High-quality cardiopulmonary resuscitation (CPR) can be a critical life or death determinant, but the last few years have made it clear that retaining, teaching and evaluating the skills required for CPR is perhaps more difficult than healthcare leaders and educators had previously understood. Specifically, accurately evaluating CPR skills can be an enormous challenge for educators.
Recent studies have concluded that the standard recommendation for 4 hours of training every two years for CPR and Automated External Defibrillator (AED) may not be sufficient. The studies cited a substantial deterioration of skills considerably before the two year mark.
Leveraging Technology to Ensure High Quality CPR
So, what is the best way to ensure that CPR skills are being properly taught and assessed across an organization? Do we have an accurate, measurable way to be sure that high-quality CPR can be consistently provided across the entire organization?
Healthcare leaders have multiple options for CPR training: 1) the traditional, instructor-led and instructor-observed classroom model, 2) instructorless models that use online content and manikins to evaluate and reinforce skills or, 3) a blended model that consists of online content with skills verified by an instructor.
First, it is important to understand some of the challenges of assessing the critical components of CPR. Some recent studies show that relying on instructor assessments of these skills can be problematic.
High quality CPR has four key components that educators need to accurately assess:
When taking a closer look at instructor-led performance and the efficacy of instructor evaluation, it is important to understand how instructors perform on some key metrics. First, the metrics themselves - in order to best understand performance, it is important to look at instructor sensitivity and instructor specificity.
Instructor sensitivity is when the instructor accurately “passes” a learner on an assessment that should have passed as judged by objective manikin data. As an example, think of compression depth. If 60 learners perform compressions in the correct depth range as judged by a manikin, and the instructor passes 55 of the 60, instructor sensitivity would be 0.92. Instructor sensitivity is the proportion of the learners that were accurately passed by the instructor that should have passed based on an objective measure.
Instructor specificity is the accuracy in “failing” learners that should have failed on an assessment when compared to an objective criterion such as manikin data. For example, if 100 assessments were judged by manikin data to fail and the instructor failed 25 of them, instructor specificity is low—it would be 0.25.
Is it Possible to Accurately Assess Key CPR Performance Metrics?
A 2016 Danish study helped bring the challenges of accurate CPR skills assessment into sharper focus. (Hansen, 2019) The purpose of the study was to “investigate certified BLS instructors’ assessment skills in terms of identifying adequate and improper performances of chest compressions and rescue breathing.” (p. 281)
After completing a four-hour training course, all learners were assessed using a manikin. In addition, two instructors also assessed learners. The differences between the two assessments was striking. The manikin’s pass rates on the four critical components of CPR was dramatically lower for every measure.
From these results, Danish researchers made these conclusions:
Somewhat similar research conducted by German researchers in 2019 reached a similar set of conclusions.
The German researchers compared results from two groups of learners. One hundred and twelve medical students were randomized to a control and an intervention group. All participants participated in a 30 minute lecture on the basics of CPR. Next, the control group participated in a 90 minute, instructor-led session of hands-on training. The intervention group took part in a 45 minute problem-based learning (PBL) session that was followed by 45 minutes of high fidelity simulation training. The PBL method helped instructors incorporate complex, real-life scenarios to help students more effectively learn CPR as well as helping to develop the critical thinking and communication skills that can be significant factors in a crisis.
Researchers also noted that at the six month mark, the differences were considerably less pronounced.
They further concluded that the use of PBL with manikins led to measurable short-term increases in initiating sufficient CPR and went on to recommend periodic self-guided training using manikins to maintain adequate CPR skills.
We believe instructors continue to play a critical role in our healthcare system and want to ensure their efforts are directed the highest use of their time for providing the best patient care. By utilizing highly accurate feedback manikins to assess and document the critical performance metrics of CPR, you can ensure the best possible adherence to resuscitation guidelines, while also saving your organization money. on all four critical components of CPR results in more accurate evaluation of those skills.
It is likely that CPR instruction that relies exclusively on instructor evaluation of performance will result in under-prepared providers. Technology, specifically manikins that can provide reliable feedback on all four critical components of CPR results in more accurate evaluation of those skills.
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