Improving the Efficiency of Advanced Life Support Training

BACKGROUND Each year, more than 1.5 million health care professionals receive advanced life support (ALS) training. OBJECTIVE To determine whether a blended approach to ALS training that includes electronic learning (e-learning) produces outcomes similar to those of conventional, instructor-led ALS training. DESIGN Open-label, noninferiority, randomized trial. Randomization, stratified by site, was generated by Sealed Envelope (Sealed Envelope, London, United Kingdom). (International Standardized Randomized Controlled Trial Number Register: ISCRTN86380392) SETTING 31 ALS centers in the United Kingdom and Australia. PARTICIPANTS 3732 health care professionals recruited between December 2008 and October 2010. INTERVENTION A 1-day course supplemented with e-learning versus a conventional 2-day course. MEASUREMENTS The primary outcome was performance in a cardiac arrest simulation test at the end of the course. Secondary outcomes comprised knowledge- and skill-based assessments, repeated assessment after remediation training, and resource use. RESULTS 440 of the 1843 participants randomly assigned to the blended course and 444 of the 1889 participants randomly assigned to conventional training did not attend the courses. Performance in the cardiac arrest simulation test after course attendance was lower in the electronic advanced life support (e-ALS) group compared with the conventional advanced life support (c-ALS) group; 1033 persons (74.5%) in the e-ALS group and 1146 persons (80.2%) in the c-ALS group passed (mean difference, -5.7% [95% CI, -8.8% to -2.7%]). Knowledge- and skill-based assessments were similar between groups, as was the final pass rate after remedial teaching, which was 94.2% in the e-ALS group and 96.7% in the c-ALS group (mean difference, -2.6% [CI, -4.1% to 1.2%]). Faculty, catering, and facility costs were $438 per participant for electronic ALS training and $935 for conventional ALS training. LIMITATIONS Many professionals (24%) did not attend the courses. The effect on patient outcomes was not evaluated. CONCLUSION Compared with conventional ALS training, an approach that included e-learning led to a slightly lower pass rate for cardiac arrest simulation tests, similar scores on a knowledge test, and reduced costs. PRIMARY FUNDING SOURCE National Institute of Health Research and Resuscitation Council (UK).

[1]  J. Finn.  E-learning in resuscitation training - students say they like it, but is there evidence that it works? , 2010, Resuscitation.

[2]  Gavin D Perkins,et al.  Guidelines for Resuscitation 2010 ection 9 . Principles of education in resuscitation , 2010 .

[3]  G G Koch,et al.  Applying sample survey methods to clinical trials data , 2001, Statistics in medicine.

[4]  W. Dick,et al.  Does standardized mega-code training improve the quality of pre-hospital advanced cardiac life support (ACLS)? , 1995, Resuscitation.

[5]  D. Cook,et al.  Internet-based learning in the health professions: a meta-analysis. , 2008, JAMA.

[6]  A. Handley,et al.  A web-based micro-simulation program for self-learning BLS skills and the use of an AED. Can laypeople train themselves without a manikin? , 2007, Resuscitation.

[7]  Douglas G Altman,et al.  Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement. , 2006, JAMA.

[8]  S. Cooper,et al.  Leadership of resuscitation teams: "Lighthouse Leadership'. , 1999, Resuscitation.

[9]  G. Perkins,et al.  Validation for a scoring system of the ALS cardiac arrest simulation test (CASTest). , 2009, Resuscitation.

[10]  S. Brett,et al.  Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: an observational study over 6 years. , 2009, Resuscitation.

[11]  L. Lockyer,et al.  Nursing and healthcare students' experiences and use of e-learning in higher education. , 2010, Journal of advanced nursing.

[12]  E L Korn,et al.  Predictive Margins with Survey Data , 1999, Biometrics.

[13]  G. Perkins,et al.  The Acute Care Undergraduate TEaching (ACUTE) Initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom , 2005, Intensive Care Medicine.

[14]  Charlotte Ringsted,et al.  Using e-learning for maintenance of ALS competence. , 2009, Resuscitation.

[15]  R. Flin,et al.  Anaesthetists' non-technical skills. , 2010, British journal of anaesthesia.

[16]  Karl B Kern,et al.  Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. , 2007, Resuscitation.

[17]  A. Lockey,et al.  The advanced life support provider course. , 2002, BMJ.

[18]  Diane Heestand,et al.  Educational Technology Infrastructure and Services in North American Medical Schools , 2006, Academic medicine : journal of the Association of American Medical Colleges.

[19]  K. Sunde,et al.  Hospital employees improve basic life support skills and confidence with a personal resuscitation manikin and a 24-min video instruction. , 2009, Resuscitation.

[20]  L. Rasmussen,et al.  Laypersons may learn basic life support in 24min using a personal resuscitation manikin. , 2006, Resuscitation.

[21]  J. Sandars.  Continuing medical education across Europe , 2010, BMJ : British Medical Journal.

[22]  S. Pocock,et al.  Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. , 2006, JAMA.

[23]  David Moher,et al.  CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials , 2010, PLoS medicine.

[24]  David A Cook,et al.  Web-based learning a systematic review of the variability of interventions , 2011 .

[25]  M. Gagnon,et al.  Perceived barriers to completing an e-learning program on evidence-based medicine. , 2007, Informatics in primary care.

[26]  J. Bion,et al.  Development of core competencies for an international training programme in intensive care medicine , 2006, Intensive Care Medicine.

[27]  Gavin D Perkins,et al.  The effect of pre-course e-learning prior to advanced life support training: a randomised controlled trial. , 2010, Resuscitation.

[28]  G. Perkins,et al.  Undergraduate training in the care of the acutely ill patient: a literature review , 2007, Intensive Care Medicine.

[29]  D. Moher,et al.  CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials , 2010, BMC medicine.

[30]  D. McAuley.  Development of core competencies for an international training programme in intensive care medicine. The CoBaTrICE Collaboration , 2006 .

[31]  M. Strehlow,et al.  Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India. , 2010, Resuscitation.

[32]  Orhan C Tuncay.  The Price of Education , 2005, Nature.

[33]  G. Perkins,et al.  Advanced life support cardiac arrest scenario test evaluation. , 2007, Resuscitation.

[34]  Gavin D Perkins,et al.  Simulation in resuscitation training. , 2007, Resuscitation.

[35]  John E Billi,et al.  Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. , 2010, Circulation.

[36]  Gavin D Perkins,et al.  AED training and its impact on skill acquisition, retention and performance--a systematic review of alternative training methods. , 2011, Resuscitation.