Education in resuscitation: an ILCOR symposium: Utstein Abbey: Stavanger, Norway: June 22-24, 2001.

The value of bystander cardiopulmonary resuscitation (CPR) has been well defined by studies in many countries and communities. Randomized clinical trials are inappropriate in this setting and cannot accurately determine the degree of benefit conferred, but observational data from 17 papers published before 19911 and 2 nationwide studies since that time2,3 suggest that the odds ratio for improved survival of victims of collapse is ≈2.5. This benefit is achieved principally by extending the period for which defibrillation can be successful in cases of ventricular fibrillation or pulseless ventricular tachycardia. These are not grounds for complacency, however. Even in countries or areas where emergency services are well developed, most victims of cardiac arrest do not receive bystander CPR, and when it is given, the quality is generally far from ideal. The need, therefore, is not only for more CPR but also for better-quality CPR. Both skills acquisition and skills retention have been shown to be poor after conventional training in CPR for laypersons. The reasons are manifold. The necessary psychomotor skills for current courses are complex and demanding, an issue of particular importance because in many countries the average student is usually older than 50 years of age. Course curricula and instructor training are generally poorly adapted to the needs of course participants, and few instructors have been trained to teach. In addition, instructors frequently digress from the planned script (telling anecdotes and providing other irrelevant material), do not allow sufficient time for practice, and provide poor supervision and feedback. This is not a criticism of individual instructors but rather of the methods that have developed as a response to a perceived need but without consideration or knowledge of educational principles, clear objectives, appropriate formats, or agreed-on methods of evaluation and audit. Unexpected cardiac arrest is a major cause …