Gavin D. Perkins, MD; Peter K. Kimani, PhD; Ian Bullock, PhD; Tom Clutton-Brock, MB; Robin P. Davies; Mike Gale, MSc; Jenny Lam, BA; Andrew Lockey, MMEd; Nigel Stallard, PhD; on behalf of the Electronic Advanced Life Support Collaborators
Acknowledgment: The authors thank Professor Ed Peile, who served as the independent chairman of the trial steering committee and provided sound advice and guidance throughout the conduct of the project. Dr. Peile declined authorship to maintain independent oversight of the trial. The authors also thank Teresa Melody (critical care research manager); Elizabeth Adey (research governance manager); and Ian Jacobs, Judith Finn, and Peter Morley (Australian Resuscitation Council) for their support in administering the trial and Sarah Mitchell, Sara Harris, and the Resuscitation Council (UK) ALS Subcommittee members for supporting the development of the e-learning material and the course centers, as well as Sultana Begum-Ali for providing the course staffing data.
Grant Support: The study was funded with a grant from the Resuscitation Council (UK). Dr. Perkins was supported by a National Institute of Health Research Clinician Scientist Award.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-3019.
Reproducible Research Statement:Study protocol: Available at www.resus.org.uk/consent/eALSprcl.pdf. Statistical code: Available at https://files.warwick.ac.uk/nstallard/browse/e-ALS. Data set: Not available.
Requests for Single Reprints: Gavin D. Perkins, MD, University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Perkins: Heart of England NHS Foundation Trust, Birmingham, and University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom.
Drs. Kimani and Stallard: University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom.
Dr. Bullock: National Clinical Guideline Centre, Royal College of Physicians, 11 Saint Andrews Place, Regents Park, London NW1 4LE, United Kingdom.
Dr. Clutton-Brock: University of Birmingham, Birmingham Medical School, Birmingham B15 2TT, United Kingdom.
Mr. Davies: Heart of England NHS Foundation Trust, Birmingham B9 5SS, United Kingdom.
Mr. Gale: Australian Resuscitation Council, c/o Royal Australasian College of Surgeons, Spring Street, Melbourne 3000, Australia.
Ms. Lam: Resuscitation Council (UK), 5th Floor, Tavistock House North, Tavistock Square, London WC1H 9HR, United Kingdom.
Mr. Lockey: Calderdale Royal Hospital, Salterhebble, Halifax HX3 0PW, United Kingdom.
Author Contributions: Conception and design: G.D. Perkins, I. Bullock, T. Clutton-Brock, R.P. Davies, M. Gale, J. Lam, A. Lockey, N. Stallard.
Analysis and interpretation of the data: I. Bullock, P.K. Kimani, M. Gale, N. Stallard.
Drafting of the article: G.D. Perkins, M. Gale, N. Stallard.
Critical revision of the article for important intellectual content: I. Bullock, R.P. Davies, M. Gale, A. Lockey.
Final approval of the article: G.D. Perkins, P.K. Kimani, I. Bullock, T. Clutton-Brock, R.P. Davies, M. Gale, J. Lam, Andrew Lockey, MMEd; and Nigel Stallard, PhD.
Provision of study materials or patients: G.D. Perkins, T. Clutton-Brock, R.P. Davies, M. Gale, J. Lam.
Statistical expertise: P.K. Kimani, N. Stallard.
Obtaining of funding: G.D. Perkins, I. Bullock, N. Stallard.
Administrative, technical, or logistic support: R.P. Davies, M. Gale, J. Lam.
Collection and assembly of data: G.D. Perkins, R.P. Davies, M. Gale, J. Lam, N. Stallard.
Perkins GD, Kimani PK, Bullock I, Clutton-Brock T, Davies RP, Gale M, et al. Improving the Efficiency of Advanced Life Support Training: A Randomized, Controlled Trial. Ann Intern Med. 2012;157:19-28. doi: 10.7326/0003-4819-157-1-201207030-00005
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Published: Ann Intern Med. 2012;157(1):19-28.
Each year, more than 1.5 million health care professionals receive advanced life support (ALS) training.
To determine whether a blended approach to ALS training that includes electronic learning (e-learning) produces outcomes similar to those of conventional, instructor-led ALS training.
Open-label, noninferiority, randomized trial. Randomization, stratified by site, was generated by Sealed Envelope (Sealed Envelope, London, United Kingdom). (International Standardized Randomized Controlled Trial Number Register: ISCRTN86380392)
31 ALS centers in the United Kingdom and Australia.
3732 health care professionals recruited between December 2008 and October 2010.
A 1-day course supplemented with e-learning versus a conventional 2-day course.
The primary outcome was performance in a cardiac arrest simulation test at the end of the course. Secondary outcomes comprised knowledge- and skill-based assessments, repeated assessment after remediation training, and resource use.
440 of the 1843 participants randomly assigned to the blended course and 444 of the 1889 participants randomly assigned to conventional training did not attend the courses. Performance in the cardiac arrest simulation test after course attendance was lower in the electronic advanced life support (e-ALS) group compared with the conventional advanced life support (c-ALS) group; 1033 persons (74.5%) in the e-ALS group and 1146 persons (80.2%) in the c-ALS group passed (mean difference, −5.7% [95% CI, −8.8% to −2.7%]). Knowledge- and skill-based assessments were similar between groups, as was the final pass rate after remedial teaching, which was 94.2% in the e-ALS group and 96.7% in the c-ALS group (mean difference, −2.6% [CI, −4.1% to 1.2%]). Faculty, catering, and facility costs were $438 per participant for electronic ALS training and $935 for conventional ALS training.
Many professionals (24%) did not attend the courses. The effect on patient outcomes was not evaluated.
Compared with conventional ALS training, an approach that included e-learning led to a slightly lower pass rate for cardiac arrest simulation tests, similar scores on a knowledge test, and reduced costs.
National Institute of Health Research and Resuscitation Council (UK).
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