Abstract
Background: Low-dose, high-frequency CPR training, such as the AHA Resuscitation Quality Improvement program, is designed to prevent skills decay. Preliminary studies have shown success in using gamification- namely a competitive leaderboard - for self-directed CPR training using a feedback-enabled CPR simulator. The purpose of this study was to determine the effect of a larger-scaled gamification system across multiple institutions on self-directed CPR practice frequency and resulting performance. Methods: This was a randomized-control study with 14 institutions. Subjects were healthcare professionals with unlimited access to a feedback-enabled CPR manikin. Subjects were asked to upload CPR scores and a ‘Selfie’ upon completion of any practice chest compressions. Each institution’s scores and photos were displayed on an online leaderboard for 4 months during the Intervention phase, and were denied access into the leaderboard for 4 additional months for the Control phase. The order of the phases was randomized per institution. Outcome variables included mean number of CPR episodes per person and mean CPR performance score measured by the simulator. Independent t-tests compared outcome variables between the 2 phases for unadjusted and adjusted results based on treatment and crossover effects. Results: A total of 919 subjects performed 1850 CPR episodes during the study period. Unadjusted mean CPR episodes per subject was higher in Control phase than the Intervention phase (2.9 +/- 7.2 vs. 1.6 +/- 1.7, p<0.001). However, when controlling for a crossover effect, there was no difference in mean CPR episodes per subject between the Intervention (1.6 [95CI 1.4, 1.9]) and Control phase (1.7 [95CI 1.5, 2.0], p=0.6). No difference in mean CPR performance scores were found (90.7 [89.4, 92.0] vs 89.3 [87.6, 91.0], p=0.2). Conclusion: A competitive gamification system did not affect self-directed simulated CPR practice frequency or CPR performance.
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