G Model AUCC-230; No. of Pages 3
ARTICLE IN PRESS Australian Critical Care xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Australian Critical Care journal homepage: www.elsevier.com/locate/aucc
Learner perceptions and reflections after simulation-based advanced life support training Judy Currey RN, BN (Hons), Crit Care Cert, PhD a,∗ , Julie Considine RN, RM, BN, GradDipNurs (AcuteCare), MNurs, PhD, FRCNA b , Josh Allen RN, BN(Hons), Grad Dip Crit Care a a
School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia Eastern Health-Deakin University Nursing and Midwifery Research Centre, Eastern Health and School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia b
article information Article history: Received 12 July 2013 Received in revised form 23 October 2013 Accepted 7 January 2014 Available online xxx
Review article: Long-term Intended and Unintended Experiences after Advanced Life Support Training Maria Birkvad Rasmussen, Peter Dieckmann, S. Barry Issenberg, Doris Østergaard, Eldar Søreide, Charlotte Vibeke Ringsted. Resuscitation 2013; 84: 373–377. Objective The aim of this study was to identify long-term learner reactions, experiences and reflections after attending a simulation-based advanced life support (ALS) course. The simulation training had taken place in Denmark during 2009–2010 and was based on the European Resuscitation Council ALS principles and algorithms. Design Based on grounded theory, this qualitative research used semi-structured interviews to address the research aims. Semistructured telephone interviews were conducted after simulation training (timeframe unspecified) for durations of between 8 and 20 min. Consistent with grounded theory, a priori themes from the literature and perceptions of interviewees influenced the interview guide and provided themes that informed the data analysis in an
∗ Corresponding author at: Faculty of Health, Deakin University, 221 Burwood Highway, Burwood 3125, Victoria, Australia. Tel.: +61 3 9244 6122; fax: +61 3 9244 6159. E-mail address: [email protected] (J. Currey).
iterative manner until saturation was reached. Ethics approval was sought and gained for the conduct of this study. Setting and sample Of 74 (63 physicians, 11 nurses) Danish individuals who completed the ALS simulation training in 2009–2010, 17 (14 physicians, 3 registered nurses) agreed to participate following an email invitation from the Chairman of the ALS steering committee. Sampling was purposive for completion of the course by residents of Copenhagen. The average age of participants during the ALS training was 55 (range 54–56) years for nurses and 31 (range 28–40) years for physicians. The average years of clinical experience was greater for nurses (mean 25; range 22–30) than physicians (mean 4; range 1–11). The specialty experience of participants included 9 with internal medicine (including cardiology), 6 from anaesthetics and 2 from surgical units. Results Analysis revealed three major themes which were highly interrelated. These themes were: contextual adaptation, communities of practice and transfer of skills. Participants found being held accountable for implementing the algorithm correctly and receiving negative feedback about their performance quite confronting. Not only did participants find learning by a structured approach initially difficult, but once learnt and appreciated, the application of this newly-found valuable approach was difficult to implement clinically due to peer pressure to do otherwise. Thus the perceived lack of synchrony between simulation and real world clinical practice was a major contributor to contextual adaptation.
http://dx.doi.org/10.1016/j.aucc.2014.01.002 1036-7314/© 2014 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
G Model AUCC-230; No. of Pages 3
ARTICLE IN PRESS J. Currey et al. / Australian Critical Care xxx (2014) xxx–xxx
2
The communities of practice theme reflected the limited understanding of other disciplines’ specific roles, responsibilities and professional knowledge; and the beneficial sense of being a part of the specific ALS-trained community. In particular, being part of the community of ALS-trained staff provided strong feelings of proficiency and confidence that they could perform resuscitation the ‘right’ way. The third theme of transfer of skills reflected participants’ usage of skills from one area to another. The use of algorithms and communication skills and processes inherent to ALS resuscitation measures were useful as a framework for usual clinical practice. However, participants found limited use and application of this framework in clinical practice in situations and contexts when working with others who had not completed ALS simulation training. The authors concluded that while the simulation based course resulted in a high degree of efficiency in applying the theoretical and practical components of ALS in the training setting, the content of the course was insufficient in developing the communication and teamwork skills necessary for transferring these skills and knowledge to the clinical setting.
Critique and discussion The aim of this study was to identify long-term intended and unintended learner reactions, experiences and reflections after attending the simulation based ALS course. Although long term was not defined in this study, it appeared to be a timeframe between 1 and 24 months after the simulation-based training. It is known that practical skills and knowledge decay over time, with practical skills decaying over about 6 weeks and knowledge over 18 months,1–3 so variable time since training may have influenced participant perceptions. This study is likely to be interesting to critical care clinicians given the emphasis and expectations surrounding education, assessment and ongoing competence in ALS. Research investigating learner reflections and experiences of ALS training is not common, so an understanding of the finer nuances of these are valuable for informing instructional design and feedback to skill clinicians in ALS, and to identify barriers to transferring skills from training into clinical practice. The current emphasis by some of our local and global colleagues on simulation as the ideal model of education and training, preparation and ongoing professional development for health clinicians warrants interest in this study’s findings. A recent systematic review and meta-analysis of simulation in emergency medicine, which included some studies of ALS, found unsurprisingly that simulation is favourable for learning over no education at all; however, we still have little understanding of how to best design simulationbased education to maximise learning efficiency and impact learner behaviours.4 The clinical background of the 17 people interviewed was provided but it would be useful to understand their level of exposure to resuscitation before and after the training, as well as their current clinical environment. Participant reactions may vary considerably as a consequence of ALS exposure due to an expected increase in experiential knowledge and skill acquisition.5 A number of studies have demonstrated that knowledge and skill acquisition and retention are improved with recent or sustained exposure to resuscitation.2,6,7 Indeed, regular practice is required after initial training to maintain skills rather than annual assessment.8 This study did not consider such ongoing exposure; but rather, it simply explored long term perceptions qualitatively. Likewise, ALS education received prior to this simulation training may positively impact clinicians’ performances during ALS practical sessions, although this expectation is not always met because some clinicians do not demonstrate their knowledge verbally or through appropriate
actions.9 Participants in this study described a lacked of confidence in their own practice and skills in emergency situations that may have related to their clinical background or exposure to resuscitation. Participants also described several expectations or prejudices about colleagues from other professions/specialties and from those with different experiences as well as conflicts arising from powerrelations or confusion about roles and responsibilities. Ways of improving resuscitation training should include considerations about the experience of team leaders and communication structures and issues specific to resuscitation.10 Of note, the clinical backgrounds of the ‘ALS team’ created during training did not reflect usual practice for these clinicians; however, the clinical reality of resuscitation is that ALS teams have to form anytime anywhere in acute or community settings, so the instructors may have chosen team diversity deliberately. These issues illustrate the need to teach teamwork, communication skills and appreciation of different professional backgrounds during resuscitation training. It is only through dialogue that role clarification, expectations and biases can be realised and dealt with appropriately to enable coordination. Ultimately, an understanding of others’ knowledge and skills contributes positively to teamwork and collaborative decision making. Indeed, teamwork skills are critical to effective resuscitative efforts.10–13 Comments by participants about having clear right and wrong answers required a contextual explanation by authors. On the one hand, the use of highly structured simulation with clear ‘wrong’ and ‘right’ is not reflective of real clinical environments, does not teach clinicians to make decisions under conditions of uncertainty; these are key factors required for decision making in a resuscitation context. On the other hand, if simulation instructors were seeking participants to adhere strictly to the ERC ALS algorithm, then the right and wrong feedback may well have been justified. It seems apparent that the right/wrong responses from instructors were not attributable to the simulation per se; but rather, the need to adhere to the algorithm. As such, any form of instruction regarding ALS training would engender this response from clinicians. The divide between instructors and participants is worthy of further exploration. For example, it is unclear what the educational andragogy underpinning the course was or how instructors were prepared for their role. Further, the teaching style used by the instructors was not explained. Likewise, the professional backgrounds of instructors were not described. Authors commented that “In these situations, the participants found it difficult, frustrating and sometimes impossible to apply the things they had learned.” This suggests an instructor style that was not conducive to participants’ application of knowledge in a stressful situation. Attention to details about these aspects of instructional design is critical to ensure participants’ acquire intended learning outcomes. Although conducted overseas, amongst a cohort of clinicians unlikely to be reflective of the composition of ALS teams in the Australian context, this paper helps us to understand some of the facilitators and barriers to transferring skills and knowledge learned in a simulation setting to the clinical environment. An understanding of participant’s reflections might shed light on the impact of attitude on future clinical behaviour and compliance with ongoing ALS training, which has traditionally been poor amongst critical care nurses.14 The limitations of this study included only 17 of 74 professionals who completed ALS simulation training participated in the study and that these individuals self-selected to be interviewed. It is likely findings in relation to reflections would always be highly individualised given the diversity of roles, discipline and experiences of participants. The paper also identifies that the clinicians involved were self-motivated to undertake the training to improve skills. In contrast, the experience in Australia is that despite the expectation
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
G Model AUCC-230; No. of Pages 3
ARTICLE IN PRESS J. Currey et al. / Australian Critical Care xxx (2014) xxx–xxx
to undertake regular ALS training, compliance is low, suggestive of low self-motivation.14 Overall, this study’s findings are useful to prompt our own reflections of our experiences during ALS training, how training teams are composed, instructional andragogy, feedback content and styles and skills one gains that transfer to usual clinical practice. References 1. Semeraro F, Signore L, Cerchiari EL. Retention of CPR performance in anaesthetists. Resuscitation 2006;68(January (1)):101–8. PMID: 16325986 (Epub 2005/12/06). 2. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation 2008;78(July (1)):59–65. PMID: 18406037 (Epub 2008/04/15). 3. Soar J, Mancini ME, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010;81(October (Suppl. 1)):e288–330. PMID: 20956038 (Epub 2010/10/20). 4. Ilgen JS, Sherbino J, Cook DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med 2013;20(2):117–27. 5. Passali C, Pantazopoulos I, Dontas I, Patsaki A, Barouxis D, Troupis G, et al. Evaluation of nurses’ and doctors’ knowledge of basic & advanced life support resuscitation guidelines. Nurs Educ Pract 2011;11:365–9.
3
6. Hammond F, Saba M, Simes T, Cross R. Advanced life support: retention of registered nurses’ knowledge 18 months after initial training. Aust Crit Care 2000;13(August (3)):99–104. PMID: 11276606 (Epub 2001/03/30). 7. Jensen ML, Lippert F, Hesselfeldt R, Rasmussen MB, Mogensen SS, Jensen MK, et al. The significance of clinical experience on learning outcome from resuscitation training – a randomised controlled study. Resuscitation 2009;80(February (2)):238–43. PMID: 19058890 (Epub 2008/12/09). 8. Allen JA, Currey J, Considine J. Annual resuscitation competency assessments: a review of the evidence. Aust Crit Care 2013;26(1):12–7. 9. Perkins G, Fullerton J, Davis-Gomez N, Davies R, Baldock C, Stevens H, et al. The effect of pre-course e-learning prior to advanced life support training: a randomised controlled trial. Resuscitation 2010;81(7):877–81. 10. Andersen P, Jensen M, Lippert A, Astergaard D. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation 2010;81(6):695–702. 11. Bucknall TK, Jones D, Bellomo R, Staples M. Responding to medical emergencies: system characteristics under examination (RESCUE). A prospective multi-site point prevalence study. Resuscitation 2013;84(2):179–83. 12. Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol 2011;57(June (24)):2381–8. 13. Siassakos D, Fox R, Crofts J, Hunt L, Winter C, Draycott T. The management of a simulated emergency: better teamwork, better performance. Resuscitation 2011;82(2):203–6. 14. Preston JL, Currey J, Eastwood GM. Assessing advanced life support (ALS) competence: Victorian practices. Aust Crit Care 2009;22(November (4)):164–71. PMID: 19540131 (Epub 2009/06/23).
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
ARTICLE IN PRESS Australian Critical Care xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Australian Critical Care journal homepage: www.elsevier.com/locate/aucc
Learner perceptions and reflections after simulation-based advanced life support training Judy Currey RN, BN (Hons), Crit Care Cert, PhD a,∗ , Julie Considine RN, RM, BN, GradDipNurs (AcuteCare), MNurs, PhD, FRCNA b , Josh Allen RN, BN(Hons), Grad Dip Crit Care a a
School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia Eastern Health-Deakin University Nursing and Midwifery Research Centre, Eastern Health and School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia b
article information Article history: Received 12 July 2013 Received in revised form 23 October 2013 Accepted 7 January 2014 Available online xxx
Review article: Long-term Intended and Unintended Experiences after Advanced Life Support Training Maria Birkvad Rasmussen, Peter Dieckmann, S. Barry Issenberg, Doris Østergaard, Eldar Søreide, Charlotte Vibeke Ringsted. Resuscitation 2013; 84: 373–377. Objective The aim of this study was to identify long-term learner reactions, experiences and reflections after attending a simulation-based advanced life support (ALS) course. The simulation training had taken place in Denmark during 2009–2010 and was based on the European Resuscitation Council ALS principles and algorithms. Design Based on grounded theory, this qualitative research used semi-structured interviews to address the research aims. Semistructured telephone interviews were conducted after simulation training (timeframe unspecified) for durations of between 8 and 20 min. Consistent with grounded theory, a priori themes from the literature and perceptions of interviewees influenced the interview guide and provided themes that informed the data analysis in an
∗ Corresponding author at: Faculty of Health, Deakin University, 221 Burwood Highway, Burwood 3125, Victoria, Australia. Tel.: +61 3 9244 6122; fax: +61 3 9244 6159. E-mail address: [email protected] (J. Currey).
iterative manner until saturation was reached. Ethics approval was sought and gained for the conduct of this study. Setting and sample Of 74 (63 physicians, 11 nurses) Danish individuals who completed the ALS simulation training in 2009–2010, 17 (14 physicians, 3 registered nurses) agreed to participate following an email invitation from the Chairman of the ALS steering committee. Sampling was purposive for completion of the course by residents of Copenhagen. The average age of participants during the ALS training was 55 (range 54–56) years for nurses and 31 (range 28–40) years for physicians. The average years of clinical experience was greater for nurses (mean 25; range 22–30) than physicians (mean 4; range 1–11). The specialty experience of participants included 9 with internal medicine (including cardiology), 6 from anaesthetics and 2 from surgical units. Results Analysis revealed three major themes which were highly interrelated. These themes were: contextual adaptation, communities of practice and transfer of skills. Participants found being held accountable for implementing the algorithm correctly and receiving negative feedback about their performance quite confronting. Not only did participants find learning by a structured approach initially difficult, but once learnt and appreciated, the application of this newly-found valuable approach was difficult to implement clinically due to peer pressure to do otherwise. Thus the perceived lack of synchrony between simulation and real world clinical practice was a major contributor to contextual adaptation.
http://dx.doi.org/10.1016/j.aucc.2014.01.002 1036-7314/© 2014 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
G Model AUCC-230; No. of Pages 3
ARTICLE IN PRESS J. Currey et al. / Australian Critical Care xxx (2014) xxx–xxx
2
The communities of practice theme reflected the limited understanding of other disciplines’ specific roles, responsibilities and professional knowledge; and the beneficial sense of being a part of the specific ALS-trained community. In particular, being part of the community of ALS-trained staff provided strong feelings of proficiency and confidence that they could perform resuscitation the ‘right’ way. The third theme of transfer of skills reflected participants’ usage of skills from one area to another. The use of algorithms and communication skills and processes inherent to ALS resuscitation measures were useful as a framework for usual clinical practice. However, participants found limited use and application of this framework in clinical practice in situations and contexts when working with others who had not completed ALS simulation training. The authors concluded that while the simulation based course resulted in a high degree of efficiency in applying the theoretical and practical components of ALS in the training setting, the content of the course was insufficient in developing the communication and teamwork skills necessary for transferring these skills and knowledge to the clinical setting.
Critique and discussion The aim of this study was to identify long-term intended and unintended learner reactions, experiences and reflections after attending the simulation based ALS course. Although long term was not defined in this study, it appeared to be a timeframe between 1 and 24 months after the simulation-based training. It is known that practical skills and knowledge decay over time, with practical skills decaying over about 6 weeks and knowledge over 18 months,1–3 so variable time since training may have influenced participant perceptions. This study is likely to be interesting to critical care clinicians given the emphasis and expectations surrounding education, assessment and ongoing competence in ALS. Research investigating learner reflections and experiences of ALS training is not common, so an understanding of the finer nuances of these are valuable for informing instructional design and feedback to skill clinicians in ALS, and to identify barriers to transferring skills from training into clinical practice. The current emphasis by some of our local and global colleagues on simulation as the ideal model of education and training, preparation and ongoing professional development for health clinicians warrants interest in this study’s findings. A recent systematic review and meta-analysis of simulation in emergency medicine, which included some studies of ALS, found unsurprisingly that simulation is favourable for learning over no education at all; however, we still have little understanding of how to best design simulationbased education to maximise learning efficiency and impact learner behaviours.4 The clinical background of the 17 people interviewed was provided but it would be useful to understand their level of exposure to resuscitation before and after the training, as well as their current clinical environment. Participant reactions may vary considerably as a consequence of ALS exposure due to an expected increase in experiential knowledge and skill acquisition.5 A number of studies have demonstrated that knowledge and skill acquisition and retention are improved with recent or sustained exposure to resuscitation.2,6,7 Indeed, regular practice is required after initial training to maintain skills rather than annual assessment.8 This study did not consider such ongoing exposure; but rather, it simply explored long term perceptions qualitatively. Likewise, ALS education received prior to this simulation training may positively impact clinicians’ performances during ALS practical sessions, although this expectation is not always met because some clinicians do not demonstrate their knowledge verbally or through appropriate
actions.9 Participants in this study described a lacked of confidence in their own practice and skills in emergency situations that may have related to their clinical background or exposure to resuscitation. Participants also described several expectations or prejudices about colleagues from other professions/specialties and from those with different experiences as well as conflicts arising from powerrelations or confusion about roles and responsibilities. Ways of improving resuscitation training should include considerations about the experience of team leaders and communication structures and issues specific to resuscitation.10 Of note, the clinical backgrounds of the ‘ALS team’ created during training did not reflect usual practice for these clinicians; however, the clinical reality of resuscitation is that ALS teams have to form anytime anywhere in acute or community settings, so the instructors may have chosen team diversity deliberately. These issues illustrate the need to teach teamwork, communication skills and appreciation of different professional backgrounds during resuscitation training. It is only through dialogue that role clarification, expectations and biases can be realised and dealt with appropriately to enable coordination. Ultimately, an understanding of others’ knowledge and skills contributes positively to teamwork and collaborative decision making. Indeed, teamwork skills are critical to effective resuscitative efforts.10–13 Comments by participants about having clear right and wrong answers required a contextual explanation by authors. On the one hand, the use of highly structured simulation with clear ‘wrong’ and ‘right’ is not reflective of real clinical environments, does not teach clinicians to make decisions under conditions of uncertainty; these are key factors required for decision making in a resuscitation context. On the other hand, if simulation instructors were seeking participants to adhere strictly to the ERC ALS algorithm, then the right and wrong feedback may well have been justified. It seems apparent that the right/wrong responses from instructors were not attributable to the simulation per se; but rather, the need to adhere to the algorithm. As such, any form of instruction regarding ALS training would engender this response from clinicians. The divide between instructors and participants is worthy of further exploration. For example, it is unclear what the educational andragogy underpinning the course was or how instructors were prepared for their role. Further, the teaching style used by the instructors was not explained. Likewise, the professional backgrounds of instructors were not described. Authors commented that “In these situations, the participants found it difficult, frustrating and sometimes impossible to apply the things they had learned.” This suggests an instructor style that was not conducive to participants’ application of knowledge in a stressful situation. Attention to details about these aspects of instructional design is critical to ensure participants’ acquire intended learning outcomes. Although conducted overseas, amongst a cohort of clinicians unlikely to be reflective of the composition of ALS teams in the Australian context, this paper helps us to understand some of the facilitators and barriers to transferring skills and knowledge learned in a simulation setting to the clinical environment. An understanding of participant’s reflections might shed light on the impact of attitude on future clinical behaviour and compliance with ongoing ALS training, which has traditionally been poor amongst critical care nurses.14 The limitations of this study included only 17 of 74 professionals who completed ALS simulation training participated in the study and that these individuals self-selected to be interviewed. It is likely findings in relation to reflections would always be highly individualised given the diversity of roles, discipline and experiences of participants. The paper also identifies that the clinicians involved were self-motivated to undertake the training to improve skills. In contrast, the experience in Australia is that despite the expectation
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
G Model AUCC-230; No. of Pages 3
ARTICLE IN PRESS J. Currey et al. / Australian Critical Care xxx (2014) xxx–xxx
to undertake regular ALS training, compliance is low, suggestive of low self-motivation.14 Overall, this study’s findings are useful to prompt our own reflections of our experiences during ALS training, how training teams are composed, instructional andragogy, feedback content and styles and skills one gains that transfer to usual clinical practice. References 1. Semeraro F, Signore L, Cerchiari EL. Retention of CPR performance in anaesthetists. Resuscitation 2006;68(January (1)):101–8. PMID: 16325986 (Epub 2005/12/06). 2. Smith KK, Gilcreast D, Pierce K. Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation 2008;78(July (1)):59–65. PMID: 18406037 (Epub 2008/04/15). 3. Soar J, Mancini ME, Bhanji F, Billi JE, Dennett J, Finn J, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010;81(October (Suppl. 1)):e288–330. PMID: 20956038 (Epub 2010/10/20). 4. Ilgen JS, Sherbino J, Cook DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med 2013;20(2):117–27. 5. Passali C, Pantazopoulos I, Dontas I, Patsaki A, Barouxis D, Troupis G, et al. Evaluation of nurses’ and doctors’ knowledge of basic & advanced life support resuscitation guidelines. Nurs Educ Pract 2011;11:365–9.
3
6. Hammond F, Saba M, Simes T, Cross R. Advanced life support: retention of registered nurses’ knowledge 18 months after initial training. Aust Crit Care 2000;13(August (3)):99–104. PMID: 11276606 (Epub 2001/03/30). 7. Jensen ML, Lippert F, Hesselfeldt R, Rasmussen MB, Mogensen SS, Jensen MK, et al. The significance of clinical experience on learning outcome from resuscitation training – a randomised controlled study. Resuscitation 2009;80(February (2)):238–43. PMID: 19058890 (Epub 2008/12/09). 8. Allen JA, Currey J, Considine J. Annual resuscitation competency assessments: a review of the evidence. Aust Crit Care 2013;26(1):12–7. 9. Perkins G, Fullerton J, Davis-Gomez N, Davies R, Baldock C, Stevens H, et al. The effect of pre-course e-learning prior to advanced life support training: a randomised controlled trial. Resuscitation 2010;81(7):877–81. 10. Andersen P, Jensen M, Lippert A, Astergaard D. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation 2010;81(6):695–702. 11. Bucknall TK, Jones D, Bellomo R, Staples M. Responding to medical emergencies: system characteristics under examination (RESCUE). A prospective multi-site point prevalence study. Resuscitation 2013;84(2):179–83. 12. Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol 2011;57(June (24)):2381–8. 13. Siassakos D, Fox R, Crofts J, Hunt L, Winter C, Draycott T. The management of a simulated emergency: better teamwork, better performance. Resuscitation 2011;82(2):203–6. 14. Preston JL, Currey J, Eastwood GM. Assessing advanced life support (ALS) competence: Victorian practices. Aust Crit Care 2009;22(November (4)):164–71. PMID: 19540131 (Epub 2009/06/23).
Please cite this article in press as: Currey J, et al. Learner perceptions and reflections after simulation-based advanced life support training. Aust Crit Care (2014), http://dx.doi.org/10.1016/j.aucc.2014.01.002
