about basic and advanced life support techniques

To design an app that helps nursing students to acquire and retain knowledge of Basic and Advanced Life Support techniques, as well as analyze the students' gamification experience. The study had two phases: 1) App design and development and 2) experimental study. A total of 184 students participated, with 92 in the experimental group and 92 in the control group. The instruments used were the Guess it (SVUAL) app, a test on knowledge and the Gameful Experience Scale. The app was deemed to have a suitable level of content and user-friendliness of 97%. The experimental group obtained a higher average score on the knowledge test than the control group (U = 2835.500; Z = -3.968; p < 0.05). On the re-test, the experimental group also obtained a higher average score than the control group. As for the experience within the game, all the dimensions scored higher than average, except the absence of negative effects dimension, which indicates that the app had very few negative consequences on the participants. The developed app has proven to have a good level of content and to be user-friendly, improving knowledge levels and retention of information in nursing students.

Using video to assess and improve patient safety during simulated and actual neonatal resuscitation

Neonatal resuscitation is an event that can cause high stress among healthcare professionals (HCPs) and is frequently associated with medical errors. Improving patient safety and reducing errors requires a concerted effort with a plan for improvement. Video can be used as a component of the improvement process at several points including standardizing educational information, assessing learner knowledge and skills during simulation, and assessing individual and team performance during actual neonatal resuscitations.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis

OBJECTIVES

It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents.

DESIGN

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search.

ELIGIBILITY CRITERIA

Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis.

RESULTS

In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence.

CONCLUSION

CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning.

PROSPERO REGISTRATION NUMBER

CRD42017067054.

Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial

BACKGROUND

Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED).

AIM

To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD).

METHODS

Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes.

RESULTS

BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004).

CONCLUSION

A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.

Associations between cardiopulmonary resuscitation (CPR) knowledge, self-efficacy, training history and willingness to perform CPR and CPR psychomotor skills: A systematic review

AIM

To determine whether training history (including number of times and duration since last training), knowledge, self-efficacy or willingness are associated with cardiopulmonary resuscitation (CPR) psychomotor skills.

METHODS

Eight databases were systematically searched from January 2005 to February 2018 for articles that involved adult layperson participants and explored an association between training history, knowledge, self-efficacy or willingness and CPR psychomotor skills or survival outcomes after real CPR attempts.

RESULTS

Thirty-four articles with a total of 35,421 participants were included. CPR training was found to improve psychomotor skills, compared to no training, and any previous training was associated with better skills, compared to no previous training, however only the use of a popular song promoted meaningful retention of a specifically targeted skill, compared to standard training methods. Skills deteriorated within 3 months, then plateaued from 3 to 6 months. Self-efficacy was weakly associated with skill level, however knowledge was not associated with skill level. No studies assessed the association between willingness and psychomotor skills.

CONCLUSION

All laypeople should attend an instructor-led CPR training session with real-time or delayed feedback to improve CPR skills. Training sessions should utilise combinations of validated skill-specific training strategies, preferably including popular songs and feedback to help ensure skills retention. Refresher training, which focusses on skills and self-confidence rather than knowledge, should be undertaken every 3-6 months, although this timeframe needs further validation. All future studies assessing CPR psychomotor skills should adhere to a standardised reporting outcome list (proposed in this paper) to ensure consistency and comparability of results.