Instructor-led Training Research Articles

Effects of different types of feedback on cardiopulmonary resuscitation skills among nursing students–a pilot study

Background: During the last 20 years there have been different approaches to teaching nurse students cardiopulmonary resuscitation (CPR). Receiving CPR with compressions of adequate depth and frequency, and ventilations of adequate volume improves the chance of survival. The aim of this study was to evaluate effects of different types of feedback on CPR skills among nursing students. Methods: A pilot study with an explorative approach including 30 nurse students. Students was randomized in three groups; 1) instructor-led training followed by self-training without feedback, 2) self-training with visual graphic feedback, and 3) self-training with voice advisory manikin (VAM). Outcomes were correct compression deep, frequency, hand position and release, and correct ventilation volume and flow. If performance was correct to 70%, students were considered to have reached approved level. The students also answered questions about theoretical knowledge about CPR. Results: In technical skills, group 2 had significant higher level of correct ventilation volume compared with the other group. Both group 1 and 3 did not reach the level of 70% correct performance. Group 1 and 2 had significant higher level of correct deep of compressions compared with group 3 which did not reach the 70% level. There was no difference in performance between groups in other parameters. Conclusion: This pilot study suggests that visual graphic feedback is promising and seemed to be more effective than self-training with voice advisory manikin and instructor-led training with followed self-training without feedback.

Print to Digital: A Study of Students’ Psychosomatic Cost in Traditional and E-Learning

The information age is characterized by the instant access to knowledge that empowers one to compete, grow and succeed. Traditional instructor-led training based on text book learning is a vast and colossal system to gain knowledge. Nevertheless, transition from traditional to e-learning system allows for transformation in educational paradigms and behavior, thus creating a new culture regarding learning and the implementation of technological evolution in education. A survey was carried out among hundred undergraduates, postgraduates and research scholars of Indian Universities to assess the impact of transition from traditional to e-learning on their psychosomatic behavior and reasons thereof. This included the psychological challenges, i.e. stress, nervousness and anxiety, in the students because of the inadequate facilities and infrastructure, apprehensions to adopt a new system, lack of computer literacy and faith on the technology, and any other cause. It was also evaluated whether the students were able to cope up with psychological challenges after imparting training and familiarization with e-learning. Based on the survey the best and most sound method of learning in Indian context was explored.

E-Learning: Future of Education

This paper highlights the significance of E-learning in modern education and discusses its technical aspect, market, pros and cons, comparison with instructor led training and possibility of weather E-learning will replace the old classroom teaching. Presently the concept of E-learning is becoming very popular as the numbers of internet savvy users are increasing. E-learning gives the advantage of 24x7 and 365 days a year round access as compared to Instructor-Led Training, which is one time class that must be scheduled. E-learning is cost effective as course content once developed could be easily used and modified for teaching and training. E-learning also provides students freedom from carrying heavy school bags and stop cutting of trees for the sake of paper, pencil and rubber. E-learning is the future of education as it is interactive, interesting and entertaining way of learning, and will soon replace the paper books in the form of touch screen tablets.

Efficacy of a self-learning station for basic life support refresher training in a hospital

Adult basic life support refresher training using voice feedback manikins has been shown to be feasible, but the superiority of this strategy over instructor-led (IL) refresher training for nurses in a hospital has not been studied in randomized trials. To study if adult basic life support refresher training for nurses in a self-learning (SL) station using a voice feedback manikin is more effective than IL training. A Resusci Anne Skills Station (Laerdal, Norway) was installed in a small room. A total of 235 nurses were randomized to SL or IL training. After 1 month and after 7 months, the proportions of nurses achieving a mean compression depth of 38-51 mm, a mean compression rate of 80-120/min, incomplete release of at least 5 mm and a mean ventilation volume of 400-1000 ml were compared between the SL and IL groups. After 1 month, the proportion of nurses with any incomplete release of at least 5 mm was significantly lower in the SL group (23 of 54 nurses, 43%) compared with the IL group (33 of 47 nurses, 70%) (P=0.005). After 7 months, a lower proportion of nurses achieved a depth of 38-51 mm in the SL group (13 of 45 nurses, 29%) compared with the IL group (25 of 45 nurses, 56%) (P=0.01). For the other outcome parameters, no differences between SL and IL training could be demonstrated. This randomized trial in a real-life setting showed that more nurses achieved adequate compression depth, 7 months after IL refresher training compared with training in a SL station. Further research is needed to improve the efficacy of this SL training strategy.

Improving the Efficiency of Advanced Life Support Training

Each year, more than 1.5 million health care professionals receive advanced life support (ALS) training. To determine whether a blended approach to ALS training that includes electronic learning (e-learning) produces outcomes similar to those of conventional, instructor-led ALS training. Open-label, noninferiority, randomized trial. Randomization, stratified by site, was generated by Sealed Envelope (Sealed Envelope, London, United Kingdom). (International Standardized Randomized Controlled Trial Number Register: ISCRTN86380392) 31 ALS centers in the United Kingdom and Australia. 3732 health care professionals recruited between December 2008 and October 2010. A 1-day course supplemented with e-learning versus a conventional 2-day course. The primary outcome was performance in a cardiac arrest simulation test at the end of the course. Secondary outcomes comprised knowledge- and skill-based assessments, repeated assessment after remediation training, and resource use. 440 of the 1843 participants randomly assigned to the blended course and 444 of the 1889 participants randomly assigned to conventional training did not attend the courses. Performance in the cardiac arrest simulation test after course attendance was lower in the electronic advanced life support (e-ALS) group compared with the conventional advanced life support (c-ALS) group; 1033 persons (74.5%) in the e-ALS group and 1146 persons (80.2%) in the c-ALS group passed (mean difference, -5.7% [95% CI, -8.8% to -2.7%]). Knowledge- and skill-based assessments were similar between groups, as was the final pass rate after remedial teaching, which was 94.2% in the e-ALS group and 96.7% in the c-ALS group (mean difference, -2.6% [CI, -4.1% to 1.2%]). Faculty, catering, and facility costs were $438 per participant for electronic ALS training and $935 for conventional ALS training. Many professionals (24%) did not attend the courses. The effect on patient outcomes was not evaluated. Compared with conventional ALS training, an approach that included e-learning led to a slightly lower pass rate for cardiac arrest simulation tests, similar scores on a knowledge test, and reduced costs. National Institute of Health Research and Resuscitation Council (UK).

Interactive distance learning for orthodontic residents: Utilization and acceptability

Sharing resources through distance education has been proposed as 1 way to deal with a lack of full-time faculty in orthodontic residency programs. To keep distance education for orthodontic residents as cost-effective as possible while retaining interaction, we developed a "blended" interactive distance learning approach that combines observation of Web-based seminars with live postseminar discussions. For the 2009-2010 academic year, a grant from the American Association of Orthodontists opened access to the blended learning experience to all orthodontic programs in the United States and Canada. The specific aims of this project were to (1) measure programmatic interest in using blended distance learning, (2) determine resident and faculty interest, (3) determine the seminars' perceived usefulness, and (4) elicit feedback regarding future use. Participants in this project were expected to (1) read all assigned articles before viewing a recorded seminar, (2) watch a 1 to 1.5 hour recording of an actual interactive seminar on a Web site, and (3) participate in a 30-minute follow-up discussion immediately after watching the recorded seminar either with a faculty member at the participating institution or via a videoconference with the leader of the Web-based seminar. The residents and faculty then completed surveys about the experience. Half (52%) of the 63 orthodontic programs in the United States fully participated in this project. The blended approach to distance learning was judged to be effective and enjoyable; faculty members were somewhat more enthusiastic about the experience than were residents. Most residents were not adequately prepared for the seminars (only 14% read all preparatory articles in depth); this impacted their perception of the effectiveness and enjoyability of the experience (P = 0.0016). Prepared residents reported a greater ability to learn from the seminars (P = 0.0035) than those who did not read, and also indicated that they were more likely to use the seminars again (P = 0.0018). Despite feedback regarding the need for technologic improvements of the recorded seminars, such as better editing, more frequent slides, quicker pace, and improved sound quality, most residents and faculty agreed that they would like to use this approach to distance learning again. Blended distance learning is an acceptable method of instruction that allows residents to access various experts, supplement traditional instructor-led training, and ease the strain of current faculty shortages. The content of the recorded seminars needs to remain evidence-based, and some technologic aspects of the recordings should be improved.

Decision support systems for human resource training and development

Human resource training and development methods and techniques have different qualitative characteristics that require a multicriteria and multiscenario framework for their assessment. This study incorporates the AHP to assess the nine most important human resource training and development methods and techniques, under five criteria and six scenarios. The methods considered are ‘on-the-job training’, ‘mentorship’, ‘apprenticeship’, ‘vestibule training/simulators’, ‘web-based learning’, ‘instructor-led classroom training’, ‘programmed self-instruction’, ‘case studies/role playing’ and ‘systematic job rotations and transfers’. ‘Vestibule training/simulators’ and ‘mentorship’ have the average best scores, and they should be among the first priorities especially when efficiency, the motivation of employees and minimization of the duration of training time are the most important factors. ‘Web-based learning’ is ideal for minimizing training costs or when ease of application is the first priority. ‘On-the-job training’ is a very good alternative when the cost of training should be reduced while the motivation of employees should be increased.

Low-Dose, High-Frequency CPR Training Improves Skill Retention of In-Hospital Pediatric Providers

To investigate the effectiveness of brief bedside cardiopulmonary resuscitation (CPR) training to improve the skill retention of hospital-based pediatric providers. We hypothesized that a low-dose, high-frequency training program (booster training) would improve CPR skill retention. CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated arrest. Basic life support-certified, hospital-based providers were randomly assigned to 1 of 4 study arms: (1) instructor-only training; (2) automated defibrillator feedback only; (3) instructor training combined with automated feedback; and (4) control (no structured training). Each session (time: 0, 1, 3, and 6 months after training) consisted of a pretraining evaluation (60 seconds), booster training (120 seconds), and a posttraining evaluation (60 seconds). Excellent CPR was defined as chest compression (CC) depth ≥ one-third anterior-posterior chest depth, rate ≥90 and ≤120 CC per minute, ≤20% of CCs with incomplete release (>2500 g), and no flow fraction ≤ 0.30. Eighty-nine providers were randomly assigned; 74 (83%) completed all sessions. Retention of CPR skills was 2.3 times (95% confidence interval [CI]: 1.1-4.5; P=.02) more likely after 2 trainings and 2.9 times (95% CI: 1.4-6.2; P=.005) more likely after 3 trainings. The automated defibrillator feedback only group had lower retention rates compared with the instructor-only training group (odds ratio: 0.41 [95% CI: 0.17-0.97]; P = .043). Brief bedside booster CPR training improves CPR skill retention. Our data reveal that instructor-led training improves retention compared with automated feedback training alone. Future studies should investigate whether bedside training improves CPR quality during actual pediatric arrests.

“Booster” training: Evaluation of instructor-led bedside cardiopulmonary resuscitation skill training and automated corrective feedback to improve cardiopulmonary resuscitation compliance of Pediatric Basic Life Support providers during simulated cardiac arrest*

To investigate the effectiveness of brief bedside "booster" cardiopulmonary resuscitation (CPR) training to improve CPR guideline compliance of hospital-based pediatric providers. Prospective, randomized trial. General pediatric wards at Children's Hospital of Philadelphia. Sixty-nine Basic Life Support-certified hospital-based providers. CPR recording/feedback defibrillators were used to evaluate CPR quality during simulated pediatric arrest. After a 60-sec pretraining CPR evaluation, subjects were randomly assigned to one of three instructional/feedback methods to be used during CPR booster training sessions. All sessions (training/CPR manikin practice) were of equal duration (2 mins) and differed only in the method of corrective feedback given to participants during the session. The study arms were as follows: 1) instructor-only training; 2) automated defibrillator feedback only; and 3) instructor training combined with automated feedback. Before instruction, 57% of the care providers performed compressions within guideline rate recommendations (rate >90 min(-1) and <120 min(-1)); 71% met minimum depth targets (depth, >38 mm); and 36% met overall CPR compliance (rate and depth within targets). After instruction, guideline compliance improved (instructor-only training: rate 52% to 87% [p .01], and overall CPR compliance, 43% to 78% [p < .02]; automated feedback only: rate, 70% to 96% [p = .02], depth, 61% to 100% [p < .01], and overall CPR compliance, 35% to 96% [p < .01]; and instructor training combined with automated feedback: rate 48% to 100% [p < .01], depth, 78% to 100% [p < .02], and overall CPR compliance, 30% to 100% [p < .01]). Before booster CPR instruction, most certified Pediatric Basic Life Support providers did not perform guideline-compliant CPR. After a brief bedside training, CPR quality improved irrespective of training content (instructor vs. automated feedback). Future studies should investigate bedside training to improve CPR quality during actual pediatric cardiac arrests.

Blended Learning – the way forward for veterinary nursing?

ABSTRACT:Distance learning, and in particular blended learning (BL) courses, are becoming an increasingly popular mode of delivery within the higher education (HE) sector. In certain disciplines, including veterinary nursing, the faculty centred paradigm is being moved away from being lecture-centred and the students are being taught critical analytical skills, where they are the focal point within the learning environment.The term blended learning has recently become a 21st century ‘buzz phrase’ and the impact of this is that it has been ‘unpicked’ by both academia and industry and hence has taken on many meanings and definitions. According to Bersin (2004) the term blended means that traditional instructor-led training is being supplemented with other formats and, in this case, they are always in the electronic form.1This interpretation insinuates that, although there will always be a role for the lecturer or tutor to deliver learning in the classroom, the prediction appears to be that BL is the next st...

Combining video instruction followed by voice feedback in a self-learning station for acquisition of Basic Life Support skills: A randomised non-inferiority trial

IntroductionCurrent computerised self-learning (SL) stations for Basic Life Support (BLS) are an alternative to instructor-led (IL) refresher training but are not intended for initial skill acquisition. We developed a SL station for initial skill acquisition and evaluated its efficacy. MethodsIn a non-inferiority trial, 120 pharmacy students were randomised to IL small group training or individual training in a SL station. In the IL group, instructors demonstrated the skills and provided feedback. In the SL group a shortened Mini Anne™ video, to acquire the skills, was followed by Resusci Anne Skills Station™ software (both Laerdal, Norway) with voice feedback for further refinement. Testing was performed individually, respecting a seven week interval after training for every student. ResultsOne hundred and seventeen participants were assessed (three drop-outs). The proportion of students achieving a mean compression depth 40–50mm was 24/56 (43%) IL vs. 31/61 (51%) SL and 39/56 (70%) IL vs. 48/61 (79%) SL for a mean compression depth ≥40mm. Compression rate 80–120/min was achieved in 49/56 (88%) IL vs. 57/61 (93%) SL and any incomplete release (≥5mm) was observed in 31/56 (55%) IL and 35/61 (57%) SL. Adequate mean ventilation volume (400–1000ml) was achieved in 29/56 (52%) IL vs. 36/61 (59%) SL. Non-inferiority was confirmed for depth and although inconclusive, other areas came close to demonstrate it. ConclusionsCompression skills acquired in a SL station combining video-instruction with training using voice feedback were not inferior to IL training.

Sexual Harassment Training: Person versus Machine

Computer-based training is rapidly being implemented in organizations. Many advantages of this approach have been suggested (e.g., self-paced instruction, uniform content, and long-run cost efficiency) along with several potential disadvantages (e.g., noncompletion rates, computer availability). Despite the purported advantages of computer-based training, little research has examined the effect of computer-based training on learning. This field study systematically compared computer-based sexual harassment training with traditional instructor-led training. Overall, the results suggested that having a training course on sexual harassment, regardless of method of training, increased learning among the university employees who participated in these sessions. Reactions to both types of training were positive.

The Impact of E-Learning on Medical Education in Russia

New educational technologies prove to be capable of solving many problems in medical training. Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with others (collaborative learning), and transforming the role of the teacher. The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency. Still, their use in medical schools is being hampered by certain factors. This survey is a look at how it is possible to effectively use e-learning in medical education and what steps need to be made in that direction.

Efficacy of a fully computerised self-learning station for initial acquisition of basic life support skills: A randomised non-inferiority trial

Introduction: Current computerised self-learning (SL) stations for Basic Life Support (BLS) are an alternative to instructor-led (IL) refresher training but are not intended for initial skill acquisition. We developed a SL station for initial skill acquisition and evaluated its efficacy.

Comparison of two instructional modalities for nursing student CPR skill acquisition

Aims The purpose of the study was to compare performance based measures of CPR skills (compressions, ventilations with bag-valve-mask (BVM), and single rescuer CPR) from two types of CPR courses: a computer-based course (HeartCode™ BLS) with voice advisory manikin (VAM) feedback and instructor-led (IL) training with traditional manikins. Methods 604 nursing students from 10 schools of nursing throughout the United States were randomized by school to course type. After successful course completion, students performed 3 min each of compressions; ventilations with BVM; and single rescuer CPR on a Laerdal Resusci Anne ® SkillReporter™ manikin. The primary outcome measures were: (1) compression rate, (2) percentage of compressions performed with adequate depth, (3) percentage of compressions performed with correct hand placement, (4) number of ventilations/min, and (5) percentage of ventilations with adequate volume. Results There were no differences in compression rates between the two courses. However, students with HeartCode BLS with VAM training performed more compressions with adequate depth and correct hand placement and had more ventilations with adequate volume than students who had IL courses particularly when learning on hard molded manikins. During single rescuer CPR, students who had HeartCode BLS with VAM training had more compressions with adequate depth and ventilations with adequate volume than students with IL training. Conclusion Students who trained using HeartCode BLS and practiced with VAMs performed more compressions with adequate depth and ventilations with adequate volume than students who had IL courses. Results of this study provide evidence to support use of HeartCode BLS with VAM for training nursing students in CPR.

Instructor retraining and poster retraining are equally effective for the retention of BLS and AED skills of lifeguards

More than a million people in the USA and Europe suffer a sudden cardiac arrest each year. Thousands of people have to be trained in delivering help in such a situation. This cluster-randomized study compared two refresher training methods for basic life support and use of an automated external defibrillation: a traditional instructor-led course, and self-instruction by poster. One hundred and thirty-nine lifeguards were assigned to one of the two groups. Group A (n=79) received a 1.5 h, instructor-led refresher training course, whereas group B (n=60) was advised to refresh their own knowledge with a poster, a manikin, and an automated external defibrillation training device. The lifeguards were assessed 3, 6, and 12 months after the initial training. Seventy-five percent of the lifeguards in each group were deemed competent after 3 months. After 6 months, 78% lifeguards in group A and 75% in group B were considered competent. After 12 months, this was 71 and 76%, respectively. Young, less experienced lifeguards performed better than older, more experienced lifeguards. Refresher self-training by the use of a poster was as effective as, and more flexible than, scheduled, instructor-led refresher training.

Comparison of instructor-led automated external defibrillation training and three alternative DVD-based training methods

Background Self-directed BLS-training, using a personal training manikin with video has been shown to be as effective as instructor-led training. This has not previously been investigated for AED-training. Materials and methods This prospective, randomized study with a non-inferiority design compared traditional instructor-led training with three DVD-based AED-training methods (2.5 min DVD without practice; 4.5 min DVD with manikin practice; 9 min DVD with manikin practice and scenario training). After DVD BLS-training, 396 participants were assigned to one of the four AED-training methods by randomization stratified for age. Participants were tested immediately after the training (post-test) and 2 months later (retention-test) using modified Cardiff criteria. The primary endpoint was the percentage of providers scoring 70% or higher on testing. The secondary endpoints were the mean scores and differences per item per age group. Results Comparison non-inferiority could not be accepted for the post-test or retention-test. Relative risk (RR) and 95% confidence interval (CI) of passing for DVD without practice, with manikin practice and with manikin practice and scenario training compared to instructor-led training were 0.36 (0.25–0.53), 0.35 (0.24–0.51), 0.55 (0.38–0.79), respectively for the post-test, and 0.82 (0.68–0.97), 0.82 (0.68–0.97), and 0.84 (0.70–1.00), respectively for the retention-test. The performance of participants in all DVD-based training groups was significantly higher on the retention-test than on the post-test. Those receiving scenario training scored higher on the post-test compared to the other DVD-training groups ( p < 0.001). Conclusions DVD-based AED-training without scenario is not recommended. Scenario training is a useful addition, but instructor-facilitated training remains the best method.

Self-Assessed Emergency Readiness and Training Needs of Nurses in Rural Texas

Nurses, particularly public health nurses, play a key role in emergency preparedness and response in rural areas. To prepare rural jurisdictions for unforeseen disastrous events it is imperative to assess the public health emergency readiness and training needs of nurses. The objective of this study was to assess the self-reported terrorism preparedness and training needs of a nurse workforce. Cross-sectional prevalence of practicing nurses in regions of North Texas. 3,508 rural nurses practicing in North Texas participated in the study. Data were collected through a mailed survey; analyses included multinominal logistic regression and descriptive statistics. A total of 941 (27%) nurses completed the survey. The majority of respondents reported limited bioterrorism-related training. Fewer than 10% were confident in their ability to diagnose or treat bioterrorism-related conditions. Although only 30% expressed a willingness to collaborate with state and local authorities during a bioterrorism event, more than 69% indicated interest in future training opportunities. Preferred training modalities included small group workshops with instructor-led training, and Internet-based training. Licensing agencies, professional organizations, and community constituencies may need to play a stronger role in improving the bioterrorism-related emergency preparedness of rural nurses.

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.

Decision Point

In the defense industry, quality training is key to the military success of our troops. Increasingly, more training is developed for delivery in an online format, as “e-learning”?a convenient and cost-effective alternative to instructor-led training. With a learning management system such as the U.S. Navy uses, courses developed by contractors are posted into its database and accessed by naval users across the world. The Defense Source Company is an industry leader in defense products and services, including training. There are two divisions that provide such training, but there are differences in orientation and infrastructure that muddy the situation when developing training. This case provides an overview of this defense contractor with two related divisions that both offer similar resources. Readers are challenged to understand the infrastructure resources of both divisions and to decide what should be done with them for the ultimate success of the company.