Elsevier

Resuscitation

Volume 34, Issue 1, February 1997, Pages 35-41
Resuscitation

Evaluation of cardiopulmonary resuscitation skills of general practitioners using different scoring methods

https://doi.org/10.1016/S0300-9572(96)01028-3Get rights and content

Abstract

In this study we evaluated the practical performance of 70 general practitioners in cardiopulmonary resuscitation (CPR) before and after instruction and compared checklist-based scores to mechanical recording scores in order to investigate which scoring method is preferable.

Both checklist and recording strip-based scores showed significant improvement after instruction, but only 37% were judged proficient according to the American Heart Association standards (checklist scoring), and 47% according to the recording print-based scoring system, while raters judged 97% as satisfactory by general impression. Interrater reliability was highest for the recording print (0.97) and lower for the checklist (0.79), especially for CPR performance (0.56). Comparison of checklist and recording print showed that the checklist was specific but not very sensitive in identifying poor performance for cardiac compression rate, since observers overestimated performance. The correlation for CPR performance between checklist score and recording strip score was low (0.45), indicating that candidates were ranked differently. The correlation between diagnosis and performance score was low for checklist as well as recording print (0.22), indicating that the score on diagnosis was a poor predictor for the score on performance of CPR.

These results support the use of the recording manikin as compared with the use of a checklist for formative evaluation of basic life support skills. However, as proficiency in diagnosis and performance in CPR are poorly correlated, assessment of diagnosis using a checklist must be included. Therefore we strongly recommend the combination of assessment by observers using a checklist for diagnostic procedures and the recording strip of the manikin for performance of CPR, as employed in most evaluation schemes.

Introduction

Acute myocardial infarction is a frequent cause of death in the developed world, with approximately two-thirds of the deaths occurring outside hospital [1]. Research evidence suggests that rapid initiation as well as correct technique of cardiopulmonary resuscitation (CPR) are essential links in the `chain of survival' 2, 3. Since the majority of sudden deaths occur in the community, many lives could possibly be saved if adequate CPR skills were present throughout the community. General practitioners are confronted each year with 5–10 patients suffering from acute myocardial infarction 4, 5. The reported risk of cardiac arrest before reaching hospital varies from approximately 5% [6]up to 25% [7]. In a recent survey in the Netherlands, general practitioners reported a mean performance of 2.0 CPR attempts per year [8]. Various studies have shown considerable deterioration in CPR skills among physicians, who had successfully completed prior courses in CPR 9, 10, 11, 12, indicating that proficiency in these skills is not maintained.

For evaluation of competence in basic life support (BLS), checklists covering criteria of adequate performance are used [13]as well as recording strips of manikins [14]. In most research a combination of these methods is used 12, 15, 16, 17, with checklist-based scoring for diagnostic procedures and the recording strip of the manikin for compression and ventilation procedures. The use of recording manikins permits assessment of outcome criteria (e.g. breathing volume and thorax compression depth) and some aspects of process, while checklists tend to concentrate on process criteria (e.g. how the ventilation procedure is performed, and position of shoulders and hands of the resuscitator during thorax compression), which are considered to be relevant for outcome. Moreover checklists can be used for scoring of the diagnostic assessment of the victim, which cannot be assessed by the recording manikin.

Only limited research has addressed comparison of checklist and recording strip as evaluation methods for CPR. Two authors reported comparisons between checklist-based scores and mechanical recording-based scores 17, 18, and concluded that checklist-based scores overestimated competence.

In this study we evaluated the practical performance of general practitioners in cardiopulmonary resuscitation before and after instruction and compared checklist-based scores to mechanical recording scores to investigate which scoring method is preferable.

Section snippets

Materials and methods

Seventy-one general practitioners participated in a continuing medical education course with basic CPR as one of the topics. An account of this course has been published elsewhere [19]. The training time for CPR was 1 h and training was given in small groups (8–12 participants) by two experienced CPR trainers. Participants were randomly divided into two groups, one was evaluated before instruction and one was evaluated after instruction.

A checklist [20]was used for evaluation based on the

Scores

In Table 3 the mean scores (S.D.) are given for the checklist, rating scale and recording print for the group before (n=32) and after (n=38) instruction. Mean scores were lowest for diagnosis and showed no significant improvement after instruction. Scores on performance were higher for the checklist compared with the recording strip, and showed improvement on both scoring methods. However, this difference was not statistically significant for checklist-based ventilation. Finally, total

Discussion

General practitioners showed considerable deficiencies in basic CPR skills. This confirms results of earlier studies among different health professionals 9, 10, 11, 12. A 1-h refresher course improved scores but was not enough for all participants to acquire an adequate level of performance according to the scoring system based on the recording strip or criteria of the AHA. However, the general impression of the raters was much more favourable. As raters were general practitioners, they could

Acknowledgements

The authors thank the SVUH (National Institute for Evaluation of Vocational Training) for permission to use the checklist, Jeroen Pielage for statistical support, and members of the Skillslab of the University of Limburg (head of department: Albert Scherpbier) and the Clinical Training Centre in Nijmegen (head of department: Jaap Metz) for their contribution. Gillian Hull of the General Practitioner Writers Association is thanked for polishing the English. This study was financially supported

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