Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

Michael Tobias Schauwinhold; Michelle Schmidt; Jenny W Rudolph; Martin Klasen; Sophie Isabelle Lambert; Alexander Krusch; Lina Vogt; Saša Sopka

doi:10.3389/fmed.2022.825823

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A Non-inferiority Trial

Front Med (Lausanne). 2022 May 12:9:825823. doi: 10.3389/fmed.2022.825823. eCollection 2022.

Authors

Michael Tobias Schauwinhold^{1

2}, Michelle Schmidt^{1

2}, Jenny W Rudolph^{3

4}, Martin Klasen^{1

2}, Sophie Isabelle Lambert^{1

2}, Alexander Krusch^{1

2}, Lina Vogt^{1

2}, Saša Sopka^{1

2}

Affiliations

¹ AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany.
² Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany.
³ Center for Medical Simulation, Boston, MA, United States.
⁴ Department of Anaesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.

Abstract

Background: Sustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk.

Methods: In a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA-Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.

Results: The results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants.

Conclusion: Tele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning.

Trial registration: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

Keywords: Cardiopulmonary Resuscitation (CPR); basic life support (BLS); external chest compression (ECC); historical control; non-inferiority; peer-teaching; tele-instructor; telehealth.