Elsevier

Resuscitation

Volume 90, May 2015, Pages 79-84
Resuscitation

Simulation and education
e-Learning in advanced life support – An evaluation by the Resuscitation Council (UK)

https://doi.org/10.1016/j.resuscitation.2015.02.026Get rights and content

Abstract

Aim

To descriptively analyse the outcomes following the national roll out of an e-Learning advanced life support course (e-ALS) compared to a conventional 2-day ALS course (c-ALS).

Method

Between 1st January 2013 and 30th June 2014, 27,170 candidates attended one of the 1350 Resuscitation Council (UK) ALS courses across the UK. 18,952 candidates were enrolled on a c-ALS course and 8218 on an e-ALS course. Candidates participating in the e-ALS course completed 6–8 h of online e-Learning prior to attending the 1 day modified face-to-face course. Candidates participating in the c-ALS course undertook the Resuscitation Council (UK) 2-day face-to-face course. All candidates were assessed by a pre- and post-course MCQ and a practical cardiac arrest simulation (CAS-test). Demographic data were collected in addition to assessment outcomes.

Results

Candidates on the e-ALS course had higher scores on the pre-course MCQ (83.7%, SD 7.3) compared to those on the c-ALS course (81.3%, SD 8.2, P < 0.001). Similarly, they had slightly higher scores on the post-course MCQ (e-ALS 87.9%, SD 6.4 vs. c-ALS 87.4%, SD 6.5; P < 0.001). The first attempt CAS-test pass rate on the e-ALS course was higher than the pass rate on the c-ALS course (84.6% vs. 83.6%; P = 0.035). The overall pass rate was 96.6% on both the e-ALS and c-ALS courses (P = 0.776).

Conclusion

The e-ALS course demonstrates equivalence to traditional face-to-face learning in equipping candidates with ALS skills when compared to the c-ALS course. Value is added when considering benefits such as increased candidate autonomy, cost-effectiveness, decreased instructor burden and improved standardisation of course material. Further dissemination of the e-ALS course should be encouraged.

Introduction

Advanced life support (ALS) courses, which include hands-on practice and simulation, are widely used in healthcare training to equip candidates with the knowledge, attitudes and technical and non-technical skills to effectively manage patients in cardiac arrest. Such courses are consistently well received by learners and have been shown in some settings to improve patient outcomes from cardiac arrest.1, 2, 3 In the United Kingdom (UK), competency in ALS is a core requirement for healthcare professionals working in front-line acute care specialties. The Resuscitation Council (UK) introduced its first ALS course in 1992,4 and since then there have been increasing numbers of candidates undertaking ALS courses nationwide. During 2013 alone, 19,082 candidates participated in an ALS course.4, 5

In recent years there has been a global change in medical education, with academic institutes pioneering e-Learning as an alternative to more traditional delivery methods. The reasons for this shift are multi-factorial but include rapid medical advancements resulting in decreased time for academics to deliver formal teaching, the increasing accessibility of online material via the internet and making education more learner-centred rather than instructor-centred.6 Several randomised controlled trials (RCTs) have demonstrated that e-Learning is superior to more traditional methods in higher education and corporate environments.7, 8 In the medical field, e-Learning courses are becoming exponentially more popular in both undergraduate and post-graduate education as candidates seek greater accessibility to pre-requisite material and a more personalised learning schedule. A large meta-analysis found that internet-based learning had comparable outcomes to conventional learning methods.9 E-Learning has been shown to be effective in areas as diverse as reproductive health training,10 ultrasound skills,11 haematological disorders12 and the management of epistaxis.13

The ability to deliver ALS course content by e-Learning was evaluated in a large, multi-centre, non-inferiority randomised controlled trial. The trial established equivalence in outcome when comparing learning methods (by finding no difference in overall pass rates) and was significantly cheaper to deliver.14 Following the results of this trial the Resuscitation Council (UK) rolled out a national e-Learning ALS course (e-ALS). The course required an update in learning materials (to reflect emerging evidence) but remains conceptually the same as the course tested in the randomised controlled trial. The methods of candidate assessment remained identical.

The aim of this study is to descriptively analyse the outcomes following the national roll out of an e-Learning ALS course.

Section snippets

Setting and participants

Potential ALS candidates were invited to participate in ALS courses through one of the 181 national training centres. Course centres were able to select the balance of e-ALS and c-ALS courses that they offered. Participants were free to register for either course at any of the course centres, thus candidate choice was based on availability of ALS courses in the local area.

Each candidate was required to register on the Resuscitation Council (UK) learning management system (LMS) prior to

Results

There were 1350 ALS courses carried out between 1st January 2013 and 30th June 2014. Nine hundred c-ALS courses were run by 181 ALS centres across the UK. The remaining 450 e-ALS courses were facilitated by 94 centres.

Discussion

The average marks are slightly higher on the pre-course MCQ for the e-ALS course (83.7%) compared to the c-ALS course (81.3%), indicating that it has potential advantages in preparing candidates prior to attending the face-to-face aspect. This is perhaps unsurprising given that e-ALS candidates had access to 12 online modules and the ALS course manual, compared to the course manual alone for the c-ALS course. This small difference narrows by completion of the course and the results of the

Conclusion

The hybrid e-ALS course is as effective at equipping candidates with ALS skills when compared to the c-ALS course. When the additional benefits of the e-ALS course are taken into account such as increased autonomy for candidates, cost-effectiveness, decreased instructor burden and the means for standardisation and evaluation of online material by course organisers, it provides an altogether more sustainable ALS course. Further research is required to determine whether e-Learning has any

Conflict of interest statement

CJT is a Trainee Representative for the ALS Subcommittee for the Resuscitation Council (UK). ASL is Honorary Secretary of the Resuscitation Council (UK) and a member of the European Resuscitation Council ALS Course Committee. IB is Lead Educator for the Resuscitation Council (UK). SH is Director of Course Development and Training for the Resuscitation Council (UK). SB-A is Project and Development Manager for the Resuscitation Council (UK). GDP is Chair of the ALS Subcommittee for the

Acknowledgments

The authors would like to acknowledge the ALS instructors and candidates who have participated in an ALS course over the duration of this study.

References (28)

  • M.L. Jensen et al.

    Using e-Learning for maintenance of ALS competence

    Resuscitation

    (2009)
  • G.D. Perkins et al.

    The effect of pre-course e-Learning prior to advanced life support training: a randomised controlled trial

    Resuscitation

    (2010)
  • K.G. Monsieurs et al.

    Learning effect of a novel interactive basic life support CD: the JUST system

    Resuscitation

    (2004)
  • S.J. Yule et al.

    Advanced life support training: does online learning translate to real-world performance?

    Ann Intern Med

    (2012)
  • Cited by (0)

    A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.02.026.

    View full text