Effects Of Near-Peer CPR Workshop On Medical Students .
Res Dev Med Educ, 2021, 10, 9doi: d.ac.irOriginal ResearchEffects of Near-Peer CPR Workshop on Medical Students’ Knowledgeand SatisfactionHakimeh Sabeghi1,2, Marziyeh Mogharab3, Zahra Farajzadeh2, Ebrahim Aria Moghaddam4,5Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University ofMedical Sciences, Tehran, Iran2Department of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran3Department of Emergency Medicine, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand,Iran4Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran5Emergency Medical System, Mashhad University of Medical Sciences, Mashhad, Iran1Article infoArticle History:Received: 26 Nov. 2020Accepted: 21 Apr. 2020epublished: 7 June 2021Keywords:Peer d: The acquisition of competencies in cardiopulmonary resuscitation (CPR) amongmedical students requires specific and up-to-date training. In this study, a near-peer workshopgroup was used to assess the effects of cardiopulmonary resuscitation training on students’satisfaction, acquisition, and retention of CPR knowledge.Methods: This quasi-experimental study using repeated measure analysis design was conductedwith 120 medical students at the Birjand University of Medical Sciences, Iran. The educationalcontent was presented in six workshop sessions under the supervision of a near-peer group. Aquestionnaire was used to assess demographics, knowledge, and satisfaction. Data analysis wasconducted using SPSS 14.Results: The mean knowledge scores of participants 6.8 2.7, 16.1 2.6, and 13.5 4.0 before,immediately, and two months after the workshop, respectively. These results showed that themean knowledge score significantly increased immediately after the training. Although themean scores fell slightly by two months after the intervention, they remained significantlyhigher than before the workshop. The satisfaction level of all the students of this method wasreported as good.Conclusion: In accordance with the positive effects of collaborative learning methods in theteaching-learning process, we used a novel and efficient collaborative method to improve thequality of cardiopulmonary resuscitation (CPR) training. CPR training with a near-peer grouphad a positive impact on student knowledge acquisition, knowledge retention, and learningsatisfaction. Therefore, this method may be a useful way to conduct such training workshops.IntroductionCardiopulmonary resuscitation (CPR) is one of thegreatest inventions in the history of medicine as animmediate intervention in preventing or delaying death inindividuals experiencing sudden cardiac arrest.1 The idealoutcome of a resuscitation operation is to fully return thepatient to life.2 Since 1960, when Kouwenhoven performedCPR with cardiac massage for the first time, there havebeen many improvements in the method, drugs used, andskill training of the medical staff; however, the mortalityrate following cardiac arrest remains high compared withother events.1Rescuing a patient from a cardiac arrest requires threeprincipal components: medical knowledge, effectiveeducation, and correct execution, all of which demonstratethe importance of training in rescuing the patient.3 Whena patient is hovering between life and death, efficient andknowledgeable staff must be present at his/her bedside.4Various studies have noted the importance of resuscitationin a patient with cardiac arrest by the first individuals toarrive at the scene.5,6 The important point is that theirinformation must always be up-to-date, meaning thatthe resuscitator must learn and then hone their skillscontinually.7 Although proficiency in resuscitation isessential for health care professionals, some studies havefound that physicians, medical staff, and students lack therequired knowledge and skills in this area.5-9It is worth noting that an important goal is improvingthe quality of CPR training. Appropriate teaching methodsshould be adopted to enhance the quality of CPR training.*Corresponding author: Ebrahim Aria Moghaddam, Email: Ariame2@mums.ac.ir 2021 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, as long as the originalauthors and source are cited. No permission is required from the authors or the publishers.
Sabeghi et alTraditional methods are accompanied by numerousshortcomings, including inconsistency of trainingprograms with the needs of participants, lack of allocationof sufficient time to put skills learned into practice, poorsupervision of training, and ignorance of the views of thetrainees.5,10 Therefore, novel teaching methods may beemployed to enhance the knowledge and skills of medicalstudents in learning CPR to achieve better, deeper, anddurable learning. By adopting a suitable learning strategy,students can rescue lives in the face of real cases.4Peer education is a modern and popular techniquederived from Bandura’s social learning theory, in whichindividuals learn from each other through observation,imitation, and modeling.9 A peer group consists ofeducational units similar to one another in terms of age,social status, behavior, and interests, and enhances socialbehaviors, personal relationships, and sense of belonging.This can make group education more effective, becausethe equality of the group of peers and learners and theclose relationships among them will contribute to betterunderstanding.11Peer learning is divided into two main types: nearpeers and tutor-peers. Tutor-peers are academically atthe same level, and therefore, relatively inexperienced;however, near-peers are students who are one or twoyears senior. In other words, academically, near peers havemore clinical experience than the students with whomthey are grouped.12-14 The difference between near-peersand tutor-peers is their educational level.9,15 It is believedthat since near peers have experience being at the samelevel as the current students, they are more familiar withtheir educational needs and thus can better understandthe students’ learning processes and possible areas ofconfusion.16 One advantages of this approach includesparticipation on the part of the individuals themselves intheir education, which leads to increased accountability,easier information transfer, and even cost savings.17The workshop method has been commonly used fortraining CPR skills since 1941.1 The results of variousstudies have shown the positive effect of this method onenhancing knowledge and skills of participants in learningCPR.1,7 Therefore, taking into account the benefits of thenear-peer method, the researchers in the present studyexamined the effect of conducting CPR workshops usingthe near-peer method on learning, knowledge retention,and satisfaction of students in various medical fields.Materials and MethodsThis quasi-experimental study was conducted with agroup of medical, nursing, midwifery, and paramedicalstudents at the Birjand University of Medical Sciences inIran. Assessments were conducted before, immediatelyafter, and two months following the workshop series. Thesample size was determined using the sample size formulafor estimating an average in a population based on thepilot study and probable attrition (135 students). In all,120 students who enrolled in the CPR training workshops2Res Dev Med Educ, 2021, 10, 9completed the questionnaire.The near peers were five undergraduate students intheir last semester of medical emergency training whowere experienced in pre-hospital emergency care. Theyhad experience working in an emergency medical centerfor at least two years and their ability to perform CPRwas attested and approved by three faculty members.Students were divided into six groups and a basic CPRworkshop was conducted separately for each group. Thisbaseline CPR workshop lasted eight hours (two and sixhours of theoretical and practical content, respectively).Initially, the theoretical content included basic CPR skillsfor adults, for specific age groups, and for those in specialcircumstances and was presented through lectures andgroup discussions. For the practical part of the workshop,students were divided into four groups of five studentseach. Each group was supervised by one member of thenear-peer group. One near-peer student was responsiblefor coordinating the groups and managing the workshop.All items presented in the theoretical part were practicedfirst on a CPR mannequin by the near peer, and then bystudents under the supervision of their near peer. At theend of the workshop, the near peer in charge of each groupprovided separate feedback on the performance of eachstudent.Data collection tools in this study included a researchercreated questionnaire consisted of three parts, includingdemographic information, assessment of CPR knowledge(25 MCQs), and satisfaction rating (15 items on a fivepoint Likert scale from very much to very little). Usingcomments of 10 faculty members at the Birjand Universityof Medical Sciences, content validity index (CVI) andface validity were used to assess the validity of thequestionnaires. The internal reliability of the questionnairewas confirmed with Cronbach’s alpha 0.85.Questionnaires were distributed among the participantsbefore the baseline workshop. It was noted in thequestionnaire guide that filling out the questionnaireindicated consent to participate in the study. Immediatelyfollowing the workshop and again two months later, theparticipants filled out the questionnaires for a total of threecollection points. The completed questionnaires werecollected and analyzed with SPSS 14, using descriptivestatistical tests (mean, standard deviation, percentage)and inferential tests (Tukey’s analysis of variance).ResultsOf the 120 students in the study, 34 (28.3%) were menand 86 (71.7%) were women. The majority of studentswere nursing students (45.8%), with a mean grade pointaverage (GPA) of 16.01-17 (30%), and, the majority wereundergraduate students (61.7%). Most of the subjects(72.5%) had no previous CPR training (Table 1).To examine the effect of time, repeated-measuresANOVA was used. First, the spherical hypothesis wasexamined by the Mauchly’s Sphericity test. Since thesphericity hypothesis was not established at P 0.001, the
Near Peer CPR WorkshopGreenhouse-Geisser test was used to evaluate the effecttrend. The results of the repeated-measures ANOVAshowed that, over time, increasing the level of studentswas significant (P 0.001; Tables 2 and 3).The results of this study showed that the amount ofstudents’ knowledge changed significantly over timeand was different based on gender, marital status, andeducational level; however, there were no significantdifferences between men and women, married and singlepeople, or different educational programs. On the otherhand, results have shown that within different programs,the effect of time, time-group, and group were significant.In other words, there was a significant difference betweendifferent fields of study in the amount of knowledge overtime, and nursing students reported the highest amount ofknowledge (Table 4).An independent t-test showed a significant differencein mean knowledge scores at baseline and immediatelyafter the intervention and at baseline and at the followup. In addition, the mean difference scores of knowledgeat baseline and immediately after the intervention, andmean difference scores after the intervention and thefollow-up were significant between the students in termsof educational level (Table 5).In this study, most students (85.0%) were satisfiedwith the near-peer teaching method. The results showedno significant difference in mean satisfaction scoresamong students in terms of gender (P 0.150); however,differences in the field of study was significant (P 0.030).The result of Tukey’s post-hoc test showed that themean satisfaction score among the medical students wassignificantly higher than in the nursing students, and it washigher in postgraduate students and general practitionersin comparison with undergraduate students (P 0.007).Spearman’s correlation test showed no correlationbetween students’ total GPA and mean scores of learning(P 0.570), retention (P 0.510), and satisfaction(P 0.480).DiscussionBased on the results of this study, mean knowledgescores of students were unsatisfactory prior to training.Abdollahi et al. also found that students lacked suitableperformance before encountering training.4 Maddenfound that 94% of students did not receive an acceptablescore in the pre-test phase due to the way CPR has beentaught in universities.18 Although CPR skills are animportant component of intensive and emergency carein the medical sciences curriculum, these skills haveunfortunately not been highly regarded and are oftenmainly taught theoretically in various subjects, and thusstudents do not receive suitable practical training.19The significant difference between pre- and post-testscores of students is indicative of the efficacy of thisteaching method in improving their knowledge. Perkinsalso confirmed a positive effect of peer education on CPRperformed successfully by medical students.19Although the mean scores of students in the follow-upphase decreased compared with the post-interventionphase, their scores were still significantly higher than atbaseline. These results support the findings of a studyby Madden.18 This study demonstrates the importanceand necessity of repetitive and continuous training ofCPR skills for students, as stated in the American HeartAssociation (AHA) guidelines that all hospital staff incontact with patients should be continuously trained forCPR.20Despite the effect of various factors on CPR qualification,Table 1. Frequency distribution of the study subjects in terms ofdemographic characteristicsVariableGenderField of studyGrade point average(GPA)Education levelPrior trainingexperienceFamiliarity with CPRNumber ing5545/8Anesthesiologyand Health2016/715 and less302515-16.012924/216.01-173630More than 172520/8BS7461/7MSc & PhD4638/3Yes3327/5No8772/5Very low6050Primary4134/2Moderate1915/8Table 2. Comparison of mean (SD) knowledge scores of studentsbefore, immediately after the education and follow-up phaseBefore the educationMean SDMaxMin6/48 2/76151Immediately after the education16/14 2/65219follow-up13/56 4/02213Table 3. Investigating the effect of peer education (repeated analysis of variance)FactorSum of squaresdMean of squaresFP315/59 37Res Dev Med Educ, 2021, 10, 93
Sabeghi et alTable 4. Investigating the effect of peer education based on gender, field of study and educational levelGroupsGenderWithin groups effectsSum of squaresdMean of SquaresFP4357.481.752490.34248.12 0.00113.261.757.580.750.45TimeTime-GroupBetween groups effects GroupField of studyWithin groups 0.84 0.001Time-Group355.646.63853.5765.911 0.001Between groups effects GroupEducation levelWithin groups effects481.814120.4512.33 0.001Time361.1122180.5522.45 0.001Time-Group203.733.2462.826.33 0.00156.47228.232.130.12Between groups effects GroupTable 5. Comparison of mean knowledge scores of students before, immediately after the education and follow-up phaseImmediatelyafter theeducationfollow-upMale7.2 15.6816.2 12.2913.3 12.578.3 97.685.4 97.09-3.3 00.95Female6.2 72.8016.2 15.7913.4 73.229.3 43.267.5 01.03-2.4 42.400.450.950.460.500.290.50Medicine5.2 89.7817.2 02.1712.3 40.5311.2 13.936.4 51.69-4.4 62.18Nursing7.2 96.4316.2 24.7615.3 62.818.2 27.997.4 65.77-0/3 62.99Anesthesiologyand Health5.2 90.5313.2 90.1010.2 50.678.3 00.664.4 60.55-3.2 40.62 0.001 0.001 0.001 0.001 0.05 0.001BS7.2 35.5715.2 55.7614.4 27.228.3 20.186.4 92.86-1.3 28.83MSc & PhD6.2 02.8917.2 09.1912.3 41.4911.2 07.936.4 39.71-4.4 67.150.010.0020/01 0.0010.56 0.001VariableGenderPField of studyPEducationlevelPan important factor affecting it is the teaching methodused.18 Peer tutoring is an approach in which students areencouraged to take charge of their learning. Learning isimproved and is more sustainable in this method becausestudents are more actively involved and participate morein their learning.19 Parcheh Bafieh et al. investigated theeffect of the near-peer teaching method on clinical selfefficacy of nursing students and found that this educationalmethod could increase the sense of clinical self-efficacy instudents, thus improving the patients’ care dimensions.14A systematic review at the University of Lathrup, Australia(2016) showed that the use of near peers in the educationprocess can be effective in the learning and performanceof both students and near peers.21 Improved learning andperformance and increased self-confidence of medicalstudents and near peers are other advantages of using thenear-peer approach.16In the present study, a large number of students (120students) were effectively trained for the important topicof CPR in a workshop that required a great deal of timeand energy by using the near-peer education technique.Wik et al. found that the baseline CPR was able to betaught to 1303 employees of a factory within three weeksusing the peer teaching method. Therefore, in addition4Mean differenceMeanMean differencescore before anddifferencescore immediatelyimmediately after score before after the educationthe educationand follow-upand follow-upBefore theeducationRes Dev Med Educ, 2021, 10, 9to the above-mentioned advantages, the peer teachingmethod is also be a potential solution to compensate forthe amount of human resources required for correct CPRtraining. Since effective training of this practical skillrequires adequate time in both theory and practice, oneof the major problems for educational institutions is ashortage of trainers.22The findings of our study suggest that medical andpostgraduate students were more satisfied with the nearpeer workshop method compared with undergraduatestudents. Given the higher exposure of medical andpostgraduate students to patients in need of clinicalresuscitation, and consequently, their higher need tolearn the resuscitation process, this group may have beenmore interested in learning skills they saw as immediatelyapplicable in their training, which may transfer to theirtheir higher satisfaction ratings as well. Various studieshave shown that peer education can contribute toincreased self-esteem, improved presentation skills,increased responsibility-taking, development of criticalthinking skills, improved test scores, and increasedopportunity for questions and answers. This teachingmethod has also been reported to increase intergroupcollaboration in the transmission of health information.23
Near Peer CPR WorkshopAll of the abovementioned factors can contribute toincreased interest in learning and increased satisfactionamong students.ConclusionAccording to the positive effects of collaborative learningmethods in the teaching-learning process, we used a noveland efficient collaborative method to improve the qualityof CPR training. The results of this study indicate positiveeffects in using near peers as educational elements, andintegrating near-peer training into workshop educationin the teaching-learning process could be considered as astrategy to facilitate this process.Ethical approvalThis article is the result of the research project, which is approvedby the code of IR.bums.REC.1394.461 at the Ethics Committee oftheBirjand University of Medical Sciences.Competing interestsThe authors have no conflicts of interest.Authors’ contributionsAll authors designed the study and collected the data. HS andEAM analyzed the data and prepared the manuscript draft. Allauthors participated in the edition of the manuscript based oneditor and reviewer comments. HS edited and approved the finalmanuscript. All the authors had full access to all data in the study.AcknowledgmentsThe authors appreciate Jalil Ahmadian Moghadam, Javad DehakiToroghi, Mahdi Razavi, Alireza Gholiyan Aval, and JaafarMehraban who cooperated in near-peer group.References1. Borimnejad L, Nikbakht Nasrabadi A, MohammadiMohammadi H. The effect of cardiopulmonary resuscitationworkshop on nurses’ sustained learning. Iran J Med Educ.2008;7(2):209-15. [Persian].2. Nasiripour AA, Masoudi Asl I, Fathi E. The relationship ofCPR success and time of patients’ referring to emergencydepartment. J Mil Med. 2012;14(1):21-5. [Persian].3. Mohsenpur M, Imani Z, Abdolkarimi M. Assessingthe effect of cardiopulmonary resuscitation training onawareness of nursing and CPR team in one of the Kerman’shospitals. Journal of Razi School of Nursing and Midwifery.2009;9(1):1-7. [Persian].4. 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2Department of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran 3Department of Emergency Medicine, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran 4Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti Univ
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the C-CPR patients and 27% of the E-CPR patients Survival rates decrease over the first 15 minutes of CPR, yet patients who received E-CPR had no difference in survival across CPR durations. Survival for patients receiving 35 minutes of C-CPR
American Heart Association Courses. The National Safety Council Student CPR. 3. Various course options are available through the following: Heartsaver CPR AED Course Options CPR in Schools. American Red Cross Training Services American CPR Training. 4. Teaching Hands Only CPR DVDs and video clips are availa
Choose between semi automatic or fully automatic models-CPR mode can be configured to 30:2, 15:2 and hands-only-Automatically adjusts CPR guidance when adult or child modes are selected.-CPR metronome-CPR real-time feedback1 Continuous encouragement during CPR process ResQNavi provides comprehensive CPR guidance in
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The popularity of peer-to-peer multimedia file sharing applications such as Gnutella and Napster has created a flurry of recent research activity into peer-to-peer architec-tures. We believe that the proper evaluation of a peer-to-peer system must take into account the characteristics
In a peer-peer file-sharing application, for example, a peer both requests files from its peers, and stores and serves files to its peers. A peer thus generates workload for the peer-peer application, while also providing the ca
CPR / AED CERTIICATION CLASS CPR / AED CERTIFICATION CLASS TAKE TEST ONLINE Adult & Adolescent - CPR Activation of Emergency Response System Send someone else, if possible, to activate the Emergency Response System by calling 911 and begin CPR immediately. If th
