The effect of peer-group size on the delivery of feedback in basic life support refresher training: a cluster randomized controlled trial

Teaching basic life support for medical students: Assessment of learning and knowledge retention

BACKGROUND

Education mediated by simulation is a widely used method for teaching basic life support (BLS). The American Heart Association recommends protocols based on scientific evidence to reduce sequelae and mortality. We aimed to assess learning and retention of knowledge of BLS in students of the first semester of the medical course using teaching methods of dialogic expository class (group 1), expository and demonstrative class (group 2), and the two previous methodologies associated with simulated practice (group 3), and after 3 months, memory retention.

MATERIALS AND METHODS

This was an experimental, prospective, randomized study. Participants were assessed in terms of performance in theoretical and simulated practical tests, satisfaction with training (Likert scale), and knowledge retention.

RESULTS

The practical test results were analyzed by two experienced observers. Students had 20% progression in knowledge and 80% retention of knowledge after 3 months of exposure comparing the theoretical pre- and posttest. The students in group 3 performed better than the others (P = 0.007) in the posttest. With the simulated practice, the knowledge acquired was maintained after 3 months with a mean performance of 90%, but in the test of the infant age group, there was a loss of learning retention by 10%. There was no difference of the results between the two evaluators (P < 0.001). The training was positively assessed by the participants.

CONCLUSION

The use of different methodologies promoted knowledge progression, with emphasis on simulated practice. Learning retention was maintained after 3 months. In order to teach BLS to infants, it may be necessary to improve teaching techniques.

Influence of pretesting and a near peer sharing real life experiences on CPR training outcomes in first year medical students: a non-randomized quasi-experimental study

BACKGROUND

Existing literature on cardiopulmonary resuscitation (CPR) training focuses on the knowledge and skill components while the attitudinal component is rarely addressed. There is a need to explore how peer interaction, learning atmosphere, and communication influence learning effectiveness during CPR training. Therefore, this study's objective was to evaluate how a senior student (near peer) sharing their real-life experience of performing CPR would influence medical students' learning and readiness to perform CPR.

METHODS

The present study involved 250 newly enrolled undergraduate medical students. The Solomon's four-group study design was used to evaluate the influence of both pretesting and peer interaction. Students belonging to two groups initially completed a pre-training knowledge test (pretest) and a questionnaire on readiness to perform CPR. Students from all four groups then participated in instructor-led hands-on skills training, after which the two intervention groups interacted with their senior, who shared their life experiences of performing CPR. Finally, all four groups underwent skills evaluation, immediate and delayed post-tests, and completed a questionnaire to assess readiness to perform CPR. The students also provided their feedback on the experience of interacting with a peer during the training.

RESULTS

Post-test scores were significantly higher than pretest scores (Kruskal-Wallis test, p < 0.05). Scores were significantly higher in pretested intervention groups than in the non-pretested non-intervention group (p < 0.05). Delayed post-test scores were slightly but not significantly lower than the immediate post-test scores with no significant difference observed in the scores among the groups. The pretested groups showed more readiness to perform CPR and the pretested intervention group were least concerned about acquiring infection during CPR. Students in all groups were confident of performing chest compressions correctly, and found it inspiring and motivating listening to and discussing real-life experiences with a near peer.

CONCLUSIONS

Hearing from peers about real-life CPR experience during CPR training sessions significantly impacted learning, enhanced student motivation to learn and may be an effective strategy to consider in routine CPR training. However, the positive effects of pretesting and peer interaction on knowledge were not sustained, highlighting a need for repeat training.

Cardiopulmonary Resuscitation Training for Healthcare Professionals: A Scoping Review

SUMMARY STATEMENT

The optimal strategy for training cardiopulmonary resuscitation (CPR) for healthcare professionals remains to be determined. This scoping review aimed to describe the emerging evidence for CPR training for healthcare professionals.We screened 7605 abstracts and included 110 studies in this scoping review on CPR training for healthcare professionals. We assessed the included articles for evidence for the following topics: training duration, retraining intervals, e-learning, virtual reality/augmented reality/gamified learning, instructor-learner ratio, equipment and manikins, other aspects of contextual learning content, feedback devices, and feedback/debriefing. We found emerging evidence supporting the use of low-dose, high-frequency training with e-learning to achieve knowledge, feedback devices to perform high-quality chest compressions, and in situ team simulations with debriefings to improve the performance of provider teams.

The effectiveness of emergency knowledge training of pediatric medical workers based on the knowledge, skills, simulation model: a quasi-experimental study

BACKGROUND

Basic life support and advanced life support are essential emergency management skills for medical workers, and pediatricians' first aid skills can be improved through emergency knowledge training.

METHODS

A controlled pre-post-intervention quasi-experimental study design was used. The study setting was a tertiary children's hospital in China. In November 2019, a KSS model of emergency knowledge learning was developed and tested, and pediatric medical workers (N = 1448) were trained with it. The outcome measures were based on an emergency knowledge questionnaire devised by the authors that measured the effectiveness of training by comparing the pre-and post-training scores of the particpants.

RESULTS

Pediatric medical workers scored significantly higher in total emergency knowledge after the training course than before [75.00 (62.50, 85.00) versus 100.00 (95.00, 100.00); P = 0.00]. Basic life support and advanced life support knowledge score significantly improved after training. Teamwork scores were significantly higher after the training than before [5.00 (5.00, 10.00) versus 10.00 (10.00, 10.00); P = 0.00]. Scores were significantly higher after the training (P < 0.001), especially for case analysis questions (P = 0.00). The attitudes of the medical workers towards the training were all positive and affirmative.

CONCLUSION

The KSS model was shown to be effective in improving the emergency knowledge of pediatric medical workers. Future research will be to explore the effectiveness of the model with different participants and at other hospitals or other institutions such as schools, encouraging more people to participate in and evaluate the model to promote its optimization.

TRIAL REGISTRATION

Hunan Children's Hospital, HCHLL-2018-03.

Pre-clinical medical student cardiac point-of-care ultrasound curriculum based on the American Society of Echocardiography recommendations: a pilot and feasibility study

Background

Cardiac point-of-care ultrasound (POCUS) training has been integrated into medical school curricula. However, there is no standardized cardiac POCUS training method for medical students. To address this issue, the American Society of Echocardiography (ASE) proposed a framework for medical student cardiac POCUS training. The objective of this pilot study was to develop a medical student cardiac POCUS curriculum with test scoring systems and test the curriculum feasibility for a future definitive study.

Methods

Based on the ASE-recommended framework, we developed a cardiac POCUS curriculum consisting of a pre-training online module and hands-on training with a hand-held ultrasound (Butterfly iQ, Butterfly Network Inc., Guilford, CT, USA). The curriculum learning effects were assessed with a 10-point maximum skill test and a 40-point maximum knowledge test at pre-, immediate post-, and 8-week post-training. To determine the curriculum feasibility, we planned to recruit 6 pre-clinical medical students. We semi-quantitatively evaluated the curriculum feasibility in terms of recruitment rate, follow-up rate 8 weeks after training, instructional design of the curriculum, the effect size (ES) of the test score improvements, and participant satisfaction. To gather validity evidence of the skill test, interrater and test-retest reliability of 3 blinded raters were assessed.

Results

Six pre-clinical medical students participated in the curriculum. The recruitment rate was 100% (6/6 students) and the follow-up rate 8 weeks after training was 100% (6/6). ESs of skill and knowledge test score differences between pre- and immediate post-, and between pre- and 8-week post-training were large. The students reported high satisfaction with the curriculum. Both interrater and test-retest reliability of the skill test were excellent.

Conclusions

This pilot study confirmed the curriculum design as feasible with instructional design modifications including the hands-on training group size, content of the cardiac POCUS lecture, hands-on teaching instructions, and hand-held ultrasound usage. Based on the pilot study findings, we plan to conduct the definitive study with the primary outcome of long-term skill retention 8 weeks after initial training. The definitive study has been registered in ClinicalTrials.gov (Identifier: NCT04083924).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00910-3.

The effective group size for teaching cardiopulmonary resuscitation skills - A randomized controlled simulation trial

AIM OF THE STUDY

The ideal group size for effective teaching of cardiopulmonary resuscitation is currently under debate. The upper limit is reached when instructors are unable to correct participants' errors during skills practice. This simulation study aimed to define this limit during cardiopulmonary resuscitation teaching.

METHODS

Medical students acting as simulated Basic Life Support course participants were instructed to make three different pre-defined Basic Life Support quality errors (e.g., chest compression too fast) in 7 min. Basic Life Support instructors were randomized to groups of 3-10 participants. Instructors were asked to observe the Basic Life Support skills and to correct performance errors. Primary outcome was the maximum group size at which the percentage of correctly identified participants' errors drops below 80%.

RESULTS

Sixty-four instructors participated, eight for each group size. Their average age was 41 ± 9 years and 33% were female, with a median [25th percentile; 75th percentile] teaching experience of 6 [2;11] years. Instructors had taught 3 [1;5] cardiopulmonary resuscitation courses in the year before the study. A logistic binominal regression model showed that the predicted mean percentage of correctly identified participants' errors dropped below 80% for group sizes larger than six.

CONCLUSION

This randomized controlled simulation trial reveals decreased ability of instructors to detect Basic Life Support performance errors with increased group size. The maximum group size enabling Basic Life Support instructors to correct more than 80% of errors is six. We therefore recommend a maximum instructor-to-participant ratio of 1:6 for cardiopulmonary resuscitation courses.

Formative peer assessment in higher healthcare education programmes: a scoping review

OBJECTIVES

Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions.

DESIGN

A scoping review.

DATA SOURCES

Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct.

ELIGIBILITY CRITERIA

Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature.

DATA EXTRACTIONS AND SYNTHESIS

Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis.

RESULT

The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning.

CONCLUSION

Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students' and teachers' experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016

OBJECTIVES

The objectives were to critically appraise the emergency medicine (EM) medical education literature published in 2016 and review the highest-quality quantitative and qualitative studies.

METHODS

A search of the English language literature in 2016 querying MEDLINE, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 510 papers related to medical education in EM. Two reviewers independently screened all of the publications using previously established exclusion criteria. The 25 top-scoring quantitative studies based on methodology and all six qualitative studies were scored by all reviewers using selected scoring criteria that have been adapted from previous installments. The top-scoring articles were highlighted and trends in medical education research were described.

RESULTS

Seventy-five manuscripts met inclusion criteria and were scored. Eleven quantitative and one qualitative papers were the highest scoring and are summarized in this article.

CONCLUSION

This annual critical appraisal series highlights the best EM education research articles published in 2016.