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Original Research

Open Access

Medical students perform basic life support skills in a simulated scenario better using a 4-stage teaching approach compared to conventional training


1Simulation Center, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

2 Clinical Department of Anesthesiology and Intensive Therapy, University Medical Center Ljubljana, Ljubljana, Slovenia

3 Chair of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

4 Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Maribor, Maribor, Slovenia

DOI: 10.22514/SV131.042017.22 Vol.13,Issue 1,March 2017 pp.61-64

Published: 20 March 2017

*Corresponding Author(s): MAJA FRANGEŽ E-mail:


Introduction. Cardiopulmonary resuscita-tion is influenced by the quality of basic life support (BLS). The primary objective of our study was to compare efficiency in the acquisition of BLS skills using conven-tional training and the 4-stage approach as a teaching method for BLS training. Methods. In a prospective, randomised, 2-parallel group study, 266 first year medi-cal students were randomised to either conventional training or the 4-stage ap-proach using 2000 and 2005 ERC (Euro-pean Resuscitation Council) guidelines. The students were tested immediately after receiving training. Three ERC-certified instructors assessed BLS skills using video recordings.

Results. The students who were taught according to the 4-stage approach using 2000 guidelines preformed significantly better in the following steps: calls for help (p<0.01), opens the airway (p<0.01), plac-es hands for chest compression correctly (p<0.01) and performs chest compressions correctly (p<0.01), while using 2005 guide-lines, only chest compression hand posi-tion improved significantly in the 4-stage teaching group (p<0.01).

Conclusions. The 4-stage approach im-proved the efficiency of several steps of the BLS algorithm and the ability to follow the algorithm in the correct sequence us-ing 2000 ERC guidelines, while in students using the 2005 ERC guidelines only chest compression hand position improved significantly. Students who were taught according to 2000 ERC guidelines had significantly better hand position than students who were taught according to 2005 guidelines, independent of teaching method used.


basic life support, medical stu-dents, education, teaching method

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MAJA FRANGEŽ,MATEJ JENKO,PRIMOŽ GRADIŠEK,MIRT KAMENIK. Medical students perform basic life support skills in a simulated scenario better using a 4-stage teaching approach compared to conventional training. Signa Vitae. 2017. 13(1);61-64.


1. Bottiger BW, Dirk B. Education. The link to survival. Notfall Rettungmedizin 2009;12 Suppl 2:24-5.

2. Lund I, Skulberg A. Cardiopulmonary resuscitation by lay people. Lancet 1967:702-4.

3. Eisenberg MS, Bergner L, Hallstrom A. Cardiac resuscitation in the community. JAMA 1979;(241):1905-7.

4. Wik L, Kramer -Johansen J, Myklebust H. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005;(293):299-304.

5. Rajapakse R, Noč M, Kersnik J. Public knowledge of cardiopulmonary resuscitation in Republic of Slovenia. Wien Klin Wochenschr 2010;(122):667-72.

6. Owen A, Kocierz L, Aggarwal N, Hulme J. Comparison of the errors in basic life support performance after training using the 2000 and 2005 ERC guidelines. Resuscitation 2010;81(6):766-8.

7. Spooner BB, Fallaha JF, Kocierz L, Smith CM, Smith SCL, Perkins GD. An evaluation of objective feedback in basic life support (BLS) training. Resuscitation 2007;73(3):417-24.

8. Chamberlain D, Hazinski MF. Education in Resuscitation. Resuscitation 2003;59(1):11-43.

9. Parnell MM, Larsen PD. Poor quality teaching in lay person CPR courses. Resuscitation 2007;73(2):271-8.

10. Kaye W, Rallis SF, Mancini ME, Linhares KC, Angell ML, Donovan DS, et al. The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum. Resuscitation 1991;21:67-87.

11. Greif R, Egger L, Basciani RM, Lockey A, Vogt A. Emergency skill training- a randomized controlled study on the effectiveness of the

4- stage approach compared to traditional clinical teaching. Resuscitation 2010;81(12):1692-7.

12. Peyton JWR, editor. Teaching and learning in medical practice. Rickmansworth: Manticore Europe; 1998.

13. Barelli A, Scapigliati A. The four-stage approach to teaching skills: the end of a dogma? Resuscitation 2010;81(12):1607-8.

14. Bullock I. Skill acquisition in resuscitation. Resuscitation 2000;45:139-43.

15. Bullock I, Davis M, Lockey A. Kevin Mackway-Jones, editors. Pocket guide to teaching for medical instructors. 2nd ed Manchester Blackwell Publ. 2008.

16. Steinmetz J, Barnung S, Nielsen SL, Risom M, Rasmussen LS. Improved survival after an out-of-hospital cardiac arrest using new guidelines. Acta Anaesthesiol Scand 2008;52(7):908-13.

17. Olasveengen TM, Vik E, Kuzovlev A, Sunde K. Effect of implementation of new resuscitation guidelines on quality of cardiopulmo-nary resuscitation and survival. Resuscitation 2009;80(4):407-11.

18. Orde S, Celenza A, Pinder M. A randomised trial comparing a 4-stage to 2-stage teaching technique for laryngeal mask insertion. Resuscitation 2010;81(12):1687-91.

19. Schwerdtfeger K, Wand S, Schmid O, Roessler M, Quintel M, Leissner KB et al. A prospective, blinded evaluation of a video-assisted “4-stage approach” during undergraduate student practical skills training. BMC Med Educ 2014;14(1):104.

20. Mohamadirizi S, Fahami F, Bahadoran P, Ehsanpour S. The effect of four phase teaching method on midwifery students emotional intelligence in managing the childbirth. J Educ Health Promot 2015;4:1-5.

21. Handley AJ, Monsieurs KG, Bossaert LL. European Resuscitation Council Guidelines 2000 for Adult Basic Life Support. Resuscita-tion 2001;48:199-205.

22. Handley AJ. Teaching hand placement for chest compression - A simpler technique. Resuscitation 2002;53(1):29-36.

23. Jenko M, Frangež M, Manohin A. Four-stage teaching technique and chest compression performance of medical students compared to conventional technique. Croat Med J 2012;53(5):486-95.

24. Saraç L, Ok A. The effects of different instructional methods on students’ acquisition and retention of cardiopulmonary resuscitation skills. Resuscitation 2010;81(5):555-61.

25. Todd KH, Braslow A, Brennan RT. Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med 1998;31(3):364-9.

26. Pande S, Parate V, Pande S, Sukhohal N. Evaluation of retention of Knowledge and skills imparted to first year medical students through basic life support training. Advan Physiol Edu 2014;38:42-5.

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