This is the first study to extensively analyze the results of pediatric CPR instructor courses and assess participants’ opinion about the course received, over a long period of time with a significant number of participants.
Course methodology
The practice methodology of the instructor course is a crucial aspect and is primarily based on simulation (11). The participants are the protagonists since they are the ones who develop the practices, evaluate themselves and participate in peer-assessment. The instructors act as facilitators and advisors, and direct and organize the practice session so that it reproduces a practice from a PALS course. Instructors also facilitate that conclusions are draw by all participants. Public speaking practices help participants improve their communication skills and solve problems related to communication and group management.
Some institutions, such as the European Resuscitation Council (ERC), consider that a general instructor course is sufficient to train professionals in teaching any type of CPR course (1,3,5). However, the SPNRG considers that instructors should be trained in each practice session of the pediatric CPR course (6), and the results of our study and the participants’ opinion support this view.
Practice sessions related to neonatal and integrated resuscitation were the most highly rated by participants, perhaps because in these practices they can best perform all instructor functions and manage a group. Although these practices are the most complex, they allow a better assessment of the ability of the instructor to teach CPR in an integrated manner.
An essential aspect of the methodology is the use of structured and supported debriefing (12). In debriefing, correction and positive feedback are very important. Analyzing mistakes is the best way to improve our competence, correcting performance without making the student feel personalized. Self-assessment and peer-assessment help create a climate of trust that favors the acceptance of feedback and helps participants learn this methodology.
Results of the course
Our results show that a specific pediatric CPR instructor course focused mainly on practice simulation methods is adequate for instructor training, since 98.9% of participants achieved the learning objectives.
Most participants passed the course, which confirms its usefulness and the fact that a good selection of candidates had been previously made. A large proportion of participants were hospital pediatricians, including PICU and senior pediatric residents. Most nurses worked in PICUs and other special units and had extensive experience in pediatric CPR. Emergency care physicians were professionals who performed CPR in their regular practice.
Our study shows that students receive sufficient global training as pediatric CPR instructors. However, some of the professional groups them (i.e. primary care nurses and pediatricians) have more difficulties in certain practices, such as in the management of arrhythmias, CPR, and trauma, and neonatal CPR in the case of nurses, or advanced CPR in the case of primary care pediatricians. This is likely because they have less clinical experience in such tasks, which reinforces the relevance that instructors are experts in the subject they teach and the fact that not all instructors can teach all practices.
The training provided in instructor courses is necessary, but not sufficient. That is why the SPNRG requires that instructors who pass the course be supervised by expert instructors for at least two PALS courses over the next two years to reinforce training. Participants’ feedback confirms this view. On the other hand, in the long term, periodic re-training and updating of instructors is necessary to maintain their competence.
Evaluation of the course by participants
The evaluation of the course by participants is a cornerstone of course quality control. This process serves to detect weaknesses and propose modifications in the organization, methodology and teaching staff for successive editions, in addition to integrating the participants in the training process (13).
The participants rated very positively organizational and methodological aspects, theory and practice sessions, and the teaching skills and attitude of instructors. Some aspects of the organization along with time schedule were among the worst rated aspects of the course. Due to the long duration of the course, the face-to-face phase has a duration of 26 to 28 hours, sessions are very long, which increases participants’ fatigue and reduces their learning capacity. Thus, it is not surprising that this aspect was the worst rated. On the other hand, participants consider very important not to reduce the number of practice hours of the course and that all participants play the role of instructor in all practice sessions. Therefore, the practice phase cannot be replaced with distance training.
Taking into account that it is increasingly easier to offer distance learning through digital platforms, it is necessary to consider reducing the duration of the theory part of the course in favor of practice sessions. However, we consider that theory should not be completely eliminated because interaction between the instructor and the student in theory sessions is also essential.
It is worth noting the excellent evaluation of instructor teaching skills, coordination and attitude, which supports the usefulness of the training system for pediatric CPR instructors developed by the SPNRG.
Limitations
Our study has some limitations. In the first place, it is a single-center study, which favors the homogeneity of the results; therefore, other training groups should confirm our results. However, the number of courses analyzed, the variety of professions of participants, and the venues where the course took place allow us to assume that the sample is representative of all the courses given in our country.
On the other hand, our study only analyzes the opinions of participants. In order to have a more comprehensive evaluation, it would have been necessary to analyze the opinions of instructors as well.
Finally, the satisfaction survey of participants did not correlate with the results obtained in the course because the survey was anonymous. Nevertheless, since the vast majority of participants passed the course, it is likely that this fact is not a critical factor in the evaluation of the course. The performance of participants as simulated instructors was not analyzed.