Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching.
BACKGROUND
The "4-stage approach" has been widely accepted for practical skill training replacing the traditional 2 stages ("see one, do one"). However, the superior effectiveness of the 4-stage approach was never proved.


OBJECTIVE
To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy, and consequently in a reduced number of attempts needed to perform the skill in <60s compared to traditional teaching.


METHODS
Randomized controlled single-blinded parallel group study at the University Hospital Bern.


METHODS
With IRB approval and informed consent 128 undergraduate medical students were randomized in four groups: traditional teaching, no stage 2, no stage 3, and 4-stage approach for the training of cricothyroidotomy. Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group. Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes. Performance time was measured from skin palpation to trachea ventilation. Study participants filled out a self-rating on competency during the training.


RESULTS
Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of <60 s. Self-rating revealed that all groups felt equally competent throughout.


CONCLUSIONS
Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching.
Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Switzerland.
Robert
R
Greif
Lars
L
Egger
Reto M
RM
Basciani
Andrew
A
Lockey
Andreas
A
Vogt
D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery; D004504:Education, Medical, Undergraduate; D004635:Emergency Medicine / Q000193:education*; D015397:Program Evaluation; D013552:Swine; D013663:Teaching / Q000379:methods*; D013957:Thyroid Cartilage / Q000601:surgery; D014140:Tracheotomy / Q000193:education; D014743:Videotape Recording