CPR ‘98: A practical multimedia computer-based guide to cardiopulmonary resuscitation for medical students
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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Comparison of an interactive CD-based and traditional instructor-led Basic Life Support skills training for nurses
2015, Australian Critical CareCitation Excerpt :To determine the overall contribution of this study's findings, it is necessary to compare the outcomes of the current study with those of comparative BLS CD literature. However, this is not possible because despite this study being conducted over a decade ago, subsequent studies have not directly compared interactive CD BLS training programmes with traditional programmes.17–19,40 Under these circumstances, it is therefore relevant to compare the findings of the current study with research that compares Multimedia (Video, DVD and Internet) programmes that included manikin practice, with a traditional BLS programme.
Pediatric resuscitation training-Instruction all at once or spaced over time?
2015, ResuscitationCitation Excerpt :Maximizing survival from cardiac arrest requires improvement in resuscitation education. Although several life support course design interventions have been shown to achieve equivalent or better knowledge and/or skills acquisition, none have been shown to impact retention of resuscitation skills or knowledge.17,18 Although we did not see differences in our primary outcomes, the differences seen on multiple critical steps in resuscitation procedural skills 4-weeks following training of students in a spaced format suggest that a difference may exist and warrants further study.
Look, listen and practice. How do you learn?
2013, Resuscitation