Kaye W, Rallis S F, Mancini M E, Linhares K C, Angell M L, Donovan D S, Zajano N C, Finger J A
Department of Surgery, Brown University, Miriam Hospital, Providence, RI 02906.
Resuscitation. 1991 Feb;21(1):67-87. doi: 10.1016/0300-9572(91)90080-i.
Many studies (several even before American Heart Association recommended in 1973 that lay public be trained in cardiopulmonary resuscitation (CPR] have documented that retention of CPR skills is poor, unaffected by modifications in curriculum or whether the students are lay or professional. We chose to investigate what actually occurs during a CPR course, and gained the following insights: despite clearly defined curricula, we found that instructors did not teach in a standardized way. Practice time was limited and errors in performance were not corrected. Instructors consistently rated the students' overall performance as acceptable; at the same time, using the same checklist, we consistently rated performance as unacceptable. The checklist is an inaccurate tool for evaluating CPR performance. Despite the poor performance that we documented, students and instructors were satisfied with the courses and believed that the level of performance was high. As a result of these studies, we discovered that the problem of poor retention of CPR skills may lie not with the learner or the curriculum, but with the instructor. But, since lives are being saved with bystander CPR, does this documented poor retention matter? Perhaps the solution is not only to improve instructor training to make certain that students receive adequate practice time and accurate skill evaluation, but also to modify the criteria for correct performance when testing for retention. These criteria should be based on the minimum CPR skills that are required to sustain life for the critical 4-8 min before defibrillation and other advanced cardiac life support are delivered.
许多研究（甚至在美国心脏协会于1973年建议对普通公众进行心肺复苏术（CPR）培训之前就有几项研究）已经证明，CPR技能的保持情况很差，不受课程修改或学生是普通公众还是专业人员的影响。我们选择调查CPR课程实际发生了什么，并获得了以下见解：尽管课程明确，但我们发现教师授课方式不规范。练习时间有限，操作错误未得到纠正。教师一直将学生的整体表现评为可接受；与此同时，使用相同的检查表，我们一直将表现评为不可接受。该检查表是评估CPR表现的不准确工具。尽管我们记录的表现不佳，但学生和教师对课程感到满意，并认为表现水平很高。通过这些研究，我们发现CPR技能保持不佳的问题可能不在于学习者或课程，而在于教师。但是，既然旁观者CPR能挽救生命，这种记录在案的技能保持不佳有关系吗？也许解决方案不仅是改进教师培训，以确保学生有足够的练习时间和准确的技能评估，还在于修改技能保持测试时正确表现的标准。这些标准应基于在进行除颤和其他高级心脏生命支持之前维持关键的4 - 8分钟生命所需的最低CPR技能。
