Journal Information
Vol. 94. Issue 3.
Pages 182-185 (01 March 2021)
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Vol. 94. Issue 3.
Pages 182-185 (01 March 2021)
Scientific Letter
DOI: 10.1016/j.anpede.2020.06.006
Open Access
Evaluation of the advanced pediatric life support courses by the students: experience of Spanish pediatric and neonatal resuscitation group
Valoración de Los cursos de reanimación cardiopulmonar avanzada pediátrica por los alumnos: experiencia del Grupo Español de Reanimacion Cardiopulmonar Pediatrica y Neonatal
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Jesús López-Hercea,b,c,d,
Corresponding author
pielvi@hotmail.com

Corresponding author.
, Ignacio Manriquea,e, Angel Carrilloa, Custodio Calvoa, Sara Ponsa,f, Gema Manriqueb,d, Grupo Español de RCP Pediátrica y Neonatal
a Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal, Valencia, Spain
b Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid, Instituto de Investigación sanitaria del Hospital Gregorio Marañón, Madrid, Spain
c Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
d Red de Salud Maternoinfantil y del Desarrollo (RedSAMID), RETICS financiada por el PN I+D+I2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD12/0026, Madrid, Spain
e Instituto Valenciano de Pediatría, Valencia, Spain
f Servicio de Pediatría, Hospital Peset de Valencia, Valencia, Spain
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Tables (2)
Table 1. Students in paediatric life support trainings.
Table 2. Questionnaire results (mean and standard deviation).
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To the Editor:

The training in cardiopulmonary resuscitation (CPR) of health care professionals is provided mainly in the form of CPR workshops. Although the evaluation of the quality of these trainings is essential, few studies have analysed the perceptions of students on the training received.1–6

In the past 25 years, 1367 trainings of paediatric advanced life support (PALS) accredited by the Spanish Group on Paediatric and Neonatal Cardiopulmonary Resuscitation (Spanish acronym, GERCPPyN) have been delivered, training 30 797 students. We analysed 1512 anonymous questionnaires filled out in the context of 128 PALS trainings held between 2014 and 2020 in 14 autonomous communities in Spain. Table 1 summarises the characteristics of the trainees, and Table 2 the results of the questionnaires, comparing the responses in different professional categories. All theoretical and practical trainings received ratings greater than 8.5 out of 10. The trainings that received the highest scores were theoretical trainings on basic life support, integrated advanced CPR and airway support and practical trainings in integrated advanced CPR, while the ones with the poorest ratings were theoretical trainings on stabilization, CPR and trauma, drugs and fluids and introduction to CPR, and practical trainings on CPR and trauma.

Table 1.

Students in paediatric life support trainings.

Profession  Count  Percentage 
Paediatrician  656  43.4% 
PICU/NICU  26  4% 
Hospital  100  15.2% 
Resident  466  71% 
Primary care  62  9.5% 
Outpatient  0.3% 
Nurse  561  37.1% 
PICU/NICU  157  15.1% 
Hospital  279  31.2% 
Resident  79  44.9% 
Primary care  21  6.8% 
Outpatient  23  2.1% 
Unknown   
Family physician  47  3.1% 
Adjunct  38  82.6% 
Resident  17.4% 
Unknown   
Anaesthesiologist -Adult ICU  118  7.8% 
Adjunct  32  27.1% 
Resident  86  72.9% 
Adult emergency physician  74  4.9% 
Inpatient  46  63% 
Outpatient  27  37% 
Unknown   
Other  30  2% 
Unknown  26  1% 
Total  1512   
Table 2.

Questionnaire results (mean and standard deviation).

  Total  Paediatricians  Nurses  Family physicians  ICU anaesthesiologists  Emergency physicians  Other  P 
Theoretical trainings
Introduction  8.77  8.72  8.85  8.87  8.33  9.09  8.77  .000 
  1.15  1.14  1.17  0.94  1.29  0.90  1.04   
Concepts and prevention  8.89  8.82  9.03  8.96  8.42  9.04  9.00  .000 
  1.09  1.13  1.04  0.77  1.27  0.97  0.94   
Basic CPR  9.15  9.09  9.26  9.21  8.75  9.23  9.53  .000 
  0.97  0.94  0.95  0.83  1.10  1.08  0.73   
Airway  9.02  8.99  9.25  9.19  7.90  9.16  9.17  .000 
  1.10  1.02  0.94  0.79  1.62  1.04  1.02   
Vascular access  8.95  8.89  9.07  9.11  8.50  9.12  8.83  .000 
  1.12  1.16  1.05  0.72  1.37  1.03  1.12   
Drugs and fluids  8.76  8.77  8.81  8.91  8.22  9.18  8.43  .000 
  1.22  1.23  1.12  1.03  1.27  0.94  1.27   
Arrythmias  8.94  8.98  8.96  8.91  8.54  9.22  8.60  .002 
  1.17  1.18  1.16  1.08  1.15  0.98  1.49   
Neonatal CPR  8.85  8.77  8.89  8.89  8.94  9.15  8.83  .252 
  1.30  1.39  1.32  0.96  0.99  1.08  0.95   
CPR and trauma  8.72  8.70  8.78  8.70  8.38  8.84  8.93  .074 
  1.30  1.29  1.31  1.28  1.48  1.08  1.04   
Stabilization  8.52  8.40  8.69  8.60  8.21  8.70  8.33  .000 
  1.37  1.47  1.28  1.33  1.42  1.03  1.15   
integrated advanced CPR  9.09  9.04  9.16  9.02  8.83  9.28  9.33  .012 
  1.02  1.04  0.99  0.92  1.12  0.94  0.75   
[0.1−9]
Practical trainings
Basic CPR  8.92  8.96  8.99  9.02  8.29  8.89  9.07  .000 
  1.27  1.15  1.32  1.03  1.48  1.52  1.20   
Airway  8.97  8.99  9.17  8.96  7.74  9.07  9.17  .000 
  1.17  1.07  0.98  0.99  1.77  1.15  0.91   
Vascular access  8.97  8.98  9.05  8.87  8.48  9.08  8.97  .000 
  1.13  1.09  1.11  0.90  1.40  1.09  1.15   
Arrythmias  9.05  9.08  9.08  9.13  8.59  9.22  9.07  .001 
  1.10  1.07  1.13  0.87  1.19  1.02  1.28   
Neonatal CPR  8.97  8.95  8.98  8.91  8.97  9.01  9.13  .991 
  1.28  1.33  1.30  0.97  1.04  1.35  0.97   
CPR and trauma  8.77  8.78  8.83  8.89  8.44  8.61  8.87  .091 
  1.32  1.32  1.28  0.89  1.55  1.46  1.31   
integrated advanced CPR  9.19  9.24  9.19  9.04  8.81  9.30  9.40  .001 
  0.96  9.19  0.97  0.93  1.10  0.91  0.81   
[0.1−9]
[0.1−9]Organization
Organization  8.96  9.00  8.93  8.89  8.59  9.26  9.37  .001 
  1.13  1.04  1.26  1.00  1.21  0.84  0.71   
Classrooms  8.32  8.29  8.29  8.57  7.98  8.89  8.47  .001 
  1.46  1.14  1.56  1.22  1.45  1.10  1.40   
Schedule  8.25  8.40  8.05  8.28  8.07  8.73  7.93  .000 
  1.54  1.44  1.69  1.39  1.54  1.22  1.72   
Slides  8.54  8.53  8.56  8.74  8.25  8.76  8.47  .104 
  1.32  1.27  1.44  1.07  1.25  1.15  1.07   
Materials used for practice  8.57  8.60  8.54  8.87  8.11  8.80  9.00  .001 
  1.33  1.32  1.37  0.99  1.43  1.22  1.14   
Materials received  8.75  8.64  8.89  8.87  8.35  9.01  9.03  .000 
  1.31  1.40  1.24  1.37  1.25  1.12  1.09   
Methodology  8.98  8.96  9.03  9.09  8.63  9.11  9.13  .010 
  1.06  1.07  1.06  0.85  1.18  1.05  0.81   
Duration of contents  8.43  8.54  8.23  8.64  8.39  8.58  8.77  .001 
  1.42  1.35  1.58  1.13  1.28  1.13  0.97   
Theoretical contents  8.76  8.70  8.89  8.85  8.42  8.91  8.67  .002 
  1.13  1.18  1.08  0.83  1.15  1.07  1.13   
Practical contents  9.11  9.16  9.13  9.13  9.00  9.16  9.47  .050 
  1.06  0.80  1.05  1.08  0.90  1.18  0.62   
Instructor competence  9.37  9.36  9.45  9.40  8.84  9.59  9.43  .000 
  0.85  0.86  0.76  0.77  1.16  0.79  0.72   
Adaptation to student needs  9.15  9.18  9.19  9.15  8.69  9.39  8.90  .000 
  1.05  0.99  1.07  0.83  1.31  1.03  1.06   
Coordination  9.14  9.10  9.24  9.28  8.62  9.39  9.17  .000 
  1.12  1.23  0.95  0.80  1.40  0.94  0.69   
Clarity  9.19  9.18  9.27  9.15  8.75  9.34  9.13  .000 
  0.96  0.98  0.92  0.78  1.05  0.99  0.81   
Ability to elicit interest  9.25  9.26  9.33  9.21  8.68  9.38  9.23  .000 
  0.95  0.96  0.90  0.72  1.12  0.81  0.81   
Ability to stimulate participation  9.27  9.30  9.31  9.23  8.77  9.43  9.23  .000 
  0.98  0.91  0.99  0.69  1.29  0.89  0.93   
Ability to give constructive feedback  9.27  9.26  9.34  9.21  8.85  9.35  9.33  .000 
  1.01  1.04  0.96  0.77  1.23  0.09  0.80   

All the variables related to the organization and methodology of the trainings received ratings above 8.5 except for the training spaces, schedule, and time devoted to present the contents. All the variables related to the evaluation of instructors received ratings above 9.

Emergency and family physicians and nurses gave significantly higher ratings to theoretical and practical trainings, while anaesthesiologists and intensive care physicians gave lower ratings compared to all other professionals.

Students suggested prolonging the trainings over a greater number of days and providing more practice time, especially in comprehensive CPR, offering trainings adapted to different professions and offering refresher trainings.

While the students generally perceived the training very positively, our study identified opportunities for improvement. The schedule, which involves long hours of training, causes fatigue and impairs the ability to learn, so it is no surprise that this was the aspect that received the worst rating. On the other hand, students considered that more time needed to be devoted to the practical components. Since increasing the duration of the training is complicated, one possible option would be to consider cutting down the time devoted to in-person theoretical training, replacing this time by distance education, but not completely eliminating in-person theoretical training, as the live interaction of instructors and students is also essential in this component.

The trauma module received the lowest ratings, probably due to the difficulty of summarizing the key aspects efficiently, although some students considered that it should not be eliminated. The GERCPPyN believes that this module needs to be maintained, but only presenting aspects related to CPR, as there are also specific trainings on paediatric trauma and the PALS training cannot address the management of every emergency and should focus on the management of cardiac arrest and teamwork.

The practical training on integrated advanced CPR received the best ratings, which highlights the importance attributed by students to practical trainings that best simulate real-life situations and where they learn to work as a team.

Adult anaesthesiologists and intensive care doctors gave the lowest ratings to the training. It is possible that the training did not meet their expectations, and perhaps what they need is training on the assessment of paediatric patients and the differences between paediatric and adult CPR protocols. Some students suggested the development of specific trainings for different health professionals. However, we believe that the combination of professionals and trainees with different skill levels is one of the pluses of this training, as it reflects the reality that students will be facing in clinical practice.

We ought to highlight the high ratings given to the instructors, evidence in support of the usefulness of the instructor training system developed in Spain. The European Resuscitation Council considers that a general instructor training is sufficient. However, the GERCPPyN considers that instructors should be trained specifically to teach each of the practical components of the PALS training.

Last of all, students considered that refresher trainings should be offered periodically, which is one of the most pressing aspects in need of improvement.

In conclusion, PALS trainings are perceived very positively by students, who underscored the importance of practical training. Some theoretical and practical trainings received lower ratings from the students, which could guide future changes to their contents or format to adapt them to the needs of the students and improve their quality.

Funding

We received no external funding for the performance of this study.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

We thank the collaboration of all the training organizers, instructors and students that participated in paediatric advanced life support trainings accredited by the Spanish Group on Paediatric and Neonatal Cardiopulmonary Resuscitation.

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Please cite this article as: López-Herce J, Manrique I, Carrillo A, Calvo C, Pons S, Manrique G. Valoración de Los cursos de reanimación cardiopulmonar avanzada pediátrica por los alumnos: experiencia del grupo español de Reanimacion Cardiopulmonar Pediatrica y Neonatal. An Pediatr (Barc). 2021;94:182–185.

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