Simulation and educationThe effect of pre-course e-learning prior to advanced life support training: A randomised controlled trial☆
Introduction
Substantial healthcare resources are invested in resuscitation training. Currently the two/three day European and UK Resuscitation Councils Advanced Life Support course1, 2 trains over 20,000 healthcare professionals in advanced resuscitation techniques each year. The curriculum design uses a variety of educational strategies to develop competency in resuscitation based around knowledge, skill and behavioral development. Current practice incorporates written material (a course manual issued four weeks prior to the course), interactive lectures, small group teaching, group discussion and cardiac arrest simulation exercise.
A recent review by the International Liaison Committee for Resuscitation (ILCOR) indicated the modifiable factors that influence outcome from cardiopulmonary arrest.3 Along with guideline quality and the local chain of survival, the importance of educational interventions was highlighted. In particular, the role ‘novel technologies’ can play in enhancing learning requires further exploration. E-learning is one such strategy and can offer multiple benefits over ‘classical’ learning techniques such as wide access and availability. Its use is rapidly expanding in healthcare training and is already integrated into many aspects of pre- and post-graduate training. It has already been utilised in areas as diverse as basic surgical skill ascertainment4 to the diagnosis of anaemia,5 or improving management of epistaxis.6 Whilst evidence from randomised controlled trials conducted has been generally positive there is a lack of clarity over whether the purported theoretical benefits will translate from research into clinical improvements.7 This however is not unique to e-learning, as it has proven extremely difficult to establish this causal relationship.
Interest in e-learning and alternative educational strategies targeted at resuscitation training has benefited from the ILCOR statement, the challenge now is establishing the potential efficacy of such novel interventions. Reported positive outcomes8, 9 do not seemingly dilute concerns about how this then directly leads to improved practical performance10 and knowledge.11 Thus embedding such a blended learning approach as common place and a viable alternative to traditional learning methods requires further study.
Microsim (Laerdal, Stavanger) is a multi-media computer simulation programme which provides structured training and feedback on medical emergencies and advanced resuscitation. Different modules cover each of the five ALS learning domains (recognition of the critically ill patient and prevention of cardiac arrest, rhythm recognition, resuscitation skills, resuscitation treatment algorithms, post-resuscitation care) and interactive simulations present the user with a virtual patient in or at risk of cardiac arrest, requiring them to lead a resuscitation team in their assessment and management. Detailed structured feedback on performance is provided, and links to the course manual help underpin learning.
The aim of this study was to evaluate the efficacy of pre-course preparation with Microsim on the Advanced Life Support (ALS) course learning outcomes and explore user perceptions and reactions to the learning material. The data from this study have also been used to validate a scoring system for the cardiac arrest scenario test.12
Section snippets
Design and participants
An open label randomised controlled study was conducted. Individuals undertaking the ALS course at 9 UK Hospitals over a ten-month period (March to December 2007) were eligible for inclusion. All participants provided written informed consent.
Participants were randomised at each site to the e-learning or control arm (allocation 1:1) in blocks of six. Randomisation was stratified by course centre. Participants in the e-learning arm received a CD version of the Microsim computer programme plus
Results
Six hundred and fifty seven people were screened for eligibility to participate. From this 572 people were randomised to the Microsim CD (n = 287) or standard (285) arms. Of these 275 and 276 people returned data for analysis. The CONSORT flow diagram (Fig. 1) describes participant flow through the study.
There were no significant differences in demographics between the groups. In the Microsim arm 183(66%) were doctors; 48(17%) nurses; 6(2%) other; 39 (14%) did not respond to this domain. The
Discussion
Microsim represents a novel, computer-based approach to augmenting candidate preparation for resuscitation training. When used as part of the pre-course preparation for ALS it was enthusiastically received by most of the candidates. Over 80% believed Microsim improved their understanding of ALS theory and skills, a similar number would recommend the programme to colleagues and a quarter felt it could replace parts of the existing course. Despite the positive feedback, allocation to the Microsim
Conclusion
The e-learning micro-simulation programme Microsim was positively evaluated by participants from advanced life support courses. In this study, distributing Microsim to healthcare providers prior to attending an Advanced Life Support courses did not improve either cognitive or psychomotor skills or performance during cardiac arrest simulation testing. The challenge that lies ahead is to identify the optimal way to use e-learning as part of a blended approach to learning for this type of training
Funding
This study was supported by an unrestricted research grant from the Laerdal Foundation for Acute Medicine. GDP is funded by a DH NIHR Clinician Scientist Award.
Conflict of interest statement
The CD's were donated by Laerdal Medical (UK). The study decision, data collection/analysis and decision to publish the findings was undertaken by the investigators.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.03.019.