Background: Medical student training and experience in cardia arrest situations is limited. Traditional Advanced Cardiac Life Support (ACLS) teaching methods are largely unrealistic with rare personal experience as team leader. Yet Postgraduate Year 1 residents may perform this role shortly after graduation. Purposes: We expanded our ACLS teaching to a "Resuscitation Boot Camp" where we taught 2010 ACLS to 19 pregraduation students in didactic (12 hours) and experiential (8 hours) format. Methods:Immediately before the course, we recorded students per-forming an acute coronary syndrome/ventricular fibrillation (VF) scenario. As a final test, we recorded the same scenario for each student. Primary outcomes were time to cardiopulmonary resuscitation (CPR) and defibrillation (DF). Secondary measures were total scenario score, dangerous actions, proportion of students voicing "ventricular fibrillation," 12-lead ST-elevation myocardial infarction (STEMI) interpretation, and care necessary for return of spontaneous circulation (ROSC). Two expert ACLS instructors scored both performances on a 121-point scale, with each student serving as their own control. We used t tests and McNemar tests for paired data with statistical significance at p < .05.Results: Before instruction, average time from arrest to CPR was 112 seconds and to first DF 3.01 minutes. Students scored 45 + 9/121 points and 9/19 (49%) performed dangerous actions. After instruction, time to CPR was 12 seconds (p = .004) and to first DF 1.53 minutes (p .03). Time to DF was delayed as students showed mastery of bag-valve-mask ventilation before DF. After instruction, students scored 97 + 4/121 points (p < .0001) with no dangerous actions. Before training, only 4 of 19 (21%) students performed both CPR and DF within 2 minutes, and 3 of these had ROSC. After training, 14 of 19 (74%) achieved CPR DF 2 minutes (p .002), and all had ROSC. Before training, 5 of 19 (26%) students said "VF" and 4 of 19 obtained an ECG, but none identified STEMI. After training, corresponding performance was 13 of 19 "VF" (68%, p .021) and 100% ECG and STEMI identification (p < .05).Conclusions: This course significantly improved knowledge and psychomotor skills. Critical actions required for resuscitation were much more common after training. ACLS training including high-fidelity simulation decreases time to CPR and DF and improves performance during resuscitation. = BACKGROUNDThe standard American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) course uses low-fidelity simulators with limited realism and is designed for all levels of healthcare providers. Hayes 1 found that residents felt unprepared to lead cardiac arrest teams despite having completed a standard ACLS course and called for high-fidelity simulation training. Similarly, Lighthall 2 found that resuscitation performance by residents included a high frequency of errors: failure to start cardiopulmonary resuscitation (CPR), notice dysrhythmias, and inquire about do-not-resuscitate status. Another study by Pr...
IntroductionTraditional Advanced Cardiac Life Support (ACLS) courses are evaluated using written multiple-choice tests. High-fidelity simulation is a widely used adjunct to didactic content, and has been used in many specialties as a training resource as well as an evaluative tool. There are no data to our knowledge that compare simulation examination scores with written test scores for ACLS courses.ObjectiveTo compare and correlate a novel high-fidelity simulation-based evaluation with traditional written testing for senior medical students in an ACLS course.MethodsWe performed a prospective cohort study to determine the correlation between simulation-based evaluation and traditional written testing in a medical school simulation center. Students were tested on a standard acute coronary syndrome/ventricular fibrillation cardiac arrest scenario. Our primary outcome measure was correlation of exam results for 19 volunteer fourth-year medical students after a 32-hour ACLS-based Resuscitation Boot Camp course. Our secondary outcome was comparison of simulation-based vs. written outcome scores.ResultsThe composite average score on the written evaluation was substantially higher (93.6%) than the simulation performance score (81.3%, absolute difference 12.3%, 95% CI [10.6–14.0%], p<0.00005). We found a statistically significant moderate correlation between simulation scenario test performance and traditional written testing (Pearson r=0.48, p=0.04), validating the new evaluation method.ConclusionSimulation-based ACLS evaluation methods correlate with traditional written testing and demonstrate resuscitation knowledge and skills. Simulation may be a more discriminating and challenging testing method, as students scored higher on written evaluation methods compared to simulation.
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