A dictum or two – proportionalities in teaching resuscitation skills

Abstract

It is very well recognised that knowledge of, and skills in, basic life support are poorly acquired and rapidly lost. Recurring advice has been to simplify what is taught,1American Heart Association (ILCOR) in collaboration with the International Liaison Committee on Resuscitation Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care – an international consensus on science.Resuscitation. 2000; 46: 1-447Abstract Full Text Full Text PDF PubMed Google Scholar and to improve instructor technique, particularly by reducing the number of extraneous facts imparted to the trainees.2Brennan R.T. Student, instructor, and course factors predicting achievement in CPR training classes.Am J Emerg Med. 1991; 9: 220-224Abstract Full Text PDF PubMed Scopus (40) Google Scholar Over the years, the author has illustrated these concepts by the use of the proportionality:Number of facts remembered∝1Number of facts taught ‘The more you try to teach, the smaller is the proportion that is remembered’3Handley A.J. Teaching resuscitation.Singapore Med J. 2001; : 36-37PubMed Google Scholar This short communication is an attempt to justify this (slightly tongue-in-cheek) concept, and to show that it is, actually, evidence-based. Since this purports to be a scientific paper, a previous error must immediately be admitted. In a published lecture, the term ‘Handley's Equation’ was used.3Handley A.J. Teaching resuscitation.Singapore Med J. 2001; : 36-37PubMed Google Scholar In fact, this is not an equation, since it does not describe ‘a statement that the values of two mathematical expressions are equal’,4Concise Oxford English Dictionary.11th ed. Oxford University Press, Oxford, UK2004Google Scholar but is a proportionality: ‘having a constant ratio to another quantity’.4Concise Oxford English Dictionary.11th ed. Oxford University Press, Oxford, UK2004Google Scholar To avoid the rather user-unfriendly term proportionality, however, it is proposed to substitute dictum: ‘a formal utterance or pronouncement; a saying or maxim.4Concise Oxford English Dictionary.11th ed. Oxford University Press, Oxford, UK2004Google Scholar What evidence is there to support the dictum that ‘the more you try to teach, the smaller is the proportion remembered’? Brennan2Brennan R.T. Student, instructor, and course factors predicting achievement in CPR training classes.Am J Emerg Med. 1991; 9: 220-224Abstract Full Text PDF PubMed Scopus (40) Google Scholar showed that ‘The effect of the instructor, adding additional material is negative, with a predicted decrement to student scores…of added material – around 1 item for every 40 min of added material’. Handley and Handley5Handley A.J Handley J.A. Four-step CPR – improving skill retention.Resuscitation. 1998; 36: 3-8Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar showed that reducing the number of steps in the sequence of CPR increased the proportion that were learnt and remembered. By comparing staged basic life support training with a single 2-h course, Assar and colleagues6Assar D. Chamberlain D. Colquhoun M. et al.Randomised controlled trials of staged teaching for basic life support. 1. Skill acquisition at bronze stage.Resuscitation. 2000; 45: 7-15Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar demonstrated ‘The disadvantages of attempting to teach the very complex routine of conventional CPR in a single…period’. After prospectively testing paramedic students’ skills in BLS and use of an AED, Rittenberger and colleagues7Rittenberger J.C. Guimond G. Platt T.E. Hostler D. Quality of BLS decreases with increasing resuscitation complexity.Resuscitation. 2006; 68: 365-369Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar concluded that ‘BLS resuscitation skill performance decreases as complexity of the resuscitation increases.’ The concept of simplification and avoidance of extraneous teaching material has been supported by a number of authorities: Chamberlain and Hazinski8Chamberlain D.A. Hazinski M.F. Education in resuscitation: ILCOR advisory statement.Resuscitation. 2003; 59: 11-43Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar have stated that ‘Established adult educational principles that encourage simplification should be adopted in resuscitation training’; the ILCOR Guidelines 2000 stated: ‘Retention is another issue in BLS education. To improve retention, the multiple performance steps should be simplified and key factors that determine successful performance and outcome highlighted’.1American Heart Association (ILCOR) in collaboration with the International Liaison Committee on Resuscitation Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care – an international consensus on science.Resuscitation. 2000; 46: 1-447Abstract Full Text Full Text PDF PubMed Google Scholar The author submits that there is sufficient evidence to justify the dictum quoted at the beginning of this paper. He also submits that a second dictum may be put forward:Knowledge acquired∝1Instructor input