IntroductionTo increase the rate of bystander resuscitation, basic life support (BLS) training for schoolchildren is now recommended on a broad level. However, debate continues about the optimal teaching methods. In this study, we investigated the effects of a 90 min BLS training on female pupils’ BLS knowledge and self-confidence and whether learning outcomes were influenced by the instructors’ professional backgrounds or test-enhanced learning.MethodsWe conducted a cluster randomised, longitudinal trial in a girls’ grammar school in Germany from 2013 to 2014. Pupils aged 10–17 years were randomised to receive BLS training conducted by either emergency physicians or medical students. Using a multiple-choice questionnaire and a Likert-type scale, BLS knowledge and self-confidence were investigated before training (t0), 1 week (t1) and 9 months after training (t2). To investigate whether test-enhanced learning influenced learning outcomes, the questionnaire was administered 6 months after the training in half of the classrooms. The data were analysed using linear mixed-effects models.ResultsThe study included 460 schoolchildren. BLS knowledge (mean number of correct answers) increased from 5.86 at t0 to 9.24 at t1 (p<0.001) and self-confidence (mean score on the Likert-type scale) increased from 8.70 at t0 to 11.29 at t1 (p<0.001). After 9 months, knowledge retention was good (8.94 at t2; p=0.080 vs t1), but self-confidence significantly declined from t1 to 9.73 at t2 (p<0.001). Pupils trained by medical students showed a slight but statistically significant greater increase in the knowledge at both t1 and t2, whereas instructors’ background did not influence gain or retention of self-confidence. Retesting resulted in a marginally, non-significantly better retention of knowledge.ConclusionsBLS training led to short-term gains in knowledge and self-confidence. Although knowledge was retained at 9 months after the training session, self-confidence significantly decreased. Interim testing did not appear to impact retention of knowledge or self-confidence. Medical students should be considered as instructors for these courses given their favourable learning outcomes and greater availability.
High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA. Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.
RPE scores were significantly increased after critical incidents during simulated anaesthesia induction and indicate good construct validity. Reliability may be impaired by the fact that the first session was announced to be without a critical incident. The RPE scale is easy to administer and a valid tool for subjective workload assessment in simulator settings. Reliability is moderate.
Abstract. In the environment of anesthesia, good performance describes the absence of threat for the patient as well as a quick reaction to challenging and possibly life-threatening circumstances. Elsewhere, performance and cognitive function have been linked to indicators of vagally-mediated heart rate variability (HRV). This exploratory study examines the correlation between anesthetists’ HRV and their performance during uneventful induction of general anesthesia and during a simulated critical incident. For this study electrocardiograms (ECG) were obtained from two different groups of anesthetists providing general anesthesia in uneventful real cases in the operation room (OR, n = 38) and during the management of a hypotension scenario in a high-fidelity human patient simulator environment (SIM, n = 23). Frequency, time domain, and nonlinear HRV metrics were calculated from 5-min ECG recordings. To separate high performing (HP) and low performing (LP) individuals, the time needed for induction (in the OR setting) and the length and depth of hypotension (in the SIM setting) were used as performance correlates. The Mann-Whitney- U-test was used to assess differences in HRV within the groups. In both settings (OR and SIM), linear and nonlinear HRV metrics did not differ significantly between the HP and LP group. Also, the anesthetists’ work experience and sex were not related to performance. While providing general anesthesia and during a simulated critical incident, high and low performing individuals do not differ with respect to HRV metrics, sex, and work experience. Further research including the HRV under resting conditions is necessary.
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