||Distance Learning Studies
Pediatric Emergency distance learning pilot test included self-study
materials contained on an Internet World Wide Web site, in published
textbooks, and on interactive CD-ROM programs. The training was
conducted by an instructor in Salt Lake City, UT, who communicated with
9 prehospital providers using E-mail and desktop video conferencing. The
instructor reviewed and critiqued videotapes of the ambulance crew
membersí performance skills. The
pilot program shows promise for making high quality training, including
performance skills training, available to all prehospital providers,
regardless of their location.
The intimate partner violence training package includes a self-study,
interactive CD-ROM, print training manual and web site. The materials
combine text, graphics and video to introduce emergency medical services
providers to the topic of intimate partner violence and to provide
examples and suggestions both for keeping themselves safe in these
volatile situations and for extending a helping hand to the victims.
Methods: A Retrospective Analysis
Pullum, J.D., Sanddal, N.D., and Obbink, K.O. (1999) Training for
rural prehospital providers: A retrospective analysis from Montana. Prehospital
Emergency Care 3:231-238
This paper provides a retrospective analysis of training methods used by
rural Montanaís prehospital providers. Drawn from both published and
unpublished sources and spanning the past 25 years, it examines the
origins of training in this vast rural state and aims to shed light on
successful, nontraditional training delivery methods currently being
used. Because volunteer personnel traditionally provide prehospital
emergency care in rural areas, development and implementation of
effective training programs are generally considered important to
helping these practitioners maintain the knowledge and skills they use
in their lifesaving methods. Examining five different training methods,
the paper suggests that remote training methods that train the providers
directly are effective and popular. It also suggests that the
application of electronic media and other distance learning techniques
have demonstrated a positive impact on the frequency, quality, and
standardization of training for volunteer prehospital EMTs.
of CD ROM Training
Sanddal, N.D., Sanddal, T.L., Werner, S.M., Dawson, D.E. (1999) A
comparison of self-study/remote televideo and traditional PALS
instruction. Bozeman, MT: Critical Illness and Trauma Foundation.
Objective: To compare
the effectiveness of a guided self-study and remote evaluation PALS
course with traditional PALS instruction. Differences were measured by
pre, post and 3 month follow-up written
exams and performance video tapes.
Methods: Two locations were selected to participate in the experimental group
and two in the control group. A medium size (15-25,000) and a small
(< 2500) community was paired in each of the two groups. The
experimental group received self-instructional materials including
video tapes, workbooks and textbooks. Participants in those groups had
to reach criteria on the written examination prior to being included
in the remote teaching and evaluation session. That session was
conducted using two way interactive video teleconferencing. The
instructor/evaluator was in one location and the students in another.
An assistant helped secure equipment and conduct administrative tasks
at the student site. At the two control sites the PALS course was
taught using standard methods by two outside faculty members. Measures
included a written exam administered prior to the course, an
end-of-course and a 3 month follow-up exam. Additionally, performances
in the evaluation stations were videotaped for later evaluation by an
independent panel. A true Likert scale was developed by the review
panel by reviewing performance tapes from individuals who had not
participated in the entire course.
Results: Both experimental groups and one control groupís knowledge improved
when measured independently between the pre and the end-of-course
written examinations. (Experimental group one (EG1) t 3.518, df 5, p =
.017, CI 3.28 - 21.06; experimental group two (EG2) t 12.484, df 3, p =
.001 CI 23.10 - 38.90; control group two (CG2) t = 4.938, df 7, p =
.002, CI 12.38 - 35.12). The remaining group (CG1) combined scored lower
on the end-of-course examination than on the pre test by an mean of 6%.
The combined experimental group (EG1 + EG 2) and combined control group
(CG1 + CG2) performed similarly on the written pre test (EG 75.6%, CG
70.5%), indicating similarities in prior knowledge. However, the
experimental group performed better on the written end-of-course exam
(experimental 95.3%, control 84.25%; t 3.631, df 20, p = .002 CI 4.7 -
17.4). Three month follow-up scores were calculated for both
experimental groups and one of the control groups. The comparative
results between the end-of-course and three month retention follow-up
showed a non-significant degradation in scores of 5.5% for the
experimental group and 4.5% for the control group.
An independent panel of PALS instructors from another state was convened
to review the performance tapes. The panel began to review the
performance tapes. However, this activity had to be abandoned since the
format of the tapes acquired at the experimental sessions was
substantially different from that acquired in the control sessions.
Additionally, it was obvious that there was significant coaching that
occurred during many of the performances. These two issues made the
independent, unbiased, review
and scoring of individual performances impossible.
Remote, self-study and guided evaluation of PALS appears feasible.
Students who prepared using these self-study methods performed better in
end-of-course measures than did those trained in more traditional
courses. Knowledge degradation at three-months post training was similar
between the two groups. Unfortunately, the effects of the strategy on
performance indicators could not be ascertained in this study due to
limitations in the implementation methods and errors in video taping of
the performances. Additional trails using more structured and closely
controlled methods are warranted.
of Self-Study and Remote Skills Training
Sanddal, N.D., Sanddal, T.L.,
Pullum, J.D., Altenhofen, K. B., Werner, S. M., Mayberry, J., Rushton,
D.B., Dawson, D.E. (2001) A randomized, prospective, multi-site
comparison of out-of-hospital pediatric training methods.
Pediatric Emergency Care
(Submitted for publication).
The U.S. Department of Health and Human Services and Emergency Medical
Services-Children channeled through the Montana Emergency Medical
Services-Children (EMSC) program to contract with CIT to evaluate two
very distinct prehospital provider training methods. It was a unique
research opportunity for CIT in that Montana was focusing its efforts on
electronic training of prehospital providers while Wyoming was using
more traditional train-the-trainer methods. After being evaluated by a
panel to determine whether there is a measurable difference in
performance in one or both of the test sites, as compared with each
other and with a control site, the study has been submitted for
publication to the Journal of Emergency Care.
Study Hypothesis: Two training
methods and a control group were compared. The null hypothesis was that
no differences between the methods would be found when measured by pre
and post test results.
Methods: The model was a prospective
randomized trial involving 12 sites and 4 demographic stratifications.
Three states were selected to participate. State EMS agencies provided
lists of ambulance services stratified by demographic characteristics.
Sites were randomly selected.
Pre-intervention measurements were
conducted by a team traveling to each of the 12 sites and included a
written measurement and 2 performance scenarios that were videotaped for
later evaluation by an independent panel. Training was made available
through either CD ROM or train-the-trainer methods. The control group
received no training. A follow-up evaluation was conducted at 12 months.
Mean changes in written, performance and combined scores were analyzed.
and Conclusion: A difference was noted in both the combined scores
and the performance evaluation scores between the self-study CD ROM
intervention group and the other two groups. No differences were noted
in written measurements. Attrition resulted in a small post intervention
sample size (N = 77) that precluded analysis by multiple stratifications
and may have produced Type II errors and/or selection bias. CD ROM
training may improve out-of-hospital care providersí performance. The
research model, with modification to protect against the high rate of
attrition, shows promise. With refinement, replication of this research
approach appears warranted and provides a working model for multi-site
EMS education research.