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Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285.

The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison. This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS. This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed. A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36% vs 25/25, 100%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US $103.68 less expensive in a single-learner, single-session model. Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale.

The effects of the flipped classroom have been demonstrated in various fields of education in recent years. Training in emergency medicine is also beginning to gradually implement the flipped classroom; however, its practical effect in emergency medicine contexts is not yet clear. The present study investigates the effects of the flipped classroom on advanced cardiopulmonary life support (ACLS) training implemented among practicum students in emergency medicine. The study randomly assigned into control and experimental conditions 108 fourth year students in the College of Medicine at Yonsei University, in Seoul, who were scheduled to take clinical practice in emergency medicine between March and July 2017. Students were taught about ACLS in either a traditional lecture-based classroom (control condition) or a flipped classroom (experimental condition); then, simulation training with ACLS scenarios was carried out. Finally, each student was rated on performance using a rating form developed in advance. ACLS simulation scores of the students in the flipped classroom were 70.9±10.9, which was higher than those of the students in the traditional classroom (67.1±11.3); however, this difference was not statistically significant (p = 0.339). In addition, the difference in student satisfaction as measured on a survey was statistically insignificant (p = 0.655). Competency assessment after simulation-based training in ACLS undergone by senior medical students randomly assigned to flipped and traditional classrooms showed no statistical difference in competency between the two groups.

To assess pharmacy students’ ability to retain advanced cardiac life support (ACLS) knowledge and skills within 120 days of previous high-fidelity mannequin simulation training. Students were randomly assigned to rapid response teams of 5-6. Skills in ACLS and mannequin survival were compared between teams some members of which had simulation training 120 days earlier and teams who had not had previous training. A checklist was used to record and assess performance in the simulations. Teams with previous simulation training (n=10) demonstrated numerical superiority to teams without previous training (n=12) for 6 out of 8 (75%) ACLS skills observed, including time calculating accurate vasopressor infusion rate (83 sec vs 113 sec; p=0.01). Mannequin survival was 37% higher for teams who had previous simulation training, but this result was not significant (70% vs 33%; p=0.20). Teams with students who had previous simulation training demonstrated numerical superiority in ACLS knowledge and skill retention within 120 days of previous training compared to those who had no previous training. Future studies are needed to add to the current evidence of pharmacy students’ and practicing pharmacists’ ACLS knowledge and skill retention.

Objective. To determine whether a high-fidelity simulation technique compared with lecture would produce greater improvement in advanced cardiac life support (ACLS) knowledge, confidence, and overall satisfaction with the training method. Design. This sequential, parallel-group, crossover trial randomized students into 2 groups distinguished by the sequence of teaching technique delivered for ACLS instruction (ie, classroom lecture vs high-fidelity simulation exercise). Assessment. Test scores on a written examination administered at baseline and after each teaching technique improved significantly from baseline in all groups but were highest when lecture was followed by simulation. Simulation was associated with a greater degree of overall student satisfaction compared with lecture. Participation in a simulation exercise did not improve pharmacy students’ knowledge of ACLS more than attending a lecture, but it was associated with improved student confidence in skills and satisfaction with learning and application. Conclusions. College curricula should incorporate simulation to complement but not replace lecture for ACLS education.

Patients with out-of-hospital respiratory distress who received treatment from emergency medical services personnel with advanced-life-support training had a lower in-hospital mortality than those who received treatment from providers without this training. The difference may be in part attributable to advanced-life-support interventions. Whether the data are sufficient to justify broad implementation of such training is unclear. Patients with out-of-hospital respiratory distress who received treatment from emergency medical services personnel with advanced-life-support training had a lower in-hospital mortality than those who received treatment from providers without this training. Each year, emergency medical services (EMS) personnel in the United States transport 2 million patients with respiratory distress to hospitals by ambulance. Respiratory distress is the second most common symptom of adults transported by ambulance and is associated with a relatively high overall mortality before hospital discharge of 18%. 1 – 3 Among the most common causes of respiratory distress in this setting are congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and asthma. In many cities in the United States and Canada, out-of-hospital care for critically ill and injured patients is provided by paramedics who are trained in advanced-life-support measures. Advanced . . .

This study examined the effect of simulation on nursing students’ knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest–posttest) design was used. The experimental group ( n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group ( n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students’ knowledge acquisition, knowledge retention, and confidence about ACLS. [ J Nurs Educ. 2014;53(1):38–44.]

First is the flexibility of PBLD. [...]PBLD enables simultaneous participation of a larger number of multi-professional participants from a variety of specialties and professions, compared to manikin-based scenario training [4].

Background Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve. Methods A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor. A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents. The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks. Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness. The results were analysed using Exact methods, chi-squared and t-test. Results A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group. There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes. Conclusions The key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.

Advanced Cardiovascular Life Support (ACLS) knowledge and skills retention is poor among clinicians. Deviations from ACLS guidelines are common and are associated with worse outcomes and less experienced code leaders often feel unprepared to lead resuscitations. To develop a schematic for assisting code leaders in managing the initial phase of cardiac arrest resuscitations. We reviewed the medical literature evaluating the effectiveness and timing of ACLS interventions in adult cardiac arrest, with a focus on identifying tasks most strongly associated with patient-centered outcomes and those most closely aligned with existing ACLS protocols. Four clinical content experts assessed the literature and independently ranked tasks to be included in the mnemonic; the final ranked list was approved by consensus discussion. We then incorporated our ranked list into a mnemonic using principles of cognitive load theory, including chunking, serial recall, and the primacy effect. We identified five early interventions with strong evidence supporting their impact on outcomes. These interventions form the core of “CPADS-30”, a simplified mnemonic designed to facilitate memory recall and facilitate task delegation in the first 30 s of cardiac arrest resuscitation. These tasks include C (Chest compressions), P (Pad [defibrillator] placement), A (Access [intravenous/intraosseous]), D (Drug administration) and S (Scribe assignment). “CPADS-30” distills down critical early actions of cardiac arrest management into a discreet, digestible schematic that complements the complete ACLS algorithm. We hope “CPADS-30” will prove useful to trainees and providers of all levels of training in various practice environments.