title: Repetitive sessions of formative self-testing to refresh CPR skills: a randomised non-inferiority trial.
abstract: OBJECTIVE
  To investigate whether repetitive sessions of formative self-testing (RFST) result in an equal cardiopulmonary resuscitation (CPR) skill level compared to repetitive sessions of formative self-testing with additional practice (RFSTAP).
  
  
  METHODS
  In a non-inferiority trial, 196 third-year medical students were randomised to an RFST or RFSTAP group. Testing and practising took place in a self-learning station equipped with a manikin connected to a computer. Each cycle of RFST consisted of a 2-min CPR test followed by feedback and feedforward. In the RFSTAP group, additional practice consisted of CPR exercises with a computer voice feedback. To be successful, a combined score consisting of ≥70% compressions with a depth of ≥50 mm and ≥70% compressions with complete release (<5 mm) and a compression rate of 100-120 min(-1) and ≥70% ventilations with a volume of 400-1000 ml had to be achieved within 6 weeks. Skill retention was measured after 6 months. The non-inferiority margin was predefined as a 10% difference in success rate.
  
  
  RESULTS
  After six weeks the success rate in both groups was 96%: 99/103 (RFST) and 89/93 (RFSTAP). After 6 months, the success rate in the competent students was 26/96 (27%) for RFST and 32/86 (37%) for RFSTAP (three students dropped out in each group). The difference in the success rate between RFSTAP and RFST was 10% and 90% (CI -2 to 23%), respectively. As the upper bound exceeded 10%, non-inferiority was inconclusive. For each CPR skill separately, RFST was non-inferior for ventilation and complete release, superior for compression depth and inferior for compression rate.
  
  
  CONCLUSIONS
  RFST and RFSTAP were equally effective to refresh skills within 6 weeks. After 6 months, non-inferiority was inconclusive for the combined score. Our results indicate the potential of RFST to refresh CPR skills.
authors.affiliation: Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium. Electronic address: nicolas.mpotos@ugent.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mpotos
authors.affiliation: Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium.
authors.forename: Bram
authors.initials: B
authors.lastname: De Wever
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
authors.forename: Nick
authors.initials: N
authors.lastname: Cleymans
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Raemaekers
authors.affiliation: Department of Data Analysis, Ghent University, H. Dunantlaan 1, B-9000 Ghent, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Loeys
authors.affiliation: Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Herregods
authors.affiliation: Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Valcke
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium; Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
authors.forename: Koenraad G
authors.initials: KG
authors.lastname: Monsieurs
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Assessment; Basic Life Support; Cardiopulmonary resuscitation; Feedback; Formative self-testing; Self-learning