Distance Learning Studies
JumpSTART Triage (click for more) In cooperation with the National Association of Emergency Medical Technicians (NAEMT), CIT evaluated the effectiveness of JumpSTART training in changing prehospital and/or registered nurses’ (from school-based settings) performance in triaging pediatric patients involved in a multiple casualty incident immediately post-training and at a 3-4 month follow-up interval. A convenience sample of participants was selected from three divergent geographic locations. This study will be published in Pediatric Emergency Care.
Randomized, Multi-Site Comparison of Pediatric Training Methods The U.S. Department of Health and Human Services and Emergency Medical Services-Children channeled through the Montana Emergency Medical Services-Children (EMSC) program to contract with CIT to evaluate two very distinct prehospital provider training methods. It was a unique research opportunity for CIT in that Montana was focusing its efforts on electronic training of prehospital providers while Wyoming was using more traditional train-the-trainer methods. After being evaluated by a panel to determine whether there is a measurable difference in performance in one or both of the test sites, as compared with each other and with a control site. Study Hypothesis: Two training methods and a control group were compared. The null hypothesis was that no differences between the methods would be found when measured by pre and post test results. Methods: The model was a prospective randomized trial involving 12 sites and 4 demographic stratifications. Three states were selected to participate. State EMS agencies provided lists of ambulance services stratified by demographic characteristics. Sites were randomly selected. Pre-intervention measurements were conducted by a team traveling to each of the 12 sites and included a written measurement and 2 performance scenarios that were videotaped for later evaluation by an independent panel. Training was made available through either CD ROM or train-the-trainer methods. The control group received no training. A follow-up evaluation was conducted at 12 months. Mean changes in written, performance and combined scores were analyzed. Results and Conclusion: A difference was noted in both the combined scores and the performance evaluation scores between the self-study CD ROM intervention group and the other two groups. No differences were noted in written measurements. Attrition resulted in a small post intervention sample size (N = 77) that precluded analysis by multiple stratifications and may have produced Type II errors and/or selection bias. CD ROM training may improve out-of-hospital care providers’ performance. The research model, with modification to protect against the high rate of attrition, shows promise. With refinement, replication of this research approach appears warranted and provides a working model for multi-site EMS education research. Interactive Video Pediatric Advanced Life Support (PALS) Training: An Exploratory Analysis Objective. An evaluation of the feasibility of conducting Pediatric Advanced Life Support (PALS) using two-way, real-time, interactive video teleconferencing was conducted. Methods. Students participated in a self-study method of mastering the didactic portion of the program using a written textbook, videotapes, and a self-study work book. All students successfully completed the written examination prior to the practical skill instruction and testing. There were three groups of students, two of which were physically remote from the physician faculty. Practical skill instruction occurred differently between the two remote groups. The first group used a videotape to guide the skill station set-up and instruction, relying on peer-to-peer mentoring for skill instruction. The second group relied on a local coordinator to assist with the skills station set-up, instruction and mentoring. Limited skill instruction was available to the remote sites via video teleconferencing. The physician faculty completed the skills evaluation for the two remote sites by using the video conferencing technology. The third group received on-site skill instruction, mentoring and evaluation from physician faculty. Results. All students (N=15, K=3) successfully completed the course. Students, local coordinators and physician faculty all rated the course average or above. Previous PALS experience influenced the results of the written examination and the overall satisfaction with the format of instruction. All participants confirmed that remote skill instruction and evaluation using video teleconferencing is a viable alternative to on-site physician faculty participation. Conclusion. Improvements in format and methods for the delivery of remote site PALS education would likely increase efficacy and satisfaction for the students. Additional, structured evaluation is warranted and planned.
Alternative Training Methods: A Retrospective
Analysis This paper provides a retrospective analysis of training methods used by rural Montana’s prehospital providers. Drawn from both published and unpublished sources and spanning the past 25 years, it examines the origins of training in this vast rural state and aims to shed light on successful, nontraditional training delivery methods currently being used. Because volunteer personnel traditionally provide prehospital emergency care in rural areas, development and implementation of effective training programs are generally considered important to helping these practitioners maintain the knowledge and skills they use in their lifesaving methods. Examining five different training methods, the paper suggests that remote training methods that train the providers directly are effective and popular. It also suggests that the application of electronic media and other distance learning techniques have demonstrated a positive impact on the frequency, quality, and standardization of training for volunteer prehospital EMTs.
Self-Study, Remote and Traditional PALS Training
Objective: To compare
the effectiveness of a guided self-study and remote evaluation PALS
course with traditional PALS instruction. Differences were measured by
pre, post and 3 month follow-up written
exams and performance video tapes.
Methods: Two locations were selected to participate in the experimental group
and two in the control group. A medium size (15-25,000) and a small
(< 2500) community was paired in each of the two groups. The
experimental group received self-instructional materials including
video tapes, workbooks and textbooks. Participants in those groups had
to reach criteria on the written examination prior to being included
in the remote teaching and evaluation session. That session was
conducted using two way interactive video teleconferencing. The
instructor/evaluator was in one location and the students in another.
An assistant helped secure equipment and conduct administrative tasks
at the student site. At the two control sites the PALS course was
taught using standard methods by two outside faculty members. Measures
included a written exam administered prior to the course, an
end-of-course and a 3 month follow-up exam. Additionally, performances
in the evaluation stations were videotaped for later evaluation by an
independent panel. A true Likert scale was developed by the review
panel by reviewing performance tapes from individuals who had not
participated in the entire course.
Results: Both experimental groups and one control group’s knowledge improved
when measured independently between the pre and the end-of-course
written examinations. (Experimental group one (EG1) t 3.518, df 5, p =
.017, CI 3.28 - 21.06; experimental group two (EG2) t 12.484, df 3, p =
.001 CI 23.10 - 38.90; control group two (CG2) t = 4.938, df 7, p =
.002, CI 12.38 - 35.12). The remaining group (CG1) combined scored lower
on the end-of-course examination than on the pre test by an mean of 6%.
The combined experimental group (EG1 + EG 2) and combined control group
(CG1 + CG2) performed similarly on the written pre test (EG 75.6%, CG
70.5%), indicating similarities in prior knowledge. However, the
experimental group performed better on the written end-of-course exam
(experimental 95.3%, control 84.25%; t 3.631, df 20, p = .002 CI 4.7 -
17.4). Three month follow-up scores were calculated for both
experimental groups and one of the control groups. The comparative
results between the end-of-course and three month retention follow-up
showed a non-significant degradation in scores of 5.5% for the
experimental group and 4.5% for the control group.
An independent panel of PALS instructors from another state was convened
to review the performance tapes. The panel began to review the
performance tapes. However, this activity had to be abandoned since the
format of the tapes acquired at the experimental sessions was
substantially different from that acquired in the control sessions.
Additionally, it was obvious that there was significant coaching that
occurred during many of the performances. These two issues made the
independent, unbiased, review
and scoring of individual performances impossible.
Conclusion:
Remote, self-study and guided evaluation of PALS appears feasible.
Students who prepared using these self-study methods performed better in
end-of-course measures than did those trained in more traditional
courses. Knowledge degradation at three-months post training was similar
between the two groups. Unfortunately, the effects of the strategy on
performance indicators could not be ascertained in this study due to
limitations in the implementation methods and errors in video taping of
the performances. Additional trails using more structured and closely
controlled methods are warranted.
The
Pediatric Emergency distance learning pilot test included self-study
materials contained on an Internet World Wide Web site, in published
textbooks, and on interactive CD-ROM programs. The training was
conducted by an instructor in Salt Lake City, UT, who communicated with
9 prehospital providers using E-mail and desktop video conferencing. The
instructor reviewed and critiqued videotapes of the ambulance crew
members’ performance skills. The
pilot program shows promise for making high quality training, including
performance skills training, available to all prehospital providers,
regardless of their location. |
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