Elsevier

Resuscitation

Volume 81, Issue 2, February 2010, Pages 217-223
Resuscitation

Simulation and education
Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India,☆☆

https://doi.org/10.1016/j.resuscitation.2009.10.013Get rights and content

Abstract

Objective

Data on the efficacy of the simulation and multimedia teaching modalities is limited, particularly in developing nations. This study evaluates the effectiveness of simulator and multimedia educational tools in India.

Methods

Advanced Cardiac Life Support (ACLS) certified paramedic students in India were randomized to either Simulation, Multimedia, or Reading for a 3-h ACLS refresher course. Simulation students received a lecture and 10 simulator cases. The Multimedia group viewed the American Heart Association (AHA) ACLS video and played a computer game. The Reading group independently read with an instructor present. Students were tested prior to (pre-test), immediately after (post-test), and 3 weeks after (short-term retention test), their intervention. During each testing stage subjects completed a cognitive, multiple-choice test and two cardiac arrest scenarios. Changes in exam performance were analyzed for significance. A survey was conducted asking students’ perceptions of their assigned modality.

Results

One hundred and seventeen students were randomized to Simulation (n = 39), Multimedia (n = 38), and Reading (n = 40). Simulation demonstrated greater improvement managing cardiac arrest scenarios compared to both Multimedia and Reading on the post-test (9% versus 5% and 2%, respectively, p < 0.05) and Reading on the short-term retention test (6% versus −1%, p < 0.05). Multimedia showed significant improvement on cognitive, short-term retention testing compared to Simulation and Reading (5% versus 0% and 0%, respectively, p < 0.05). On the survey, 95% of Simulation and 84% of Multimedia indicated they enjoyed their modality.

Conclusion

Simulation and multimedia educational tools were effective and may provide significant additive benefit compared to reading alone. Indian students enjoyed learning via these modalities.

Introduction

Medical education utilizes multiple teaching modalities, such as lectures, reading, and problem-based learning. Schools in the United States, Europe, and Australia have recently incorporated advanced modalities, such as simulators, computer games, and videos, into their curricula. Insight into which modalities are most effective is imperative given resource limitations in both developing and developed nations and the vast amounts of cognitive knowledge and psychomotor skills that must be mastered during medical training.

Use of high-fidelity patient simulators for education is expanding in the United States and abroad,1, 2, 3, 4, 5, 6 however, studies evaluating the efficacy of simulation versus other teaching modalities are limited. Simulator-based instruction has been demonstrated to improve psychomotor skills4, 5, 6 and possibly retention of Advanced Cardiac Life Support (ACLS) training.7 Computer-based gaming in medical education is also on the rise8, 9, 10, 11 and has shown promise in improving knowledge retention.

The worldwide demand for skilled medical practitioners exceeds the supply. India exemplifies this with a projected shortfall of 45,000 physicians, 250,000 nurses, and 30,000 paramedics by 2012.8 Determination of the most effective and efficient means of training providers is crucial to meet these demands. While interactive education including simulation and computer gaming is employed in many developed countries, it is rarely utilized in India where large-group lecture and independent study predominate. Many “high-tech” teaching tools require a substantial investment and there is limited data demonstrating superiority over traditional teaching modalities. Such factors prevent adoption in resource-limited nations.

The purpose of this study was to evaluate the effectiveness of advanced teaching modalities (simulators, computers, and videos) for medical education in the setting of a developing nation.

Section snippets

Study design

This was a prospective, randomized, interventional trial. The study took place over a 4-week period in April 2008 (Fig. 1). Institutional review board (IRB) approval was obtained and participants consented to participate. Students were informed that performance would not impact class standing.

Study setting and population

The study was conducted at the Emergency Management and Research Institute (EMRI), located in Andhra Pradesh, India. The subjects were students enrolled in EMRI's Post Graduate Program in Emergency Care

Sample size

Of the original 125 students enrolled, 117 (94%) students participated in the entire study, completing the pre-test, educational intervention, post-test and retention test. Eight students were not included due to an absence at one of the study days. Of the non-participants, three were assigned to Simulation, three to Multimedia, and two to Reading. In the final data analysis, 38 students were in Simulation, 39 in Multimedia, and 40 in Reading. There were no significant differences in the

Discussion

This is the largest study to date assessing the efficacy of high-definition human simulators and computer-based gaming programs in medical education. It demonstrates that technologically advanced educational modalities such as simulation, computer games, and videos may provide significant added benefit to traditional learning methods in the retention of medical knowledge and psychomotor skills. High-fidelity human simulators were superior to reading and videos/computer games for immediate

Limitations

There were limitations to this study that are important to note. The finding that students in the Simulation group performed better on the cardiac arrest scenarios, especially immediately following their intervention, may be secondary to increased comfort and familiarity with the simulation setting. This limitation was anticipated and, therefore, scenario based testing was carried out using basic rhythm generators and mannequins and not with the Laerdal Advanced ALS Simulator. Additionally, all

Conclusions

Simulation and multimedia educational tools were effective and may provide significant additive benefit compared to reading alone. High-definition human simulation produced the best short-term performance improvement in cardiac arrest scenario management, while the use of videos and a computer game was associated with less knowledge decay. Students in India enjoyed learning via these newer technologies and desired the incorporation of these methodologies into their educational curriculum.

Conflict of interest statement

All authors have no financial or other conflicts of interests to disclose. Funding source was through the Stanford University Medical Scholars program for original research.

References (14)

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.10.013.

☆☆

Paper presented as a poster at the National SAEM Meeting in New Orleans in May 2009.

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