- Email: [email protected]
Basic life support training for health care students
Resuscitation 41 (1999) 19 – 23
Basic life support training for health care students Gavin D. Perkins a, Jonathan Hulme a, Hannah R. Shore b, Julian F. Bion c,* a
Department of Medicine, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK b Department of Paediatrics, City Hospital, Birmingham B18 7QH, UK c Uni6ersity Department of Anaesthetics and Intensi6e Care Medicine N5, Queen Elizabeth Hospital, Birmingham B15 2TH, UK Received 3 February 1999; received in revised form 5 February 1999; accepted 24 March 1999
Abstract This paper describes a novel method for delivering basic life support training to undergraduate healthcare students. A comprehensive 8 h programme is organised and delivered by undergraduate students to their peers. These students have undergone training as basic life support instructors validated by the Royal Life Saving Society UK. The course is delivered to multiprofessional groups of medical, dental, physiotherapy, biomaterial and nursing undergraduates. It has been well received by students and academic staff and provides a solution to reduce the workload of over burdened clinical staff while at the same time enhancing quality. It forms part of an overall strategy for improving resuscitation training for undergraduates from all disciplines. © 1999 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Basic life support; Training; Cardiopulmonary resuscitation
1. Introduction Resuscitation training for healthcare students has historically been a neglected area in the undergraduate curriculum. Basic first aid and resuscitation skills should be taught to all professional healthcare students as both patients and the lay public have an inherent expectation they will know what to do in an emergency irrespective of the point they have reached in their training. It was identified in 1995 that the resuscitation training programme at the University of Birmingham did not provide undergraduate students with an adequate level of training. A survey of medical students’ attitudes to the existing programme revealed a significant degree of dissatisfaction. In response the curriculum development committee set up a working group to examine and improve the delivery of resuscitation and life support teach* Corresponding author.
ing. This paper describes the solution devised to provide a comprehensive basic life support (BLS) and first aid programme for first year medical, dental, physiotherapy, nursing and biomaterial students.
2. Background The existing provision of BLS training for first year students consisted of four 1 h lectures to audiences in excess of 300. The working group identified that this method of teaching BLS and first aid was no longer acceptable. The challenge was therefore to develop a more comprehensive course within the constraints of the limited resources available. A questionnaire survey was distributed to the coordinators of resuscitation training at 28 UK medical schools in order to establish current practice for BLS training countrywide. Responses were
0300-9572/99/$ - see front matter © 1999 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 0 0 - 9 5 7 2 ( 9 9 ) 0 0 0 3 7 - 4
20
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
received from 16 medical schools. It was found that the training provided in different schools varied in almost every respect. There were variations in the timing of the course, the curriculum, the course duration, the student to teacher ratios and the backgrounds of the instructors. Medical schools were using a variety of instructors drawn from consultant and junior medical staff, nursing staff, resuscitation training officers, ambulance officers and voluntary aid organisations. Only four of the courses met the recommendations for resuscitation training produced by the Royal College of Physicians [1]. In the absence of a common method for delivering BLS and first aid training to undergraduates, the working group (which included medical students) chose to develop a sustainable programme that would deliver high quality training, at a reasonable cost, without adding too greatly to existing academic commitments. The new student-led programme is described below.
3. Methods
3.1. O6er6iew The new course consists of a total of 8 h of BLS and first aid teaching for all first year medical, dental, physiotherapy, nursing and biomaterial undergraduate students. The course is organised and delivered by a dedicated committee of undergraduate students supported by four doctors, three of whom were in the original group of medical students who devised the scheme. The course is run four times a year on four consecutive Monday evenings. It is delivered in multiprofessional groups each of ten students and trains a total of 400 students each year. Each group is lead by two to three student instructors.
3.2. Course content and examination The course is based on the Royal Life Saving Society (RLSS) UK Life Support Training Scheme. The RLSS is a voluntary aid organisation with specialist interests in drowning and resuscitation. The course covers the assessment and management of an unconscious casualty, expired air ventilation, cardiopulmonary resuscitation, paediatric resuscitation and the management of bleed-
ing, choking and shock. Tuition is based on the current European Resuscitation Council basic life support guidelines [2] as presented in the publication ‘Life Support’ [3]. The course is structured so that 75% of the time is spent developing practical life support skills. At the end of the course the competence of each student is formally assessed to the standards of a nationally recognised RLSS award by external examiners from the RLSS UK.
3.3. Student instructors The student instructors are recruited annually from second year students who have performed well on the preceding year’s course. Each year approximately 25 students are selected to attend a fourteen hour BLS instructor course organised through the RLSS UK. The course covers the theoretical principles and practical approaches to teaching resuscitation, develops presentation techniques and class management skills. The instructors then gain practical teaching experience whilst their technical knowledge and teaching skills are assessed in small groups. At the completion of the course the students are issued with a BLS instructor certificate endorsed by The RLSS UK. They then begin the task of teaching their first year colleagues BLS for the next year. The programme becomes self perpetuating by recruiting new student teachers each year.
3.4. Resources After an initial outlay for equipment to allow sufficient manikins for students to gain as much practical exposure as possible in the available time, the ongoing costs are modest at around £11 per student. The student instructors are paid a nominal fee of £10 per course and the external examiners are paid for their travel expenses. A small sum is also allocated each year for disposable items and repairs to equipment. The training course for instructors is run free of charge by the RLSS UK with the medical school providing the venue and course materials.
4. Results The programme has now entered its fourth year during which time over 1000 students have re-
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
21
Fig. 1. Examination success rates.
ceived BLS tuition and 77 students have been trained as instructors. A total of 99% of students are successful in the end of course assessment on their first attempt, with the remainder passing on their second attempt (Fig. 1). In addition to the examination results, another marker of the success of the course is that a high proportion of students feel confident to perform resuscitation in an emergency at the end of the course. A previous survey undertaken at this medical school in 1994 indicated that 40% of first year students claimed to lack the confidence to initiate BLS in an emergency (personal communication). Whilst it is accepted that confidence does not equate to competence [4,5], it is important that students believe in their capabilites. It has been suggested that even clinicians who are knowledgeable and skilled in resuscitation techniques, may fail to apply them successfully unless they have an adequately strong belief in their capabilities [6]. Early concerns about the quality of students as teachers have proved unfounded. Quality control has been assured by assessment of standards by an external organisation which is expert in training and assessing BLS and first aid. Feedback from that organisation (RLSS UK) are that the standards of teaching and students presented for assessment are outstanding. Course evaluation questionnaires indicate that the course has been exceedingly well received by students. They show a high level of satisfaction with the quality of teaching and course structure.
The results of the feedback questionnaire for the 1997/98 academic year are summarised in Table 1. A clear demonstration of the enthusiasm for the course is exemplified by the fact that over half of the students expressed an interest in training to become next year’s instructors. Table 1 Student evaluation of the course 1997/98 Academic Year
Numbers Percentage of Respondents
Number Number Number Number BLS
of participants of respondents that enjoy the course confident in performing
354 313 302 303
88.4 96.5 96.8
Assessment of course organisation Excellent Good Average Poor Very poor
79 217 17 0 0
25.2 69.4 5.4 0 0
153 142 17 1 0 293
48.9 45.4 5.4 0.3 0 93.6
260
83.1
165
52.7
Assessment of teaching Excellent Good Average Poor Very poor Prefer being taught by peers compared to clinicians Teacher credibility increased if healthcare background Desire to become an Instructor
22
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
The only recurring complaint from the students is that the course takes place during the evenings. This is not the only programme in their undergraduate courses that runs outside the traditional teaching day. At this time it is not possible to change this arrangement as the medical staff and second year students involved in delivering the course are not available to teach during normal office hours. Enthusiasm for the new course is not limited to students. It has been recognised by two awards from the RLSS and by continued support from the medical school. Perhaps a real illustration of the enthusiasm with which the course has been received is the request by members of the academic staff to attend the course for their own needs alongside their students. 5. Discussion Resuscitation training is an essential component of the undergraduate curriculum for medical and other healthcare students. Despite developments being pioneered by some universities [7] many continue to fail to provide adequate time or attention to training healthcare students in resuscitation [8–10]. The Royal College of Physicians has recommended minimum training standards for medical students [1]. These recommendations stated that: all medical students should be taught BLS during the first preclinical term; competence should be reassessed and reinforced in the second year; advanced life support should be taught during the clinical course and knowledge and skills should be tested in the professional qualifying examinations. The first step in providing a full resuscitation training package is establishing a comprehensive BLS education programme. There are many advantages of promoting a student led programme. First, the organisation and delivery of a comprehensive basic life support training programme is inherently a teacher intensive exercise with recommended ratios of student to teacher in the region of 6:1 [1]. This is at a time when the workload for NHS staff is escalating exponentially. Utilising student teachers allows the time of senior staff to be used more effectively teaching advanced life support and trauma life support. Second, basic life support can be taught effectively to lay people by appropriately trained
lay instructors [11,12]. As at the start of an undergraduate course students are little different in their knowledge base from the general public; tuition by lay instructors would appear acceptable. Third, the competence of healthcare professionals putting themselves forward to provide BLS training has been questioned [13]. By overseeing the regular training of instructors it is possible to ensure that they are both competent and up to date. Fourth, it is recognised that being able to teach effectively is becoming an increasingly important skill for all healthcare professionals. Therefore receiving instruction on how to teach in an undergraduate course places students at an advantage when entering their professional working lives. Finally, the idea originated from medical students. Students are increasingly encouraged to take responsibility for their own development and education—what better way can this be achieved than empowering them to develop, lead and assess their own educational programme? A large proportion of the success of this programme comes from the fact that students feel in control of their own and their peers’ education The concept of students teaching resuscitation is not new. Medical students have been found to be competent BLS instructors when teaching on a school first aid course [14]. In the USA, The Mount Sinai School of Medicine utilised second and third year students to deliver a first aid and CPR course to its first year students. [15] Contrary to reports that medical personnel may not be receptive to being taught by anyone other than qualified clinicians [16], our course evaluations show that the students prefer to be taught by their peers, regardless of professional background, supporting the findings of others [15]. This is because the students perceive their peers as delivering teaching at an appropriate level, in a non threatening manner, with recent experience of being taught the material themselves. Of interest was the finding that students felt their teachers credibility was increased by coming from a healthcare background especially as at the time of the survey the teachers were mostly still in their pre-clinical studies with little or no experience of cardiac arrests or resuscitation. Whilst an elementary BLS course could be conducted in 2 h, this would limit the content. The decision to run a comprehensive course of 8 h duration was designed to allow a greater breadth of material to be covered and more time for
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
practical CPR training on mannequins. There is evidence also to suggest that a longer course improves skill retention [17,18]. Another important element of the course is the opportunity it creates for multi-professional training, involving students and instructors from different healthcare backgrounds. This not only satisfies current educational trends [19,20], but also replicates the increasingly collaborative delivery of care in resuscitation and other areas of medicine.
6. Conclusion Basic life support and first aid are important components of a health students training. This paper has described a novel approach utilising students as instructors in providing a comprehensive BLS training package. This approach could be introduced with relative ease at other universities that wished to develop their own programmes.
Acknowledgements The undergraduate student organisers: Caroline Lee, Elizabeth Cooper, Clare Fitzsimmons, Brett Garner and Madhu Tamilarasan. The Royal Life Saving Society UK
References [1] Royal College of Physicians. Resuscitation from cardiopulmonary arrest: organisation and training. J R Col Phys Lond 1987;21:176–82. [2] Handley AJ, Bahr J, Baskett P, Bossaert L, Chamberlain D, Dick W, Ekstrom L, Juchems R, Kettler D, Marsden A, Moeschler O, Monsieurs K, Parr M, Petit P, Van Drenth A. The 1998 European Resuscitation Council guidelines for adult single rescuer basic life support. Resuscitation 1998;37:67–80.
.
23
[3] Handley AJ. Life support. 3rd ed. Missouri: Mosby Year Book, 1998. [4] Marteau TM, Wynne G, Kaye W, Evans TR. Resuscitation: experience without feedback increases confidence but not skill. Br Med J 1990;300:849 – 50. [5] Wynne G, Marteau RM, Johnston M, Whitely CA, Evans TR. Inability of trained nurses to perform basic life support. Br Med J 1987;294:1198– 9. [6] Maibach EW, Schieber RA, Carroll MFB. Self-efficacy in pediatic resuscitation: implications for education and performance. Pediatrics 1996;97:94 – 100. [7] Leah V, Whitbread M, Coats TJ. Resuscitation training for medical students. Resuscitation 1998;39:87 – 90. [8] Graham CA, Guest KA, Scollen D. Cardiopulmonary Resuscitation Paper 1: A survey of undergraduate training in UK medical schools. J Acc Emerg Med 1994;11:162 – 5. [9] Baskett PJF. Resuscitation needed for the curriculum. Br Med J 1985;290:31 – 2. [10] Graham CA, Scollen D. CPR training for UK undergraduate dental students. Resuscitation 1996;32:105–8. [11] Safar P, Bircher NG. Teaching first aid and resuscitation. In: Cardiopulmonary cerebral resuscitation. WB Saunders, London, 3rd ed. 1988:339 – 359. [12] Ramierez AG, Weaver FJ, Raizner AE, Dorfman SB, Herrick KL, Gotto AM. The efficacy of lay CPR instruction:an evaluation. AJPH 1977;67:1093 – 5. [13] Wynne G, Marteau T, Evans TR. Instructors-a weak link in resuscitation training. J R Col Phys Lond 1992;26:372 – 3. [14] Mowbray A, McCullock WJD, Conn AG, Spence AA. Teaching of cardiopulmonary resuscitation by medical students. Med Educ 1987;21:285 – 7. [15] Nelson M. A first aid and CPR course for first year medical students. Med Educ 1982;16:7 – 11. [16] Dalen JE, Howe JP, Membrino GE, McIntyre MD. CPR training for physicians. New Engl J Med 1980;303: 455–7. [17] Twwed WA, Wilson E, Isfeld B. Retention of CPR skills after initial over training. Crit Care Med 1980;8:651–3. [18] Yakel ME. Retention of cardiopulmonary resuscitation skills amongst nursing personnel: What makes the difference? Heart Lung 1989;18:520 – 5. [19] Areskog NH. The need for multiprofessional health education in undergraduate studies. Med Educ 1988;22: 251–2. [20] Parsell G, Bligh J. Interprofessional learning. Postgrad Med J 1998;74:89 – 95.
Basic life support training for health care students Gavin D. Perkins a, Jonathan Hulme a, Hannah R. Shore b, Julian F. Bion c,* a
Department of Medicine, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK b Department of Paediatrics, City Hospital, Birmingham B18 7QH, UK c Uni6ersity Department of Anaesthetics and Intensi6e Care Medicine N5, Queen Elizabeth Hospital, Birmingham B15 2TH, UK Received 3 February 1999; received in revised form 5 February 1999; accepted 24 March 1999
Abstract This paper describes a novel method for delivering basic life support training to undergraduate healthcare students. A comprehensive 8 h programme is organised and delivered by undergraduate students to their peers. These students have undergone training as basic life support instructors validated by the Royal Life Saving Society UK. The course is delivered to multiprofessional groups of medical, dental, physiotherapy, biomaterial and nursing undergraduates. It has been well received by students and academic staff and provides a solution to reduce the workload of over burdened clinical staff while at the same time enhancing quality. It forms part of an overall strategy for improving resuscitation training for undergraduates from all disciplines. © 1999 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Basic life support; Training; Cardiopulmonary resuscitation
1. Introduction Resuscitation training for healthcare students has historically been a neglected area in the undergraduate curriculum. Basic first aid and resuscitation skills should be taught to all professional healthcare students as both patients and the lay public have an inherent expectation they will know what to do in an emergency irrespective of the point they have reached in their training. It was identified in 1995 that the resuscitation training programme at the University of Birmingham did not provide undergraduate students with an adequate level of training. A survey of medical students’ attitudes to the existing programme revealed a significant degree of dissatisfaction. In response the curriculum development committee set up a working group to examine and improve the delivery of resuscitation and life support teach* Corresponding author.
ing. This paper describes the solution devised to provide a comprehensive basic life support (BLS) and first aid programme for first year medical, dental, physiotherapy, nursing and biomaterial students.
2. Background The existing provision of BLS training for first year students consisted of four 1 h lectures to audiences in excess of 300. The working group identified that this method of teaching BLS and first aid was no longer acceptable. The challenge was therefore to develop a more comprehensive course within the constraints of the limited resources available. A questionnaire survey was distributed to the coordinators of resuscitation training at 28 UK medical schools in order to establish current practice for BLS training countrywide. Responses were
0300-9572/99/$ - see front matter © 1999 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 0 0 - 9 5 7 2 ( 9 9 ) 0 0 0 3 7 - 4
20
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
received from 16 medical schools. It was found that the training provided in different schools varied in almost every respect. There were variations in the timing of the course, the curriculum, the course duration, the student to teacher ratios and the backgrounds of the instructors. Medical schools were using a variety of instructors drawn from consultant and junior medical staff, nursing staff, resuscitation training officers, ambulance officers and voluntary aid organisations. Only four of the courses met the recommendations for resuscitation training produced by the Royal College of Physicians [1]. In the absence of a common method for delivering BLS and first aid training to undergraduates, the working group (which included medical students) chose to develop a sustainable programme that would deliver high quality training, at a reasonable cost, without adding too greatly to existing academic commitments. The new student-led programme is described below.
3. Methods
3.1. O6er6iew The new course consists of a total of 8 h of BLS and first aid teaching for all first year medical, dental, physiotherapy, nursing and biomaterial undergraduate students. The course is organised and delivered by a dedicated committee of undergraduate students supported by four doctors, three of whom were in the original group of medical students who devised the scheme. The course is run four times a year on four consecutive Monday evenings. It is delivered in multiprofessional groups each of ten students and trains a total of 400 students each year. Each group is lead by two to three student instructors.
3.2. Course content and examination The course is based on the Royal Life Saving Society (RLSS) UK Life Support Training Scheme. The RLSS is a voluntary aid organisation with specialist interests in drowning and resuscitation. The course covers the assessment and management of an unconscious casualty, expired air ventilation, cardiopulmonary resuscitation, paediatric resuscitation and the management of bleed-
ing, choking and shock. Tuition is based on the current European Resuscitation Council basic life support guidelines [2] as presented in the publication ‘Life Support’ [3]. The course is structured so that 75% of the time is spent developing practical life support skills. At the end of the course the competence of each student is formally assessed to the standards of a nationally recognised RLSS award by external examiners from the RLSS UK.
3.3. Student instructors The student instructors are recruited annually from second year students who have performed well on the preceding year’s course. Each year approximately 25 students are selected to attend a fourteen hour BLS instructor course organised through the RLSS UK. The course covers the theoretical principles and practical approaches to teaching resuscitation, develops presentation techniques and class management skills. The instructors then gain practical teaching experience whilst their technical knowledge and teaching skills are assessed in small groups. At the completion of the course the students are issued with a BLS instructor certificate endorsed by The RLSS UK. They then begin the task of teaching their first year colleagues BLS for the next year. The programme becomes self perpetuating by recruiting new student teachers each year.
3.4. Resources After an initial outlay for equipment to allow sufficient manikins for students to gain as much practical exposure as possible in the available time, the ongoing costs are modest at around £11 per student. The student instructors are paid a nominal fee of £10 per course and the external examiners are paid for their travel expenses. A small sum is also allocated each year for disposable items and repairs to equipment. The training course for instructors is run free of charge by the RLSS UK with the medical school providing the venue and course materials.
4. Results The programme has now entered its fourth year during which time over 1000 students have re-
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
21
Fig. 1. Examination success rates.
ceived BLS tuition and 77 students have been trained as instructors. A total of 99% of students are successful in the end of course assessment on their first attempt, with the remainder passing on their second attempt (Fig. 1). In addition to the examination results, another marker of the success of the course is that a high proportion of students feel confident to perform resuscitation in an emergency at the end of the course. A previous survey undertaken at this medical school in 1994 indicated that 40% of first year students claimed to lack the confidence to initiate BLS in an emergency (personal communication). Whilst it is accepted that confidence does not equate to competence [4,5], it is important that students believe in their capabilites. It has been suggested that even clinicians who are knowledgeable and skilled in resuscitation techniques, may fail to apply them successfully unless they have an adequately strong belief in their capabilities [6]. Early concerns about the quality of students as teachers have proved unfounded. Quality control has been assured by assessment of standards by an external organisation which is expert in training and assessing BLS and first aid. Feedback from that organisation (RLSS UK) are that the standards of teaching and students presented for assessment are outstanding. Course evaluation questionnaires indicate that the course has been exceedingly well received by students. They show a high level of satisfaction with the quality of teaching and course structure.
The results of the feedback questionnaire for the 1997/98 academic year are summarised in Table 1. A clear demonstration of the enthusiasm for the course is exemplified by the fact that over half of the students expressed an interest in training to become next year’s instructors. Table 1 Student evaluation of the course 1997/98 Academic Year
Numbers Percentage of Respondents
Number Number Number Number BLS
of participants of respondents that enjoy the course confident in performing
354 313 302 303
88.4 96.5 96.8
Assessment of course organisation Excellent Good Average Poor Very poor
79 217 17 0 0
25.2 69.4 5.4 0 0
153 142 17 1 0 293
48.9 45.4 5.4 0.3 0 93.6
260
83.1
165
52.7
Assessment of teaching Excellent Good Average Poor Very poor Prefer being taught by peers compared to clinicians Teacher credibility increased if healthcare background Desire to become an Instructor
22
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
The only recurring complaint from the students is that the course takes place during the evenings. This is not the only programme in their undergraduate courses that runs outside the traditional teaching day. At this time it is not possible to change this arrangement as the medical staff and second year students involved in delivering the course are not available to teach during normal office hours. Enthusiasm for the new course is not limited to students. It has been recognised by two awards from the RLSS and by continued support from the medical school. Perhaps a real illustration of the enthusiasm with which the course has been received is the request by members of the academic staff to attend the course for their own needs alongside their students. 5. Discussion Resuscitation training is an essential component of the undergraduate curriculum for medical and other healthcare students. Despite developments being pioneered by some universities [7] many continue to fail to provide adequate time or attention to training healthcare students in resuscitation [8–10]. The Royal College of Physicians has recommended minimum training standards for medical students [1]. These recommendations stated that: all medical students should be taught BLS during the first preclinical term; competence should be reassessed and reinforced in the second year; advanced life support should be taught during the clinical course and knowledge and skills should be tested in the professional qualifying examinations. The first step in providing a full resuscitation training package is establishing a comprehensive BLS education programme. There are many advantages of promoting a student led programme. First, the organisation and delivery of a comprehensive basic life support training programme is inherently a teacher intensive exercise with recommended ratios of student to teacher in the region of 6:1 [1]. This is at a time when the workload for NHS staff is escalating exponentially. Utilising student teachers allows the time of senior staff to be used more effectively teaching advanced life support and trauma life support. Second, basic life support can be taught effectively to lay people by appropriately trained
lay instructors [11,12]. As at the start of an undergraduate course students are little different in their knowledge base from the general public; tuition by lay instructors would appear acceptable. Third, the competence of healthcare professionals putting themselves forward to provide BLS training has been questioned [13]. By overseeing the regular training of instructors it is possible to ensure that they are both competent and up to date. Fourth, it is recognised that being able to teach effectively is becoming an increasingly important skill for all healthcare professionals. Therefore receiving instruction on how to teach in an undergraduate course places students at an advantage when entering their professional working lives. Finally, the idea originated from medical students. Students are increasingly encouraged to take responsibility for their own development and education—what better way can this be achieved than empowering them to develop, lead and assess their own educational programme? A large proportion of the success of this programme comes from the fact that students feel in control of their own and their peers’ education The concept of students teaching resuscitation is not new. Medical students have been found to be competent BLS instructors when teaching on a school first aid course [14]. In the USA, The Mount Sinai School of Medicine utilised second and third year students to deliver a first aid and CPR course to its first year students. [15] Contrary to reports that medical personnel may not be receptive to being taught by anyone other than qualified clinicians [16], our course evaluations show that the students prefer to be taught by their peers, regardless of professional background, supporting the findings of others [15]. This is because the students perceive their peers as delivering teaching at an appropriate level, in a non threatening manner, with recent experience of being taught the material themselves. Of interest was the finding that students felt their teachers credibility was increased by coming from a healthcare background especially as at the time of the survey the teachers were mostly still in their pre-clinical studies with little or no experience of cardiac arrests or resuscitation. Whilst an elementary BLS course could be conducted in 2 h, this would limit the content. The decision to run a comprehensive course of 8 h duration was designed to allow a greater breadth of material to be covered and more time for
G.D. Perkins et al. / Resuscitation 41 (1999) 19–23
practical CPR training on mannequins. There is evidence also to suggest that a longer course improves skill retention [17,18]. Another important element of the course is the opportunity it creates for multi-professional training, involving students and instructors from different healthcare backgrounds. This not only satisfies current educational trends [19,20], but also replicates the increasingly collaborative delivery of care in resuscitation and other areas of medicine.
6. Conclusion Basic life support and first aid are important components of a health students training. This paper has described a novel approach utilising students as instructors in providing a comprehensive BLS training package. This approach could be introduced with relative ease at other universities that wished to develop their own programmes.
Acknowledgements The undergraduate student organisers: Caroline Lee, Elizabeth Cooper, Clare Fitzsimmons, Brett Garner and Madhu Tamilarasan. The Royal Life Saving Society UK
References [1] Royal College of Physicians. Resuscitation from cardiopulmonary arrest: organisation and training. J R Col Phys Lond 1987;21:176–82. [2] Handley AJ, Bahr J, Baskett P, Bossaert L, Chamberlain D, Dick W, Ekstrom L, Juchems R, Kettler D, Marsden A, Moeschler O, Monsieurs K, Parr M, Petit P, Van Drenth A. The 1998 European Resuscitation Council guidelines for adult single rescuer basic life support. Resuscitation 1998;37:67–80.
.
23
[3] Handley AJ. Life support. 3rd ed. Missouri: Mosby Year Book, 1998. [4] Marteau TM, Wynne G, Kaye W, Evans TR. Resuscitation: experience without feedback increases confidence but not skill. Br Med J 1990;300:849 – 50. [5] Wynne G, Marteau RM, Johnston M, Whitely CA, Evans TR. Inability of trained nurses to perform basic life support. Br Med J 1987;294:1198– 9. [6] Maibach EW, Schieber RA, Carroll MFB. Self-efficacy in pediatic resuscitation: implications for education and performance. Pediatrics 1996;97:94 – 100. [7] Leah V, Whitbread M, Coats TJ. Resuscitation training for medical students. Resuscitation 1998;39:87 – 90. [8] Graham CA, Guest KA, Scollen D. Cardiopulmonary Resuscitation Paper 1: A survey of undergraduate training in UK medical schools. J Acc Emerg Med 1994;11:162 – 5. [9] Baskett PJF. Resuscitation needed for the curriculum. Br Med J 1985;290:31 – 2. [10] Graham CA, Scollen D. CPR training for UK undergraduate dental students. Resuscitation 1996;32:105–8. [11] Safar P, Bircher NG. Teaching first aid and resuscitation. In: Cardiopulmonary cerebral resuscitation. WB Saunders, London, 3rd ed. 1988:339 – 359. [12] Ramierez AG, Weaver FJ, Raizner AE, Dorfman SB, Herrick KL, Gotto AM. The efficacy of lay CPR instruction:an evaluation. AJPH 1977;67:1093 – 5. [13] Wynne G, Marteau T, Evans TR. Instructors-a weak link in resuscitation training. J R Col Phys Lond 1992;26:372 – 3. [14] Mowbray A, McCullock WJD, Conn AG, Spence AA. Teaching of cardiopulmonary resuscitation by medical students. Med Educ 1987;21:285 – 7. [15] Nelson M. A first aid and CPR course for first year medical students. Med Educ 1982;16:7 – 11. [16] Dalen JE, Howe JP, Membrino GE, McIntyre MD. CPR training for physicians. New Engl J Med 1980;303: 455–7. [17] Twwed WA, Wilson E, Isfeld B. Retention of CPR skills after initial over training. Crit Care Med 1980;8:651–3. [18] Yakel ME. Retention of cardiopulmonary resuscitation skills amongst nursing personnel: What makes the difference? Heart Lung 1989;18:520 – 5. [19] Areskog NH. The need for multiprofessional health education in undergraduate studies. Med Educ 1988;22: 251–2. [20] Parsell G, Bligh J. Interprofessional learning. Postgrad Med J 1998;74:89 – 95.