title: Use of a checklist during observation of a simulated cardiac arrest scenario does not improve time to CPR and defibrillation over observation alone for subsequent scenarios.
abstract: BACKGROUND
  Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial.
  
  
  OBJECTIVE
  The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone.
  
  
  METHODS
  Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers.
  
  
  RESULTS
  Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = -2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts.
  
  
  CONCLUSIONS
  Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.
authors.affiliation: a Clinical Education and Simulation Centre, University of Melbourne Department of Medicine, St. Vincent's Hospital Melbourne, Melbourne , Victoria , Australia.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Dilley
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: Robert
authors.initials: R
authors.lastname: O'Brien
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Cunningham
authors.forename: Julian E
authors.initials: JE
authors.lastname: Van Dijk
authors.forename: Rosie M
authors.initials: RM
authors.lastname: Mahoney
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Williams
mesh_terms: D000328:Adult; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D057189:Checklist; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D004554:Electric Countershock; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D019370:Observation; D013997:Time Factors
keywords: advanced cardiac life support; cardiopulmonary resuscitation; heart arrest; patient simulation