Pedagogy in lay-person CPR training

[medicdan]

I am already an ARC CPR Instructor, and sent for materials to become an EFR Instructor. Emergency First Response is a company, formed partially by PADI (SCUBA certification agency). Essentially, EFR reframes and rebrands the same material that other courses teach. They teach Primary Care (CPR, life-threatening injuries, assuming quick access to EMS) and Secondary Care (First Aid, longer EMS response times). The materials are all in line with international standards (AHA 2005, ILCOR, etc)

Let me start by saying that I believe as many people as possible should learn CPR, First Aid, etc, but I think they need to be trained properly and refreshed often (I saw a study not too long ago that cited that lay responders only retained their skills for 9 months after training, anyone know where I could find the study again?)

EFR courses are modeled to be self-study for what would be the lectures (using a book and DVD), then a shorter meeting time with skill sessions and a practical assessment.
Several times in the instructor materials they emphasize that "Adequate care provided is better then perfect care withheld", they continue later in the materials, "You want to do the best you can, but it's unlikely a minor error will make much of a difference, much less hurt or kill a patient".

I understand that they are trying to reduce hesitations to act or care. To some degree I agree that participants focused on performing perfect care or perfect skills might possibly be more hesitant to care in an emergency, but I think this goes too far.
"Minor Errors" like poor hand placement in CPR (breaking the xyphoid, causing abdominal injuries, etc, WILL make a difference, and may hurt or kill a patient. What about forgetting a step in assessment, opening an airway before checking for obstructions (like vomit) WILL make a difference, if the patient ends up aspirating, if the patient lives causing PNA, and making the airway harder to control in the short term.

Because of this insistence on “Adequate care”, there are fewer repetitions of practical skills, leading to students learning less and absorbing less material and for less time. As an aside, while AHA and ARC recommend one mannequin for every 2-3 participants, EFR says 1:12 is an appropriate ratio. How much practice are you going to get if you have to wait in line after 11 other students?

What do you think of all of this? I have not yet observed or taught a class for this agency, and I have no idea what actual compliance is like (although I am sure it varied by audience), but I wonder how many students actually do the self study. How many finish it? How well do they retain the knowledge? Do they ask the same questions after the fact that they would while learning the material? What is the pressure to “skim” the book, then “skim” over the review in class? I know that I will be very careful when I teach not to do so, but what do other instructors do?

I can bet that some combination of KEV, Rid and Bossy are going to tell me to run away, fast, but I’m curious what this course has to offer.

So? Among my other questions, what I am really asking is what the value is of perfection in lay response. What is the value of instructor-led lectures? What is the value of repetition in skill retention?

 

[Arkymedic]

This type of stuff is why I never went through with EFR and why I dropped my ASHI instructor. Glad I decided to stick with good ol AHA.

I am already an ARC CPR Instructor, and sent for materials to become an EFR Instructor. Emergency First Response is a company, formed partially by PADI (SCUBA certification agency). Essentially, EFR reframes and rebrands the same material that other courses teach. They teach Primary Care (CPR, life-threatening injuries, assuming quick access to EMS) and Secondary Care (First Aid, longer EMS response times). The materials are all in line with international standards (AHA 2005, ILCOR, etc)

Let me start by saying that I believe as many people as possible should learn CPR, First Aid, etc, but I think they need to be trained properly and refreshed often (I saw a study not too long ago that cited that lay responders only retained their skills for 9 months after training, anyone know where I could find the study again?)

EFR courses are modeled to be self-study for what would be the lectures (using a book and DVD), then a shorter meeting time with skill sessions and a practical assessment.
Several times in the instructor materials they emphasize that "Adequate care provided is better then perfect care withheld", they continue later in the materials, "You want to do the best you can, but it's unlikely a minor error will make much of a difference, much less hurt or kill a patient".

I understand that they are trying to reduce hesitations to act or care. To some degree I agree that participants focused on performing perfect care or perfect skills might possibly be more hesitant to care in an emergency, but I think this goes too far.
"Minor Errors" like poor hand placement in CPR (breaking the xyphoid, causing abdominal injuries, etc, WILL make a difference, and may hurt or kill a patient. What about forgetting a step in assessment, opening an airway before checking for obstructions (like vomit) WILL make a difference, if the patient ends up aspirating, if the patient lives causing PNA, and making the airway harder to control in the short term.

Because of this insistence on “Adequate care”, there are fewer repetitions of practical skills, leading to students learning less and absorbing less material and for less time. As an aside, while AHA and ARC recommend one mannequin for every 2-3 participants, EFR says 1:12 is an appropriate ratio. How much practice are you going to get if you have to wait in line after 11 other students?

What do you think of all of this? I have not yet observed or taught a class for this agency, and I have no idea what actual compliance is like (although I am sure it varied by audience), but I wonder how many students actually do the self study. How many finish it? How well do they retain the knowledge? Do they ask the same questions after the fact that they would while learning the material? What is the pressure to “skim” the book, then “skim” over the review in class? I know that I will be very careful when I teach not to do so, but what do other instructors do?

I can bet that some combination of KEV, Rid and Bossy are going to tell me to run away, fast, but I’m curious what this course has to offer.

So? Among my other questions, what I am really asking is what the value is of perfection in lay response. What is the value of instructor-led lectures? What is the value of repetition in skill retention?

 

[BossyCow]

This is a pet peeve of mine. While I applaud the idea of getting first aid/CPR training out to the general public I'm appalled at the way the role of the instructor is being relegated to flesh covered remote control device. I've taught for many years. I have found that while you can have a high pass rate from a canned program, I believe the retention is higher if there is a real class taught. My students often remember the things I have illustrated with a joke, a real life incident (names withheld, of course) or a personal anecdote, while remaining fuzzy on some of the dry details. The rapport between the instructor and student in an active communication will allow the student to ask more questions on the things they don't understand which brings the entire class a deeper level of understanding.

I have had certs with ASHI, ARC and AHA and they are all going to the canned program where the instructor is encouraged to 'allow the DVD to do the teaching'.

Now is crappy information and a 'make the organization feel good' approach better than nothing? Perhaps. But the effort required to actually teach the general public the simple tasks of controlling a bleed, splinting and what constitutes a real emergency is worth doing well. Unfortunately there are too many crappy instructors out there that ruined it for the rest of us. The need to document that the same exact information was presented in the exact format designed by the 'experts' has become more important than creating a sense of confidence in those trained.

Case in point.. CPR/AED class I just taught, student was concerned because although the school had trained them in AED every couple of years and she had repeatedly gotten the certification, she was unaware that the AED would not shock someone who didn't need it. She was afraid to use the device because what if she did it wrong and killed them. But for years sat in the class, regurgitated the information and passed the tests, but said there was no way she would step forward and actually use an AED before my class. Said for the first time, she felt confident in her ability to help.

PS the study you mentioned about how long people retain their CPR skills was an ARC study quoted in their instructor class. If you look through the class materials from that class, you should find the study info.