Elsevier

Resuscitation

Volume 44, Issue 2, April 2000, Pages 109-117
Resuscitation

CPR ‘98: A practical multimedia computer-based guide to cardiopulmonary resuscitation for medical students

https://doi.org/10.1016/S0300-9572(99)00171-9Get rights and content

Abstract

This paper describes an initiative to build a multimedia computer-based teaching package for cardiopulmonary resuscitation. The project resulted from a perceived gap in the undergraduate medical curriculum allied to concern from medical students. The software application was designed to be networked and used as an adjunct to taught life support courses for undergraduate medical students. The package comprises tutorials and test questions in basic and advanced life support. It incorporates sound, video, graphics and animation to illustrate the techniques involved and is distributed on CD ROM for the PC. The content is based on the 'Advanced Life Support Manual', produced by the Resuscitation Council (UK) and incorporates all changes to the guidelines made during 1997 and 1998. The basic life support section has been networked locally, and has been tested on more than 60 third year medical students attending a local basic life support course. It was found that students who used the package performed significantly better in theoretical assessments than those who did not.

Introduction

It has been shown in out-of-hospital cardiac arrest studies that prompt delivery of cardiopulmonary resuscitation (CPR) and reduction in arrest to first shock time have resulted in improved survival [1], [2] and neurological recovery [3]. The BRESUS study [4], which looked at in-hospital resuscitation also came to the conclusion that hospital resuscitation is both life saving and cost effective and ‘warrants appropriate attention, training, co-ordination and equipment’.

In 1987, a comparison of resuscitation training between American and UK medical schools highlighted the relative inferiority of CPR training in British centres [5]. A more recent survey of resuscitation training in UK medical schools [6] suggests that the level of training in this area is still inadequate. Whilst most medical schools teach their students some Advanced Life Support (ALS) skills, only 45% provide formal ALS courses. 35% of the respondents (those persons responsible for organizing CPR training for medical undergraduates) considered that undergraduate medical students were not taught enough resuscitation skills to enable them to provide an effective resuscitation service as junior house officers. Not surprisingly, this was reflected in the opinions of 3rd year undergraduate students surveyed at the University of Glasgow [7] where 81% of the study group believed that there should be more resuscitation training. As a result, the University of Glasgow wished to enhance the teaching of CPR. In particular, the Dean of Medicine was anxious that appropriate software for CPR teaching be made available.

It is appreciated that CPR is best taught with ‘hands on’ experience. However, appropriate resources are not always readily available for large classes of students. While video presentations also help to demonstrate the procedures involved, it was felt that a multimedia computer based teaching package could offer a complementary teaching aid to hands-on taught courses. Technology is moving forward rapidly in multimedia. The facilities for incorporating sound and visual material in teaching software are now readily available, and reducing in price as the market expands.

The introduction of the Internet and improvements in communication and information technology have led to a vast array of computer based learning material now being made available to the medical community. The sheer volume of material can be overwhelming and quality can be variable — especially so with Internet resources. In the UK, until recently, the University of Bristol based Computers in Teaching Initiative Centre for Medicine [8] acted as an advisor on best practice in using computers in all clinical teaching and maintained a database of peer reviewed medical software. Funding has now ceased for this project and its successor is still to be announced. Other organisations such as the University of Nottingham based OMNI (Organising Medical Networked Information) [9] have been developed to provide gateway sites to quality biomedical Internet resources, whilst the Cochrane Library [10] provides a central site for evidence based medicine. Other international attempts to provide centralised sources for medical Internet resources include the University of Iowa's Virtual Hospital [11] and Medical Student.com [12] as well as the UK based Cyber Hospital [13].

Given all of this background including the move to self-directed learning, the availability of computing facilities in medical schools (both of which initiatives were stimulated by GMC recommendations [14]) and a need for material for CPR training, it was decided to develop a multimedia based package for teaching CPR to medical undergraduates. Despite the increasing trend in medical education towards producing Internet-based packages, a decision was made to develop a low cost, CD-ROM based program which would operate on all but the most basic of PCs as it was thought that there would be a significant number of potential users who would have poor or no Internet communications. Also at the time of development, downloading of video material across the Internet was deemed to be unacceptably slow and impractical for classroom situations.

Section snippets

Aims

The principal aim of the project was to improve the teaching of life support skills to medical students by providing a computerised life support tutorial, which would act as an adjunct to hands-on teaching. It was felt that the package could give added value over and above that provided by traditional books and papers by the use of moving and still images and sounds to demonstrate procedures and techniques. The application was required to provide feedback in the form of self-test questions and

Results

Hands on course results (multiple-choice questions, practical examination and total scores) were obtained from students who did not view the program prior to the BLS course (n=62) and were compared with the results from students who had used the BLS program prior to the hands-on course (n=67). All outliers were included in the final results. Using the Mann–Whitney analysis method, student results for the MCQs and overall scores were shown to be significantly better (P=0.0007) in the group who

Discussion

The fact that the use of the program made no significant difference to the practical test scores indicates that cardiopulmonary resuscitation is a skill best taught with 'hands on' experience. However, the significant improvement in theoretical and overall test results suggests that the program is a valuable supplement to taught courses. Technique is best learned through experience but the knowledge underpinning technique is supported by the package. It is recommended that the CD-ROM be used as

Acknowledgements

The authors gratefully acknowledge the financial support of the British Heart Foundation, and assistance from the Resuscitation Council (UK) in terms of content detail. The project was strongly supported in terms of expertise and medical content by members of staff in Glasgow Royal Infirmary (GRI) and other Glasgow hospitals. The authors would particularly like to acknowledge assistance from the Medical Illustration Department, GRI and the guidance of Dr Keith Simpson of the Renal Unit, GRI.

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