Advanced Cardiac Resuscitation Evaluation (ACRE): A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

Abstract

BackgroundAdvanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve.MethodsA single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor.A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents.The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks.Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness.The results were analysed using Exact methods, chi-squared and t-test.ResultsA total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group.There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes.ConclusionsThe key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.

Effect of peer teaching on the performance of undergraduate nursing students enrolled in nursing administration course

“…On the same line [43,44] found that peer teaching was more effective than traditional methods in improving the practices grades of students. Our findings add more support in favor of the peer-teaching approach against what has been reported in other previous studies [19,[45][46][47] that failed to show the supremacy of peers teaching compared with traditional approaches.…”

“…This prepares the nursing students for their future roles as educators, builds their self esteem, and enhances their psychomotor skills and their attitudes [16][17][18][19][20][21] . As for nurse educators and faculty, peer teaching may reduce their workload in teaching, and provides them with more opportunities to observe and provide feedback to their students regarding their performance [22][23][24][25][26][27] .…”

Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

“…A total of six studies6,25–28 were set in the United Kingdom and they originated from four different educational institutions. Germany and the United States were the next two countries most commonly represented, each with four studies originating from them.…”

“…The majority of studies did not provide readers with descriptions of these programs. Four studies6,28–30 described the total duration of their medical programs and these were all 6 years in duration. Three studies25,31,32 described their medical programs as comprising of pre-clinical and clinical phases but provided no further details clarifying class sizes, duration of program, structure of the curriculum, etc.…”

IMPLSE course: a near-peer simulation course

“…There is increasing interest in this form of teaching,4 with a push to encourage and formalise such programmes5 in both undergraduate and postgraduate educations. This has resulted in efficacious and sustainable near-peer programmes emerging on both the local6 and regional scales 7. These programmes can effectively be designed and delivered by newly qualified junior doctors 7 8…”