Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial

Abstract

Background Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition. Objective This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics. Methods A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a “Declaration of no objection.” Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague. Results The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12). Conclusions Use of an e-learning module shows promising results in teaching the NIHSS to paramedics.

Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial

“…This version of the module contains video extracts in all chapters, including for the items related to dysarthria, level of consciousness – global, and level of consciousness – questions. In the previously studied version of our module (version 20), there were no video extracts for these items [ 23 ].…”

“…Since the release of Patrick Lyden’s didactic video in 1994 [ 22 ], the development of NIHSS teaching material has been rather limited. We have recently shown that compared to this didactic video, a highly interactive e-learning module improved NIHSS knowledge acquisition in paramedics [ 23 ]. We defined this module as “highly interactive” because it uses multiple learning mechanics to promote interaction and engagement.…”

Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial

“…Nevertheless, most participants were unable, regardless of their assigned intervention, to reconstruct either the donning (assessed preintervention) or the doffing (assessed postintervention) sequences. This potential limitation has already been highlighted in the paper describing the development of the gamified e-learning module used in this study [ 13 ], though cut scenes were embedded to provide direct demonstration [ 40 , 41 ].…”

Impact of an e-learning module on personal protective equipment knowledge in student paramedics: a randomized controlled trial

“…This interactive module was created under Articulate Storyline 3 (Articulate Global, New York, USA). Feedback [ 19 ], pretesting [ 16 ], avoiding content skipping [ 20 , 21 ], embedded videos [ 22 ] and gamification [ 23 ] were used as learning mechanics. Gamification was used for donning and doffing sequences.…”