Developing a learning tool for advanced life support and resuscitation: Performance Reflection Model for Resuscitation (PRM-Resus)

Abstract

Background: Acquiring proficiency in advanced life support (ALS) can pose challenges for novice learners. Simulation-based training (SBT) is widely used to address this, offering learners opportunities to practise and receive feedback during debriefing. However, existing performance tools often lack the clarity, behavioural specificity, and educational scaffolding required to support deep reflective learning. This study aimed to develop and evaluate the Performance Reflection Model for Resuscitation (PRM-Resus) and to integrate it with the ALS Team Model and structured video exemplars as a comprehensive learning package to enhance ALS training.

Methods: The study involved four phases. Phase 1 created the ALS Team Model to clarify individual roles. Phase 2 focused on co-designing PRM-Resus, using team expertise and the Team Model to create behaviourally anchored performance descriptors. In Phase 3, video scenarios were produced to represent ALS team performance at varying proficiency levels. Phase 4 evaluated the PRM-Resus through expert think-aloud studies. Qualitative content analysis was used alongside Cronbach's alpha to assess internal consistency and its use for SBT.

Results: The PRM-Resus comprises four domains-clinical skills, clinical knowledge, team management, and leadership-each defined by behavioural descriptors across three performance levels. The participating experts endorsed the tool's clarity, structure, and educational value for novice learners. Internal consistency was high (α > 0.95). When used alongside the ALS Team Model and video exemplars, PRM-Resus facilitated deeper performance analysis, which had potential for enhancing post-simulation reflection and supporting faculty development.

Conclusions: This study presents a novel, interdisciplinary framework that integrates PRM-Resus, the ALS Team Model, and video exemplars to support reflective learning in ALS simulation. Together, these tools help novice learners build a concrete understanding of effective team performance and enable educators to deliver more structured feedback. Further research should explore its impact on learner development and potential translation into improved clinical outcomes.

Keywords: Advanced life support; Interdisciplinary; Non-technical skills; Performance assessment; Simulation; Team work.

Fig. 1

The overall process of cross-sector development and evaluation of the PRM-Resus comprises four iterative phases. The tool was designed to support ALS novice learners by guiding reflection and performance analysis. It is intended for use alongside the ALS Team Model, video scenarios as training videos, and a catalogue of performance exemplars

Fig. 2

Video Set 2 shows examples of both standard and pandemic ALS scenarios. Note: Pandemic ALS also provided footage from outside the room

Fig. 3

Early and final versions of the ALS Team Model. It included seven clinical roles—airway, compression, defibrillator, circulation (drugs and fluid), scribe, runner, work safety—to be managed as a team and one leadership role to manage the team

Fig. 4

Page one of the final version of the PRM-Resus

Fig. 5

Page two of the final version of the PRM-Resus

Fig. 6

Clinical knowledge influencing role operational performance

Fig. 7

PRM-Resus example: The lack of clear leadership and failure to introduce team members’ skillsets at the beginning (red font) were identified as the root cause of the chaotic situation, resulting in poor role performance and delayed intervention (blue)