Is patient morbidity and mortality improved with a skill teaching strategy embedded in learning theory?

Purpose: Basic and Advanced Life Support have improved survival in people who experience cardiac arrest [1]. In clinical education, performance is assessed as an indicator of future skill performance, but the assumption that this relates to patient outcomes has not been widely tested. This study examines the relationship between two common skill teaching methods (Walker and Peyton's 4-Stage approach [2], and a more traditional 2-Stage approach) and factors predictive of patient morbidity and mortality. Methods: A skill checklist was developed for both Manual IntraOsseous (IO) and Laryngeal Mask Airway (LMA) insertion based on published literature [3–5] and manufacturers recommendations. A Delphi study further validated these checklists to identify expert pre-hospital clinician consensus on how IO and LMA should be inserted. Clinicians also identified which steps relate to reduction of morbidity and mortality. Undergraduate paramedic and nursing students were invited to participate in a randomised crossover trial where manual IO and LMA were taught by two different teaching strategies. Their skill performance was video recorded immediately before and after teaching, and then again 7 months later. These checklists were applied to the student performance videos by blinded assessors to investigate whether the two teaching methods were comparable in patient outcomes 7 months following teaching. Results: Preliminary results indicate improved skill performance in students who are taught with a 4-Stage approach compared to a traditional teaching model. Patient morbidity and mortality data is being finalised and is expected to support preliminary findings. Conclusions: This research brings the patient to the forefront of clinical skill education. Teaching is often driven by assessment outcomes which are not validly aligned to anticipated patient outcomes. This study empowers clinical educators to improve morbidity and mortality through intentional teaching strategies.