title: Accuracy of instructor assessment of chest compression quality during simulated resuscitation.
abstract: OBJECTIVE
  The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.
  
  
  METHODS
  This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.
  
  
  RESULTS
  We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100-120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02-0.32) and specificity of 0.06 (CI -0.04-0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18-0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08-0.42).
  
  
  CONCLUSIONS
  Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
authors.affiliation: *Department of Emergency Medicine,Queen's University,Kingston,ON.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Brennan
authors.affiliation: *Department of Emergency Medicine,Queen's University,Kingston,ON.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McGraw
authors.affiliation: *Department of Emergency Medicine,Queen's University,Kingston,ON.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Brooks
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement; D005180:Faculty, Medical; D005246:Feedback; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D011786:Quality Control; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical
keywords: cardiopulmonary resuscitation; educational assessment; feedback; patient simulation