title: Retention of Basic Life Support in Laypeople: Mastery Learning vs. Time-based Education.
abstract: To compare the effectiveness of a mastery learning (ML) versus a time-based (TB) BLS course for the acquisition and retention of BLS knowledge and skills in laypeople.
  
  
  
  After ethics approval, laypeople were randomized to a ML or TB BLS course based on the American Heart Association (AHA) Heartsaver course. In the ML group, subjects practiced and received feedback at six BLS stations until they reached a pre-determined level of performance. The TB group received a standard AHA six-station BLS course. All participants took the standard in-course BLS skills test at the end of their course. BLS skills and knowledge were tested using a high-fidelity scenario and knowledge questionnaire upon course completion (immediate post-test) and after four months (retention test). Video recorded scenarios were assessed by two blinded, independent raters using the AHA skills checklist.
  
  
  
  Forty-three subjects were included in analysis (23ML;20TB). For primary outcome, subjects' performance did not change after four months, regardless of the teaching modality (TB from (median[IQR]) 8.0[6.125;8.375] to 8.5[5.625;9.0] vs. ML from 8.0[7.0;9.0] to 7.0[6.0;8.0], p = 0.12 for test phase, p = 0.21 for interaction between effect of teaching modality and test phase). For secondary outcomes, subjects acquired knowledge between pre- and immediate post-tests (p < 0.005), and partially retained the acquired knowledge up to four months (p < 0.005) despite a decrease between immediate post-test and retention test (p = 0.009), irrespectively of the group (p = 0.59) (TB from 63.3[48.3;73.3] to 93.3[81.7;100.0] and then 93.3[81.7;93.3] vs. ML from 60.0[46.7;66.7] to 93.3[80.0;100.0] and then 80.0[73.3;93.3]). Regardless of the group after 4 months, chest compression depth improved (TB from 39.0[35.0;46.0] to 48.5[40.25;58.0] vs. ML from 40.0[37.0;47.0] to 45.0[37.0;52.0]; p = 0.012), but not the rate (TB from 118.0[114.0;125.0] to 120.5[113.0;129.5] vs. ML from 119.0[113.0;130.0] to 123.0[102.0;132.0]; p = 0.70). All subjects passed the in-course BLS skills test. Pass/fail rates were poor in both groups at both the simulated immediate post-test (ML = 1/22;TB = 0/20; p = 0.35) and retention test (ML pass/fail = 1/22, TB pass/fail = 0/20; p = 0.35). The ML course was slightly longer than the TB course (108[94;117] min vs. 95[89;102] min; p = 0.003).
  
  
  
  There was no major benefit of a ML compared to a TB BLS course for the acquisition and four-month retention of knowledge or skills among laypeople.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
authors.forename: Ashlee-Ann
authors.initials: AA
authors.lastname: Pigford
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rössler
authors.forename: Pratheeban
authors.initials: P
authors.lastname: Nambyiah
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bunting
authors.forename: Karl
authors.initials: K
authors.lastname: Schebesta
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D012153:Retention, Psychology; D016037:Single-Blind Method; D013997:Time Factors; D055815:Young Adult
keywords: education; life support, basic cardiac; patient simulation; randomized controlled trial