Studies show that acquisition and retention of BLS skills is poor, and this may contribute to low survival from cardiac arrest. Feedback from instructors during BLS training is often lacking. This study investigates the effects of continuous feedback from a manikin on chest compression and ventilation techniques during training compared to instructor feedback alone.
A prospective randomised controlled trial. First-year healthcare students at the University of Birmingham were randomised to receive training in standard or feedback groups. The standard group were taught by an instructor using a conventional manikin. The feedback group used a 'Skillreporter' manikin, which provides continuous feedback on ventilation volume and chest compression depth and rate in addition to instructor feedback. Skill acquisition was tested immediately after training and 6 weeks later.
Ninety-eight participants were recruited (conventional n=49; Skillreporter n=49) and were tested after training. Sixty-six students returned (Skillreporter n=34; conventional n=32) for testing 6 weeks later. The Skillreporter group achieved better compression depth (39.96mm versus 36.71mm, P<0.05), and more correct compressions (58.0% versus 40.4%, P<0.05) at initial testing. The Skillreporter group also achieved more correct compressions at week 6 (43.1% versus 26.5%, P<0.05).
This study demonstrated that objective feedback during training improves the performance of BLS skills significantly when tested immediately after training and at re-testing 6 weeks later. However, CPR performance declined substantially over time in both groups.
"In fact, CPR skills deteriorate more rapidly than does BLS knowledge (De Regge et al., 2008; Smith et al., 2008; Spooner et al., 2007). Many studies showed that the nurses returned back to their regular duties without further practice or discussion and they lose the opportunity to properly reflect, learn, and grow from the experience (Alinier et al., 2009). "
"Simulations were successfully used as a research tool to evaluate variations in the retention of knowledge and skills over time (Smith et al. 2008 ), in the appropriate time intervals for refresher trainings (Woollard et al. 2006 ), and in alternative training devices to enhance retention (Spooner et al. 2007 ). Arriaga et al. ( 2013 ) investigated operating room teams working in a series of surgical crisis scenarios in a simulated operating room. "
[Show abstract][Hide abstract] ABSTRACT: An overview is presented of the strengths and limitations of simulation learning, with a particular focus on simulation learning in medicine and health care. We present what simulation learning is about and what the main components of simulations are. The most important theoretical approaches are reviewed which were developed in order to explain why simulation learning is effective. The most prominent best-practice examples of simulation learning applications are presented, and a short overview on research fi ndings concerning simulation learning is given.
International Handbook of Research in Professional and Practice-based Learning, Edited by S. Billett, C. Harteis, H. Gruber, 01/2014: chapter Simulation learning: pages 673-98; Springer, Heidelberg., ISBN: 978-94-017-8901-1
"Both auditory and visual feedback improved the percent of correct compressions (recommended rate, depth, and full release of pressure at the end of compression) and percent of compressions of adequate depth (38 mm or more) among females certified in basic life support performing 10 minutes of 30:2 CPR. Similar positive benefits of feedback in simulated resuscitation are reported by others using auditory feedback (VAM) [8-11] and audiovisual feedback (CPREzy™, Health Affairs, London, UK) [12,13]. "
[Show abstract][Hide abstract] ABSTRACT: Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR). Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only) on the quality of CPR and rescuer fatigue.
Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter® software. Blood lactate (mmol/dl) and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set a priori at 0.05.
Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2%) than did auditory (65.4 ± 7.6%) or no feedback (44.5 ± 8.1%). Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute) was less than it was with both visual and no feedback (p < 0.05). CPR performed with no feedback (39.2 ± 0.5 mm) yielded a shallower average depth of compression and a lower percentage (55 ± 8.9%) of compressions within the accepted 38-50 mm range than did auditory or visual feedback (p < 0.05). The duty cycle for auditory feedback (39.4 ± 1.6%) was less than it was with no feedback (p < 0.05). Auditory feedback produced lower lactate concentrations than did visual feedback (p < 0.05) but there were no differences in perceived exertion.
In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback. The perfect confounding of sensory modality and periodicity of feedback (visual feedback provided continuously and auditory feedback provided to correct error) leaves unanswered the question of optimal form and timing of feedback.
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