Randomized trial of a novel ACLS teaching tool: does it improve student performance?

Effects of Prebriefing Using Online Team-Based Learning in Advanced Life Support Education for Nurses

An effective prebriefing strategy is needed that can improve the learning outcomes of nurses in advanced life support education. This study aimed to identify the effects of prebriefing with online team-based learning on hospital nurses' knowledge, performance, and self-efficacy in advanced life support education. A nonequivalent control group pretest-posttest design was adopted. Nurses in the experimental group (n = 26) participated in prebriefing using online team-based learning followed by self-directed learning, whereas nurses in the control group (n = 27) experienced only self-directed learning before advanced life support education. Wilcoxon signed-ranks tests were used to identify the posttest-pretest differences of the study variables in each group. Both groups showed improved knowledge, individual performance, and self-efficacy after the education. Nurses in the experimental group reported higher self-efficacy scores compared with those in the control group. There were no differences between the experimental and control groups in knowledge, individual performances, or team performance. Online team-based learning as a prebriefing modality resulted in greater improvements in self-efficacy in advanced life support education.

Blended Learning in Health Care Education: An Overview and Overarching Meta-analysis of Systematic Reviews

INTRODUCTION

Blended learning is an educational approach that integrates face-to-face with online instruction. This overview of existing systematic reviews aims to evaluate the impact of blended learning on educational outcomes in health care professional education, identify gaps in the current evidence, and direction for future reviews.

METHODS

Five databases were searched (January 1, 2000 to January 14, 2021) for systematic reviews of blended versus nonblended learning approaches for health care education. "Flipped classroom", unpublished studies, abstracts, and study protocols were excluded. The extracted data included details of included reviews, description of populations, and outcomes according to Kirkpatrick levels. A narrative review is presented, along with an overarching meta-analysis, which evaluates a synthesized estimate of the effect of blended learning based on standardized mean differences.

RESULTS

Eleven systematic reviews were included, comprising of 160 primary studies (including 117 randomized controlled trials) from 56 countries with over 18,000 participants. The overall level of evidence was very low quality. An overarching meta-analysis of 93 studies addressing knowledge acquisition favored blended over nonblended learning methods (standardized mean difference 0.768 [95% confidence interval 0.594-0.941]; P < .001). None of the reviews identified an adverse effect on other educational outcomes.

DISCUSSION

Blended learning may be superior to traditional teaching approaches in improving knowledge acquisition. We recommend further research to describe the relative benefits of blended learning in each individual context and identify which elements of instructional design are beneficial for each outcome. Finally, we recommend the use of clear and consistent terminology in reported studies.

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.

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.

Utilizing High-fidelity Simulators in Improving Trainee Confidence and Competency in Code Management

Simulation training is central in preparing practitioners for code management that is free from patient harm.¹ The purpose of this study was to determine if using a high-fidelity simulator in pediatric code education would improve trainee confidence and competency compared with the use of a traditional mannequin in the same setting.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

Alternatives to High-Fidelity Simulation

Simulation-based education improves health care professionals' performance in managing critical events. Limitations to widespread uptake of high-fidelity simulation include barriers related to training, technology, and time. Alternatives to high-fidelity simulation that overcome these barriers include in situ simulation, classroom-based simulation, telesimulation, observed simulation, screen-based simulation, and game-based simulation. Some settings have limited access to onsite expert facilitation to design, implement, and guide participants through simulation-based education. Alternatives to onsite expert debriefing in these settings include teledebriefing, scripted debriefing, and within-group debriefing. A combination of these alternatives promotes successful implementation and maintenance of simulation-based education for managing critical health care events.

Simulation in Neurocritical Care: Past, Present, and Future

Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.

The association between physician turnover (the "July Effect") and survival after in-hospital cardiac arrest

IMPORTANCE

The July Effect refers to adverse outcomes that occur as a result of turnover of the physician workforce in teaching hospitals during the month of June.

OBJECTIVE

As a surrogate for physician turnover, we used a multivariable difference-in-difference approach to determine if there was a difference in outcomes between May and July in teaching versus non-teaching hospitals.

DESIGN

We used prospectively collected observational data from United States hospitals participating in the Get With The Guidelines^®-Resuscitation registry. Participants were adults with index in-hospital cardiac arrest between 2005-2014. They were a priori divided by location of arrest (general medical/surgical ward, intensive care unit, emergency department). The primary outcome was survival to hospital discharge. Secondary outcomes included neurological outcome at discharge, return of spontaneous circulation, and several process measures.

RESULTS

We analyzed 16,328 patients in intensive care units, 11,275 in general medical/surgical wards and 3790 in emergency departments. Patient characteristics were similar between May and July in both teaching and non-teaching hospitals. The models for intensive care unit patients indicated the presence of a July Effect with the difference-in-difference ranging between 1.9-3.1%, which reached statistical significance (p<0.05) in all but one model (p=0.07). Visual inspection of monthly survival curves did not show a discernible trend, and no July Effect was observed for return of spontaneous circulation, neurological outcome or process measures except for airway confirmation in the intensive care unit. We found no July Effect for survival in emergency departments or general medical/surgical wards (p>0.20 for all models).

CONCLUSIONS

There may be a July Effect in the intensive care unit but the results were mixed. Most survival models showed a statistically significant difference but this was not supported by the secondary analyses of return of spontaneous circulation and neurological outcome. We found no July Effect in the emergency department or the medical/surgical ward for patients with in-hospital cardiac arrest.