Basic life support skills training in a first year medical curriculum: six years’ experience with two cognitive–constructivist designs

Figures & data

Table

Practice points

Better training designs are needed for BLS in medical education. Cognitive–constructivist training designs are promising in skills training and associated with high student satisfaction. With a competence based, cognitive apprenticeship model, the training program, including 9 hours theoretical and 12 hours practical small group sessions, is sufficient for BLS skills.

Table 1.  Basic properties of implemented BLS skills training modules

	Educational years^a
Properties	1997–1998	1998–1999	1999–2000	2000–2001	2001–2002	2002–2003
Number of students	136	372	301	293	258	400
Number of rotated groups	2^c	3^b	3^b	3^b	4^c	4^b
Number of skill tutorial groups	8	24	24	24	16	32
Students per trainer	16	16	13	12	16	13
Practical hours per student	20	14	14	12	18	12
Theoretical hours per student	9	9	9	9	9	9
Total training hours per student	29	23	23	21	27	21
Fail rates (%)	2, 2	1, 1	1, 0	1, 4	1, 2	1, 0

^a Four tutors facilitated the training sessions.

^b Each rotation group was divided into eight small groups. Sessions were divided into two parts and two small groups rotated in these sessions.

^c Each rotation group was divided into four small groups.

Figure 1. The BLS Skills Training module's educational approaches.

Figure 2. Basic Life Support Skills and their clustered skills tutorial at the module.

Table 2.  The types and sessions of instructional activities of module by the stages

Instructional activities		Stage 1	Stage 2
1. Introductory lessons	Lecture	2	1
2. Video film	Documentary film about BLS	1	–
3. Chain of survival and BLS algorithms	Small group discussion	–	1
4. Checking consciousness, airway management, foreign body removal and recovery position	Skill tutorial	1	1
5. One rescuer CPR procedures for adults		1	1
6. Two rescuer CPR procedures for adults		1
7. Pediatric CPR and airway management		1	1
8. Automatic external defibrillation and general repetition of CPR skills		1	1
9. Scenario based reinforcement and repetition	Small group discussion and practice	–	1
10. Self study-drill	Study with peers	1	1

Table 3.  Components of the Cognitive Apprenticeship Model and their counterparts in the BLS module

Component		Sub-process	Principles	Module's training activities
Trainer	1. Modeling	Explanations, correct and fluid demonstration	Observation-clarifying Goal Setting Knowledge acquisition Encoding Elaboration, networking	Introductory lectures Video session Algorithm tutorial Demonstration in skills tutorials
	2. Coaching	Observing student performance, providing feedback, providing corrective instruction	Feedback Reinforcement Metacognition	Video session Algorithm tutorial Reader and training checklists
	3. Scaffolding	Suggesting, hints, physical props	Accomplishment of the task (motivation)	Skills tutorials’ process Scenario session Video session Algorithm tutorial
Student	4. Articulation	Summarizing, describing, reasoning, etc.	Learning is constructive process—constructive acting	Articulation and practice in the skills tutorials
	5. Reflection	Evaluating own learning process	Metacognition Expert model	Algorithm tutorial Scenario session
	6. Exploration	Pursuit of new goals, testing hypothesis or assumptions	Motivation Transfer Self directed learning	Peer evaluation Self study

Adapted from Ford (1995).

Table 4.  Means and standard deviations (between brackets) of the students’ scores in the years

	1997–1998	1998–1999	1999–2000	2000–2001	2001–2002	2002–2003	Sig.
Assessment procedure	n = 136	n = 372	n = 301	n = 293	n = 258	n = 400	F	p
MCQ	77.3 (13.5)	79.5 (12.5)	81.3 (11.5)	80.9 (11.6)	81.0 (11.2)	81.3 (12.2)	1.403	0.11
OSCE	81.3 (13.0)	81.9 (12.8)	82.0 (11.8)	81.5 (12.2)	81.6 (12.4)	81.8 (13.0)	0.656	0.96

Table 5.  Educational years and number of responses and coverage rates and average means and standard deviations (in bracket) of the students’ ratings

	Items	1997–1998	1998–1999	1999–2000	2000–2001	2001–2002	2002–2003	Total	F(Anova)	p*
		N = 103 (75.7%)	N = 345 (92.7%)	N = 208 (69.1%)	N = 265 (90.4%)	N = 210 (81.4%)	N = 366 (91.5%)	N = 1497 (91.5%)
Input	1. Physical settings were adequate	3.4 (0.6)	3.4 (0.8)	3.6 (0.8)	3.8 (1.0)	4.0 (0.9)	4.0 (0.9)	3.7 (0.9)	27.799	0.000
	2. Total duration of the module was sufficient	3.9 (0.8)	4.1 (0.8)	3.8 (0.9)	4.1 (0.8)	4.0 (0.7)	4.1 (0.7)	4.0 (0.8)	2.756	0.017
	3. Various appropriate educational devices were used	4.3 (0.6)	4.1 (1.0)	4.0 (0.9)	4.1 (1.0)	4.0 (1.0)	4.1 (0.9)	4.1 (0.8)	1.518	0.181
	4. Module notes and study guide helped me to learn	3.5 (0.9)	4.2 (0.9)	4.0 (0.9)	3.7 (1.0)	4.0 (0.9)	4.0 (0.9)	3.9 (0.9)	15.216	0.000
	5. Skills trainers had sufficient level of knowledge and skills to teach BLS	NA	NA	NA	4.4 (0.8)	4.3 (0.9)	4.3 (0.8)	4.3 (0.9)	2.534	0.004
	6. Skills trainers were good COACHES to teach BLS	4.3 (0.9)	4.1 (0.9)	4.3 (0.9)	4.4 (0.8)	4.1 (0.8)	4.2 (0.8)	4.3 (0.9)	2.332	0.002
Process	7. There was enough opportunity provided to be actively involved in the sessions	4.1 (0.9)	4.1 (0.9)	4.1 (0.9)	4.3 (0.8)	4.2 (0.8)	4.2 (0.8)	4.2 (0.9)	6.163	0.000
	8. I enjoyed this module while I was learning	4.1 (0.6)	4.3 (0.6)	4.3 (0.8)	4.5 (0.8)	4.3 (0.8)	4.3 (0.9)	4.3 (0.9)	4.279	0.014
	9. In the sessions there was overload of information	NA	NA	NA	2.4 (1.0)	2.9 (1.2)	3.0 (1.2)	2.8 (1.2)	28.190	0.000
	10. During the module “where I must be when” information was always sufficiently provided	NA	NA	NA	4.5 (0.7)	4.3 (0.8)	4.3 (0.8)	4.3 (0.8)	3.508	0.004
Output	11. I believe I’ll use these skills in my further educational years	NA	NA	NA	4.2 (0.9)	4.2 (0.9)	4.2 (0.9)	4.2 (0.9)	0.068	0.934
	12. I believe I’ll use these skills in my professional life	NA	NA	NA	3.9 (0.9)	3.9 (0.9)	3.9 (1.0)	3.9 (0.9)	0.248	0.781

* The mean difference is significant at the 0.05 level.

Table 6.  Bonferroni post hoc analysis results for significant differences

Years	1	2	3	4	5	6
1
2	(4), (7)
3	(4), (7)	(1), (2)
4	(1), (7), (8)	(1), (4)	(4)
5	(1), (4), (7)	(1), (4)	(1)	(6), (9), (10)
6	(1), (4), (7)	(1), (4)	(1), (2)	(5), (6), (9), (10)	–

The mean difference is significant at the 0.05 level. (The numbers in plain brackets indicate the SEQa--b items’ numbers. The numbers in bold brackets indicate the SEQb items’ numbers.)