G Model RESUS-5965; No. of Pages 1
ARTICLE IN PRESS Resuscitation xxx (2014) xxx.e1
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Future resuscitation guidelines should contain more specific recommendations regarding simulation-based training Sir, In the past decades an increasing focus has been placed on effective medical education and training, as outcomes of critically ill patients undoubtedly depend on healthcare providers’ proficiency in basic and advanced life support (ALS). Simulationbased resuscitation training results in increased knowledge, skills, and patient outcomes,1 and has been recommended by current European Resuscitation Council (ERC) guidelines as educational methodology.2 As a matter of fact, simulation-based training (SBT) has been designated as an “essential part of resuscitation training”.2 According to ERC guidelines, refresher training is required for maintenance of cognitive and technical skills, as there is an inevitable decay after initial training.2 However, there was no specific recommendation regarding ALS training intervals in 2010. This important topic warrants further analysis, as relevant evidence has emerged in recent years. In a study among registered nurses, Smith et al.3 reported good retention of theoretical ALS knowledge, while ALS performance decreased shortly after initial training. Skills assessments after nine and twelve months were passed by only 27.3% and 14% of participants, respectively, which certainly represent worrying numbers especially for healthcare professionals. These results are confirmed by a systematic review of ALS knowledge and skill retention in healthcare providers. Despite the relatively small number of included studies and heterogeneity of study designs, Yang et al.4 reported (1) ALS knowledge and skills decline to be most significant within the first six to twelve months after training and (2) skills to decay faster than knowledge. On the contrary, “booster” training and additional practice opportunities are associated with improved learning outcomes.1 Mundell et al.1 reported significantly positive effects both for learners’ satisfaction and process skills, defined as observed proficiency, economy of movements, and minor technical errors. Lo and colleagues5 studied the impact of high-fidelity SBT on ALS retention. After high-fidelity SBT or participation in a traditional ALS course, medical students in the high-fidelity group scored significantly better on two megacode scenarios than students receiving traditional training. However, at 12 months post-training performance decreased irrespective of group allocation, indicating no sustained impact of high-fidelity SBT on ALS skill retention. In light of the upcoming 2015 ERC guidelines, this letter shall inform guideline authors about recent evidence regarding retention of ALS knowledge and skills. Although there is still substantial need for further research, studies have shown a significant decline of life-saving skills after six months, emphasizing the need for at least annual refresher training. As knowledge seems to be
maintained better over time, more resources should be allocated for hands-on skills practice. High-fidelity SBT may not provide an additional benefit regarding skills retention. Given the increasing amount of evidence, future ERC guidelines should define specific intervals for ALS refresher training, prompting healthcare institutions to implement faculty training more frequently and, thus, possibly improving patient care. Conflict of interest statement Lukas P. Mileder works part-time as instructor at the Clinical Skills Center, Medical University of Graz. For both authors, there are no real or perceived conflicts of interest associated with this article. References 1. Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: a systematic review and meta-analysis. Resuscitation 2013;84:1174–83. 2. Soar J, Monsieurs KG, Ballance JH, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010;81:1434–44. 3. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation 2008;78:59–65. 4. Yang CW, Yen ZS, McGowan JE, et al. A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers. Resuscitation 2012;83:1055–60. 5. Lo BM, Devine AS, Evans DP, et al. Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge. Resuscitation 2011;82:1440–3.
Lukas P. Mileder a,b,∗ Clinical Skills Center, Medical University of Graz, Austria b Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria a
Georg M. Schmölzer a,b,c Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria b Department of Pediatrics, University of Alberta, Edmonton, Canada c Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada
a
∗ Corresponding
author at: Clinical Skills Center, Medical University of Graz, Auenbruggerplatz 33, 8036 Graz, Austria. E-mail address: [email protected] (L.P. Mileder) 7 April 2014
http://dx.doi.org/10.1016/j.resuscitation.2014.04.006 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Mileder LP, Schmölzer GM. Future resuscitation guidelines should contain more specific recommendations regarding simulation-based training. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.04.006
ARTICLE IN PRESS Resuscitation xxx (2014) xxx.e1
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Future resuscitation guidelines should contain more specific recommendations regarding simulation-based training Sir, In the past decades an increasing focus has been placed on effective medical education and training, as outcomes of critically ill patients undoubtedly depend on healthcare providers’ proficiency in basic and advanced life support (ALS). Simulationbased resuscitation training results in increased knowledge, skills, and patient outcomes,1 and has been recommended by current European Resuscitation Council (ERC) guidelines as educational methodology.2 As a matter of fact, simulation-based training (SBT) has been designated as an “essential part of resuscitation training”.2 According to ERC guidelines, refresher training is required for maintenance of cognitive and technical skills, as there is an inevitable decay after initial training.2 However, there was no specific recommendation regarding ALS training intervals in 2010. This important topic warrants further analysis, as relevant evidence has emerged in recent years. In a study among registered nurses, Smith et al.3 reported good retention of theoretical ALS knowledge, while ALS performance decreased shortly after initial training. Skills assessments after nine and twelve months were passed by only 27.3% and 14% of participants, respectively, which certainly represent worrying numbers especially for healthcare professionals. These results are confirmed by a systematic review of ALS knowledge and skill retention in healthcare providers. Despite the relatively small number of included studies and heterogeneity of study designs, Yang et al.4 reported (1) ALS knowledge and skills decline to be most significant within the first six to twelve months after training and (2) skills to decay faster than knowledge. On the contrary, “booster” training and additional practice opportunities are associated with improved learning outcomes.1 Mundell et al.1 reported significantly positive effects both for learners’ satisfaction and process skills, defined as observed proficiency, economy of movements, and minor technical errors. Lo and colleagues5 studied the impact of high-fidelity SBT on ALS retention. After high-fidelity SBT or participation in a traditional ALS course, medical students in the high-fidelity group scored significantly better on two megacode scenarios than students receiving traditional training. However, at 12 months post-training performance decreased irrespective of group allocation, indicating no sustained impact of high-fidelity SBT on ALS skill retention. In light of the upcoming 2015 ERC guidelines, this letter shall inform guideline authors about recent evidence regarding retention of ALS knowledge and skills. Although there is still substantial need for further research, studies have shown a significant decline of life-saving skills after six months, emphasizing the need for at least annual refresher training. As knowledge seems to be
maintained better over time, more resources should be allocated for hands-on skills practice. High-fidelity SBT may not provide an additional benefit regarding skills retention. Given the increasing amount of evidence, future ERC guidelines should define specific intervals for ALS refresher training, prompting healthcare institutions to implement faculty training more frequently and, thus, possibly improving patient care. Conflict of interest statement Lukas P. Mileder works part-time as instructor at the Clinical Skills Center, Medical University of Graz. For both authors, there are no real or perceived conflicts of interest associated with this article. References 1. Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: a systematic review and meta-analysis. Resuscitation 2013;84:1174–83. 2. Soar J, Monsieurs KG, Ballance JH, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010;81:1434–44. 3. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation 2008;78:59–65. 4. Yang CW, Yen ZS, McGowan JE, et al. A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers. Resuscitation 2012;83:1055–60. 5. Lo BM, Devine AS, Evans DP, et al. Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge. Resuscitation 2011;82:1440–3.
Lukas P. Mileder a,b,∗ Clinical Skills Center, Medical University of Graz, Austria b Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria a
Georg M. Schmölzer a,b,c Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria b Department of Pediatrics, University of Alberta, Edmonton, Canada c Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada
a
∗ Corresponding
author at: Clinical Skills Center, Medical University of Graz, Auenbruggerplatz 33, 8036 Graz, Austria. E-mail address: [email protected] (L.P. Mileder) 7 April 2014
http://dx.doi.org/10.1016/j.resuscitation.2014.04.006 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Mileder LP, Schmölzer GM. Future resuscitation guidelines should contain more specific recommendations regarding simulation-based training. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.04.006
