Elsevier

Resuscitation

Volume 83, Issue 9, September 2012, Pages 1055-1060
Resuscitation

Review
A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers,☆☆

https://doi.org/10.1016/j.resuscitation.2012.02.027Get rights and content

Abstract

Objective

Advanced life support (ALS) guidelines are widely adopted for healthcare provider training with recommendations for retraining every two years or longer. This systematic review studies the retention of adult ALS knowledge and skills following completion of an ALS course in healthcare providers.

Methods

We retrieved original articles using Medline, CINAHL, Cochrane Library, and PubMed, and reviewed reference citations to identify additional studies. We extracted data from included articles using a structured approach and organized outcomes by evaluation method, and knowledge and skills retention.

Results

Among 336 articles retrieved, 11 papers were included. Most studies used multiple-choice questionnaires to evaluate knowledge retention and cardiac arrest simulation or other skills tests to evaluate skills retention. All studies reported variable rates of knowledge or skills deterioration over time, from 6 weeks to 2 years after training. Two studies noted retention of knowledge at 18 months and up to 2 years, and one reported skills retention at 3 months. Clinical experience, either prior to or after the courses, has a positive impact on retention of knowledge and skills.

Conclusion

There is a lack of large well-designed studies examining the retention of adult ALS knowledge and skills in healthcare providers. The available evidence suggests that ALS knowledge and skills decay by 6 months to 1 year after training and that skills decay faster than knowledge. Additional studies are needed to help provide evidence-based recommendations for assessment of current knowledge and skills and need for refresher training to maximize maintenance of ALS competency.

Introduction

Maximizing outcomes from cardiac arrest requires healthcare providers to acquire and retain the knowledge and skills associated with advanced life support.1 Furthermore, the providers must be able to translate the knowledge and skills into practice and provide high-quality resuscitation when needed in actual situations. In response to this need, the advanced life support (ALS) guidelines were first published in 1974 by the American Heart Association (AHA)2 and have had six subsequent revisions. The most recent AHA and European Resuscitation Council (ERC) ALS guidelines were based on the 2010 International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR).1, 3, 4 These guidelines have been regarded as a “gold standard” for the treatment of cardiac arrest and other life threatening medical emergencies.

The 2010 ILCOR CoSTR includes a new chapter on education and implementation, emphasizing the importance of provider education in optimizing the chain of survival and delivery of high-quality resuscitation and post-cardiac arrest care.4 Significant effort and financial resources have been expended worldwide to train healthcare providers in standardized ALS courses.5 Yet despite rigorous knowledge and skills training and initial demonstration of competence, poor quality resuscitation is commonly observed in actual cardiac arrests.6, 7, 8 Decay of acquired skills over time in many settings has been documented in the educational literature.9, 10 Cardio-pulmonary resuscitation (CPR) knowledge and skills have also been shown to decay in both healthcare providers and lay rescuers.11, 12, 13, 14 It is unclear if ALS knowledge and skills show similar patterns of decay, and whether the rigorous and intensive training in ALS courses slows the decay of knowledge and skills.

Resuscitation Councils worldwide traditionally recommend that healthcare providers receive ALS retraining or refresher courses every 2 years or longer.15, 16, 17 However, the choice of a specific interval for refresher training was somewhat arbitrary and it is not clear whether trained providers can maintain an adequate level of knowledge and skills appropriate for patient care throughout the interval. On the other hand, more frequent updates with hands-on practice increase the burden on trainees and instructors at a time when resources and time for training of healthcare professionals are limited.18 In this systematic review we analyzed the current evidence for learning retention of adult ALS knowledge and skills in healthcare providers and the implications of the evidence in terms of optimal refresher intervals and strategies for retraining.

Section snippets

Search strategies

We based our search strategy and review on the ILCOR evidence evaluation process.19, 20 We identified studies published between 1974 and 2011 for review that addressed the question “What is the retention time of adult ALS knowledge and skills in healthcare providers after initial training?”. We searched Medline (OvidSP), CINAHL (EBSCOhost), Cochrane Library, and PubMed databases using the keywords “advanced life support”, “education”, “learn”, “memory”, “retention”, “interval” and “skill

Results

Our initial database search produced 336 citations. After removing the duplications, and following a screening review of the titles and abstracts, we identified 17 original articles published in peer-reviewed journals that appeared relevant to our topic. Of these, 9 studies were ultimately excluded because they addressed training courses other than adult ALS or used modified teaching modalities. Three articles not initially found by the database search were identified and included after review

Discussion

The literature demonstrates that ALS knowledge and skills of healthcare providers decline before the traditionally recommended 2-year (or even longer) ALS retraining interval. This decline appears to occur, on average, between 6 months and 1 year after ALS training and may occur sooner. The evidence for decay of knowledge and skills between 6 weeks and 6 months of training remains less certain and requires further study. Perhaps not surprisingly, skills appear to deteriorate more rapidly than

Conclusions

There is a lack of large well-designed studies that examined the retention of adult ALS knowledge and skills in healthcare providers. The available studies suggest that ALS knowledge and skills decay between 6 months and 1 year after ALS training, and skills decay faster than knowledge. Clinical experience, either prior to or after the courses, may slow this decay process. Many issues such as determining the acceptable or clinically meaningful level of ALS knowledge and skills for providers,

Conflict of interest statement

Several authors served as co-chairs (MEM, JS), worksheet authors (JEM, MHMM), and worksheet collaborators (CWY, ZSY) on the working group to develop the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations Part 12: Education, Implementation, and Teams.

Acknowledgment

This work was partially supported by National Science Council, Taiwan (NSC97-2511-S-002-006 and NSC99-2511-S-002-010).

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  • Cited by (0)

    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.02.027.

    ☆☆

    This review project grew out of work that several authors initially completed for the ILCOR Task Forces working through the C2010 Consensus on Science and Treatment Recommendations process. Authors JEM and MHMM were individually assigned to complete a detailed structured review of the literature and complete a detailed worksheet on the research question relating to ALS knowledge and skills retention. Their worksheets were reviewed and discussed at ILCOR meetings to reach consensus and guidelines were published in 2010 as the Consensus on Science and Treatment Recommendations (CoSTR).4 The conclusions and recommendations published in the final CoSTR consensus document may differ from the discussion points and conclusions in this review since the CoSTR consensus reflects input from other working group members and discussants at the conference, and takes into consideration implementation and feasibility issues.

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