Impact of instructor professional background and interim retesting on knowledge and self-confidence of schoolchildren after basic life support training: a cluster randomised longitudinal study

Abstract

IntroductionTo increase the rate of bystander resuscitation, basic life support (BLS) training for schoolchildren is now recommended on a broad level. However, debate continues about the optimal teaching methods. In this study, we investigated the effects of a 90 min BLS training on female pupils’ BLS knowledge and self-confidence and whether learning outcomes were influenced by the instructors’ professional backgrounds or test-enhanced learning.MethodsWe conducted a cluster randomised, longitudinal trial in a girls’ grammar school in Germany from 2013 to 2014. Pupils aged 10–17 years were randomised to receive BLS training conducted by either emergency physicians or medical students. Using a multiple-choice questionnaire and a Likert-type scale, BLS knowledge and self-confidence were investigated before training (t0), 1 week (t1) and 9 months after training (t2). To investigate whether test-enhanced learning influenced learning outcomes, the questionnaire was administered 6 months after the training in half of the classrooms. The data were analysed using linear mixed-effects models.ResultsThe study included 460 schoolchildren. BLS knowledge (mean number of correct answers) increased from 5.86 at t0 to 9.24 at t1 (p<0.001) and self-confidence (mean score on the Likert-type scale) increased from 8.70 at t0 to 11.29 at t1 (p<0.001). After 9 months, knowledge retention was good (8.94 at t2; p=0.080 vs t1), but self-confidence significantly declined from t1 to 9.73 at t2 (p<0.001). Pupils trained by medical students showed a slight but statistically significant greater increase in the knowledge at both t1 and t2, whereas instructors’ background did not influence gain or retention of self-confidence. Retesting resulted in a marginally, non-significantly better retention of knowledge.ConclusionsBLS training led to short-term gains in knowledge and self-confidence. Although knowledge was retained at 9 months after the training session, self-confidence significantly decreased. Interim testing did not appear to impact retention of knowledge or self-confidence. Medical students should be considered as instructors for these courses given their favourable learning outcomes and greater availability.

Outcomes of medical students training schoolchildren of ages 13–18 in cardiopulmonary resuscitation: A systematic review

“…The included studies were spread geographically (7 from Europe, 2 from America, 2 from Asia), with a total participant number of 1,670 schoolchildren (all aged 13–17, and one study where less than 25% of the cohort was under 13) 24 and 355 medical students (across all year levels 1–5). Four RCTs compared the effectiveness in knowledge transfer of medical students as instructors with other groups of instructors, and two RCTs compared knowledge and skills for medical students conducting CPR training after being provided with different modalities of instruction themselves.…”

“…Where outcomes related to schoolchildren, eight studies measured confidence (Kirkpatrick Level 1b), knowledge (Kirkpatrick Level 2b) and skills (Kirkpatrick Level 2c) gained by the students post-training. 18 , 19 , 24 , 26 , 33 , 34 , 35 , 36 Two studies measured outcomes for medical students as CPR instructors, with the focus on professional practice skills (Kirkpatrick Level 2c) and CPR technical skills (Kirkpatrick Level 2c). 27 , 29 One study measured outcomes for both schoolchildren and medical students, namely confidence and theoretical knowledge in CPR (Kirkpatrick Levels 1b and 2b) for schoolchildren and confidence in professional practice outcomes (Kirkpatrick Level 1b) for medical students.…”

“…An alternate option is to involve medical students in CPR-instructor roles as a form of near-peer learning. Current literature suggests that medical students are as effective as physicians in teaching basic life support to schoolchildren, 22 , 23 with benefits thought to be bi-directional – children acquire CPR skills and confidence, 24 , 25 , 26 whilst medical students improve their own CPR skills 27 , 28 in addition to developing important soft skills such as teaching, mentorship and communication. 25 , 27 , 29 …”

Effectiveness of school-based CPR training among adolescents to enhance knowledge and skills in CPR: A systematic review

“…All of the studies were carried out within the last decade (January 2012 – August 2021), indicating the recent attention on the need to train schoolchildren on how to carry out CPR among their peers and others outside the school to save lives. Among the 14 included studies, 9 were RCTs (Barsom et al 2020 ; Cortegiani et al 2017 ; Fonseca Del Pozo et al 2016 ; Haseneder et al 2019 ; Li et al 2018 ; Nord et al 2017 ; Suss-Havemann et al 2020 ; Wingen et al 2018 ), while the remaining five were nonrandomised studies. In the 14 included studies, 11 of the studies were conducted in Europe, with only three from Asia (Li et al 2018 ; Mathew et al 2020 ; Tsai et al 2019 ).…”

“…The studies’ predominant tool for outcome measure was questionnaires combined with technical skills assessed by the instructors after the CPR training interventions (Haseneder et al 2019 ; Li et al 2018 ; Meissner et al 2012 ; Wingen et al 2018 ). In that way, the researchers could ascertain what steps to perform when witnessing a person with cardiac arrest after the training.…”