Elsevier

Resuscitation

Volume 80, Issue 2, February 2009, Pages 238-243
Resuscitation

Simulation and education paper
The significance of clinical experience on learning outcome from resuscitation training—A randomised controlled study

https://doi.org/10.1016/j.resuscitation.2008.10.026Get rights and content

Abstract

Context

The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated.

Aim

To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning.

Materials and methods

This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge.

Intervention

The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation.

Results

Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the immediate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80–83), control group mean 78% (CI 76–80), P = 0.002. The magnitude of this difference was medium (effect size = 0.57).

Conclusions

Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome.

Introduction

Resuscitation training is an increasingly popular component of undergraduate and postgraduate medical education curricula. As simulation-based courses represent a substantial cost1 the educational effectiveness should be determined as a part of the implementation in curricula.2, 3 Learning theories indicate that learning from simulation-based training may rapidly decay over time4, 5, 6 and that is generally supported by experimental studies on cardiopulmonary resuscitation training of health professionals.7, 8, 9, 10, 11 It is therefore important to identify strategies that maximize the retention of learning from resuscitation courses.

One area of concern is the timing of resuscitation training in relation to clinical experience.12 The maximum learning outcome from a training programme is obtained when content, methods and strategies fit participants’ characteristics such as prior knowledge and skills.13 In theory, clinical experience prior to a resuscitation course might influence the participants’ understanding of the subject5 and perceived need for training and intention to learn, which might increase the learning outcome.14 Supporting this is a study by Semeraro et al., who found that senior anesthesiologists retain knowledge gained in a resuscitation course better than junior anesthesiologists.15 In addition a study by Wayne et al16 on residents in internal medicine found a 14 months retention of learned resuscitation skills. However, a consistent finding in other studies is that the acquired competence declines to a significantly lower level within a year after the course8, 10, 11, and a previous study by Wayne et al. demonstrated no advantage of 3 months prior clinical experience on learning from a resuscitation course.17 Despite these indications15, 16 the impact of clinical experience on learning outcome from resuscitation training has not to our knowledge been systematically investigated. Hence, the aim of this study was to examine the significance of clinical experience on the learning outcome from a resuscitation course.

The context was the European Resuscitation Council (ERC)’s Advanced Life Support (ALS) course, which is one example of an internationally recognized highly standardized cardiopulmonary resuscitation course18 and newly graduated doctors about to enter clinical practice as interns.

The specific research question was: does half a year of clinical experience before participation in an ALS course increase immediate learning outcome and the 6-month retention of the learned compared to participation in the course immediately following graduation from medical school?

Section snippets

Design

This project was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course using pre-, post-, and retention measurements of ALS-competence. The intervention group engaged in half a year of clinical work as interns before receiving a standard ALS course. The control group received a standard ALS course before gaining clinical experience as interns. Both groups were assessed regarding ALS-competence at four measurement points: immediately

Results

Invitation to participate in the study was accepted by 154/240 (64%) graduates. Comparison of participants and non-participants has been reported previously19 revealing that the participating group had significantly higher overall average grades compared to non-participants. The magnitude of the differences was medium (ES = 0.4).

Of the 154 who volunteered to participate in the study 76% (117/154) completed the entire protocol and were included in further analyses. There were 17 dropouts in the

Discussion

This study demonstrates that placing a resuscitation course after half a year of clinical experience increases the retention of learning from the course. The magnitude of the effect in terms of ALS-competence score is medium, from 78% to 82% (ES = 0.57).

Conflict of interest

The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or the preparation, review, or approval of the manuscript.

F. Lippert is the national director for the ALS-courses in Denmark. M.L. Jensen is ALS-course coordinator. T. Frost and M.K. Jensen are ALS-instructors.

Acknowledgements

Funding/support: We thank TrygFonden, The Laerdal Foundation for Acute Medicine, Toyota-Fonden Denmark, Broedrene Hartmanns Fond, Lippmann Fonden, Frimodt-Heineke Fonden, and Else og Mogens Wedell-Wedellsborgs Fond for financial support. We thank the companies Laerdal and Medtronics for help with equipment.

Additional contributions: We thank the ERC for granting us permission to use the MCQ-Test and the CASTest. We wish to thank all the participants for their participation in this study and the

References (36)

  • D. Druckman et al.

    Optimizing long-term retention and transfer. In the mind's eye: enhancing human performance

    (1991)
  • J. Patrick

    Skill Retention. Training: research and practice

    (1992)
  • D.A. Gass et al.

    Physicians’ and nurses’ retention of knowledge and skill after training in cardiopulmonary resuscitation

    Can Med Assoc J

    (1983)
  • H.J. Berden et al.

    How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills?

    BMJ

    (1993)
  • E. Su et al.

    A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course

    Acad Emerg Med

    (2000)
  • P. Boonmak et al.

    Knowledge and skill after brief ACLS training

    J Med Assoc Thai

    (2004)
  • R.L. Kneebone et al.

    Simulation and clinical practice: strengthening the relationship

    Med Educ

    (2004)
  • J. Patrick

    Training design: introduction and theories. Training: research and practice

    (1992)
  • Cited by (37)

    • Improving skills retention after advanced structured resuscitation training: A systematic review of randomized controlled trials

      2019, Resuscitation
      Citation Excerpt :

      Clinical experience prior to resuscitation training and improving adherence to core elements of resuscitation such as CPR time have been shown to improve skills retention in ALS. Jensen et al.64 randomized first-year residents to ALS course immediately following graduation vs. six months after acquiring some clinical experience and found a significantly higher 6-month mean retention scores in those with prior clinical experience (82% vs. 78%, p = 0.002). Krogh et al.65 examined CPR taught in real-time training cycles (120 s) compared to shortened CPR training cycles (30–45 sec).

    • Learner perceptions and reflections after simulation-based advanced life support training

      2014, Australian Critical Care
      Citation Excerpt :

      Participant reactions may vary considerably as a consequence of ALS exposure due to an expected increase in experiential knowledge and skill acquisition.5 A number of studies have demonstrated that knowledge and skill acquisition and retention are improved with recent or sustained exposure to resuscitation.2,6,7 Indeed, regular practice is required after initial training to maintain skills rather than annual assessment.8

    • Evaluation of a 3D serious game for advanced life support retraining

      2013, International Journal of Medical Informatics
    View all citing articles on Scopus

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.10.026.

    View full text