A single-blinded randomized crossover trial comparing peer-to-peer and standard instruction on airway management skill training

Abstract

Background Peer-to-peer teaching, which is an alternative to standard teaching (by expert instructors), has the potential to emphasize student self-learning and reduce the cost and workload of the instructor. Self-instruction videos with peer feedback are highlighted in many medical and nursing school curricula. Objective To evaluate whether peer to peer instruction supported by a structured curriculum and video exemplars is not inferior to standard instructor-led teaching in basic airway management skill, knowledge, and confidence attainment. Method This single blinded randomized crossover trial was conducted with a sample of novice nursing students. Data was collected through the pre- to post- knowledge and confidence assessments. The students were randomly assigned to two crossover groups. Each student learned basic airway management skills through both methods. The students performances were recorded in every session with recordings reviewed by blinded expert instructors. Results The study included 48 participants, who were assigned into both the expert instruction group and peer-to-peer group through computer generated randomization. The skill rating scores of the peer-to-peer group were not inferior to the standard teaching. With further analysis, we noted that the peer-to-peer group scores had significantly higher scores demonstrating a large effect size (Cohens d of 1.07 (p-value 0.002) for oropharyngeal airway insertion, 1.14 (p-value <0.001) for nasopharyngeal airway insertion and 0.81 (p-value 0.003) for bag mask ventilation). There was no significant difference between pre- and post- knowledge scores across groups (p-value of 0.13 and 0.22 respectively). Participants in both groups reported higher confidence after learning. However, the difference was not statistically significant. Conclusions Undergraduate nursing students trained in basic airway management skills by peer-to-peer instruction and a structured curriculum did not show inferior scores compared to the students who were trained by expert instructors. There was no significant difference in the knowledge and confidence levels between the groups.