Importance of Immediate Electronic-based Feedback to Enhance Feedback for First-time CPR Trainees

doi:10.21203/rs.3.rs-148427/v1

Background: Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality Cardiopulmonary Resuscitation (CPR). Training mannequins should be combined with technology that provide students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it influences the quality of their performance and the motivation to improve their skills.

Methods: The study was conducted at the Medical University of Lublin among 694 multi professional health students during first aid classes on Basic Life Support (BLS). The students first practiced on an adult mannequin with a basic control panel; afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students' work and behavior.

Results: In the students’ opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR proficiency than the one with a basic control panel. Furthermore, the comments given from devices seem to be more acceptable to the students, who did not see any bias in the device’s evaluation compared to that of the instructor.

Conclusions: Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.

Critical Care & Emergency Medicine

Educational Philosophy and Theory

first aid

education

basic life support

cardiopulmonary resuscitation

feedback device

simulation

quality

skill retention

motivation

chest recoil

mannequin

The immediate initiation of Cardiopulmonary Resuscitation (CPR) by bystanders in an incident is crucial for the survival of patients in cases of Out of Hospital Cardiac Arrest (OHCA). The International Consensus on CPR and ECC Science with Treatment and Recommendations, developed by the International Liaison Committee on Resuscitation (ILCOR) published updated recommendations and guidelines for CPR in 2020 [1,2]. The authors highlighted evidence that supports the important relationship between quality of CPR and resuscitation outcomes [1,2].

Two key recommendations from the 2020 ILCOR resuscitation guidelines are the use of real-time audiovisual feedback as means to maintain CPR quality and the importance of early initiation of CPR by bystanders [3].

These findings indicate that besides bystanders' ability to perform CPR, educational quality is also crucial to increasing the chance of survival. In several studies, the authors examined the necessary parameters for effective chest compressions and rescue breaths during CPR training with and without feedback (visual/voice). Parameters such as: the correct hand placement, the right frequency of chest compressions, the correct depth of compressions, adequate chest recoil and the proper time and volume of rescue breaths influence the outcome of successful resuscitation attempts. Consequently, special attention must be paid to students’ performance by instructors by providing corrective feedback to help ensure consistency of high-quality performance and to increase the trainees’ self-confidence in performing CPR under stressful conditions [4-6].

Previous reviews of the literature have provided good evidence supporting the use of CPR feedback/prompt devices during CPR training to improve CPR skill acquisition and retention [7-9]. These devices are used frequently in clinical practice and are part of an overall strategy to improve the quality of CPR. Their accuracy to measure some of the aforementioned parameters, such as the compression depth accommodate for the calibration needed to adjust the stiffness of the support surface upon which CPR is being performed (e.g., floor/mattress).

Currently, simulation mannequins are manufactured with the ability to provide basic and detailed feedback ability. The former uses an indicator lamp to light up different colors to indicate failure or success in student performance while the latter shows more detailed and instant information such as exact depth of each individual compression, or the pace of the performance. Clinical and practical beliefs among instructors of CPR courses, where this study is conducted, favor the use of instant feedback mannequins. However, there is a lack of adequate studies to demonstrate how students rate CPR learning in these two options [8-11]. This study, therefore aimed to evaluate the perceived utility of training on a mannequin with basic and detailed instant feedback [12].

2.1 Study location

The research was conducted from January 2018 to December 2020 at the Medical University of Lublin, Eastern Poland, during First Aid classes on basic life support (BLS) in the following faculties: dietetics, cosmetology, physiotherapy, pharmacy, public health, and medical emergency.

2.2 Study population

All seven hundred and nine students receiving training participated in the study (100%). After setting aside incomplete questionnaires, 694 students (98%) qualified for further evaluation, of which 416 were from the Faculty of Health Sciences (dietetics, physiotherapy, medical emergency, public health), and 278 came from the Faculty of Pharmacy (pharmacy, cosmetology).

2.3 Study preparation

CPR training began with a theoretical introduction to first aid and CPR. The algorithm for OHCA management in an adult was presented (compliant with the 2015 European Resuscitation Council guidelines) [13]. High-quality CPR was emphasized, and students were familiarized with all the parameters that should be achieved for optimum CPR performance. A demonstration was conducted on an adult Resusci Anne® Skill Reporter^TM mannequin from Laerdal Medical with a basic control panel. Afterwards, the students practiced CPR on the same mannequin, using the same control panel. The students could observe their CPR's quality on two types of feedback, presented in figure 1 and 2.

The basic feedback device contained a panel with LEDs that lit up, informing the students about the following: compression depth level (correct or incorrect), the amount of air during rescue breaths (correct or incorrect), incorrect hand placement for chest compressing - signaled on an image of the chest on the panel, incorrect airway patency - signaled by the diode placed on the neck shown on the figure indicator.

The feedback received by the basic control panel indicators (figures 1 and 2) consisted of lighting up the indicator lamps, where green indicated a well-done activity, while orange and red indicated elements that needed improvement. After connecting the mannequin to the laptop, SkillReporter^TMdisplayed the exact results of ongoing activities on the monitor screen. Consequently, during chest compression, the student could observe an amplitude graph showing the exact depth of each individual compression, and the pace of chest compressions (compressions per minute). During ventilation, the student could observe an amplitude graph showing at what rate and amount of air is given. Students could constantly observe the effects of their actions and incorrect measures at a given moment and try to correct areas of improvement on a regular basis. This detailed feedback gave the opportunity to adjust their hand movements to achieve better quality compressions. (figures 1 and 2)

During student’s CPR performance, the instructor observed the following: careful hand placement for resuscitation, the quality of chest compressions performed, and the quality of rescue breaths.

All methods were carried out in accordance with relevant guidelines and regulations.

2.4 Next phase

In the next class, the same students continued to learn CPR with the same mannequin. However, this time with an altered form of feedback. The mannequin was connected to a laptop, from which the indicators of resuscitation were displayed on the screen to the class using a projector. The outcome of the resuscitation was displayed synchronously in milliseconds response. Figures 3, 4 and 5 presents a picture of the feedback screen, as seen by the students. (figures 3-5)

A detailed record presented the following:

Current and average compression rate,
The exact number of compressions implemented,
The ratio of the number of chest compressions to the number of rescue breaths,
Compression depth given in millimeters,
Relaxation error,
Hand position error indicating the direction of the wrong hand position,
The airway patency,
The exact amount of air supplied,
The speed with which the air is introduced during rescue breaths)
Resuscitation time.

Students were able to observe their performance and correct the quality of CPR activities on an ongoing basis. Moreover, the instructor conducting the classes observed the students and analyzed their behavior during exercises with the device and gave detailed feedback.

2.5 Questionnaire

A questionnaire was developed using multiple strategies. First, the authors conducted a literature review to identify the critical dimensions for developing a questionnaire to be used after practical sessions and for the aim of this study. For the review purpose, the following keywords: first aid, education, basic life support, cardiopulmonary resuscitation, feedback device, simulation, quality, skill retention, motivation, chest recoil, mannequins alone or in combination were used. The acquired data from PUBMED, SCOPUS, and WEB OF SCIENCE were organized, categorized, and mapped to create the questions in the questionnaire. Secondly, a total nine questions were chosen through Nominal Group Technique [14] with five students from a local university to evaluate the questionnaire (Supplementary File 1). These participants were later excluded from the study, and their responses were not used in the final analysis. Validity was reviewed based on a combination of logic, relevance, comprehension, legibility, clarity, and usability before the final administration.

2.6 Statistical analysis

Statistical analysis was performed using SPSS Statistics version 25. A level of α <0.05 was considered statistically significant. Due to the ordinal and nominal nature of the measurement of variables considered essential for the study, non-parametric tests were used. The median, mean, and standard deviation values, percentage distribution, and mean rank were used to describe the obtained results' distribution. The mannequin dependent score measurements were compared using the Wilcoxon test. The Glass' delta expressed the effect size for the calculated difference. The Mann-Whitney U test was used to compare the two groups in terms of the ordinal variable, and the H Kruskal-Wallis test was used to compare more groups. The Mann-Whitney U test was also used as a post hoc test. Its significance level was adjusted using the Bonferroni correction. The effect size for the calculated differences was expressed using Glass's r coefficient and eta - square. Comparing the groups in terms of the qualitative variable was made using the chi-square test, with a Z test with a Bonferroni correction used to compare the columns' proportions. The effect size for the calculated differences was expressed using Cramer's V coefficient.

Approximately, 78.70% of the respondents' group identified as female and 21.30% male. The average age of the respondents was 20.27 years, with a standard deviation of 1.54. The youngest respondent was 19 years old, and the oldest 30 years old. The most frequent age group was 19 years old, accounting for 29.80% of all respondents. The second-largest group was the group of respondents aged 20 (28.00%) and the third group aged 21 (19.60%). More detailed data on the characteristics of the studied group are presented in Table 1.

To assess the degree of students' motivation to learn, the subjects were asked to mark both types of feedback on an 11-point scale, separately for classes with a basic feedback device and separately for a detailed feedback device, providing their opinion on their motivation to practice CPR. The closer the respondent's answer was to 10, the higher was the motivation to work with given feedback, while values close to 0 indicated no such motivation. Figure 6 presents the distribution of the answers given by the respondents

The respondents scored the assessed detailed feedback significantly higher than with the basic one, as shown by the Wilcoxon test (Z = 21.941; p <0.001, rg = 0.832). The median score for high fidelity mannequins was 10 (Me = 10), while the median score for low fidelity mannequin was 7 (Me = 7). The H Kruskal-Wallis test was used to investigate a relationship between the respondents studying in different faculties and the feedback assessment. The test showed statistically significant yet minute differences between the above-mentioned groups of respondents in the assessment of basic feedback (χ2 = 27.594; p <0.001; η2 = 0.027) and detailed feedback (χ2 = 25.175; p = 0.001; η2 = 0.024). The medians of the results obtained by the groups of respondents and the post hoc tests carried out in pairs to examine the differences in detail are presented in Table 2.

The observed differences were statistically significant in assessing the basic feedback device in the view of respondents from pharmacy and those from public health, dietetics (2nd and 4th year), and cosmetology.

Respondents studying pharmacy assessed the detailed feedback device statistically higher compared to the respondents studying the combination of emergency medical services and pharmacy.

Figure 7 shows the difference between the high-fidelity mannequin score and the low fidelity mannequin. Negative results indicate a better response to the high-fidelity mannequin, and positive results indicate a better response to the low-fidelity one.

The vast majority of respondents, as shown above, assessed detailed feedback higher than the basic one. Only 4 (0.6%) respondents rated the basic feedback higher than the detailed feedback device. A small number of respondents (n=50:7.2%) did not notice any difference between the two types of feedback.

Three groups of respondents divided according to the scheme above (lower ratings for detailed feedback, the same assessment for both feedback types, higher ratings for detailed feedback) were compared in terms of response to displaying their CPR outcomes on the projector (in the group), and in terms of self-assessment of their CPR ability. Analysis conducted using the chi-square test showed a statistically significant, however weak relationship, between the assessment of the feedback type and the reaction to displaying respondents’ outcomes on the projector in the presence of the group, χ2 = 24.061; p <0.001; V = 0.132 (Table 3.). However, no correlation was found between the difference in the assessment of feedback types and the overall self-assessment of CPR skills (Kruskal-Wallis test - test2 = 2.489; p = 0.288). The median self-assessment of the ability to provide CPR in the group of respondents who rated the basic feedback higher was 3.50 (Me = 3.50), while the median in the group of respondents who assessed the detailed feedback higher and assessed them both at the same level was 4 (Me = 4).

Comparing the proportions of the columns using the Z test showed that the respondents who preferred the basic feedback, more often than the respondents preferring the detailed feedback or those without the preference, experienced adverse embarrassment to the presentation of their outcomes on the projector.

The next stage of the analysis was to answer the question of whether the belief about which type of feedback should be used in CPR classes is related to the fear of displaying the subject's outcomes on the projector in front of the entire group and to the self-assessment of one's own CPR abilities. The Mann-Whitney U test (U = 12,045.00; p = 0.257) and the Chi-square test (χ2 = 0.404; p = 0.816) did not show that there were statistically significant relationships between the above-mentioned variables. The median self-assessment of one's abilities, both in the group of respondents who believed that classes should be conducted with a basic feedback device and in the group of respondents who believed that a detailed feedback device is best suited, was 4 (Me = 4). The distribution of respondents' responses to displaying their outcomes on the projector is presented in Table 4.

In the group of respondents who believed that it was more reasonable to use a basic feedback device during CPR practice, 5% declared experiencing negative emotions when their actions were displayed on a projector, and 12.5% reported a neutral attitude. In comparison, 82.5% experienced an increase in motivation in such a situation of social exposure. In the group of respondents who believed that it was more appropriate to use the detailed feedback device during CPR classes, 4.13% reported experiencing negative emotions when their actions were displayed on a projector, 9.79% reported a neutral attitude towards it. In comparison, 86.09% experienced an increase in motivation in this situation.

There was no significant difference in the BLS management algorithm's knowledge, regardless of the used feedback method. Minor errors in sequencing the procedure or forgetting some activities happened when using either a basic or a more detailed feedback tool. However, a significant difference was observed in students who practiced with a detailed feedback device. The students strived more to achieve high quality concerning both chest compressions and rescue breaths than when working with a basic feedback device.

Also, receiving information about mistakes made was better received by students when the information came from the device than from the instructor. Students accepted corrective instruction from the computer program record and found it more objective compared to the instructor. In situations where corrective action was recommended by the instructor, some students interpreted this as instructor bias against the student and viewed this as unjustified criticism. More than once, students tried to contest a negative comment, questioning and failing to accept it, or requesting the instructor to give a higher grade by disputing error occurrence. Conversely, the device's result was not subject to discussion on the student's part; it was accepted, and the students understood improvement was required.

The World Health Organization aims to empower communities during disasters and emergencies [15-18]. First aid and CPR skill training contribute to community preparedness and resilience and should be widely available [19]. There is scientific evidence that introducing lay BLS courses improved survival rates 30 days and one year after Sudden Cardiac Arrest [20,21]. Given the positive response from student health professionals, to improve skill acquisition and retention in BLS courses to health and laypeople, detailed feedback should be provided during all CPR training. In particular, high fidelity device training that provides instant feedback should be available to students e pursuing health professions training and careers, as well as laypeople who are obliged to provide first aid, e.g., teachers, medical guardians, security guards, and police officers. From a cognitive perspective, learning during training signifies an individual's capacity to obtain and reflect on external information to apply it in real-life scenarios [22-26]. To optimize utility, it needs to be a constructive alignment between learning goals and learning activities [27]. All students have different ways of learning. As Hattie discovered, students have additional attributes, prior knowledge, motivations, and intentions to participate in learning, thus constitutes the student the most significant variance in learning [28].

According to this study, students learning with mannequins that provided instant and accurate feedback were more engaged and motivated to have the best quality CPR result. These results were statistically significant and regardless of the participants’ field of study, the vast majority of students highlighted that their CPR practice should be based on mannequins providing detailed feedback (94.2%).

Most often students had prior experience with basic mannequins that made a sound or showed light when pressed, with a basic control panel and no feedback. As a result, their actions were often rated very high or entirely correct, and the students were thus convinced that CPR was very simple to perform. However, after using the mannequin with detailed feedback, the students realize that they did not achieve the recommended depth of compressions, usually compressed too quickly, had problems with proper airway patency and gave far too little or, too much air during rescue breaths. In accordance with other studies receiving detailed feedback from the device, enabled them to improve their CPR results as high as 100% [29-31]. Students practiced on the mannequin willingly; students (mostly male students) asked to be allowed to test/retest their abilities many times. This willingness to practice allowed the students to measure the time in which their activities resulted in effective resuscitation until the quality of their actions clearly decreased. On the first day of the class, when the exercises were performed on the mannequin with a basic control panel, the students performed CPR less willingly, without significant engagement. Eshel et al. reached similar conclusions when comparing the CPR quality performed on two students' groups [32]. One class (the control group) was taught using standard mannequin-based CPR models. The second class (the intervention group) was taught similarly but with real-time CPR quality feedback. In multiple regression analysis, the real-time feedback group results were significantly better than the control group in all baseline scores, adjusted to the participant's age, gender, and body mass index characteristics [32]. Another study similar to the present report was conducted by Lu et al., in which the authors verified whether a smartwatch with real-time feedback could improve the quality of CPR performed by healthcare professionals [33]. It showed that, without real-time feedback, chest compressions are usually too fast and too shallow, and that CPR quality can be improved with a smartwatch that provides real-time feedback [34]. Tanaka et al. conducted a randomized, controlled trial to compare standard CPR training (control) and QCPR Classroom (intervention) amongst 642 Japanese students over 15 years of age. As in this study, QCPR Classroom participants could see their CPR results on a large screen, while the control group only received subjective instructor feedback. QCPR Classroom was found to help students obtain high-quality CPR training, especially on correct compression depth and full recoil [35]. Other research studying the influence of received feedback on CPR quality [36-37] have reported similar conclusions.

During the SARS-CoV-2 (COVID-19) pandemic, the provision of mouth-to-mouth rescue breaths by lay people is not recommended due to the risk of transmission of infection [38]. Therefore, the focus should be on high-quality chest compressions [39]. A study by Stiell et al. proves the importance of chest compressions quality during CPR. A study of patients with pre-hospital Sudden Cardiac Arrest demonstrated that increased compression depth in CPR is strongly associated with better survival [40]. Maximum survival was in the depth range of 40.3 to 55.3 mm (peak, 45.6 mm) [41]. However, in this study, approximately 20% of participants showed the lack of full chest expansion during CPR, claiming that that no one had informed them about the significance and possibility of this error before. As noted in the ERC 2015 guidelines, it is often found that the rescuer's hands rest on the chest during CPR so that the return to its original shape is incomplete [42], while a full chest recoil after each compression results in a better return of venous blood to the chest, which may improve CPR effectiveness [43].

In this study, the authors recognize that the students better perceived receiving information about mistakes when the information came from the device than by the instructor. Another argument in favor of introducing accurate feedback devices can be derived from the exciting results of the research by Hansen et al., who investigated whether BLS instructors correctly assess medical students' CPR skills. They found that certified BLS instructors rated the CPR abilities of participants poorly. Of the 90 CPR assessments conducted by 16 pairs of instructors, 90% passed the exam (81 students), while the mannequin pass rate was only 2% [44]. Other authors have also come to similar conclusions [45].

Another interesting result of this study was the outcome of participants’ self-assessment of CPR skills. All students assessed themselves very similarly, regardless of whether they were students of emergency medical services, whose profession would involve performing medical rescue activities, or students of other faculties, e.g., cosmetology or public health. Students did not rate themselves highly; most of them rated their skills as 4, on a five-point Likert scale, indicating a high awareness of their deficits and the need for regular practice and recall of CPR procedures. It can be concluded, after the class using a mannequin with detailed feedback, that students were aware that not everything was performed correctly. They observed that it was not easy to maintain the correct pace of compressions or maintain an appropriate depth, so they approached self-assessment critically and objectively. By their self-esteem, they somehow demonstrated that the highest rating (5) requires regular exercise. The only similar study that we could refer to when comparing our results was the study by Abolfotouh et al., who verified, among other things, the importance of mental attitude in its respondents towards CPR [45]. The respondents' positive attitude was significantly more often shown, in statistical terms, by participants who recently completed BLS training and a higher number of previous BLS training and had earlier exposure to cardiac arrest, which means that, with more experience, self-confidence, and self-esteem, one's abilities increase.

This study has some limitations. This was a convenience sample from one University. Due to the convenience sample, a lack of medical students from medical faculty participated because the Emergency Department does not conduct CPR classes for them. This study could be performed with two groups of control and study to further evaluate the differences. The outcome of this study indicates a need for further controlled studies with a larger sample. This study may also initiate a discussion on this subject and the perspective of broader research in this area. The experience gained from this study will form the basis for planned future research, comparing training methods in other countries globally providing a wider standardization of the research tool used.

This study found that detailed feedback provided via training mannequins increases participants' motivation to learn and improve their CPR proficiency. Devices that provide detailed feedback during BLS courses may contribute to improving overall CPR quality increasing the chances of survival in cases of OHCA. Providing detailed feedback concerning CPR provider performance in the presence of other students may be an effective motivator to improve or correct technique.

BLS: basic life support

COVID-19: Coronavirus Disease 2019

CPR: Cardiopulmonary Resuscitation

ILCOR: International Liaison Committee on Resuscitation

OHCA: Out of Hospital Cardiac Arrest

Ethics approval and consent to participate. The information included the study’s purpose, the voluntary nature of their participation, and strict confidentiality and secure data storage. The survey was anonymous, and all respondents agreed to participate in the survey. Verbal and informed consent was obtained from participants who completed the paper questionnaire. This study complied with the ethical principles stipulated by Polish law and thus were exempted from ethics approval requirements by a named institutional and/or licensing committee. Under this provision, approval from the IRB (Medical University of Lublin) was not needed as the study is not a medical experiment and legally does not require the opinion of the Bioethics Committee within the meaning of Polish Law: Act of 5 December 1996, the professions of doctor and dentist. Article 29.a. The Polish Sejm site: https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU19970280152 (in Polish). And Act of September 6, 2001. Article. 37l. Pharmaceutical Law. The Polish Sejm site: https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20200000944 (in Polish)

Consent for publication. Not applicable.

Availability of data and materials. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests. Authors declare that they have no competing interests

Author’s contributions. P.M-O provided the main framework, identified and organized primary materials, and collaborated in writing the manuscript. K.G, identified appropriate references, and collaborated on the writing of the manuscript. M.G was involved in data analysis, interpretation of the results and collaborated on the writing of the manuscript. J.R; AJ.H; L.G; E.C and J.L-S. contributed to drafting sections of the manuscript. A.K-M collaborated on the writing and editing the paper. All authors have read and agreed to the published version of the manuscript.

Acknowledgements. Not applicable.

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Table 1. Characteristics of the researched group

Faculty	N	%	M	Female	Male
Dietetics II year	136	20	21.33	124	12
Dietetics IV year	30	4	23.12	29	1
Pharmacy I year	105	15	20.08	87	18
Pharmacy IV year	41	6	23.04	29	12
Physiotherapy I year	118	17	19.48	76	42
Cosmetology I year	132	19	19.19	132	0
Public Health II year	51	7	20.29	43	8
Medical Rescue I year	81	12	20.67	26	55
Total	694	100	20.89	552	157

Table 2. Mannequin assessment depending on the respondents’ group

Feedback type	Faculty	M	n	Me	Pharmacy IV year	Dietetics IV year	Dietetics II year	Medical Rescue I year	Physiotherapy I year	Public Health II year	Pharmacy I year
basic	Cosmetology I year	372,33	132	7	2404,5	1761,0	8152,5	5286,5	6328,5	3154,5	5147,5*
	Pharmacy IV year	335,59	41	7		469,0	2529,5	1475,5	2191,0	853,0	1785,5
	Dietetics IV year	412,63	30	8			1746,0	1113,0	1225,0	730,0	962,0*
	Dietetics II year	365,82	136	7				5340,0	6607,5	3165,5	5336,5*
	Medical Rescue I year	372,43	81	7					3954,0	1962,5	3265,0
	Physiotherapy I year	306,33	118	7						2242,5	5813,0
	Public Health II year	395,00	51	7							1796,0**
	Pharmacy I year	282,58	105	7
detailed	Cosmetology I year	333,42	132	10	2266,0	1782,5	8402,5	4994,0	7374,5	2985,5	5844,5
	Pharmacy IV year	278,71	41	10		461,5	2160,5	1513,0	1905,5	766,5	1493,0**
	Dietetics IV year	367,92	30	10			1960,5	1023,5	1685,0	755,5	1490,0
	Dietetics II year	355,14	136	10				4811,0	7942,0	3290,5	6456,5
	Medical Rescue I year	311,65	81	10					4225,5	1710,0	3351,0*
	Physiotherapy I year	351,60	118	10						2826,0	5548,5
	Public Health II year	372,41	51	10							2563,0
	Pharmacy I year	387,27	105	10

*p < 0.05; **p < 0.01; M – average rank; n – number; Me - median

Table 3. Distribution of the feedback type by the respondents and the reaction to displaying their outcomes on a projector in the presence of their group

Students’ reaction to displaying their outcomes on a projector	n	Feedback preferences
	n	Basic feedback	No preference	Detailed feedback
Adverse- embarrassment	n	2_a	0_b	27_b
Adverse- embarrassment	%	50,00%	0,00%	4,22%
Positive – motivation increase	n	2_a	43_a	551_a
Positive – motivation increase	%	50,00%	86,00%	86,09%
Neutral	n	0_a	7_a	62_a
Neutral	%	0,00%	14,00%	9,69%

Each subscript letter represents a subset of the feedback preference category whose column proportions do not differ significantly (by 0.05).

Table 4. Distribution of basic and detailed feedback devices in conducting CPR classes and the reaction to displaying their work on a projector in the presence of a group

Students’ reaction to displaying their outcomes on a projector	n	The belief in the usefulness of the given feedback
	n	Highest usefulness of basic feedback device	Highest usefulness of detailed feedback device
Adverse – embarrassment	n	2_a	27_a
Adverse – embarrassment	%	5,00%	4,13%
Positive – motivation increase	n	33_a	563_a
Positive – motivation increase	%	82,50%	86,09%
Neutral	n	5_a	64_a
Neutral	%	12,50%	9,79%

Each subscript letter represents a subset of the feedback preference category whose column proportions do not differ significantly (by 0.05).

No competing interests reported.

Supplementaryfile1.docx

Importance of Immediate Electronic-based Feedback to Enhance Feedback for First-time CPR Trainees

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Abstract

Figures

1. Background

2. Methods

3. Results

4. Discussion

5. Conclusions

List Of Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Journal Publication

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