A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer.

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months.   Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Effectiveness of self-re-learning using video recordings of advanced life support on nursing students' knowledge, self-efficacy, and skills performance.

BACKGROUND: Nurses are presumably the first to see an in-hospital cardiac arrest patient. This study proposed measuring nursing students' knowledge, self-efficacy, and skills performance in advanced life support (ALS), 6 months after training, by sending videos taken during their final skills test after the ALS training. METHODS: This is an experimental study using a randomised control group design. This study was conducted from June to December 2018, and the subjects of the study were 4th year students, recruited through a bulletin board at a nursing university. The participants' knowledge, self-efficacy, and skill performance in ALS were evaluated immediately after the training, and participants were videotaped during the final skills test. Thereafter, the videos were sent to the experimental group through a mobile phone messenger application, once a month, from the third month after training. Approximately six months after training day, a follow-up test was conducted for the measured variables using a blinded method. The paired t-test and Wilcoxon signed-rank test were used to compare the two groups pre-and post-intervention. The statistical significance level was set at p < .05. RESULTS: Six months after the ALS training, knowledge scores decreased significantly in both groups (p < 0.001). Self-efficacy decreased by about 3 points from 50.55 to 47.18 in the experimental group (p = 0.089), while it decreased by 10 points in the control group, from 50.67 to 39 (p < 0.001). The skills performance decreased from 27.5 to 26.68 in the experimental group, while it decreased significantly from 27.95 to 16.9 in the control group (p < 0.001). CONCLUSION: Self-study with videos taken during an ALS skills test helps enhance the sustainable effects of training such as knowledge, self-efficacy, and skills performance.

Performing newborn life support in advance of neonatal advanced life support course-back to basics?

In this retrospective analysis, the Newborn Life Support (NLS) test scenario performance of participants of the Dutch Neonatal Advanced Life Support (NALS) course was assessed. Characteristics of participants and total amount of failures were collected. Failures were subdivided in (1) errors of omission; (2) errors of commission; and (3) unspecified if data was missing. Pearson's chi-squared test was used to assess differences between participant groups. In total, 23 out of 86 participants (27%) failed their NLS test scenario. Life support course instructors in general (20/21) passed their test scenario more often compared to other participants (43/65) (p = 0.008). In total 110 fail items were recorded; the most common errors being not assessing heart rate (error of omission) (n = 47) and inadequate performance of airway management (error of commission) (n = 24).Conclusion: A substantial part of NALS participants failed their NLS test scenario. Errors of omission could be reduced by the availability of a checklist/NLS algorithm. Life support course instructors possibly make less errors of commission due to retention of skills by teaching these skills at least twice a year. Therefore, our study suggests that neonatal basic life support skills should be retained by local assurance of training programmes. What is Known: • Retention of skills after life support courses decreases after three months. • Adherence to newborn life support guidelines is suboptimal. What is New: • NLS performance is suboptimal in participants for advanced neonatal life support. • Most common failures are not assessing heart rate and inadequate airway management.

Aquisição e retenção de conhecimentos e habilidades em bases da técnica cirúrgica por estudantes de Medicina / Acquisition and retention of knowledge and abilities on basic surgical technique by students of Medicine

O médico de formação geral necessita possuir competências essenciais em cirurgia para a realização de pequenos procedimentos cirúrgicos. Tais competências precisam ser adquiridas ao longo do curso de graduação, cabendo ao currículo da escola médica oportunizá-las. Objetivo: este trabalho tem o objetivo de verificar a aquisição e a retenção de conhecimentos e de habilidades em bases da técnica cirúrgica por estudantes de Medicina ao longo de um curso médico. Metodologia: trata-se de um estudo longitudinal e quase-experimental na Fase 1 e transversal e observacional na Fase 2, em educação médica, realizado com a participação de estudantes do curso de Medicina da UNIFENAS, câmpus Alfenas, distribuídos entre 6º, 7º, 9º e 11º períodos do curso, que verificou a aquisição e a retenção de conhecimentos e de habilidades em bases da técnicas cirúrgicas proporcionadas ao longo do currículo. Os participantes foram submetidos a testes teóricos e práticos pré e pós a atividade curricular de cirurgia desses períodos. Resultados: o desempenho geral dos participantes nas provas, teórica e prática, revela uma relevante aquisição de conhecimento e de habilidades cirúrgicas em alunos do 6º período após a realização da disciplina de Bases da Técnica Cirúrgica (BTC) (p<0,001). Entretanto, a retenção desses conhecimentos e habilidades sofre queda progressiva, atingindo seu nadir 18 meses após a aquisição (p<0,001), com uma tímida recuperação nos estágios de Clínica Cirúrgica I e II, em que a maior exposição às atividades práticas nesses estágios pareceu favorecer a recuperação de habilidades práticas, ainda que não tenham retornado ao patamar da aquisição, no 6º período, porém o mesmo não se deu com o conhecimento. Conclusão: 1. A disciplina de BTC, ofertada no 6º período do curso de Medicina da UNIFENAS, câmpus Alfenas, permite uma adequada aquisição de conhecimentos e de habilidades em técnicas cirúrgicas aos estudantes. 2. Existe uma queda progressiva no desempenho em técnicas cirúrgicas dos alunos ao longo do currículo de cirurgia entre o 6º e o 9º períodos, com uma pequena recuperação no 11º período do curso. 3. A retenção de conhecimentos e de habilidades em técnicas cirúrgicas por estudantes de Medicina ao longo do curso atinge seu nadir aos 18 meses. 4. Os estágios de Clínica Cirúrgica I e II favorecem a recuperação de habilidades em técnicas cirúrgicas mais do que de conhecimentos

The general medical practitioner needs to have essential surgical skills to perform minor surgical procedures. These competencies need to be acquired throughout the undergraduate course, and the medical school curriculum must opportunize them. Objective: This study aims to verify the acquisition and retention of knowledge and skills on Bases of Surgical Technique by medical students throughout a medical course. Methodology: This is a longitudinal and quasi-experimental study in Phase 1 and transversal and observational in Phase 2 in medical education carried out with the participation of students from UNIFENAS medical school, Campus Alfenas, distributed between 6th, 7th, 9th and 11th periods of the course, which verified the acquisition and retention of knowledge and skills in Bases of Surgical Techniques provided throughout the curriculum. The participants were submitted to theoretical and practical tests before and after the curricular activity of surgery of these periods. Results: The general performance of the participants in the tests, theoretical and practical, reveals a relevant acquisition of knowledge and surgical skills in students of the 6th period after completion Bases of Surgical Technique discipline (BST) (p <0.001). However, the retention of this knowledge and skills suffers a progressive decrease, reaching its nadir 18 months after the acquisition (p <0.001), with a slight recovery in the stages of Surgical Clinic I and II, where the greater exposure to the practical activities in these stages seemed to favor the recovery of practical skills, although they did not return to the level of the acquisition, in the 6th period, but the same did not happen with the knowledge.Conclusion: 1. The BST discipline, offered in the 6th period of UNIFENAS medical course, Alfenas campus, allows an adequate acquisition of knowledge and skills in surgical techniques to students. 2. There is a progressive decrease in the performance of students in surgical techniques throughout the 6th and 9th periods, with a slight recovery in the 11th period of the course.3. The retention of knowledge and skills in surgical techniques by medical students throughout the course reaches its nadir at 18 months. 4. The stages of Surgical Clinic I and II favor the recovery of skills in surgical techniques rather than knowledge.

Evaluation of palliative care training and skills retention by medical students.

BACKGROUND: Training in palliative and end-of-life care has been introduced in medical education; however, the impact of such training and the retention of skills and knowledge have not been studied in detail. This survey study examines long-term follow-up on end-of-life communication skills training, evaluation, and skills retention in medical students. MATERIALS AND METHODS: During the surgical clerkship, all third-year medical students received communication skills training in palliative care using simulated patients. The training involved three scenarios involving diverse surgical patients with conditions commonly encountered during the surgical clerkship. The students used web-based best practice guidelines to prepare for the patient encounters. The following communication abilities were evaluated: (1) giving bad news clearly and with empathy, (2) initiating death and dying conversations with patients and/or their family members, (3) discussing do not resuscitate status and exploring preferences for end-of-life care, and (4) initiating conversations regarding religious or spiritual values and practices. All students were surveyed after 1 year (12-24 mo) to ascertain: (1) the retention of skills and/or knowledge gained during this training, (2) application of these skills during subsequent clinical rotations, and (3) overall perception of the value added by the training to their undergraduate medical education. These results were correlated with residency specialty choice. RESULTS: The survey was sent to all graduating fourth-year medical students (n = 105) in our program, of which 69 students responded to the survey (66% response rate). All respondents agreed that palliative care training is essential in medical school training. Seventy percent of the respondents agreed that the simulated encounters allowed development of crucial conversation skills needed for palliative/end-of-life care communications. The most useful part of the training was the deliberate practice of "giving bad news" (85%). Most of the respondents (80%) indicated retention of overall communication skills with regard to approach and useful phrases. Forty-five percent claimed retention of communication skills surrounding death and dying, and 44% claimed retention of end-of-life preferences/advance directives/do not resuscitate. Relatively few respondents (16%) retained skills regarding religious or spiritual values. There was no correlation between training evaluation/skill retention and the area of residency specialty the students pursued on graduation. CONCLUSIONS: Early training in palliative and end-of-life care communication is feasible and effective during the surgical clerkship. Students highly valued the simulated patient and/or family discussions and retained most of the skills and knowledge from the experiential simulated encounters. However, students felt the skills developed could be reinforced with opportunities to observe their attending physicians or residents leading such discussions and involving students in such discussions as and when appropriate.

Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal.

BACKGROUND: Each year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal. METHODS: A time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis. RESULTS: One hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9-13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4-9.7). CONCLUSIONS: Health workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing. TRIAL REGISTRATION: ISRCTN97846009 . Date of Registration- 15 August 2012.