Indian and United States paramedic students: comparison of examination performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) training

Background

The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US).

Study Objectives

As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students.

Methods

First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance.

Results

There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p = 0.508) and a Wilcoxon test (p = 0.242).

Conclusion

Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.     

Pre-training evaluation and feedback improved skills retention of basic life support in medical students

Background

Pre-training evaluation and feedback have been shown to improve medical students’ skills acquisition of basic life support (BLS) immediately following training. The impact of such training on BLS skills retention is unknown. This study was conducted to investigate effects of pre-training evaluation and feedback on BLS skills retention in medical students.

Methods

Three hundred and thirty 3rd year medical students were randomized to two groups, the control group (C group) and pre-training evaluation and feedback group (EF group). Each group was subdivided into four subgroups according to the time of retention-test (at 1-, 3-, 6-, 12-month following the initial training). After a 45-min BLS lecture, BLS skills were assessed (pre-training evaluation) in both groups before training. Following this, the C group received 45 min training. 15 min of group feedback corresponding to students’ performance in pre-training evaluation was given only in the EF group that was followed by 30 min of BLS training. BLS skills were assessed immediately after training (post-test) and at follow up (retention-test).

Results

No skills difference was observed between the two groups in pre-training evaluation. Better skills acquisition was observed in the EF group (85.3 ± 7.3 vs. 68.1 ± 12.2 in C group) at post-test (p < 0.001). In all retention-test, better skills retention was observed in each EF subgroup, compared with its paired C subgroup.

Conclusions

Pre-training evaluation and feedback improved skills retention in the EF group for 12 months after the initial training, compared with the control group.     

Effects of BLS training on factors associated with attitude toward CPR in college students

Aim

In order to elucidate the factors for willingness to perform CPR, we evaluated the responses of college students to questionnaires before and after basic life support (BLS) training.

Methods

Before and after participating in a small group BLS course, 259 students completed questionnaires. A logistic regression model was used to elucidate independent factors for their willingness to attempt resuscitation.

Results

Factors associated with willingness to perform BLS for strangers were “anxiety for a bad outcome” (odds ratio (OR) 0.08) and “having knowledge of automated external defibrillator (AED)” (OR 4.5) before training. The proportion of students showing willingness to perform BLS increased from 13% to 77% after the training even when the collapsed person is a stranger. After training, “anxiety for being sued because of a bad outcome” (OR 0.3), and “anxiety for infection” (OR 3.8) were significant factors. Those who preferred to perform BLS without ventilation increased from 40% to 79% (p < 0.0001).

Conclusion

The proportion of students showing willingness to perform BLS increased after the training. Significant association between “anxiety for infection” and willingness to perform BLS might indicate that those who wish to perform BLS developed their awareness of risk of infection more than the counterparts. For future guidelines for resuscitation and the instruction consensus, the reluctance of bystanders to perform CPR due to the hesitation about mouth-to-mouth ventilation should be reconsidered with other recent reports indicating the advantage of compression-only CPR.     

Peer evaluation in reciprocal learning with task cards for acquiring Basic Life Support (BLS)

Background

Research emphasises the need for instructional methods and tools which can improve Basic Life Support (BLS) performance or reduce instructional time.

Aim

To investigate the effect of peer evaluation to improve reciprocal learning with task cards as instructional tools for acquiring BLS.

Methods

A total of 78 kinesiology students from a Belgian university were paired and randomised across two groups to learn BLS in 20 min with task cards. In the control group, students worked together in a defined doer–helper relationship and switched roles every 5 min. In the peer evaluation group, students followed the same co-operation procedure as in the control group. In addition, 1 min before every switching of roles, the helper evaluated the doer's performance. All BLS skills were individually assessed on a Laerdal AED Resusci Anne mannequin (Laerdal Medical, Vilvoorde, Belgium) using the Laerdal PC-Skill reporting system. A total BLS score was calculated and performance was measured before training (baseline), immediately after training (intervention) and 2 weeks later (retention).

Results

Significantly more students from the evaluation group remembered and consequently performed all BLS skills at intervention (P = 0.03). No significant differences were found between groups for main cardiopulmonary resuscitation (CPR) variables and total BLS scores at baseline, intervention and retention. Both groups achieved more than 70% of the maximum BLS score at intervention and retention.

Conclusions

This study demonstrated that 20 min reciprocal-learning setting with task cards is an effective method to learn BLS. The implementation of peer evaluation in this setting has an immediate, however small, positive impact on BLS skill learning.     

Use of an electronic decision support tool improves management of simulated in-hospital cardiac arrest

Introduction

Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA.

Methods

After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists.

Results

Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p < 0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p < 0.012).

Conclusion

Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.     

Cardiopulmonary resuscitation. Paper 1: A survey of undergraduate training in UK medical schools.

This paper presents the results of a UK national survey of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training for undergraduate medical students. In all responding medical schools, undergraduates are taught BLS at least once during their course but the assessment and refresher aspects of BLS training are not uniformly covered. There are inconsistencies in ACLS teaching, with some schools providing formal courses, some teaching specific techniques and others providing no ACLS teaching. Most interestingly, of those completing the questionnaire, only 52% considered present undergraduate training adequate to enable junior house officers to provide an effective resuscitation service. We recommend that all aspects of BLS and ACLS training for medical undergraduates be improved and standardized throughout the UK.     

Reciprocal Learning with Task Cards for Teaching Basic Life Support (BLS): Investigating Effectiveness and the Effect of Instructor Expertise on Learning Outcomes. A Randomized Controlled Trial

Background

Basic Life Support (BLS) education in secondary schools and universities is often neglected or outsourced because teachers indicate not feeling competent to teach this content.

Objective

Investigate reciprocal learning with task cards as instructional model for teaching BLS and the effect of instructor expertise in BLS on learning outcomes.

Methods

There were 175 students (mean age = 18.9 years) randomized across a reciprocal/BLS instructor (RBI) group, a reciprocal/non-BLS instructor (RNI) group, and a traditional/BLS instructor group (TBI). In the RBI and RNI group, students were taught BLS through reciprocal learning with task cards. The instructor in the RBI group was certified in BLS by the European Resuscitation Council. In the TBI, students were taught BLS by a certified instructor according to the Belgian Red Cross instructional model. Student performance was assessed 1 day (intervention) and 3 weeks after intervention (retention).

Results

At retention, significantly higher BLS performances were found in the RBI group (M = 78%), p = 0.007, ES = 0.25, and the RNI group (M = 80%), p < 0.001, Effect Size (ES) = .36, compared to the TBI (M = 73%). Significantly more students remembered and performed all BLS skills in the experimental groups at intervention and retention. No differences in BLS performance were found between the reciprocal groups. Ventilation volumes and flow rates were significantly better in the TBI at intervention and retention.

Conclusion

Reciprocal learning with task cards is a valuable model for teaching BLS when instructors are not experienced or skilled in BLS.     

Paediatric resuscitation training--do medical students believe it should be a mandatory component of the curriculum?

Background

Resuscitation outcomes are related to care delivered by ‘first responders’, even for hospitalized patients. Third year medical students (clinical clerks) at McGill University are trained and certified in Advanced Cardiac Life Support (ACLS) for critically ill adult patients, but receive only minimal instruction, in the form of a brief introductory lecture, on paediatric life support.

Methods

We developed an interactive, case-based 4-h Paediatric Resuscitation Course based on the objectives and teaching methods of the Pediatric Advanced Life Support (PALS) course. Objectives were tailored to an appropriate level for medical students through the consensus of the two content-expert authors and two external expert physician-educators.Students completed equivalent pre and post course multiple-choice exams, using questions selected from the PALS course. In order to minimize ‘guessing’, subjects were penalized for incorrect answers. Upon completion of the course, students were anonymously surveyed on the perceived educational value of the resuscitation course.

Results

49 subjects voluntarily participated, in groups of 6-8 at a time, with 47 subjects completing the study protocol. Students’ test scores significantly increased from the pre to post test (12.65/22 vs. 17.70/22; p < 0.001). All students believed the course was delivered at an appropriate level for them, that it was a worthwhile use of their time, and that it should be a mandatory course in their clinical clerkship.

Conclusion

Medical students can learn from appropriately designed paediatric resuscitation courses and believe it should be mandatory in their training.     

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

Aim of the study

Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory.

Methods

All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data.

Results

For each year of the study period (2008–2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P = 0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P = 0.073).

Conclusion

The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest.     

CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway

Background

Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum.

Methods

Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16-19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR.

Results

Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training.

Conclusion

Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA.     

Written evaluation is not a predictor for skills performance in an Advanced Cardiovascular Life Support course

Objective

Both a written cognitive knowledge evaluation and a practical evaluation that tests psychomotor skills, cognitive knowledge, and affective behaviors such as leadership and team skills are required for successful completion of American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course. The 2005 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations noted that in Basic Life Support (BLS) there is little to no correlation between written and practical skills. The current study was conducted to determine if there is a correlation between written and practical evaluations in an ACLS course.

Methods

34 senior nursing students from four nursing programs participated in two separate ACLS classes, completing both the written and practical evaluations. Immediately following the courses, all participants served as team leader for a video recorded simulated cardiac arrest event. A panel of expert ACLS instructors who did not participate as instructors in the courses reviewed each video and independently scored team leaders’ performances.

Results

Spearman's rho correlation coefficient between the written test scores and practical skills performance was 0.194 (2-tailed significance = 0.272).

Conclusion

The ACLS written evaluation was not a predictor of participant skills in managing a simulated cardiac arrest event immediately following an ACLS course. The single case simulations used in ACLS skills evaluation test a narrow portion of ACLS content while written evaluation tests can more practically test a broader spectrum of content. Both work in concert to define participant knowledge and neither should be used exclusively to determine participant competence.     

Bispectral index monitoring is useless during cardiac arrest patients’ resuscitation

Aim

It has been suggested that out-of-hospital bispectral (BIS) index monitoring during advanced cardiac life support (ACLS) might provide an indication of cerebral resuscitation. The aims of our study were to establish whether BIS values during ACLS might predict return to spontaneous circulation, and whether BIS values on hospital admission might predict survival.

Materials and methods

This was a prospective observational study in 92 patients with cardiac arrest who received basic life support from a fire-fighter squad and ACLS on arrival of an emergency medical team on the scene. BIS values, electromyographic activity, and signal quality index were recorded throughout resuscitation and out-of-hospital management.

Results

Seven patients had recovered spontaneous cardiac activity by the time the medical team arrived on scene. Of the 92 patients, 62 patients died on scene and 30 patients returned to spontaneous cardiac activity and were admitted to hospital. The correlation between BIS values and end-tidal CO₂ during the first minutes of ACLS was poor (r² = 0.02, P = 0.19). Of the 30 admitted patients, 27 died. Three were discharged with no disabilities. There was no significant difference in BIS values on admission between the group of patients who died and the group who survived (P = 0.78).

Conclusions

Although BIS monitoring during resuscitation was not difficult, it did not predict return to spontaneous cardiac activity, nor survival after admission to intensive care. Its use to monitor cerebral function during ACLS is therefore pointless.     

Electroencephalography during Out-of-hospital Cardiopulmonary Resuscitation

Background

At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR).

Objectives

The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity.

Case Report

We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index.

Conclusion

These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.     

Retraining basic life support skills using video,voice feedback or both: A randomised controlled trial

Introduction

The optimal strategy to retrain basic life support (BLS) skills on a manikin is unknown. We analysed the differential impact of a video (video group, VG), voice feedback (VFG), or a serial combination of both (combined group, CG) on BLS skills in a self-learning (SL) environment.

Methods

Two hundred and thirteen medicine students were randomly assigned to a VG, a VFG and a CG. The VG refreshed the skills with a practice-while-watching video (abbreviated Mini Anne™ video, Laerdal, Norway) and a manikin, the VFG with a computer-guided manikin (Resusci Anne Skills Station™, Laerdal, Norway) and the CG with a serial combination of both. Each student performed two sequences of 60 compressions, 12 ventilations and three complete cycles of BLS (30:2). The proportions of students achieving adequate skills were analysed using generalised estimating equations analysis, taking into account pre-test results and training strategy.

Results

Complete datasets were obtained from 192 students (60 VG, 69 VFG and 63 CG). Before and after training, ≥70% of compressions with depth ≥50 mm were achieved by 14/60 (23%) vs. 16/60 (27%) VG, 24/69 (35%) vs. 50/69 (73%) VFG and 19/63 (30%) vs. 41/63 (65%) CG (P < 0.001). Compression rate 100–120/min was present in 27/60 (45%) vs. 52/60 (87%) VG, 28/69 (41%) vs. 44/69 (64%) VFG and 27/63 (43%) vs. 42/63 (67%) CG (P = 0.05). Achievement of ≥70% ventilations with a volume 400–1000 ml was present in 29/60 (49%) vs. 32/60 (53%) VG, 32/69 (46%) vs. 52/69 (75%) VFG and 25/63 (40%) vs. 51/63 (81%) CG (P = 0.001). There was no between-groups difference for complete release.

Conclusions

Voice feedback and a sequential combination of video and voice feedback are both effective strategies to refresh BLS skills in a SL station. Video training alone only improved compression rate. None of the three strategies resulted in an improvement of complete release.     

Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome

Objective

To examine whether values of arterial base excess or lactate taken 3 h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome.

Design

Single Centre retrospective observational study.

Setting

University teaching hospital general adult intensive care unit.

Patients

15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support.

Interventions

Arterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3 h after.

Results

Both base excess and arterial lactate measured 3 h after starting ECLS effectively predict multiorgan failure occurrence and mortality in the following 21 h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3 h after starting ECLS of less than −10 mmol/l and lactate concentrations greater than 12 mmol/l. The combination of these two markers measured 3 h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21 h with a sensitivity of 70% and a specificity of 100%.

Conclusions

Combination of base excess and lactate, measured 3 h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21 h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA.     

Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims

Background

The Prehospital Trauma Life Support (PHTLS) course has been widely implemented and approximately half a million prehospital caregivers in over 50 countries have taken this course. Still, the effect on injury outcome remains to be established. The objective of this study was to investigate the association between PHTLS training of ambulance crew members and the mortality in trauma patients.

Methods

A population-based observational study of 2830 injured patients, who either died or were hospitalized for more than 24 h, was performed during gradual implementation of PHTLS in Uppsala County in Sweden between 1998 and 2004. Prehospital patient records were linked to hospital-discharge records, cause-of-death records, and information on PHTLS training and the educational level of ambulance crews. The main outcome measure was death, on scene or in hospital.

Results

Adjusting for multiple potential confounders, PHTLS training appeared to be associated with a reduction in mortality, but the precision of this estimate was poor (odds ratio, 0.71; 95% confidence interval, 0.42–1.19). The mortality risk was 4.7% (36/763) without PHTLS training and 4.5% (94/2067) with PHTLS training. The predicted absolute risk reduction is estimated to correspond to 0.5 lives saved annually per 100,000 population with PHTLS fully implemented.

Conclusions

PHTLS training of ambulance crew members may be associated with reduced mortality in trauma patients, but the precision in this estimate was low due to the overall low mortality. While there may be a relative risk reduction, the predicted absolute risk reduction in this population was low.     

Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: A randomised simulation study

Background

Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers’ performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality.

Methods

In this open, prospective, randomised, controlled trial we compared three CPR feedback devices (PocketCPR^®, CPRmeter^®, iPhone app PocketCPR^®) with standard BLS without feedback in a simulated scenario. 240 trained medical students performed single rescuer BLS on a manikin for 8 min. Effective compression (compressions with correct depth, pressure point and sufficient decompression) as well as compression rate, flow time fraction and ventilation parameters were compared between the four groups.

Results

Study participants using the PocketCPR^® performed 17 ± 19% effective compressions compared to 32 ± 28% with CPRmeter^®, 25 ± 27% with the iPhone app PocketCPR^®, and 35 ± 30% applying standard BLS (PocketCPR^® vs. CPRmeter^®p = 0.007, PocketCPR^® vs. standard BLS p = 0.001, others: ns). PocketCPR^® and CPRmeter^® prevented a decline in effective compression over time, but overall performance in the PocketCPR^® group was considerably inferior to standard BLS. Compression depth and rate were within the range recommended in the guidelines in all groups.

Conclusion

While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome.     

An analysis of the introduction and efficacy of a novel training programme for ERC basic life support assessors

Aim

Existing ERC BLS/AED accreditation procedures allow BLS instructors to assess the capability of BLS/AED providers, without undergoing additional training as an assessor. The reliability of instructor-based assessment has been questioned. This study sought to determine the efficacy of a simple training programme for BLS/AED instructors aimed at standardising assessment decisions.

Methods

An Assessment Training Programme (ATP) which provides additional, assessment-focused tuition for BLS instructors was introduced. Eighteen ERC accredited instructors participated in the study. Nine received standard ERC training (instructors); nine received additional training through the ATP (assessors). The assessment of 73 students’ BLS/AED capabilities was carried out by an assessor, ERC instructor and ERC instructor trainer concurrently. Participants independently completed an ERC assessment form. Decisions for instructors and assessors were compared to the instructor trainers’ decisions; those not agreeing were deemed to be incorrect.

Results

Instructors (49.3%) had lower raw pass rates than assessors (67.1%) and instructor trainers (64.4%). There was a significant difference in overall decisions between instructors and instructor trainers (p = 0.035), and instructors and assessors (p = 0.015). There was no difference between assessors and instructor trainers (p = 0.824). Instructors were more prone to incorrectly failing candidates than assessors (sensitivities of 80.5% and 63.8% respectively, p = 0.077). AED-capability decisions were significantly different from instructor trainers in both the instructor (p = 0.007) and assessor groups (p = 0.031).

Conclusion

BLS instructors incorrectly fail candidates for reasons that should not normally constitute a true assessment failure. The ATP is an effective intervention to reduce false-failure rates and improve compliance with an experienced instructor trainer's decision. Consideration should be made to integrate such programmes into current BLS instructor accreditation procedures.     

The analysis of self and tutor assessment in the skill of basic life support (BLS) and endotracheal intubation: focused on the discrepancy in assessment

Introduction

This paper reports the results of a study of fourth year medical students that assessed whether assessments of basic life support (BLS) and intubation performance differ when assessed by the students themselves or by tutors. This information should be helpful for designing the contents of a complementary education core.

Methods

Tutor assessments and student-assessments were conducted using a checklist and a fivepoint rating scale, and then compared. For the two skill performance tests, Resusci^® Anne SkillGuide™ and Laerdal^® Airway Management Trainer (Laerdal, Norway) devices were used. The check-lists used to evaluate students were based on International Liasion Committee on Resuscitation (ILCOR) guidelines and Korean Emergency Airway Management Society (KEAMS) tutor guidelines.

Results

A total of 83 medical students participated in the study, intra-class correlation coefficient between tutor and student assessment were 0.542 (95% CI 0.371-0.678) in BLS and 0.693 (0.538-0.802). There were also no significant differences between self-assessments and tutor assessments based on the five-point. In BLS skill session, we found out that “maintenance of airway” and “palpating a carotid pulse” were the mostly missed parts. In the intubation skill, omitting the parts of ‘securing the airway’ while preparing for intubation, proper positioning of blade tip in the valleculae, and appropriate insertion of endotracheal tube were demonstrated.

Conclusion

We observed correlations between student self-assessments and tutor assessments for both BLS and intubation. Analyzing the discrepancies between self-assessment and tutor assessment will be helpful in focusing training on the steps that were omitted by students or during which students demonstrated incompetence.