Elsevier

Resuscitation

Volume 73, Issue 2, May 2007, Pages 271-278
Resuscitation

Training and educational paper
Poor quality teaching in lay person CPR courses

https://doi.org/10.1016/j.resuscitation.2006.09.008Get rights and content

Summary

Recent studies have found that poor cardiopulmonary resuscitation (CPR) is commonly performed in resuscitation attempts, both by health professionals and lay people. One of the contributing factors to poor performance of CPR may be poor initial teaching. This study was conducted to investigate the quality of 14 CPR courses complying with New Zealand Qualifications Authority standards, which includes formal assessment of CPR. While courses taught by the large first aid training organisations in New Zealand had a student to manikin ratio of around 3:1, courses taught by smaller providers had a ratio of over 4:1. During the 4 h course, only 20 ± 2 min were spent demonstrating CPR, and 26 ± 4 min were spent with students practising CPR. The assessment of adult, child and infant CPR took on average less than 2.5 min in total. Importantly, in the majority of courses (71%), certification was granted when the CPR technique was performed incorrectly, with both compression depth and compression place being corrected only 57% of the time. Courses only discussed the importance of early defibrillation 57% of the time, and provided limited information on symptoms of acute coronary syndromes. In light of these observations it is suggested that the current style of teaching is unlikely to result in students being able to perform adequate CPR if required in the community.

Introduction

Two of the critical determinants of survival in the event of out of hospital cardiac arrest are the rapid activation of emergency medical services, and the performance of bystander cardiopulmonary resuscitation (CPR).1, 2, 3, 4 It has been suggested that bystander CPR atleast doubles survival from cardiac arrest,5 with studies that have differentiated between effective and ineffective bystander CPR demonstrating even greater benefits.6

Because of the importance of bystander CPR as a determinant of survival, an importance has been placed on community CPR education and skill acquisition. Previously, we found that 74% of an adult population in Wellington had received CPR training, although for most this was more than 5 years ago, and the level of knowledge retained regarding how to perform CPR was extremely low.7 These findings support others, where it is well known that practical skills are often lost within 1 year of training in lay public8 as well as medically trained personnel.9, 10, 11 In a study of 280 members of the community, only 7% were judged to produce a safe and effective CPR technique 6 months post-training, while 39% were regarded as both ineffective and potentially dangerous.8 At least part of the problem of poor retention of CPR skills may be poor initial teaching of CPR, and the recent International Liaison Committee on Resuscitation advisory statement on education in resuscitation suggested “Course curricula and instructor training are generally poorly adapted to the needs of course participants, and few instructors have been trained to teach. In addition, instructors frequently digress from the planned script, telling anecdotes and providing other irrelevant material, do not allow sufficient time for practice, and provide poor supervision and feedback”.12

In an attempt to provide quality assurance first aid courses for the general public in New Zealand are accredited and moderated by the New Zealand Qualification Authority (NZQA). The criteria for learning are well defined, and key learning end points are explicitly stated. In the context of resuscitation, correct CPR techniques must be examined before certificates of competence are issued. This study was conducted to assess the effectiveness of basic life support courses complying with the NZQA standards. In particular, we wished to observe the accuracy of information imparted, and the quality of teaching and assessment of correct CPR technique.

Section snippets

Study design

After gaining institutional ethical committee approval, one investigator attended 14 basic life support (BLS) courses anonymously from eight different cities in New Zealand over a 6-month period. Seven of these were conduced by large, multi-centred providers, and seven by smaller private providers. These short (no more than 4 h) BLS courses corresponded to the New Zealand Qualification Authority Unit Standard (NZQA) 6402. All courses attended for this study were registered and accredited NZQA

Results

Fourteen first aid courses, seven large and seven smaller providers, were attended by the same investigator between September 2005 and March 2006. The majority of instructors were female (11 out of 14). The average number of students on a course was 13 ± 6, the larger providers courses was 15 ± 5 students compared with smaller providers 10 ± 6 students. All courses were managed by a single instructor, excluding one large provider course, where the instructor was being assessed that day. This assessor

Discussion

This study raises a number of concerns about the quality of community CPR teaching on NZQA approved courses. Only 36% of the courses attended offered each student their own manikin, leaving the remainder of courses with students observing others during practise time. This is of importance when the time allotted to practise CPR techniques was on average only 20 min. The time taken for assessment was less than 2.5 min, and assessment often took place within a bulk group scenario, minimising the

Conclusion

While CPR courses continue to provide members of the community with the ability to initiate BLS in an out-of-hospital collapse situation, it is disappointing to discover that New Zealand courses are lacking in practise experience and adequate feedback to ensure a competent technique. We have found that many of the courses do not comply completely with NZQA criteria, and do not allow sufficient time for skill acquisition and competence. They provide limited feedback due to insufficient

Conflict of interest

None of the authors have a conflict of interest with respect to this study.

Acknowledgments

The authors wish to acknowledge and thank the Surgical Research Trust and Wakefield Hospital for funding this research and Miss Zoe Canvin for technical assistance.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.09.008.

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