Simulation and education paperThe significance of clinical experience on learning outcome from resuscitation training—A randomised controlled study☆
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)
- et al.
Immediate life support (ILS) training impact in a primary care setting?
Resuscitation
(2007) - et al.
Assessment of Advanced Life Support competence when combining different test methods-reliability and validity
Resuscitation
(2007) - et al.
Newly graduated doctors’ competence in managing cardiopulmonary arrests assessed using a standardized Advanced Life Support (ALS) assessment
Resuscitation
(2008) - et al.
Recall after cardiac arrest scenario testing
Resuscitation
(2006) - et al.
Teaching adult resuscitation in the United States—time for a rethink
Resuscitation
(1998) - et al.
Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case–control study
Chest
(2008) - et al.
Simulation technology for health care professional skills training and assessment
JAMA
(1999) - et al.
Educational epidemiology: applying population-based design and analytic approaches to study medical education
JAMA
(2004) - et al.
Surgical simulation: a systematic review
Ann Surg
(2006) Factors that influence skill decay and retention: a quantitative review and analysis
Human Perform
(1998)
Optimizing long-term retention and transfer. In the mind's eye: enhancing human performance
Skill Retention. Training: research and practice
Physicians’ and nurses’ retention of knowledge and skill after training in cardiopulmonary resuscitation
Can Med Assoc J
How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills?
BMJ
A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course
Acad Emerg Med
Knowledge and skill after brief ACLS training
J Med Assoc Thai
Simulation and clinical practice: strengthening the relationship
Med Educ
Training design: introduction and theories. Training: research and practice
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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.