Top

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Published in:

Open Access 01-12-2012 | Original research

Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study

Authors: Johan Creutzfeldt, Leif Hedman, Li Felländer-Tsai

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2012

Abstract

Background

Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students’ retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.

Methods

Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.

Results

The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).

At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.

Conclusions

This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

Available only for authorised users

Herlitz J: National Swedish registry for cardiac arrest – Yearly report of 2011. (in Swedish) Accessed 3 April 2012, at http://www.hlr.nu/sites/hlr.nu/files/attachment/Rapport%202011.pdf

Nordberg P, Hollenberg J, Herlitz J, Rosenqvist M, Svensson L: Aspects on the increase in bystander CPR in Sweden and its association with outcome. Resuscitation. 2009, 80 (3): 329-333. 10.1016/j.resuscitation.2008.11.013.CrossRefPubMed

McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, Sasson C, Crouch A, Bray Perez A, Merritt R: Out-of-Hospital Cardiac Arrest Surveillance — Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005–December 31, 2010. Morbidity and mortality weekly report. Edited by: Moolenaar RL, Casey CG, Rutledge TF. 2011, Atlanta, GA: Office of Surveillance, Epidemiology, and Laboratory Services, Center for Disease Control and Prevention, U.S. Department of Health and Human Services, vol. 60th

Edwards S, Siassakos D: Training teams and leaders to reduce resuscitation errors and improve patient outcome. Resuscitation. 2012, 83 (1): 13-15. 10.1016/j.resuscitation.2011.10.015.CrossRefPubMed

Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, Ma MH, Perkins GD, Rodgers DL, Hazinski MF: Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010, 122 (16 Suppl 2): S539-S581.CrossRefPubMed

Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, Marsch S: Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011, 57 (24): 2381-2388. 10.1016/j.jacc.2011.03.017.CrossRefPubMed

Tschan F, Vetterli M, Semmer NK, Hunziker S, Marsch SC: Activities during interruptions in cardiopulmonary resuscitation: a simulator study. Resuscitation. 2011, 82 (11): 1419-1423. 10.1016/j.resuscitation.2011.06.023.CrossRefPubMed

Eikeland Husebø SI, Bjørshol CA, Rystedt H, Friberg F, Søreide E: A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams. Scand J Trauma Resusc Emerg Med. 2012, 20: 23-10.1186/1757-7241-20-23.PubMedCentralCrossRefPubMed

Hew KF, Cheung WS: Use of three-dimensional (3D) immersive virtual worlds in K-12 and higher education settings: A review of the research. Brit J Educ Technol. 2010, 41 (1): 33-55. 10.1111/j.1467-8535.2008.00900.x.CrossRef

10.

Means B, Toyama Y, Murphy R, Bakia M, Jones K: Evaluation of evidence-based practices in online learning - a meta-analysis and review of online learning studies. 2010, Washington D.C: Center for Technology in Learning, U.S. Department of Education

11.

Peterson M: Computerized games and simulations in computer-assisted language-learning: A meta-analysis of research. Simulat Gaming. 2010, 41 (1): 72-93. 10.1177/1046878109355684.CrossRef

12.

Dickey MD: Three-dimensional virtual worlds and distance learning: two case studies of Active Worlds as a medium for distance learning. Brit J Educ Technol. 2005, 36 (3): 439-451. 10.1111/j.1467-8535.2005.00477.x.CrossRef

13.

Richardson A, Hazzard M, Challman SD, Morgenstein AM, Bruechner JK: A “Second Life” for gross anatomy: applications for multiuser virtual environments in teaching the anatomical sciences. Anat Sci Educ. 2011, 4 (1): 39-43. 10.1002/ase.195.CrossRefPubMed

14.

Wiecha J, Heyden R, Sternthal E, Merialdi M: Learning in a virtual world: experience with using second life for medical education. J Med Internet Res. 2010, 12 (1): e1-10.2196/jmir.1337.PubMedCentralCrossRefPubMed

15.

Knight JF, Carley S, Tregunna B, Jarvis S, Smithies R, de Freitas S, Dunwell I, Mackway-Jones K: Serious gaming technology in major incident triage training: A pragmatic controlled trial. Resuscitation. 2010, 81 (9): 1175-1179. 10.1016/j.resuscitation.2010.03.042.CrossRefPubMed

16.

Mjelstad S, Halvorsrud R, Bach-Gansmo E: Field experiment with MATADOR – a system for net-based trauma team training. (in Norwegian) Scand J Trauma Resusc Emerg Med. 2007, 15: 6-10.

17.

Dev P, Heinrichs WL, Youngblood P: CliniSpace: a multiperson 3D online immersive training environment accesible through a browser. Stud Health Technol Inform. 2011, 163: 173-179.PubMed

18.

Oblinger DG: The next generation of educational engagement. J Interact Media in Educ. 2004, 8: Accessed 4 December 2012, at http://www-jime.open.ac.uk/article/2004-8-oblinger/199

19.

Taekman JM, Shelley K: Virtual environments in healthcare: immersion, disruption, and flow. Int Anesthesiol Clin. 2010, 48 (3): 101-121. 10.1097/AIA.0b013e3181eace73.CrossRefPubMed

20.

Akl EA, Pretorius RW, Sackett K, Erdley WS, Bhoopathi PS, Alfarah Z, Schunemann HJ: The effect of educational games on medical students’ learning outcomes: a systematic review: BEME Guide No 14. Med Teach. 2010, 32 (1): 16-27. 10.3109/01421590903473969.CrossRefPubMed

21.

Andreatta PB, Maslowski E, Petty S, Shim W, Marsh M, Hall T, Stern S, Frankel J: Virtual reality triage training provides a viable solution for disaster-preparedness. Acad Emerg Med. 2010, 17 (8): 870-876. 10.1111/j.1553-2712.2010.00728.x.CrossRefPubMed

22.

Hansen MM: Versatile, immersive, creative and dynamic virtual 3-D healthcare learning environments: a review of the literature. J Med Internet Res. 2008, 10 (3): e26-10.2196/jmir.1051.PubMedCentralCrossRefPubMed

23.

Heinrichs WL, Youngblood P, Harter PM, Dev P: Simulation for team training and assessment: case studies of online training with virtual worlds. World J Surg. 2008, 32 (2): 161-170. 10.1007/s00268-007-9354-2.CrossRef

24.

Bransford JD, Brown AL, Pellegrino JW, Anderson JR, Berliner D, Cooney MS, Eisenkraft A, Gelman R, Ginsburg HP, Glaser R: Learning: from speculation to science. How people learn: brain, mind, experience, and school. Edited by: Bransford JD, Brown AL, Cocking RR, Donovan MS, Pellegrino JW. 2000, Washington D.C: National Academy Press, 3-30.

25.

McKendree J: e-Learning. Understanding medical education: evidence, theory, and practice. Edited by: Swanwick T. 2010, Chichester, West Sussex, UK: John Wiley & Sons, 151-163.CrossRef

26.

Creutzfeldt J, Hedman L, Medin C, Heinrichs WL, Felländer-Tsai L: Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary resuscitation in medical students. J Med Internet Res. 2010, 12 (3): e38-10.2196/jmir.1426.PubMedCentralCrossRefPubMed

27.

Creutzfeldt J, Hedman L, Youngblood P, Heinrichs WL, Felländer-Tsai L: Cardiopulmonary resuscitation training in high school using avatars in virtual worlds: Feasibility in a bi-national study. J Med Internet Res. 10.2196/jmir.1715. in press

28.

Kaufman DM, Mann KV: Teaching and learning in medical education: how theory can inform practice. Understanding medical education: evidence, theory, and practice. Edited by: Swanwick T. 2010, Chichester, West Sussex, UK: Wiley-Blackwell, 16-36. 1stCrossRef

29.

Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH: Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med. 1992, 63 (9): 763-770.PubMed

30.

International Liaison Committee on Resuscitation: 2005 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 2: adult basic life support. Resuscitation. 2005, 67 (2-3): 187-201.CrossRef

31.

Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O’Hearn N, Hoek TL, Becker LB: CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation. 2007, 73 (1): 54-61. 10.1016/j.resuscitation.2006.10.027.CrossRefPubMed

32.

Hostler D, Wang H, Parrish K, Platt TE, Guimond G: The effect of a voice assist manikin (VAM) system on CPR quality among prehospital providers. Prehosp Emerg Care. 2005, 9 (1): 53-60. 10.1080/10903120590891660.CrossRefPubMed

33.

Aramendi E, Ayala U, Irusta U, Alonso E, Eftestol T, Kramer-Johansen J: Suppression of the cardiopulmonary resuscitation artefacts using the instantaneous chest compression rate extracted from the thoracic impedance. Resuscitation. 2012, 83 (6): 692-698. 10.1016/j.resuscitation.2011.11.029.CrossRefPubMed

34.

Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010, 122 (16 Suppl 2): S250-S581.CrossRefPubMed

35.

Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D: Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009, 120 (13): 1241-1247. 10.1161/CIRCULATIONAHA.109.852202.PubMedCentralCrossRefPubMed

36.

Kahol K, Vankipuram M, Smith ML: Cognitive simulators for medical education and training. J Biomed Inform. 2009, 42 (4): 593-604. 10.1016/j.jbi.2009.02.008.CrossRefPubMed

37.

Berkenstadt H, Ziv A, Gafni N, Sidi A: The validation process of incorporating simulation-based accreditation into the anesthesiology Israeli national board exams. Isr Med Assoc J. 2006, 8 (10): 728-733.PubMed

Title: Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study
Authors: Johan Creutzfeldt
Leif Hedman
Li Felländer-Tsai
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2012
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-20-79

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2012

A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality

Early insulin resistance in severe trauma without head injury as outcome predictor? A prospective, monocentric pilot study

Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?

Pain after earthquake