Impact of blended learning on manual defibrillator's use: A simulation-based randomized trial

Abstract

Background: Blended learning, defined as the combination of traditional face-to-face instructor-led learning and e-learning course, has never been validated as a teaching method for the effective use of manual defibrillators in cardiopulmonary resuscitation.

Aim: To evaluate whether paediatric emergency and critical care providers exposed to a blended learning session performed better and recalled more defibrillator skills than those exposed to face-to-face learning only.

Study design: A two-period prospective, stratified, single-centre, simulation-based, randomized, controlled trial.

Methods: Registered nurses and postgraduate residents from either a paediatric emergency department or an intensive care unit were randomly assigned to a blended learning or face-to-face learning sessions on the recommended use of a manual defibrillator. Participants' adherence to recommendations was assessed by testing defibrillator skills in three consecutive paediatric cardiopulmonary scenarios performed on the day of the training and once again 2 months later. The primary endpoint was the number of errors observed during defibrillation, cardioversion, and transcutaneous pacing at the time of the initial intervention.

Results: Fifty participants were randomized to receive the intervention and 51 to the control group. When pooling all three procedures, the median total errors per participant was lower (2 [IQR: 1-4]) in providers exposed to blended learning than in those exposed to face-to-face learning only (3 [IQR: 2-5]; P = .06). The median of total errors per procedure was also lower. However, both training methods appeared insufficient to maintain appropriate skill retention over time as a repetition of procedures 2 months later without any refresher learning session yielded more errors in both groups.

Conclusions: Learners exposed to blended learning showed a reduced number in the total amount of errors compared with those exposed to face-to-face learning alone, with waning of skills over time.

Relevance to clinical practice: Proficiently teaching the use of a manual defibrillator can be performed through blended learning.

Keywords: blended learning; defibrillator; education; educational technology; emergency medicine; nursing; paediatrics.

FIGURE 1

CONSORT flow chart

FIGURE 2

Number of errors per participants (count), electrical procedure, and study arm. The upper left panel shows the overall number of errors for the three electrical procedures pooled. The upper right, lower left, and lower right panels show the number of errors for defibrillation, cardioversion, and transcutaneous pacing, respectively. The axes represent the number of errors per study arm (x‐axis) and the count of participants delivering the electrical therapies (y‐axis). FFL, face‐to‐face learning study arm; BL, blended learning study arm. A trend towards a reduction in the number of errors per participant can be visualized in this figure for cardioversion and pacing procedures as well as for the three electrical procedures pooled