한국학술정보. How Knowledge-only Reinforcement Can Impact Time-related Changes in Basic Life Support (BLS) Skills of Medical Students on Clinical Clerkship

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1 How Knowledge-only Reinforcement Can Impact Time-related Changes in Basic Life Support (BLS) Skills of Medical Students on Clinical Clerkship Yo-Sub Park, M.D., Young-Min Kim, M.D., Won-Jae Lee, M.D., Han-Jun Kim, M.D., Yong-Bum Kim, M.D., Won-Jung Jeong, M.D., Seok-Hwan Kim, M.D., Yoon-Hee Kim, M.P.H. 1 P u r p o s e: Some report that basic life support (BLS) skills decay rapidly, mostly by three months after initial training. Retraining at specific intervals or with more effective methods is necessary to delay this decay. This study was undertaken to determine the effects of the time interval from initial training and to evaluate the impacts of a knowledge-only reinforcement on BLS skills in medical students and interns. M e t h o d s: We tested the single-rescuer BLS performance of 92 medical students and interns with Resusci A n n e S k i l l R e p o r t e r T M and BLS performance criteria. All trainees had been instructed by senior residents in 1~24 months before the test and were assigned into four groups by interval from initial training [group A: 1~3 months (n=21), group B: 4~7 (n=26), group C: 8~15 (n=20), group D: 16~24 (n=25)]. Groups C and D had 1-hour knowledge-only lectures. R e s u l t s: The performance criteria score of group B was lower than that of group A (p=0.005), but that of group C was higher than that of group B (p=0.025). The percent correct of ventilation (PCV) and compression (PCC) decreased surprisingly during the first three months after initial training. There was no difference in the PCC among 45 the four groups. However, the PCV in group C was lower than that in group A (p=0.047). The PCV and the interval from initial training had a negative correlation (R=-0.273, p=0.009). C o n c l u s i o n: Overall BLS performance of medical students and interns on clinical clerkship, without reinforcement, decreases more significantly after three months compared to the first three months from initial training. The accuracy of the skills decreases rapidly from the time of initial training. A knowledge-only reinforcement could temporally improve overall BLS performance. However, the accuracy of the ventilation skill decays regardless of reinforcement. Key Words: Basic cardiac life support, Reinforcement Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Department of Biostatistics and Epidemiology, School of Public health, Seoul National University 1

2 46 / Fig. 1. Result of single-rescuer BLS performance in Resusci Anne SkillReporter TM (Laerdal, Norway).

3 47 Table 1. Simplified checklist for single-rescuer BLS performance No. Performance Criteria Score Yes No 1 Establish unresponsiveness 10 2 Activate the emergency response system 10 3 Open the airway (head tilt-chin lift or jaw thrust) 10 4 Check breathing (look, listen, and feel) 10 5 Give Two slow breaths (two seconds per breath) 10 6 Check for signs of circulation (carotid pulse) 10 7 Begin cycles of 15 chest compressions followed by 2 slow breaths 10 8 Four cycles of compression & breathing (15:2) 10 9 All correct sequence 20 Examinee Examiner : Total: Table 2. Performance criteria score and percent correct of ventilation, compression in four groups* Group Performance criteria Percent correct of Percent correct of scores ventilation compression A (n=21) B (n=26) C (n=20) D (n=25) (Group A:1~3months, group B:4~7, group C:8~15, group D:16~24, *; means S.D.)

4 48 / Fig. 3. Correlation between intervals from the initial training and percent correct of ventilation. (r=-0.282, p=0.006) A B Fig. 2. (A) Comparison of performance criteria score in four groups. (C.I.; 95%, *; p<0.05) (B) Comparison of percent correct of ventilation in four groups. (C.I.; 95%, *; p<0.05)

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