A retrospective analysis of the results of pediatric and neonatal CPR instructor courses given between 1999 and 2019 and certified by the SPNRG was carried out.
The methodology of the course is described elsewhere (6). The duration of the course was 26–28 hours distributed over 3–4 days. The number of participants ranged from 20 to 36, depending on the classrooms and instructors available, with a maximum number of six participants per practice group.
The minimum requirements for the course were to have passed a SPNRG-certified PALS course and having clinical experience in pediatric and neonatal CPR. Participants were selected by the director of the course according to their previous training and experience in CPR and teaching, as well as to the educational needs of their professional area.
All instructors were SPNRG-certified PALS instructors.
The course is divided into two phases: an initial preparation phase and a phase involving face-to-face sessions.
In the initial phase, participants receive the Guide for Instructors and were given instructions to prepare for each practice session. In this phase, doubts are resolved by distance communication with the director of the course.
The face-to-face phase consists of theory and practice sessions. Theory sessions (i.e. instructor course, organization of pediatric life support courses, teaching methods, preparation of clinical cases and practice sessions, and evaluation methodology) have a duration of 6 hours and are developed interactively, stimulating the participation of students. Practice sessions (i.e. public speaking, basic life support, airway ventilation, venous and intravenous access, arrhythmias, trauma and CPR, neonatal resuscitation, and integrated advanced resuscitation) have a duration of 20 hours. In practice sessions, the instructor first explains the material and scenario and the guide-model of practice and then each participant plays the role of instructor, while the other participants act as if they were attending a PALS course. After each performance, the participant performs self-assessment and, afterwards, the whole group analyzes how the student managed the session (i.e. presentation of the clinical case, development of the practice class, and student evaluation). Finally, the instructor makes a summary. Positive feedback is used to build up a climate of friendship and confidence within the group.
In the public speaking practice, each student gives an oral presentation using four or five slides from PALS courses which they had received in advance. After each presentation, the participant, their colleagues, and the instructor analyze the quality of the presentation, the capacity to catch and maintain attention, clarity, oral expression, and body language, among other elements.
Over time, some modifications have been made to the program, according to the evaluations made by the participants and instructors of the course, progressively increasing the workload of participants prior to the course.
The final theory test consisted of 20 items, including multiple-choice questions with 5 options and sequential-order tasks. Theory tests were scored over a 10-point scale.
The performance of each participant as an instructor at each practice session was evaluated, and an overall score ranging from 1 to 5 was obtained according to the criteria shown in table 1.
Table 1. Evaluation criteria for the practice sessions
Practice of evaluation sheet of the instructor course
Practice: Instructor: Date:
- Presentation and objectives
- Guide model
- Planning and monitoring of the simulation
- Overall impression
Practice of oral expression techniques:
- Presentation and objectives
- Verbal expression
- Gestural expression
- Overall impression
1: The student does not do it
2: The student does it wrong
3: The student does it with some defects, but ends up doing it properly
4: The student does it well, with some minor flaws
5: The student does it very well
The overall impression should reflect the ability of the student to lead practice as an instructor.
Theory and practice evaluations and the evaluation criteria were previously validated by the Scientific Committee of the SPNRG.
At the end of the course, the instructors evaluated theory and practice test results and judged whether the participants had reached sufficient level to merit the instructor diploma. To pass the course, participants were required to have a minimum score of 6.5 in theory tests, and a mean score higher than 3.5 in practice tests. A score < 3 was not allowed in more than two practice evaluations.
At the end of the course, participants filled in an anonymous questionnaire aimed at assessing the quality of the course, including individual evaluations of each theory and practice session, different aspects of organization, methodology and evaluation of instructors, with a score from 0 to 10.
All participants gave consent for participation in the study and publication of results.
Statistical analysis of the results was performed with SPSS version 20 software (SPSS Inc, Chicago, USA). Continuous variables are expressed as mean values and standard deviations, whereas categorical variables are expressed as frequencies and percentages. The chi-square test was used to compare categorical variables. For the comparison of the scores in the different professional categories, Student’s t-tests and ANOVA tests were applied, with Bonferroni correction or Games-Howell tests based on the homogeneity of variances. For comparison of theory and practice scores, the ANOVA test of repeated measures with Bonferroni correction was used. A p value lower than 0.05 was considered statistically significant.