Combination of problem-based learning with high-fidelity simulation in CPR training improves short and long-term CPR skills: a randomised single blinded trial

Abstract

Background: Performance of sufficient cardiopulmonary resuscitation (CPR) by medical personnel is critical to improve outcomes during cardiac arrest. It has however been shown that even health care professionals possess a lack of knowledge and skills in CPR performance. The optimal method for teaching CPR remains unclear, and data that compares traditional CPR instructional methods with newer modalities of CPR instruction are needed. We therefore conducted a single blinded, randomised study involving medical students in order to evaluate the short- and long-term effects of a classical CPR education compared with a bilateral approach to CPR training, consisting of problem-based learning (PBL) plus high fidelity simulation.

Methods: One hundred twelve medical students were randomized during a curricular anaesthesiology course to a control (n = 54) and an intervention (n = 58) group. All participants were blinded to group assignment and partook in a 30-min-lecture on CPR basics. Subsequently, the control group participated in a 90-min tutor-guided CPR hands-on-training. The intervention group took part in a 45-min theoretical PBL module followed by 45 min of high fidelity simulated CPR training. The rate of participants recognizing clinical cardiac arrest followed by sufficiently performed CPR was the primary outcome parameter of this study. CPR performance was evaluated after the intervention. In addition, a follow-up evaluation was conducted after 6 months.

Results: 51.9% of the intervention group met the criteria of sufficiently performed CPR as compared to only 12.5% in the control group on the day of the intervention (p = 0.007). Hands-off-time as a marker for CPR continuity was significantly less in the intervention group (24.0%) as compared to the control group (28.3%, p = 0.007, Hedges' g = 1.55). At the six-month follow-up, hands-off-time was still significantly lower in the intervention group (23.7% vs. control group: 31.0%, p = 0.006, Hedges' g = 1.88) but no significant difference in sufficiently performed CPR was detected (intervention group: 71.4% vs. control group: 54.5%, p = 0.55).

Conclusion: PBL combined with high fidelity simulation training leads to a measurable short-term increase in initiating sufficient CPR by medical students immediately after training as compared to classical education. At six month post instruction, these differences remained only partially.

Keywords: Advanced adult CPR; Cardiopulmonary resuscitation; Hands-on training; High-fidelity simulation; Medical students’ education; Problem-based learning.

Fig. 1

Percentage of ERC-Guideline conform CPR. Intervention vs. control group (Intervention group 28 out of 54, 51.9%; control group 6 out of 48, 12.5%), Follow-up after six months (Intervention group 20 out of 28, 71.4%; control 12 out of 22, 54.5%); (* = p < 0.05)

Fig. 2

Compression quality. a Percentage of hands off time during treatment (intervention group 24.0(23.0/26.7)%, control group 28.3(24.3/31.7)%;Follow-up: intervention group 23.7(19.3/26.6)%, control group 31.0(25.0/33.7)%) b Time from beginning to first sufficient compression (intervention group 41.2(33.0/53.5)sec., control group 32.6(21.4/77.7)sec.; Follow-up: intervention group 41.2(33.8/57.0)sec., control group 38.4(31.6/120.7)sec.) c Time from beginning to first ten sufficient compressions in a row (intervention group 52.3(39.3/72.8)sec., control group 109.6(42.6/158.2)sec.; Follow-up: intervention group 46.9(40.6/103.5)sec., control group 43.0(34.5/59.8)sec.); (* = p < 0.05)

Fig. 3

Ventilation quality. a Mean ventilations per minute (intervention group 2.8 ± 0.8 min^− 1,control group 3.9 ± 0.9 min^− 1; Follow-up: intervention 2.7 ± 1.0 min^− 1, control group 3.2 ± 1.0 min^− 1) b Mean compression pause for ventilation (intervention group 4.4(3.8/5.4)sec., control group 5.3(4.5/6.1)sec.; Follow-up: intervention 4.4(3.8/4.8)sec., control group 5.1(4.9/5.9)sec.) c Percentage of accurate ventilations (intervention group 23.2(0/35.2%)%,control group 29.0(13.2/40.7)%; Follow-up: intervention 19.4(3.4/25.0)%, control group 15.9(0/36.4)%) d Mean ventilation tidal volume (intervention group 185 ± 155 ml, control group 275 ± 115 ml; Follow-up: intervention 169 ± 97 ml, control group 150 ± 141 ml); (* = p < 0.05)

Fig. 4

Questionnaires. a Students change in self-assessment in CPR skills during the training (intervention 2.7 ± 1.0 vs. 4.1 ± 0.7; control 2.7 ± 1.0 vs. 4.0 ± 0.9) b Questionnaire assessment after training in adequacy of the teaching technique (intervention: 5.0 ± 1.0 vs. control: 5.6 ± 0.8), self-estimation of increase in CPR abilities (intervention: 4.6 ± 1.4 vs. control: 5.4 ± 0.9) and threshold reduction in performing CPR (intervention: 4.3 ± 1.5 vs. control: 5.1 ± 1.1) between both groups; (* = p < 0.05)