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1.  Advanced Cardiac Resuscitation Evaluation (ACRE): A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training 
Background
Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve.
Methods
A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor.
A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents.
The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks.
Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness.
The results were analysed using Exact methods, chi-squared and t-test.
Results
A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group.
There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes.
Conclusions
The key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.
doi:10.1186/1757-7241-18-3
PMCID: PMC2818633  PMID: 20074353
2.  Low-Dose, High-Frequency CPR Training Improves Skill Retention of In-Hospital Pediatric Providers 
Pediatrics  2011;128(1):e145-e151.
OBJECTIVE:
To investigate the effectiveness of brief bedside cardiopulmonary resuscitation (CPR) training to improve the skill retention of hospital-based pediatric providers. We hypothesized that a low-dose, high-frequency training program (booster training) would improve CPR skill retention.
PATIENTS AND METHODS:
CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated arrest. Basic life support–certified, hospital-based providers were randomly assigned to 1 of 4 study arms: (1) instructor-only training; (2) automated defibrillator feedback only; (3) instructor training combined with automated feedback; and (4) control (no structured training). Each session (time: 0, 1, 3, and 6 months after training) consisted of a pretraining evaluation (60 seconds), booster training (120 seconds), and a posttraining evaluation (60 seconds). Excellent CPR was defined as chest compression (CC) depth ≥ one-third anterior-posterior chest depth, rate ≥ 90 and ≤120 CC per minute, ≤20% of CCs with incomplete release (>2500 g), and no flow fraction ≤ 0.30.
MEASUREMENTS AND MAIN RESULTS:
Eighty-nine providers were randomly assigned; 74 (83%) completed all sessions. Retention of CPR skills was 2.3 times (95% confidence interval [CI]: 1.1–4.5; P = .02) more likely after 2 trainings and 2.9 times (95% CI: 1.4–6.2; P = .005) more likely after 3 trainings. The automated defibrillator feedback only group had lower retention rates compared with the instructor-only training group (odds ratio: 0.41 [95% CI: 0.17–0.97]; P = .043).
CONCLUSIONS:
Brief bedside booster CPR training improves CPR skill retention. Our data reveal that instructor-led training improves retention compared with automated feedback training alone. Future studies should investigate whether bedside training improves CPR quality during actual pediatric arrests.
doi:10.1542/peds.2010-2105
PMCID: PMC3387915  PMID: 21646262
pediatric; cardiopulmonary resuscitation; quality appraisal
3.  Evaluation of a newly developed media-supported 4-step approach for basic life support training 
Objective
The quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach.
Materials and methods
After baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach.
Results
Participants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills.
Conclusions
The “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared.
doi:10.1186/1757-7241-20-37
PMCID: PMC3461483  PMID: 22647148
Basic Life Support (BLS); Cardiopulmonary resuscitation (CPR); External chest compressions (ECC); Training; Media; 4-step approach
4.  Training hospital providers in basic CPR skills in Botswana: Acquisition, retention and impact of novel training techniques☆ 
Resuscitation  2012;83(12):1484-1490.
Objective
Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana.
Methods
HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation.
Results
Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p < 0.01; adult 28% vs. 48%, p < 0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p < 0.01) and 6 months (38% vs. 67%, p < 0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance.
Conclusions
HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.
doi:10.1016/j.resuscitation.2012.04.014
PMCID: PMC3600577  PMID: 22561463
Developing countries; Emergency training; Resuscitation education; CPR; Chest compression; Competence; Resource-limited setting; Basic life support; Cardiopulmonary resuscitation; Manikin
5.  Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial 
Abstract
Background
Several studies have found a positive effect on the learning curve as well as the improvement of basic psychomotor skills in the operating room after virtual reality training. Despite this, the majority of surgical and gynecological departments encounter hurdles when implementing this form of training. This is mainly due to lack of knowledge concerning the time and human resources needed to train novice surgeons to an adequate level. The purpose of this trial is to investigate the impact of instructor feedback regarding time, repetitions and self-perception when training complex operational tasks on a virtual reality simulator.
Methods/Design
The study population consists of medical students on their 4th to 6th year without prior laparoscopic experience. The study is conducted in a skills laboratory at a centralized university hospital. Based on a sample size estimation 98 participants will be randomized to an intervention group or a control group. Both groups have to achieve a predefined proficiency level when conducting a laparoscopic salpingectomy using a surgical virtual reality simulator. The intervention group receives standardized instructor feedback of 10 to 12 min a maximum of three times. The control group receives no instructor feedback. Both groups receive the automated feedback generated by the virtual reality simulator. The study follows the CONSORT Statement for randomized trials. Main outcome measures are time and repetitions to reach the predefined proficiency level on the simulator. We include focus on potential sex differences, computer gaming experience and self-perception.
Discussion
The findings will contribute to a better understanding of optimal training methods in surgical education.
Trial Registration
NCT01497782
doi:10.1186/1472-6920-12-7
PMCID: PMC3311079  PMID: 22373062
Virtual reality simulation; Laparoscopy; Training; Salpingectomy; Feedback
6.  Use of instructional video to prepare parents for learning infant cardiopulmonary resuscitation 
Parents of premature infants often receive infant cardiopulmonary resuscitation (CPR) training prior to discharge from the hospital, but one study showed that 27.5% of parents could not demonstrate adequate CPR skills after completing an instructor-led class. We hypothesized that parents who viewed an instructional video on infant CPR before attending the class would perform better on a standardized skills test than parents who attended the class with no preparation. Parents randomized to the intervention (video) group viewed the video within 48 hours of the CPR class. Parents in the control group attended the class with no special preparation. All parents completed the CPR skills checklist test, usually within 7 days after class and before the infant's hospital discharge. The test rated subjects' skills in the areas of assessment, ventilation, and chest compressions; each section was rated as good, fair, or fail. In this pass/fail test, students had to be rated good or fair on all three sections to pass. All 10 subjects in the video group passed the test versus only 9 of 13 in the control group, but this difference was not significant (P = 0.08). However, 8 of 10 (80%) subjects in the video group were rated as good on all three sections, versus only 3 of 13 (18.7%) in the control group, and this was a significant difference (P = 0.012). We conclude that preparation of students using an instructional video prior to infant CPR class is associated with improvement in skills performance as measured by a standardized skills test. Video preparation is relatively inexpensive, eliminates the barrier of reading ability for preparation, and can be done at the convenience of the parent.
PMCID: PMC2666859  PMID: 19381314
7.  Benefits of a programme taking advantage of patient‐instructors to teach and assess musculoskeletal skills in medical students 
Annals of the Rheumatic Diseases  2006;65(12):1626-1630.
Aim
To evaluate a rheumatoid arthritis patient‐instructor‐based formation–assessment programme for its ability to improve and assess musculoskeletal knowledge and skills in third‐year medical students.
Methods
(1) The quality of our musculoskeletal teaching was assessed before patient‐instructor intervention through an open‐questions test (pre‐test) and performance record forms (PRFs) filled in by the patient‐instructors. (2) The improvement afforded by patient‐instructors was evaluated through a second (identical) open‐questions test (post‐test). (3) The resulting skills in the students were further assessed by an individual patient‐instructors physical status record form (PSRF), filled in by the students.
Results
Pre‐tests and post‐tests showed an improvement in correct answers from a mean score of 39% to 47%. The history‐taking questions that obtained <50% scores in the pre‐test mostly dealt with the consequences of a chronic illness. Intervention of patient‐instructors especially improved knowledge of the psychosocial aspects and side effects of drugs. With regard to physical examination, patient‐instructors makedly improved the identification of assessment of signs of active and chronic inflammation. PRF analysis showed that 10 of 28 questions answered by <50% of the students were related to disease characteristics of rheumatoid arthritis, extra‐articular signs, side effects of drugs and psychosocial aspects. Analysis of the PSRF indicated that the weakness of our students' physical examination abilities in particular is related to recognising the types of swelling and differentiating tenderness from pain on motion.
Conclusion
This study proves the considerable benefits of the involvement of patient‐instructors in the teaching and assessment of clinical skills in students.
doi:10.1136/ard.2004.031153
PMCID: PMC1798454  PMID: 16707537
8.  Advanced Trauma Life Support instructor training in the UK: an evaluation. 
Postgraduate Medical Journal  1998;74(870):220-224.
The paper reports on a questionnaire evaluation of the UK-based ATLS (Advanced Trauma Life Support) instructor course. The trainee instructors who responded were mainly at consultant grade with some senior registrars. The course was regarded as being very effective in achieving most of its objectives and in raising the confidence of postgraduate medical instructors, especially those lacking previous training in instructional methods. This is particularly so for practical skills training. The least effective areas of the course concern small group teaching and questioning techniques.
PMCID: PMC2360852  PMID: 9683975
9.  Trauma Care Training for National Police Nurses in Colombia 
Introduction
In response to a requirement for advanced trauma care nurses to provide combat tactical medical support, the antinarcotics arm of the Colombian National Police (CNP) requested the Colombian National Prehospital Care Association to develop a Combat Tactical Medicine Course (MEDTAC course).
Objective
To evaluate the effectiveness of this course in imparting knowledge and skills to the students.
Methods
We trained 374 combat nurses using the novel MEDTAC course. We evaluated students using pre-and postcourse performance with a 45-question examination. Field simulations and live tissue exercises were evaluated by instructors using a Likert scale with possible choices of 1 to 4. Interval estimation of proportions was calculated with a 95% confidence interval (95% CI). Differences in didactic test scores were assessed using a t-test at 0.05 level of statistical significance.
Results
Between March 2006 and July 2007, 374 combat nursing students of the CNP were trained. The difference between examination scores before and after the didactic part of the course was statistically significant (p < 0.01). After the practical session of the course, all participants (100%) demonstrated competency on final evaluation.
Conclusions
The MEDTAC course is an effective option improving the knowledge and skills of combat nurses serving in the CNP. MEDTAC represents a customized approach for military trauma care training in Colombia. This course is an example of specialized training available for groups that operate in austere environments with limited resources.
doi:10.3109/10903120903349762
PMCID: PMC3413284  PMID: 19947877
tactical medicine; education; trauma; international medicine; combat medicine; Colombia
10.  Editorial: The necessity of adult learning methods in programs of intensive study 
This article presents the educational methodologies that prove effective in adult educational programmes of intensive study. The many facets of a quality educational programme are discussed and I will focus on four topics that any adult educational programme must have: an adult learner, an instructor of adults, a curriculum, and a response to outside forces.
These topics become increasingly critical when one examines the components of technical education and, especially, an intensive training programme in laboratory automation systems. The adult will be discussed as a learner and the associated myths and principles. Next, I will focus on the instructor and his/her necessary personal and professional qualities, including essential skills and psychological elements required. Aspects of curriculum will then be studied. The conventional and the innovative approaches to curriculum design, development, and delivery differ markedly. Development and delivery are so closely linked to the curriculum that both will be discussed under the one title of ‘curriculum’. The final discussion will focus on the outside forces that directly and indirectly affect adult education; since these are many, they are limited to a few salient ones.
doi:10.1155/S146392469100024X
PMCID: PMC2547922  PMID: 18924896
11.  A multipurpose teaching workstation using expert systems, CD ROM and interactive laserdisc. 
This demonstration shows a multipurpose workstation used in a clinical teaching application which combines currently available software suitable for clinical diagnosis and teaching. The medical software includes QMR, Scientific American Medicine, the Slice of Life and generic video laserdisc authoring software developed at the University of Ottawa. The system allows a clinical instructor either in an individual or in a small group teaching setting on a ward or in a classroom, to access high quality differential diagnosis information via QMR, which is then supplemented by the text components of Scientific American Medicine on CD ROM, with video laserdisc of the appropriate anatomy, imagery and pathology provided by one of the various laserdiscs. The generic authoring software allows the instructor or students to construct subject related tutorial or testing modules either with or without video laserdisc support. The workstation uses DESQview as the multitasking environment to control the various resources. This program allows easy transfer from one application to another and allows for marking and pasting of text material into a study document. DESQview can also be used to script a specific learning sequence. The demonstration will show the interaction required to study a specific clinical problem and how this can be made into a meaningful multimedia experience with hardcopy for study purposes.
PMCID: PMC2248070  PMID: 1483005
12.  Retention, retention, retention: targeting the young in CPR skills training! 
Critical Care  2009;13(5):185.
The usefulness of basic cardiopulmonary resuscitation (CPR) training in school systems has been questioned, considering that young students may not have the physical or cognitive skills required to perform complex tasks correctly. In the study conducted by Fleishhackl and coworkers, students as young as 9 years were able to successfully and effectively learn basic CPR skills, including automated external defibrillator deployment, correct recovery position, and emergency calling. As in adults, physical strength may limit the depth of chest compressions and ventilation volumes given by younger individuals with low body mass index; however, skill retention is good. Training all persons across an entire community in CPR may have a logarithmic improvement in survival rates for out-of-hospital cardiac arrest because bystanders, usually family members, are more likely to know CPR and can perform it immediately, when it is physiologically most effective. Training captured audiences of trainees, such as the entire work-force of the community or the local school system, are excellent mechanisms to help achieve that goal. In addition to better retention with new half hour training kits, a multiplier effect can be achieved through school children. In addition, early training not only sets the stage for subsequent training and better retention, but it also reinforces the concept of a social obligation to help others.
doi:10.1186/cc7997
PMCID: PMC2784341  PMID: 19769783
13.  Effects of a Structured Decoding Curriculum on Adult Literacy Learners’ Reading Development 
This article reports the results from a randomized control field trial that investigated the impact of an enhanced decoding and spelling curriculum on the development of adult basic education (ABE) learners’ reading skills. Sixteen ABE programs that offered class-based instruction to Low-Intermediate level learners were randomly assigned to either the treatment group or the control group. Reading instructors in the 8 treatment programs taught decoding and spelling using the study-developed curriculum, Making Sense of Decoding and Spelling (MSDS), and instructors in the 8 control programs used their existing reading instruction. A comparison group of 7 ABE programs whose instructors used K-3 structured curricula adapted for use with ABE learners were included for supplemental analyses. Seventy-one reading classes, 34 instructors, and 349 adult learners with pre- and posttests participated in the study. The study found a small but significant effect on one measure of decoding skills, which was the proximal target of the curriculum. No overall significant effects were found for word recognition, spelling, fluency, or comprehension. Pretest to posttest gains for word recognition were small to moderate, but not significantly better than the control classes. Adult learners who were born and educated outside of the U.S. made larger gains on 7 of the 11 reading measures than learners who were born and educated within the U.S. However, participation in the treatment curriculum was more beneficial for learners who were born and educated in the U.S. in developing their word recognition skills.
doi:10.1080/19345747.2011.555294
PMCID: PMC3232465  PMID: 22163055
14.  Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals 
Background
D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR.
Methods
Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention.
Results
There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P < 0.001). In total, 41% of the participants used AED before and 96% of the participants used AED after the intervention (P < 0.001). Before intervention, it took a median time of 120 seconds until the AED was used; after the intervention, it took 82 seconds.
Conclusion
Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.
doi:10.1186/1757-7241-19-3
PMCID: PMC3026050  PMID: 21235765
15.  Work of CPR During Two Different Compression to Ventilation Ratios With Real-time Feedback 
Resuscitation  2008;79(2):278-282.
Background
The 2005 Emergency Cardiac Care guidelines for basic life support (BLS) recommend a compression to ventilation ratio of 30:2. The effect of the additional exertion required to deliver more chest compressions may present a considerable physical burden on the provider.
Objective
To compare cardiopulmonary resuscitation (CPR) performance and perceived exertion during compression to ventilation ratios of 15:2 and 30:2 with real-time feedback during two-rescuer CPR.
Methods
Eighteen BLS-certified healthcare providers each performed five minutes of chest compressions on a manikin with compression to ventilation ratios of 15:2 or 30:2 on two separate sessions. Heart rate, capillary lactate, and OMNI Rate of Perceived Exertion (RPE) were recorded before and after each session. Subjects were given continuous, automated, feedback via an accelerometer that measured rate, depth, duration, and release of compressions. Compression measurements and feedback messages were recorded continuously during each five minute session. Data were analyzed using descriptive statistics and t-test to compare groups. Repeated measures ANOVA was used to compare data over the five minute epoch.
Results
After performing external chest compressions for five minutes, peak heart rate (102±24 vs. 106±27), capillary lactate (2.2±0.95 vs. 2.2±0.96), and OMNI RPE (4.3±1.2 vs. 4.6±1.1) were higher were higher than baseline, but did not differ between 15:2 and 30:2. Compression rate (102 ± 24 vs.106 ± 27) and depth (38.8±3.6 vs. 38.2±2.9) did not differ between 15:2 and 30:2 groups or at any minute. Total chest compressions delivered were higher (p<0.05) in the 30:2 group (457±43) compared to 15:2 (379±28). The average no flow time was lower (p<0.05) in the 30:2 group (22±3.03) compared to the 15:2 group (33±2.64). Number of correction prompts (48±55 vs. 64±70) did not differ significantly between the 15:2 and 30:2 groups.
Conclusions
In a cohort of healthcare providers, increasing the CPR ratio from 15:2 to 30:2 did not change physical or perceived exertion during a five-minute bout of CPR when continuous, real-time feedback is provided. The 30:2 compression to ventilation ratio resulted in more chest compressions per minute without decreasing CPR quality.
doi:10.1016/j.resuscitation.2008.06.016
PMCID: PMC2613429  PMID: 18684548
Cardiopulmonary resuscitation; Guidelines; Compression to ventilation ratio; Manikin; Healthcare provider; Lactate
16.  Clinical Instructors' and Student Athletic Trainers' Perceptions of Helpful Clinical Instructor Characteristics 
Journal of Athletic Training  2001;36(1):58-61.
Objective:
To compare the perceptions of students and clinical instructors regarding helpful clinical instructor characteristics.
Design and Setting:
We developed a questionnaire containing helpful clinical instructor characteristics for facilitating student learning from a review of the medical and allied health clinical education literature. Respondents rated clinical instructor characteristics from 1 (among the least helpful) to 10 (among the most helpful). Respondents also identified the overall 10 most helpful and 10 least helpful characteristics.
Subjects:
A total of 206 undergraduate students and 46 clinical instructors in the National Athletic Trainers' Association District 4 athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs responded to the survey.
Measurements:
We computed individual-item and subgroup mean scores for students, clinical instructors, and combined students and instructors. Pearson product moment correlations were computed to evaluate the level of agreement between students and instructors. Correlations were also computed to evaluate the level of agreement between the open-ended responses and the Likert-scale responses.
Results:
Agreement was high between the students' and the clinical instructors' ratings of individual items. Agreement was also high between individual-item means and the directed, open-ended 10 most helpful and 10 least helpful clinical instructor characteristics. Modeling professional behavior was considered the most helpful subgroup of clinical instructor characteristics. Integration of knowledge and research into clinical education was considered the least helpful subgroup of clinical instructor characteristics.
Conclusions:
Clinical instructors should model professional behavior to best facilitate student learning. Integration of research into clinical education may need more emphasis.
PMCID: PMC155403  PMID: 12937516
clinical education; clinical skills; teaching and learning
17.  At what age can schoolchildren provide effective chest compressions? An observational study from the Heartstart UK schools training programme 
BMJ : British Medical Journal  2007;334(7605):1201.
Objective To determine at what age children can perform effective chest compressions for cardiopulmonary resuscitation.
Design Observational study.
Setting Four schools in Cardiff.
Participants 157 children aged 9-14 years in three school year groups (ages 9-10, 11-12, and 13-14).
Interventions Participants were taught basic life support skills in one lesson lasting 20 minutes.
Main outcome measure Effectiveness of chest compression during three minutes' continuous chest compression on a manikin.
Results No year 5 pupil (age 9-10) was able to compress the manikin's chest to the depth recommended in guidelines (38-51 mm). 19% of pupils in year 7 (age 11-12) and 45% in year 9 (age 13-14) achieved adequate compression depth. Only the 13-14 year olds performed chest compression as well as adults in other reported studies. Compression depth showed a significant relation with children's age, weight, and height (P<0.001). Multivariate analyses showed that, if the age and weight of the children were both known, the height (which is closely related to both) was no longer significant (P=0.95). No association was found between pupils' age, sex, weight, or height and the average rate of chest compressions over the three minute period. Similarly, no relation was found between year group and ability to place the hands in the correct position. During the three minutes' compression, compression rate increased and depth decreased.
Conclusions The children's ability to achieve an adequate depth of chest compression depended on their age and weight. The ability to provide the correct rate and to employ the correct hand position was similar across all the age ranges tested. Young children who are not yet physically able to compress the chest can learn the principles of chest compression as well as older children.
doi:10.1136/bmj.39167.459028.DE
PMCID: PMC1889955  PMID: 17468118
18.  Learning Cell Biology as a Team: A Project-Based Approach to Upper-Division Cell Biology 
Cell Biology Education  2002;1:145-153.
To help students develop successful strategies for learning how to learn and communicate complex information in cell biology, we developed a quarter-long cell biology class based on team projects. Each team researches a particular human disease and presents information about the cellular structure or process affected by the disease, the cellular and molecular biology of the disease, and recent research focused on understanding the cellular mechanisms of the disease process. To support effective teamwork and to help students develop collaboration skills useful for their future careers, we provide training in working in small groups. A final poster presentation, held in a public forum, summarizes what students have learned throughout the quarter. Although student satisfaction with the course is similar to that of standard lecture-based classes, a project-based class offers unique benefits to both the student and the instructor.
doi:10.1187/cbe.02-03-0006
PMCID: PMC149487  PMID: 12669105
collaborative learning; upper-division cell biology; team building; assessment; project-based learning; human diseases
19.  Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting 
Background
Ambulance personnel play an essential role in the ‘Chain of Survival’. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island.
Methods
The Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given.
Results
On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01).
During the rhythm analysis, 65% did not perform any visual or verbal safety check.
Conclusion
The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.
doi:10.1186/1757-7241-20-34
PMCID: PMC3430550  PMID: 22569089
Emergency Medical Services; Training; Basic Life Support; Manikin
20.  Can performance indicators be used for pedagogic purposes in disaster medicine training? 
Background
Although disaster simulation trainings were widely used to test hospital disaster plans and train medical staff, the teaching performance of the instructors in disaster medicine training has never been evaluated. The aim of this study was to determine whether the performance indicators for measuring educational skill in disaster medicine training could indicate issues that needed improvement.
Methods
The educational skills of 15 groups attending disaster medicine instructor courses were evaluated using 13 measurable performance indicators. The results of each indicator were scored at 0, 1 or 2 according to the teaching performance.
Results
The total summed scores ranged from 17 to 26 with a mean of 22.67. Three indicators: 'Design', 'Goal' and 'Target group' received the maximum scores. Indicators concerning running exercises had significantly lower scores as compared to others.
Conclusion
Performance indicators could point out the weakness area of instructors' educational skills. Performance indicators can be used effectively for pedagogic purposes.
doi:10.1186/1757-7241-17-15
PMCID: PMC2663536  PMID: 19292895
21.  A Virtual Practice Environment to Develop Communication Skills in Pharmacy Students 
Objective. To develop communication skills in second-year pharmacy students using a virtual practice environment (VPE) and to assess students’ and tutors’ (instructors’) experiences.
Design. A VPE capable of displaying life-sized photographic and video images and representing a pharmacy setting was constructed. Students viewed prescriptions and practiced role-playing with each other and explored the use of nonverbal communication in patient-pharmacist interactions. The VPE experiences were complemented with lectures, reflective journaling, language and learning support, and objective structured clinical examinations (OSCEs).
Assessment. Most students believed the VPE was a useful teaching resource (87%) and agreed that the video component enabled them to contextualize patient problems (73%). While 45% of students questioned the usefulness of watching the role plays between students after they were video recorded, most (90%) identified improvement in their own communication as a result of participating in the tutorials. Most tutors felt comfortable using the technology. Focus group participants found the modified tutorials more engaging and aesthetically positive than in their previous experience.
Conclusion. The VPE provided an effective context for communication skills development classes.
doi:10.5688/ajpe7610202
PMCID: PMC3530064  PMID: 23275667
communication; counseling; virtual environment; simulation; pharmacy students; video; tutorials
22.  A Seminar Course on Contemporary Pharmacy Issues 
Objectives
To implement and evaluate an innovative approach to a pharmacy seminar course intended to develop students' presentation skills and encourage them to think critically about contemporary pharmacy issues.
Design
The instructor provided lectures intended to prepare students for their presentations. These lectures included tips on writing abstracts, learning objectives, use of visual aids, and presentation delivery. Pairs of students chose a pharmacy issue, researched their topic including identifying various strengths of evidence to support a perspective, wrote an abstract and learning objectives, prepared their visual aids, and delivered a pro/con perspective. Students also provided peer evaluations for these presentations. A personal response system was used to provide class input on the presentations.
Assessment
Ninety-five percent of the peer evaluations of the presentations were good to excellent. The overall course evaluations indicated achievement of course goals.
Conclusions
A pharmacy seminar course intended to develop student presentation skills and critical thinking about contemporary pharmacy issues was demonstrated to be successful. The “taking sides” format was an effective design for accomplishing these objectives.
PMCID: PMC2384205  PMID: 18483598
presentation skills; contemporary issues
23.  The influence of personality and ability on undergraduate teamwork and team performance 
SpringerPlus  2013;2(1):16.
The ability to work effectively on a team is highly valued by employers, and collaboration among students can lead to intrinsic motivation, increased persistence, and greater transferability of skills. Moreover, innovation often arises from multidisciplinary teamwork. The influence of personality and ability on undergraduate teamwork and performance is not comprehensively understood. An investigation was undertaken to explore correlations between team outcomes, personality measures and ability in an undergraduate population. Team outcomes included various self-, peer- and instructor ratings of skills, performance, and experience. Personality measures and ability involved the Five-Factor Model personality traits and GPA. Personality, GPA, and teamwork survey data, as well as instructor evaluations were collected from upper division team project courses in engineering, business, political science, and industrial design at a large public university. Characteristics of a multidisciplinary student team project were briefly examined. Personality, in terms of extraversion scores, was positively correlated with instructors’ assessment of team performance in terms of oral and written presentation scores, which is consistent with prior research. Other correlations to instructor-, students’ self- and peer-ratings were revealed and merit further study. The findings in this study can be used to understand important influences on successful teamwork, teamwork instruction and intervention and to understand the design of effective curricula in this area moving forward.
Electronic supplementary material
The online version of this article (doi:10.1186/2193-1801-2-16) contains supplementary material, which is available to authorized users.
doi:10.1186/2193-1801-2-16
PMCID: PMC3568485  PMID: 23420685
Five-factor personality model; Big five personality model; Ability; Teamwork instruction; Capstone course
24.  Perspectives on Learning Styles in Motor and Sport Skills 
We present the perspective that while coaches and instructors commonly adapt learning styles to maximize training outcomes, there has been little to no empirical support for the efficacy of this practice. Learning styles is a learner’s preferred mode (e.g., visual, verbal) of taking in and processing new information. Although it is a relevant topic for the learning of motor and sport skills, few studies have used an appropriate methodology to test the effectiveness of learning style-based instruction. We highlight the need for a learning style assessment tool specific to motor skills and call for a test of the learning style hypothesis, the claim that learners will benefit from instruction that is tailored to their individual learning style. To this end, we suggest methodological guidelines.
doi:10.3389/fpsyg.2012.00069
PMCID: PMC3298967  PMID: 22416240
learning styles; sport skills; tennis; skill acquisition; instruction
25.  A Student Team in a University of Michigan Biomedical Engineering Design Course Constructs a Microfluidic Bioreactor for Studies of Zebrafish Development 
Zebrafish  2009;6(2):201-213.
The zebrafish is a valuable model for teaching developmental, molecular, and cell biology; aquatic sciences; comparative anatomy; physiology; and genetics. Here we demonstrate that zebrafish provide an excellent model system to teach engineering principles. A seven-member undergraduate team in a biomedical engineering class designed, built, and tested a zebrafish microfluidic bioreactor applying microfluidics, an emerging engineering technology, to study zebrafish development. During the semester, students learned engineering and biology experimental design, chip microfabrication, mathematical modeling, zebrafish husbandry, principles of developmental biology, fluid dynamics, microscopy, and basic molecular biology theory and techniques. The team worked to maximize each person's contribution and presented weekly written and oral reports. Two postdoctoral fellows, a graduate student, and three faculty instructors coordinated and directed the team in an optimal blending of engineering, molecular, and developmental biology skill sets. The students presented two posters, including one at the Zebrafish meetings in Madison, Wisconsin (June 2008).
doi:10.1089/zeb.2008.0572
PMCID: PMC2777541  PMID: 19292670

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