First aid skill retention of first responders within the workplace

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 investigation of the efficiency of basic life support education among high school students: Protocol, design and implementation of an interventional, prospective longitudinal, individually randomised, parallel 1:1 grouped trial

Background

Basic life support (BLS) skills are crucial not only for healthcare workers but for all lay people as well. Timely recognition of out-of-hospital cardiac arrest (OHCA) and the initiation of BLS by bystanders before the arrival of healthcare personnel may improve survival. There are several methods of spreading BLS skills and improve BLS skill retention among lay people. One of these methods can be the education of adolescent school children. The introduction of mandatory BLS education in schools was very effective in some European countries to increase the rate of bystander BLS.

Methods/design

The current study aims to investigate the efficacy of a BLS training and BLS curriculum among high school children in Hungary. Moreover, the investigators would like to optimise factors influencing skill retention in this first responder group and aim to compare two types of teaching methods: feedback given by the instructor or software-based feedback on the efficacy of chest compressions during the course. This study will be an interventional, assessor blinded, individually randomised parallel group trial recruiting 360 students. BLS skill retention will be assessed at the end of the course, two months after the training and six months after training.

Discussion

The current study will increase our knowledge on the methods educating BLS among high school children. The results will help us to create an effective BLS curriculum at schools.Trial registration: ClinicalTrials.gov: NCT06016153. Prospectively registered on 08/2023.

Effects of an advanced first aid course or real-time video communication with ambulance personnel on layperson first response for building-site severe injury events: a simulation study

BACKGROUND

The risk of high-energy trauma injuries on construction sites is relatively high. A delayed response time could affect outcomes after severe injury. This study assessed if an advanced first aid course for first aid response for laypersons (employees or apprentices) in the construction industry or real-time video communication and support with ambulance personnel, or neither, together with access to an advanced medical kit, would have an effect on immediate layperson vital responses in a severe injury scenario.

METHOD

This was a controlled simulation study. Employees or apprentices at a construction site were recruited and randomly allocated into a group with video support or not, and advanced first aid course or not, and where one group had both. The primary outcomes were correct behavior to recognize and manage an occluded airway and correct behavior to stop life-threatening bleeding from a lower extremity injury. Secondary outcomes included head-to-toe assessment performed, placement of a pelvic sling, and application of remote vital signs monitors.

RESULTS

Ninety participants were included in 10 groups of 3 for each of 4 exposures. One group was tested first as a baseline group, and then later after having done the training course. Live video support was effective in controlling bleeding. A first aid course given beforehand did not seem to be as effective on controlling bleeding. Video support and the first aid course previously given improved the ability of bystanders to manage the airway, the combination of the two being no better than each of the interventions taken in isolation. Course exposure and video support together were not superior to the course by itself or video by itself, except regarding placing the biosensors on the injured after video support. Secondary results showed an association between video support and completing a head-to-toe assessment. Both interventions were associated with applying a pelvic sling.

CONCLUSION

These findings show that laypersons, here construction industry employees, can be supported to achieve good performance as first responders in a major injury scenario. Prior training, but especially live video support without prior training, improves layperson performance in this setting.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

Introduction

Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research.

Methods

We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data.

Results

Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted.

Conclusion

A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.

Knowledge of handling medical emergencies among general dental practitioners pan India: a cross-sectional survery

BACKGROUND

Medical emergency situations in dental clinics have been contemplated to be an issue in most of the countries by reason of dentist's lack of knowledge and preparedness to attend emergency situations in dental offices. The aim of this paper is to observe the knowledge, attitude, and perceived confidence of the general dental practitioners regarding emergency medical care and its practical application. Questionnaire on knowledge assessment was circulated among 500 dentists using printed questionnaire formats and various social media platforms. The questionnaire included details on treating hypertensive patients, cardiopulmonary resuscitation training, accessibility of medical emergency equipments in the dental clinics, prevalence of medical emergency cases in the dental office and the self-assessed competence to handle medical emergency situations in the dental clinics. Data was surveyed and scrutinized using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Descriptive statistics was tabulated and Chi square tests was applied.

FINDINGS

500 general dental practitioners pan India were involved in the study (294 were females and 207 were males). They were grouped into different age groups (20-30 yrs, 30-40 yrs, 40-50 yrs, 50 and above) and experience (0-5 yrs, 5-10 yrs and more than 10 years). 279 participants did not attend any medical emergency training whereas, 222 participants from all groups attended training program. It was observed that with increased experience in the field, the knowledge, awareness and confidence to treat medical emergency situation in the dental clinics was better. Dentists should update themselves from time-to-time with the latest technologies in the field and need to attend training programs to handle any medical emergency situations in the dental offices. Medical emergencies in a dental clinic can be encountered at any point of time and the clinician should have apt knowledge in handling such situations. Majority of the dentists feel subdued in managing medical situations in dental offices. Training and workshops for handling medical situations in the dental offices should be mandated at the undergraduate and postgraduate levels. This will help the dentist to shape one's confidence in managing such situations without apprehension. Availability of proper infrastructure and equipments is recommended in every dental clinics so as to ease the handling of the situation.

CONCLUSION

This paper enlightens the need of basic life support training on regular basis among the dentists to improve the competence among them and to improve the confidence in handling such situations.

Teacher Preparedness for Medical Emergencies in Belgian Classrooms: Studying Objective and Subjective First-Aid Knowledge

About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers’ objective first-aid knowledge—particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career.

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.

Communication Patterns During Routine Patient Care in a Pediatric Intensive Care Unit: The Behavioral Impact of In Situ Simulation

OBJECTIVE

Effective communication minimizes medical errors and leads to improved team performance while treating critically ill patients. Closed-loop communication is routinely applied in high-risk industries but remains underutilized in healthcare. Simulation serves as an educational tool to introduce, practice, and appreciate the efficacy of closed-loop communication.

METHODS

This observational before-and-after study investigates behavioral changes in communication among nurses brought on by simulation team training in a pediatric intensive care unit (PICU). The communication patterns of PICU nurses, who had no prior simulation experience, were observed during routine bedside care before and after undergoing in situ simulation.One month before and 1 and 3 months after simulation (intervention), 2 trained raters recorded nurse communications relative to callouts, uttered by the sender, and callbacks, reciprocated by the recipient. The impact of simulation on communication patterns was analyzed quantitatively.

RESULTS

Among the 15 PICU nurses included in this study, significant changes in communication behavior were observed during patient care after communication-focused in situ simulation. The PICU nurses were significantly less likely to let a callout go unanswered during clinical routine. The effect prevailed both 1 month (P = 0.039) and 3 months (P = 0.033) after the educational exposure.

CONCLUSIONS

This observational before-and-after study describes the prevalence and pattern of communication among PICU nurses during routine patient care and documents PICU nurses transferring simulation-acquired communication skills into their clinical environment after a single afternoon of in situ simulation. This successful transfer of simulation-acquired skills has the potential to improve patient safety and outcome.

Retention of Sterile Compounding Knowledge Among Pharmacy Technicians

Background: Patient safety is in jeopardy due to a rise in the preparation of adulterated parenteral products with poor technique identified as a significant contributing factor. Pharmacy technicians perform an overwhelming majority of aseptic compounding practices; however, this group's progressive loss of aseptic technique knowledge has not been documented. Objective: The purpose of this correlational research study was to investigate the association between sterile compounding knowledge and years in the field controlling for formal training in sterile compounding techniques. Methods: An assessment tool of fundamental sterile compounding content was electronically distributed to sterile compounding technician members of pharmacy organizations in the southeastern United States. A multiple regression was conducted to predict sterile compounding knowledge from number of years in the field and prior years of formal compounding training. Results: Sixty-eight assessments were returned complete. The overall model was significant (P < .0005), explaining 22% of the variance in knowledge retention. Years in the field was the only significant predictor (P < .001). Each additional year of work experience was associated with a 0.18 drop in the assessment score. Conclusions: The longer pharmacy technicians remain in the field, the more aseptic technique knowledge they will lose. Modeling of poor sterile compounding techniques in the workplace may promote loss of competency of the skill. As a result, a plan to address continuing education for pharmacy technician sterile compounders is necessary to ensure patient safety.

Development of Novel Video-Based First Responder Opioid Hazard Refresher Training

First responders encounter many hazards in the execution of their duties, and exposure to hazardous materials such as opioids is a primary safety concern. The ongoing opioid crisis in the United States continues to be a major public health issue, with overdose deaths from opioids reaching epidemic levels. Although responders frequently encounter opioids, available data on safety and risk are not always well-communicated, and we identified a need for refresher and just-in-time training products on this topic. In response, we created a training video series that is informative, concise, and visually appealing. The video series, available on YouTube, was tested with a small initial population, with findings suggesting key questions for a larger study focused on integration of the refresher training with existing programs to optimize retention and adoption of safety practices.

Factors influencing the willingness to perform bystander cardiopulmonary resuscitation on the workplace: a study from North-Eastern Italy

Background:

Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR.

Methods:

Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated.

Results:

A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p=0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p=0.002), and exhibiting a better knowledge of CPR (KS≥75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442-14.350).

Conclusions:

Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.(www.actabiomedica.it)

Medical Student Skill Retention After Cardiopulmonary Resuscitation Training: A Cross-Sectional Simulation Study

INTRODUCTION

The retention of cardiopulmonary resuscitation skills and the ideal frequency of retraining remain unanswered. This study investigated the retention of cardiopulmonary resuscitation skills by medical students for up to 42 months after training.

METHODS

In a cross-sectional study, 205 medical students received 10 hours of training in basic life support in 3 practical classes, during their first semester at school. Then, they were divided into 4 groups, according to the time elapsed since the training: 73 after 1 month, 55 after 18 months, 41 after 30 months, and 36 after 42 months. Nineteen cardiopulmonary resuscitation skills and 8 potential technical errors were evaluated by mannequin-based simulation and reviewed using filming.

RESULTS

The mean retention of the skills was 90% after 1 month, 74% after 18 months, 62% after 30 months, and 61% after 42 months (P < 0.001). The depth of chest compressions had the greatest retention over time (87.8%), with no significant differences among groups. Compressions performed greater than 120 per minute were less likely to be done with adequate depth. Ventilation showed a progressive decrease in retention from 93% (n = 68) after 1 month to 19% (n = 7) after 42 months (P < 0.001). All 205 students were able to turn the automated external defibrillator on and deliver the shock.

CONCLUSIONS

The depth of chest compressions and the use of an automated external defibrillator were the skills with the highest retention over time. Based on a skills retention prediction curve, we suggest that 18 to 24 months as the minimum retraining interval to maintain at least 70% of skills.

Perception of Impact of Frequent Short Training as an Enhancement of Annual Refresher Training

Introduction of facilitated hands-on drills as often as monthly and the use of online modules prior to annual refresher training for emergency response teams were investigated through surveys and group discussions. This research explores how these drills are perceived by emergency response team members, emergency response team coordinators, instructors, and management at the company. Using these tools throughout the year, members of emergency response teams from automobile manufacturing facilities reported an increased ability to maintain their skill sets, build teamwork, and continually refresh and strengthen their ability to protect their fellow workers as well as plant operations and equipment. The results also document examples of how this innovative program that incorporates frequent training has led to workplace improvements.

The timing of testing influences skill retention after basic life support training: a prospective quasi-experimental study

BACKGROUND

Proper basic life support (BLS) is key in improving the survival of out-of-hospital cardiac arrest. BLS skills deteriorate in three to 6 months after training. One method to improve skill retention may be using the "testing effect" to test skills at the end of a BLS course. The aim of our study was to investigate whether either testing or the timing of such testing after BLS training have any influence on skill retention.

METHODS

This was a post-test only, partial coverage, prospective quasi-experimental study designed to evaluate a BLS training course among 464 fifth year medical students at Semmelweis University in the first semester of 2013/2014. Groups were systematically but non-randomly assigned to either a control group that took no exam or one of two experimental groups that took an exam (N = 179, NoExam group; N = 165, EndExam group - exam at the end of the BLS training; N = 120, 3mExam group - exam 3 months after the BLS training). The ability to perform ten prescribed essential BLS steps was evaluated during a skill retention assessment 2 months after the course in the NoExam, 2 months after the course (and the exam) in the EndExam and 5 months after the course (2 months after the exam) in the 3mExam group to measure skill retention and the effect of our intervention. Scores were calculated for each BLS step, and also summed up as a total score. We used Kruskal-Wallis test to assess differences in skill retention.

RESULTS

Overall, NoExam and EndExam groups showed similar skill retention. The mean total score (and many of the sub-scores) of students was significantly higher in the 3mExam group compared to both the NoExam and the EndExam groups, and there was no difference in the total score (and many of the sub-scores) of the latter two groups. The 3mExam group had less variability in total scores (and many of the sub-scores) than the other two groups.

CONCLUSION

Our study provides evidence that testing these skills 3 months after BLS training may be more effective than either testing immediately at the end of the course or no testing at all.

Emergency first aid readiness in Antarctica: Australian Antarctic expeditioners' first aid credentials and self-efficacy

INTRODUCTION

To help prevent future morbidity and mortality, this study examined Australian Antarctic expeditioners' first aid credentials and self-efficacy in providing emergency first aid in extreme environments.

METHODS

A mixed method survey assessed Australian personnel working on Antarctic stations. Volunteer participants (n = 83) provided data on first aid training, self-confidence of first aid readiness, and first aid preparations. The Extreme Conditions First Aid Confidence Scale (EC-FACS) was developed and validated for this study. Multivariate analyses tested associations between first aid background, demographics and EC-FACS. Open-ended comments were subjected to thematic analysis.

RESULTS

Over one-third of participants did not hold current first aid certificates at expedition commencement. Factor analysis demonstrated the EC-FACS was unidimensional, and internal consistency was high (α = 0.94), and showed first aid self-efficacy was moderately high, but participants' confidence decreased as first aid scenarios became more complex. Experience providing emergency first aid and level of first aid qualification were the strongest predictors of overall first aid self-efficacy. Thematic analysis revealed expeditioners support higher first aid qualifications and want Antarctic-specific wilderness first aid training.

CONCLUSIONS

These findings revealed that many Antarctic expeditioners may not be adequately prepared for first aid emergencies and have low confidence in handling complex medical situations. Based on these findings, we recommend higher first aid qualifications and training tailored to the Antarctic context. These modest steps can help prevent unnecessary and costly morbidity and mortality for extreme-condition expeditioners.

Paediatric cardiopulmonary resuscitation: Knowledge and perceptions of surf lifeguards

AIM

To conduct a comprehensive analysis of surf lifeguards' real and perceived ability in paediatric cardiopulmonary resuscitation (CPR), knowledge of child resuscitation protocols and technical competency during a simulated CPR scenario.

METHODS

Surf lifeguards aged 16 years and over were invited to complete a written survey and simulated test of five cycles of single-rescuer CPR on a paediatric manikin. In accordance with the latest Australia and New Zealand Committee on Resuscitation (ANZCOR) guidelines, practical skills were assessed by trained observers. A manikin fitted with electronic data-collection capability recorded technical compression and ventilation skills.

RESULTS

A total of 244 participants were entered into the study. Most previous CPR training did not include a paediatric component (53%). Lifeguards rated their ability to perform CPR on an adult as 'highly effective' or 'effective' in 56% of responses. Less than a quarter (23%), however, gave this response when compared to a child. Observed CPR skills were mostly compliant with ANZCOR guidelines (80-99%). Manikin data provided a median compression rate of 115.6 min^-1 , compression depth of 3.7 cm and tidal volume of 220.0 mL. Almost half of ventilations were too little (45%), and around one fifth were too much (22%).

CONCLUSIONS

Surf lifeguards are less confident in paediatric CPR. The overall performance of observed and technical CPR skills, which were mostly ANZCOR guideline compliant, suggests that performance could be improved if paediatric-specific training is provided to supplement the adult-focused methods currently in use. The use of electronic feedback manikins is recommended to address the technical compression and ventilation issues identified in this study.

Comparison of ultrasound-guided and landmark-based techniques for central venous catheterization via the external jugular vein in healthy anesthetized dogs

OBJECTIVE To compare time to achieve vascular access (TTVA) between an ultrasound-guided technique (UST) and landmark-based technique (LMT) for central venous catheter (CVC) placement in healthy anesthetized dogs. ANIMALS 39 purpose-bred hounds. PROCEDURES Anesthetized dogs that were hemodynamically stable following completion of a terminal surgical exercise were enrolled in the study during 2 phases, with a 45-day intermission between phases. For each dog, a UST and LMT were used for CVC placement via each external jugular vein by 2 operators (criticalist and resident). The TTVA and number of venipuncture attempts and catheter redirections were recorded for each catheterization. Placement of the CVC was confirmed by contrast fluoroscopy. After euthanasia, a gross dissection was performed during which a hematoma score was assigned to the catheter insertion site. For each phase, nonlinear least squares estimation was used for learning curve analysis of the UST. RESULTS Median TTVA, number of venipuncture attempts and catheter redirections, and hematoma score did not differ significantly between the 2 operators for either technique. Median TTVA for the UST (45 seconds) was significantly longer than that for the LMT (7 seconds). Learning curve analysis indicated that 8 and 7 UST catheterizations were required to achieve performance stability in phases 1 and 2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the UST was comparable to the LMT for CVC placement in healthy dogs. The extra time required to perform the UST was not clinically relevant. Additional studies evaluating the UST for CVC placement in clinically ill dogs are warranted.

Response times by the police and ambulance services at motor vehicle crashes in the West Mercia region

The relative response times of the ambulance and police services at serious motor vehicle crashes in the West Mercia region of the UK are reported. The police often arrive before the ambulance service. The types of immediate medical care which the police and other non-medical responders might administer are discussed.

Brief, Web-based Education Improves Lay Rescuer Application of a Tourniquet to Control Life-threatening Bleeding

OBJECTIVE

The objective was to determine whether brief, Web-based instruction several weeks prior to tourniquet application improves layperson success compared to utilizing just-in-time (JiT) instructions alone.

BACKGROUND

Stop the Bleed is a campaign to educate laypeople to stop life-threatening hemorrhage. It is based on U.S. military experience with lifesaving tourniquet use. While previous research shows simple JiT instructions boost laypeople's success with tourniquet application, the optimal approach to educate the public is not yet known.

METHODS

This is a prospective, nonblinded, randomized study. Layperson participants from the Washington, DC, area were randomized into: 1) an experimental group that received preexposure education using a website and 2) a control group that did not receive preexposure education. Both groups received JiT instructions. The primary outcome was the proportion of subjects that successfully applied a tourniquet to a simulated amputation. Secondary outcomes included mean time to application, mean placement position, ability to distinguish bleeding requiring a tourniquet from bleeding requiring direct pressure only, and self-reported comfort and willingness to apply a tourniquet.

RESULTS

Participants in the preexposure group applied tourniquets successfully 75% of the time compared to 50% success for participants with JiT alone (p < 0.05, risk ratio = 1.48, 95% confidence interval = 1.21-1.82). Participants place tourniquets in a timely fashion, are willing to use them, and can recognize wounds requiring tourniquets.

CONCLUSIONS

Brief, Web-based training, combined with JiT education, may help as many as 75% of laypeople properly apply a tourniquet. These findings suggest that this approach may help teach the public to Stop the Bleed.

Wilderness First Responder: Are Skills Soon Forgotten?

Wilderness first responders are trained to provide competent medical care in wilderness settings or until evacuation for more advanced treatment can be obtained. In light of the isolated environments in which they are called upon to respond to illnesses and injuries, their ability to effectively apply their training is crucial. Despite the responsibility assigned to them, there is an absence of research assessing the skill and knowledge retention of wilderness first responders, creating a gap in understanding whether a deficit in their ability to perform exists between certifications. Without such research, it is important to review knowledge and skill retention in related responder groups. The literature over the past 4 decades documents the loss over time of skills and knowledge across an array of trained responders, both professional and laypeople. Although the findings reviewed suggest that WFRs will exhibit a similar pattern of increasing skill loss beginning shortly after certification and a slower, but concurrent, decrease in knowledge, research is needed to document or refute this assumption.

Cohort study to evaluate the assimilation and retention of knowledge after theoretical test in undergraduate health science

Highlights

Study was conducted at the UniLurio to evaluate the assimilation and retention capacity.Students from undergraduate in Medicine, Dentistry, Pharmacy, Nutrition, Optometry and Nursing.A questionnaire was applied in three evaluation periodspretest), posttest) and after six months.Assimilation and retention capacity improves student knowledge.Assimilation and retention capacity suffered a small deterioration with passage oftime.

Background

Each year new undergraduate courses are emerging in Mozambique, and with them the number of students has been increasing exponentially. In higher education institutions, particularly in the health sciences, knowledge retention becomes essential for learning and for efficient and effective training of capable health professionals.

Methodology

This is a prospective cohort study, conducted at the Lurio University, Mozambique. To evaluate the assimilation and retention of knowledge, a theoretical lesson was taught. The class time was 90 minutes divided into a theoretical stageand the other was a discussion stage (30 minutes) for clarification of doubts. Questionnaire was administered in the pretest, post-test and after six months.

Results

Of all students (n = 241), enrolled in the second semester of the first year of the course, 190 students did the pretest, 187 did the post-test and 183 students did the test after six months. Before the lecture none of the course managed to achieve the satisfactory percentage of 75% of correct answers (p<0,001). Assimilation of knowledge in the post-test performance there has been a significant increase in knowledge, in all questions the students reached the recommended percentage as "satisfactory knowledge" (p < 0.001). The post-test suggests that participants in this study had a significant capacity of memorization which is essential in the retention of knowledge.

Conclusion

It can be concluded that the assimilative and retention capacity improve the student knowledge immediately after a theoretical lesson with addition audiovisual resources, and the acquired knowledge remains even though there is a deterioration with passage of the time.

Effects of extended lay-off periods on performance and operator trust under adaptable automation

Little is known about the long-term effects of system reliability when operators do not use a system during an extended lay-off period. To examine threats to skill maintenance, 28 participants operated twice a simulation of a complex process control system for 2.5 h, with an 8-month retention interval between sessions. Operators were provided with an adaptable support system, which operated at one of the following reliability levels: 60%, 80% or 100%. Results showed that performance, workload, and trust remained stable at the second testing session, but operators lost self-confidence in their system management abilities. Finally, the effects of system reliability observed at the first testing session were largely found again at the second session. The findings overall suggest that adaptable automation may be a promising means to support operators in maintaining their performance at the second testing session.

Repeated versus varied case selection in pediatric resident simulation

BACKGROUND

Repeated exposure to pediatric emergency scenarios improves technical skills, but it is unclear whether repeated exposure to specific cases affects medical decision making in varied cases.

OBJECTIVE

We sought to determine whether repeated exposure to 1 scenario would translate to improved performance and decision making in varied scenarios.

METHODS

Senior pediatrics residents participated in 3 scenarios with scripted debriefing. Residents were randomized to repeated practice (RP) scenarios or mixed (MIX) scenarios. RP residents completed pulseless electrical activity (PEA) with different stems (Case 1, 2, 3). MIX residents completed PEA (Case 1), seizure (Case 2), and ventricular tachycardia (Case 3) scenarios. Four months later, participants returned to complete 3 more cases: PEA (Case 4), seizure (Case 5), and critical coarctation (Case 6).

RESULTS

Twenty-three residents participated in the study and were randomized to either the RP or the MIX group. The RP group showed statistically significant improvement in time to start chest compressions, whereas the MIX group showed no improvement. Use of a backboard improved significantly in Case 4 for the RP group but not for the MIX group. Similarly, time to check glucose in the seizure scenario was significantly better in the MIX group that had previous exposure to a seizure scenario. No differences in performance were noted between groups in Case 6, which was new to both groups.

CONCLUSIONS

Results of this study indicate that whereas repeated exposure may improve decision-making skills in similar scenarios, it may not translate to improved medical decision making in other scenarios.

"Best practice" skills lab training vs. a "see one, do one" approach in undergraduate medical education: an RCT on students' long-term ability to perform procedural clinical skills

Background

Benefits of skills lab training are widely accepted, but there is sparse research on its long-term effectiveness. We therefore conducted a prospective, randomised controlled-trial to investigate whether in a simulated setting students trained according to a "best practice" model (BPSL) perform two skills of different complexity (nasogastral tube insertion, NGT; intravenous cannulation, IVC) better than students trained with a traditional "see one, do one" teaching approach (TRAD), at follow-up of 3 or 6 months.

Methodology and Principal Findings

94 first-year medical students were randomly assigned to one of four groups: BPSL training or TRAD teaching with follow-up at 3 (3M) or 6 (6M) months. BPSL included structured feedback, practice on manikins, and Peyton’s "Four-Step-Approach", while TRAD was only based on the "see one - do one" principle. At follow-up, manikins were used to assess students’ performance by two independent blinded video-assessors using binary checklists and a single-item global assessment scale. BPSL students scored significantly higher immediately after training (NGT: BPSL3M 94.8%±0.2 and BPSL6M 95.4%±0.3 percentage of maximal score ± SEM; TRAD3M 86.1%±0.5 and TRAD6M 84.7%±0.4. IVC: BPSL3M 86.4%±0.5 and BPSL6M 88.0%±0.5; TRAD3M 73.2%±0.7 and TRAD6M 72.5%±0.7) and lost significantly less of their performance ability at each follow-up (NGT: BPSL3M 86.3%±0.3 and TRAD3M 70.3%±0.6; BPSL6M 89.0%±0.3 and TRAD6M 65.4%±0.6; IVC: BPSL3M 79.5%±0.5 and TRAD3M 56.5%±0.5; BPSL6M 73.2%±0.4 and TRAD6M 51.5%±0.8). In addition, BPSL students were more often rated clinically competent at all assessment times. The superiority at assessment after training was higher for the more complex skill (IVC), whereas NGT with its lower complexity profited more with regard to long-term retention.

Conclusions

This study shows that within a simulated setting BPSL is significantly more effective than TRAD for skills of different complexity assessed immediately after training and at follow-up. The advantages of BPSL training are seen especially in long-term retention.

Medical students teaching cardiopulmonary resuscitation to middle school Brazilian students

BACKGROUND

Diseases of the circulatory system are the most common cause of death in Brazil. Because the general population is often the first to identify problems related to the circulatory system, it is important that they are trained. However, training is challenging owing to the number of persons to be trained and the maintenance of training.

OBJECTIVES

To assess the delivery of a medical-student led cardiopulmonary resuscitation (CPR) training program and to assess prior knowledge of CPR as well as immediate and delayed retention of CPR training among middle school students.

METHODS

Two public and two private schools were selected. CPR training consisted of a video class followed by practice on manikins that was supervised by medical students. Multiple choice questionnaires were provided before, immediately after, and at 6 months after CPR training. The questions were related to general knowledge, the sequence of procedures, and the method to administer each component (ventilation, chest compression, and automated external defibrillation). The instructors met in a focus group after the sessions to identify the potential problems faced.

RESULTS

In total, 147 students completed the 6-month follow-up. The public school students had a lower prior knowledge, but this difference disappeared immediately after training. After the 6-month follow-up period, these public school students demonstrated lower retention. The main problem faced was teaching mouth-to-mouth resuscitation.

CONCLUSIONS

The method used by medical students to teach middle school students was based on the see-and-practice technique. This method was effective in achieving both immediate and late retention of acquired knowledge. The greater retention of knowledge among private school students may reflect cultural factors.

The benefits of a simplified method for CPR training of medical professionals: a randomized controlled study

OBJECTIVES

We developed and tested a training method for basic life support incorporating defibrillator feedback during simulated cardiac arrest (CA) to determine the impact on the quality and retention of CPR skills.

METHODS

298 subjects were randomized into 3 groups. All groups received a 2h training session followed by a simulated CA test scenario, immediately after training and at 3 months. Controls used a non-feedback defibrillator during training and testing. Group 1 was trained and tested with an audiovisual feedback defibrillator. During training, Group 1 reviewed quantitative CPR data from the defibrillator. Group 2 was trained as per Group 1, but was tested using the non-feedback defibrillator. The primary outcome was difference in compression depth between groups at initial testing. Secondary outcomes included differences in rate, depth at retesting, compression fraction, and self-assessment.

RESULTS

Groups 1 and 2 had significantly deeper compressions than the controls (35.3 ± 7.6 mm, 43.7 ± 5.8 mm, 42.2 ± 6.6 mm for controls, Groups 1 and 2, P=0.001 for Group 1 vs. controls; P=0.001 for Group 2 vs. controls). At three months, CPR depth was maintained in all groups but remained significantly higher in Group 1 (39.1 ± 9.9 mm, 47.0 ± 7.4 mm, 42.2 ± 8.4 mm for controls, Groups 1 and 2, P=0.001 for Group 1 vs. control). No significant differences were noted between groups in compression rate or fraction.

CONCLUSIONS

A simplified 2h training method using audiovisual feedback combined with quantitative review of CPR performance improved CPR quality and retention of these skills.

Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial

Background

Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered “novel” in that they are not typically used to refresh CPR knowledge and skills.

Methods

The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training.

Results

Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two) did not have a significant effect on any outcomes.

Conclusions

There was no consistent evidence for the superiority of novel refreshers as compared with a traditional mailed brochure, but the low degree of actual exposure to the materials does not allow a definitive conclusion. An online web-based approach seems to have the most promise for future research on electronic CPR refreshers.

Laparoscopic simulation training: Testing for skill acquisition and retention

BACKGROUND

Simulation in laparoscopy leads to skill acquisition. Although many curricula for simulation training have been described, the nature of skill deterioration remains unclear. We evaluated skill acquisition and retention after laparoscopic simulation training.

METHODS

Thirty-six novices in surgery (medical students) underwent a 5-day curriculum consisting of 9 skills of increasing complexity. Each subject underwent baseline and post-training evaluation after completion of the course. Skill retention testing was measured after 6 weeks (group 1; n = 18) and after 11 weeks (group 2; n = 18). Neither group had access to a training facility during this interval. Task completion was measured in time (s) with penalties for inaccurate performance.

RESULTS

Comparison of the baseline and post-training values revealed a significant learning outcome for all exercises in both groups (P < .001). In group 1, skill retention testing found no significant decrease in skill level when compared to post-training values in all but 1 task (extracorporeal knot tying; P = .007). In group 2, differences between skill retention and post-training evaluation were observed for 5 of the 9 tasks (transfer task, positioning, loop tie, extracorporeal knot, and intracorporeal knot; P ≤ .05 for each).

CONCLUSION

Basic laparoscopic skills can be learned successfully by novices in surgery using a compact curriculum. These skills are retained for at least 6 weeks. Eleven weeks after initial training, skill deterioration is likely, and therefore an opportunity for practice and repetition is desirable.