Undergraduate cardiac arrest team training Valerie O’Toole Baker1, Suzanne Sturdivant2, Carolynn Masters3, Michael McCarthy4 and Jestin Carlson4,5,6 1
Villa Maria School of Nursing, Morosky College of Health Professions and Sciences, Gannon University, Erie, Pennsylvania, USA 2 Radiologic Sciences Program, Morosky College of Health Professions and Sciences, Gannon University, Erie, Pennsylvania, USA 3 Morosky College of Health Professions and Sciences, Gannon University, Erie, Pennsylvania, USA 4 Patient Simulation Center, Morosky College of Health Professions and Sciences, Gannon University, Erie, Pennsylvania, USA 5 Department of Emergency Medicine, Saint Vincent Health System, Erie, Pennsylvania, USA 6 Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA SUMMARY Background and objectives: Health profession students are traditionally educated within their discipline with little to no interaction with other health professionals, but are expected to function as integral members of the health care team after graduation. Health profession educators must bridge this disconnect by providing interprofessional learning experiences for students. We sought to evaluate the impact of interdisciplinary team-based (ITB) versus individual discipline-based (DB) learning with multiple health care disciplines during a simulated cardiac arrest.
Methods: We performed a randomised trial with trainees from radiologic science (RS), physician assistant (PA) and nursing programmes (RN), taught by ITB and DB methods. Teams assessed a simulated patient experiencing a cardiac arrest before and after being educated using the First 5 Minutes® Curriculum (First–5). Knowledge and subjective evaluations were collected on each participant both before and after the educational intervention. The data were analysed using generalised estimating equations to account for correlated data. Results: We enrolled 29 subjects: 15 ITB (4 PA, 5 RN, 6 RS) and
14 DB (3 PA, 5 RN, 6 RS). Knowledge improved more in the ITB group than in the DB group: with a median change of 2 (IQR 0–2) versus 1 (IQR 0–2), respectively (p = 0.014). Subjectively, participants overwhelmingly responded that working and learning with other disciplines was a valuable experience, and that more opportunities for interdisciplinary learning should be integrated into the curriculum. Discussion: In our pilot study using a simulated model and the First–5, ITB education appears to improve trainees’ knowledge over DB education, and was subjectively preferred by the learner.
More opportunities for interdisciplinary learning should be integrated into the curriculum
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Most undergraduate health professional students have little knowledge of the role and responsibilities of other disciplines
nterprofessional collaborative practice, where health professionals from multiple professions work together as a team, is essential when providing safe, high-quality and effective patient-centred care.1 Health profession educators traditionally focus on discipline-specific responsibilities in the treatment of patients with students, having little to no interaction with other health professionals. As a result, most undergraduate health professional students have little knowledge of the role and responsibilities of other disciplines, yet are expected to collaboratively care for patients when practising as a health care provider. Health profession educators can help bridge this disconnect by providing interprofessional team-based (ITB) learning experiences for students, as opposed to traditional discipline-based (DB) education.2,3 Efficient team performance is critical in the care of acutely ill patients, whereas the stressful nature of these situations can lead to increased confusion, impaired team communication and poor clinical outcomes.4 Multiple educational programmes have been developed to help train providers for these situations, including The First 5 Minutes® Curriculum (First–5; WISER, Pittsburgh, PA, USA). We sought to determine the impact of ITB versus DB cardiac arrest training on undergraduate students using the First–5.
METHODS Study population We performed a pilot study, enrolling students from the second year of a 2–year associates Radiologic Science (RS) programme, the fourth year of a 5–year master’s degree Physician Assistant (PA) programme and the fourth year of a 4–year
baccalaureate Registered Nurse (RN) programme. We required participants to have previous cardiopulmonary resuscitation (CPR) certification to help reduce variation in baseline acute-care knowledge across participants. Students from each discipline were randomly drawn from a list of volunteers and assigned to one of two training groups (DB or ITB), in alternating fashion. All participants completed a prescenario test of knowledge, were involved in a simulated cardiac arrest and then educated using First–5 training with either the DB or the ITB method.5 A single educator provided all education using the predesigned First–5 curriculum with both the DB and ITB groups.5 Participants then completed a second simulated cardiac arrest followed by a post-scenario test of knowledge. All data were collected on a single day at our Patient Simulation Center using a convenience sample of student volunteers. Educational experience Students participated in cardiac arrest training using the First 5 Minutes Simulation Based Training Module (WISER, Pittsburgh, PA). Although there are several training programmes
that are designed to teach individuals how to care for acutely ill patients, the First–5 has been designed specifically for interprofessional training. The First–5 is a didactic and simulation-based course designed for multiple disciplines to foster collaboration while completing key resuscitative tasks prior to the arrival of medical emergency response teams. Although it has been used to educate practising providers we are unaware of any published studies regarding its use in the undergraduate health science population, and we sought to test its impact on this population.5 Primary outcome Early problem recognition and rapid responder activation are key components in the chain of survival for hospitalised patients in cardiac arrest, highlighting the importance of provider knowledge relating to basic life support.6,7 Given the limited data regarding interprofessional cardiac arrest training for undergraduate students, we developed a questionnaire through consensus of the authors. This was designed to assess knowledge regarding the primary goals of the First–5 when caring for patients in cardiac arrest (Figure S1).5 Our primary outcome was knowledge as
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measured by pre- and post-test scores, ranging from 0 (lowest) to 10 (highest). Data analysis After obtaining informed consent, we collected baseline demographics on participants along with pre- and post-training data on participants’ knowledge of care of the patient in cardiac arrest. Objective data were analysed using descriptive statistics with STATA 12 (Stata Corp., College Station, TX, USA). As subjects initially may have differing levels of knowledge, we collected both pre- and post-training data, allowing us to assess the impact of each training method. To account for the correlated nature of the data (multiple data points collected on the same individual) we used generalised estimating equations. During debriefing, participants were allowed to write subjective comments regarding their experience, and these were grouped thematically by author consensus. This study was approved by our university’s Institutional Review Board.
Table 1. Participant demographics Interdisicplinary team based (n = 15)
Discipline based (n = 14)
Mean age (SD)
20 (1) years
20 (1) years
Radiologic science (%)
Physician assistant (%)
Pre-scenario knowledge Median (IQR)
Change in knowledge (p = 0.014) Median (IQR)
Participants gained an increased awareness of the crossover of knowledge between all health care professionals
IQR, interquartile range; SD, standard deviation.
Table 2. Thematic analysis of participants’ experiences Question
What did you like best about the experience? (n = 20)
Working with other disciplines (14)
What did you like least about the experience? (n = 21)
Groups were too large (7)*
Learning skills (6)
I didn’t know what to expect (5) The scenario is not within my role (2) Others’ attitudes (2)
RESULTS We enrolled 29 subjects: 15 ITB and 14 DB (Table 1). Knowledge improved more in the ITB group than in the DB group: with a median change of 2 (IQR 0–2) and 1 (IQR 0–2), respectively (p = 0.014). Reviews of the interprofessional experience by participants were overwhelmingly positive. Nearly half of the ITB participants suggested a follow-up scenario working with one member of each discipline (Table 2).
DISCUSSION In our pilot study students taught with ITB education showed a greater improvement in knowledge of patients in cardiac arrest, and this methodology was preferred by the participants. When asked what they liked best about interprofessional training,
Other majors took over (2) Being recorded (1) Having to work with other majors (1) What would you suggest to improve this experience? (n = 23)
Make the groups smaller (9)* More than one scenario to practice (7) Nothing, it was great (3) Teach more skills in the scenario (2) Include more disciplines in the scenario (2)
*All ITB group.
70 per cent of the participants responded with ‘Working with other disciplines’, and suggested including more ITB learning experiences in the curriculum. Health educators often include care of the patient in medical crisis in their respective curricula, and graduates are then expected to function as integral members of the health care team, working
with others to care for patients in crisis. Participants stated that they gained an increased awareness of the crossover of knowledge between all health care professionals in the care of the patient in cardiac arrest. Many participants (75%) were not aware of the fact that other health care professionals are CPR certified.
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Participants in our study subjectively preferred the ITB educational method over DB education
We are unaware of any cardiac arrest training programmes specifically designed for interprofessional training of undergraduate students. After a review of several cardiac arrest training programmes for health care providers, we chose to use the First–5 course, which was designed to improve the interprofessional care of patients prior to the arrival of the emergency response team. Previous work has shown that nursing students subjectively rated their experience with the First–5 positively [4.75, on a scale ranging from 1 (lowest) to 5 (highest)], and stated that they felt more comfortable and confident about implementing what they learned; however, these students were educated within the confines of their own discipline.5 Participants in our study subjectively preferred the ITB educational method over DB education and had improved knowledge of the care of the acutely ill patient. Team training improves clinical knowledge, as well as clinical skills, communication patterns, teamwork and overall performance, leading to potential increased patient safety and better clinical outcomes in other settings, and with other provider populations.8,9 Our data
suggest that incorporating team-based training for the care of acutely ill patients into the undergraduate curriculum for health science students may offer similar benefits. Limitations Our study has several limitations. Coordinating schedules between faculty members and students of several disciplines was our greatest challenge, limiting the number of disciplines that were included. As we did not want to deny individuals the opportunity to participate, we included all students who wished to participate, resulting in groups that differed in size by one (15 ITB versus 14 DB). We feel that this is unlikely to have affected the results. All participants were included in one of two groups for the study: DB or ITB. For the DB groups, students were trained in small groups of four or five students per team. The nature of ITB, with students from multiple disciplines learning together, resulted in larger group sizes of about 15 (Figure 1). Although smaller sized DB groups (four or five per team) allowed for more individualised focused education, scheduling and training groups this small in undergraduate education is time-intensive, and
may often not be feasible in this educational arena. The larger sized ITB group (with 15 participants) more accurately reflects the current scheduling of undergraduate health professions education, as this is close to the range of laboratory sections of classes. We used only one educational programme. Multiple educational programmes have been developed to help train providers for situations with critically ill patients. Future work would be needed to evaluate the impact of ITB with other training programmes for undergraduate students. We evaluated the impact of ITB versus DB training in the care of a patient in cardiac arrest in a simulated setting. Future research will be needed to determine the generalisability of ITB training in other patient populations, as well as its long-term benefits in the clinical realm. We tested the impact of ITB on knowledge, as measured by pre-/post-training changes. This was designed with a consensus approach by the authors, and has not been validated or tested in other settings. Future efforts will be needed to externally validate our findings and expand the use of this metric to other disciplines, settings and populations. There are multiple other metrics that have been proposed to determine the impact of educational interventions on providers, such as self-efficacy and locus of control. There are also other measurements, both qualitative and quantitative, to evaluate team performance that we did not test. Future efforts will be needed to assess the impact of undergraduate ITB on these other metrics.
CONCLUSION Figure 1. Schematic of training and simulation experience. PA, Physician Assistant students; RS, Radiologic Science students; RN, Nursing students
In this pilot study in a simulated model of cardiac arrest,
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the use of the ITB method of First–5 training appeared to improve participants’ knowledge and was preferred by participants. REFERENCES 1.
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The use of the ITB method of First-5 training appeared to improve participants’ knowledge
SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at http://onlinelibrary.wiley.com/ doi/10.1111/tct.12303/suppinfo Figure S1. Data collection tool for knowledge.
Corresponding author’s contact details: Jestin Carlson, Allegheny Health Network, Department of Emergency Medicine, Saint Vincent Hospital, 232 West 25th St, Erie, PA 16544, USA. E-mail: [email protected]
Funding: None. Conflict of interest: The authors have no financial conflicts of interests to disclose. Acknowledgements: None. Ethical approval: The study was approved by our Institutional Review Board. doi: 10.1111/tct.12303
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