Fatores envolvidos na fixação do aprendizado durante os cursos de suporte avançado de vida em cardiologia

Abstract

Evidences showed that good emergency training for lay person or health care professionals reduces prehospital and hospital mortality. However, even after a good training the knowledge and skills retention are poor and is a challenge. The knowledge and skills retention loss become evident as soon as after some weeks after a regular Advanced Cardiac Life Support course (ACLS). Some variables had been implicated in skills and knowledge loss or course failure. These variables motivated this dissertation in article format. The first article tested the hypothesis of using live actors, increasing scenarios realism, could improve knowledge acquisition and retention compared to conventional manikin commonly used in ACLS courses. With this purpose, nineteen selected courses from December 2004 to October 2005 were randomly divided in two groups: Group A (ACLS courses with conventional manikins plus live actors) and group B (ACLS courses with conventional manikins). After a signed informed consent, health care providers were randomly allocated in one of the courses without knowing what kind of instruction would be offered. All courses followed the ACLS instructor manual and were administered by the same team of instructors. Live actors used their voices to promote more realistic scenarios. Knowledge (cognition) measurement was assessed by theoretical evaluation before course (pre-test), immediately after the course (post-test) and after 6 months (final test). From 435 participants recruited to the study and randomly allocated in one of the groups A or B 225 participants (51.7%; 111 group A and 114 group B) completedall sequence of pre-test, post-test and final test and were included in this trial. By univariate analysis the use of live actors, gender and health care providers professions did not affect pre-test, post-test and final test results (p>0.1) and consequently theorical retention. Comparison of time elapsed after medical or nurse graduation and age with all three tests showed a negative correlation (95% C.I. - 0.53 to -0.17, -0.43 to -0.2, -0.42 to -0.11 respectively p < 0.05 for time after graduation and 95% C.I. -0.56 to -0.21, -0.42 to -0.2, -0.38 to -0.07 respectively p < 0.05 for age). An inverse correlation was maintained if type of manikin was includedin analyses of pre-, post- and final tests scores and time elapsed after medical or nurse graduation and age (Linear regression coefficient; 95% C.I. -0.4 to -0.1, -0.45 to -0.21, -0.6 to -0.21 p < 0.05). We concluded that the use of live actors did not influence knowledge retention in thisgroup and older age and longer time elapsed after graduation were associated with worst scores and knowledge retention. The second article evaluated the effect of financial support and the place where course occurs in the learning of emergency. With this objectives we analyzed the data bank of American Heart Association (AHA)certificated training organization center. From December 2005 to December 2006 Eight hundred and nineteen health care professionals who had participated in the ACLS courses were enrolled in this retrospective study. These providers had been subdivided in 3 groups in accordance with the financial support. Group 1: Integral financial support (n=199, 24%); Group 2: 50% financial support (n=122, 15%) andGroup 3: Without any kind of financial support (n=498, 61%). They also had been subdivided in 2 groups in accordance with the place where the course was carried through. Place A: course carried through in urban center with more than one million inhabitants (n=482, 59%); Place B: course carried through in urban center with less than 1 million inhabitants (n=337, 41%). All providers had been compared in terms oftheorical and practical evaluation approval and theorical scores. Group 3 (without any financial support) had more approvals and better scores than any other groups. In terms of course localization, practical evaluation was similar in both groups (p=0.33), however theorical approval were bigger in place A than in place B (73% versus 65% - p=0.021. OR=1.44 and IC: 1.05 1.97). Providers in local A had better scores thanproviders in local B (87.1 ± 10.4 and 86 ± 11 respectively p < 0.05). In conclusion, financial support and the place where the courses carries through influences theorical and practical approval.