The effect of instructor experience and manikin KR feedback on the acquisition of cardiopulmonary resuscitation skill proficiency
Date
1983
Authors
Campbell, Noreen Agnes Anne
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
This study evaluated the proficiency of cardiopulmonary resuscitation (CPR) skill demonstrated by forty- eight female subjects enrolled in a Basic Life Support Course. Instructor experience and the knowledge of results (KR) potential of the CPR training manikin were independent variables while CPR proficiency was the dependent variable. Aspects of CPR performance analyzed were ventilation technique, compression technique, incidence of camping, incidence of pressure points, and timing of performance (ventilation phase, compression phase and total cycle).
The criterion performance was the Canadian Heart Foundation standard for Single Person Rescue (1978). Prior to skill practice with the manikin a taped criterion was obtained as a control. A learning trial consisted of three minutes of instruction by either an inexperienced or experienced instructor on a manikin with either gross or precise KR potential. Three consecutive trials were conducted to provide information about the acquisition of CPR skill. A post-test performance was recorded after a minimum of fifteen minutes to reduce the possible effect of fatigue and determine CPR skill proficiency at the time of certification.
Data from performance tracings were used to calculate absolute error (AE), constant error (CE), and variable error (VE). Proficiency is based on the degree to which the magnitude of error (AE) approximates the criterion performance which is considered error free (zero). The CE score indicates the directional bias of the errors relative to the criterion and may be used to provide specific remedial instruction. The VE value reflects the consistency of the subject's performance. Error analysis provides quantitive and qualitive data which is sensitive to gradual changes in motor skill performance.
Results were subjected to two-way ANOVA (2 x 2, instructor experience x type of KR) and significant differences were further tested by three-way ANOVA (2 x 2 x 5, instructor experience x type of KR x time). Evidence of superior performance by the experienced instructor group compared to the inexperienced instructor group was obtained for timing of the ventilation phase (p=. 000) and total cycle time (p= .002). Subjects using manikins with precise KR potential were superior in compression technique (p =. 001) , timing of the compression phase (p = .03) and total cycle time (p =.02) , compared to the group using gross KR manikins. No significant difference in the post-test was identified for an interaction between instructor experience and type of KR.
Although the study failed to identify a clear advantage of either, instructor experience or type of KR provided by the manikin it provided descriptive information about the acquisition of CPR skill proficiency. The error information identified a graded response to instruction, with unique patterns of error change relative to the four treatment groups. A possible speed/accuracy trade-off may exist for ventilation time and technique. Further research is required to identify effective instructional strategies. A gender effect is suspected in view of the finding of under-ventilation and compression by the female subjects while in Tweed's study (1980, b) male subjects demonstrated over-ventilation and over-compression errors. The disparity between actual and assumed CPR proficiency of certified learners, if the finding of this study are replicated, may indicate experimental error in determining CPR skill retention and subsequent interpretation of the significance of retention studies. This study indicates the need for objective methods to evaluate CPR proficiency and determine the efficacy of instructional strategies.