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Evaluation of a Novel Web-Based Pediatric Advanced Life Support Course

Students perceive Web-PALS as a positive educational experience. Though not identical to students taking the Trad-PALS course, they performed well on postcourse cognitive and psychomotor testing. These findings support Web-PALS as an acceptable format for administering the PALS course.

In cooperation with the American Heart Association (AHA), in July 2002, we introduced a Web-based pediatric advanced life support course (Web-PALS) that teaches the cognitive portion of the PALS material via an Internet Web site. Through the Web site, students learn PALS concepts by completing 6 interactive, case-based modules. After completing online modules, students attend a 1-day course that provides the psychomotor training and testing components of the course.

This format is similar to other self-directed, distance-taught life support courses such as the CD-ROM–based HeartCode advanced cardiac life support Anywhere course and the online basic life support for health care providers and electronic advanced cardiac life support3 renewal courses. Web-PALS is offered to students taking an initial course and to those seeking recertification.

The Web-PALS course allows students to review the cognitive portion of the PALS material at a convenient time and at their own pace. The reduced onsite time lessens time away from home and office and has the potential to decrease travel-related expenses. The Web-PALS course offers advantages for PALS instructors and administrators by providing cognitive material online, thus decreasing the number of instructor-hours and related expenses to teach the PALS course.

It ensures that the cognitive material is provided in a consistent manner, including the dissemination of PALS updates to all students. Finally, with the increasing availability of broadband Internet access, in the future, Web-PALS will be ideally suited to present AHA-developed instructional videos to students taking the PALS course.

We describe the development of the Web-PALS course and a pilot study to assess its educational efficacy. The primary objective of the study was to compare the cognitive and psychomotor performance of students who completed the Web-PALS course with that of students who completed a traditional, classroom-based PALS course (Trad-PALS). Secondary goals were to assess the effect of the Web-PALS course on student self-confidence to perform PALS assessments and procedures and their overall satisfaction with the course.

Course development

Core material from the PALS course was incorporated into 6 interactive, case-based modules: respiratory failure, shock, newly born, rhythm disturbances, trauma, and cardiac arrest. Each module contains a list of objectives, an interactive case, links to pertinent algorithms, and postmodule questions. Postmodule questions differ from those on the postcourse written examination. For each module, students select from a prehospital or hospital setting. Each module is designed to take approximately 1 to 1½ hours to complete.

The current charge for taking Web-PALS, including online and onsite components, is comparable to the charge for a traditional 2-day PALS course. A link for purchasing a hard-copy PALS textbook is provided on the Web site. Students must satisfactorily complete the AHA PALS pretest (minimum score, 85%) online before entering the modules. To complete each module, students must correctly answer 85% of the postmodule questions.

After completing the modules, students are eligible to take a 1-day skills/testing course, which is an 8-hour onsite class formatted to meet all of the AHA requirements for instruction of the psychomotor components of the PALS course. During the 1-day skills/testing course, students rotate through skills instructional stations and case scenario practice stations. At the end of the course, students attend practical evaluation stations and complete the postcourse written examination. After satisfactory completion of the course, students receive an AHA course completion card.

Study design and subjects.

Between July 16, 2002, and September 4, 2003, health care providers (includes physicians, nurses, paramedics, and respiratory therapists) taking either a Web-PALS or Trad-PALS course at the Saint Louis University Health Sciences Center were recruited into the study. The Trad-PALS course taught at our institution is a 3-day pediatric advanced cardiorespiratory and trauma support (PACTS)–PALS course that integrates all of the PALS elements with additional PACTS material.

The PACTS curriculum, developed at our institution, consists of classroom lectures on topics such as surgical, neurosurgical, and toxicologic emergencies. In addition, students rotate through a practical trauma skills and scenario station.

During the study, subjects were recruited from 14 PALS courses (8 Web-PALS and 6 Trad-PALS). All students, regardless of profession or previous PALS experience, were eligible to participate. Subjects were excluded from consideration if they were enrolled in a 1-day PALS recertification course. As an incentive, study subjects were reimbursed $50.00. The study was approved by the Institutional Review Board at Saint Louis University. All subjects provided written informed consent.

Demographic and self-confidence data

Before the start of each PALS course, study subjects completed questionnaires to provide demographic and self-confidence data. The self-confidence portion, adapted from a questionnaire developed by Craven and Froman,6 consisted of 39 items on which students rated their confidence level to perform various PALS assessments and procedures on a 5-point Likert scale (1, very little; 5, quite a lot).

Students taking the Web-PALS course completed the questionnaire online before being allowed into the educational modules. Students taking the Trad-PALS course completed the questionnaire at the beginning of the first day of each course. The self-confidence questionnaire was readministered to subjects immediately after completion of the course. Changes in self-confidence scores were assessed for students within each study group.

Cognitive performance

To assess cognitive performance, scores from the AHA postcourse written examination were collected. The postcourse written examination consists of 33 multiple-choice questions developed and validated by the Pediatric Resuscitation Subcommittee of the AHA (Mary Fran Hazinski, MSN, written communication, January 2004). Successful completion of the written examination (minimum score, 84%) is required to receive PALS certification. Version A of the 2002 AHA PALS examination was used for both groups throughout the study. The frequency of correct responses for each examination question and overall mean examination scores were compared between groups.

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