Author
Emergency Medicine, Government Medical College, Kannur, Pariyaram, Kerala, India
Abstract
BACKGROUND: Demonstration‑Observation‑Assistance‑Performance (DOAP) and Video‑Assisted
Learning (VAL) are small‑group teaching/learning methods (TLM) in medical education. Comparison
studies between the two are scanty. There is a gap in knowledge, skills, and attitude among medical
interns toward Advanced Cardiac Life Support (ACLS). The author studied the effectiveness of DOAP
and VAL in training ACLS using mannequins and automated external defibrillator (AED)-simulators
among interns in 2021.
MATERIALS AND METHODS: This descriptive study was done in the Emergency Department of
a tertiary teaching hospital in South India. Out of 80 medical interns, 39 and 41 were allocated to
ACLS training by DOAP (Group 1) and VAL (Group 2), respectively, by convenient sampling with
random allocation, with the use of mannequins and AED‑Simulators (10 interventions in each small
group; three‑five participants in each session). Pre‑validated pre‑test and posttest multiple‑choice
questionnaires (MCQs) and attitude questionnaires, OSCE by two blinded assessors, and perception
by Likert‑based questionnaire were analyzed with appropriate statistical analysis.
RESULTS: The mean pretest and posttest MCQs and Attitude and OSCE scores of DOAP and VAL
showed no statistically significant difference between them (MCQ pre‑test 44.51 (11.43); 42.54 (6.56);
p = 0.350 and MCQ posttest, 78.97 (8.59); 77.22 (11.29); p = 0.438; OSCE 40.51 (2.43) and
40.63 (1.92); p = 0.804; Attitude: 11 (3), 11 (2); p = 0.567; 14 (2), 14 (3); p = 0.095). MCQ post‑tests
showed improved scores (p < 0.001) in both the methods and the standardized mean difference
based on the MCQ scores for the DOAP group was 3.02, and for the VAL group 3, showed the
effectiveness of both methods. Perception scores showed learners’ interest and positive feedback
to both methods and ACLS.
CONCLUSION: Both DOAP and VAL were equally effective TLMs in imparting knowledge, skills, and
attitude to medical interns with positive feedback. In DOAP, the learner performs under supervision
and clarifies doubts. As repeatable and cost‑effective, VAL is useful in resource‑limited settings.
Both can be used as complementary methods in training ACLS. The attitude of learners towards
ACLS improved with training.
Keywords
curriculum for the UG Curriculum for the Indian Medical
Graduate, 2018. Available from: https://www.nmc.org.in/
wpcontent/uploads/2020/01/UGCurriculum‑Vol‑II.pdf.
2. Ananthakrishnan N. Competency‑based undergraduate
curriculum for the Indian medical Graduate, the new MCI
curricular document. Positive and areas of concern. J Basic Clinical
App Health Sci 2018;2:184‑92.
3. Sundeep S, Pillai SK. Demonstrate observe assist perform
versus video‑assisted teaching in teaching deep tendon reflexes
to medical students: A comparative study. Int J Res Med Sci
2020;8:613‑7.
4. Ahmet A, Gamze K, Rustem M, Sezen KA. Is video‑based
education an effective method in surgical education? A systematic
review. J Surg. Educ 2018;75:1150‑8.
5. Todd KH, Braslow A, Brennan RT, Lowery DW, Cox RJ,
Lipscomb LE, et al. Randomized, controlled trial of video
self‑instruction versus traditional CPR training. Ann Emerg Med
1998;31:364‑9.
6. Yaqinuddin A, Kashir J, AlKattan W, AlKattan K. Applying
integrated video‑assisted learning approaches for medical
clerkship – potential adaptations in the post‑COVID‑19
era. J Med Educ Curric Dev 2020;7:2382120520963043. doi:
10.1177/2382120520963043.
7. Mouneghi HK, Derakhshan A, Valai N, Mortazavi F. The
effectiveness of video‑based education on gaining practical
learning skills in comparison with demonstrating method’s
effectiveness among university students. J Med Educ 2003;4:27‑30.
8. Prabhu S. Comparison of traditional versus video‑based teaching
on neurological assessment among undergraduate nursing
students. J Health Allied Sci NU 2013;3:29‑32.
9. Pilieci SN, Salim SY, Heffernan DS, Itani KMF, Khadaroo RG.
A randomized controlled trial of video education versus skill
demonstration: Which is more effective in teaching sterile surgical
technique? Surg Infect (Larchmt) 2018;19:303‑12.
10. Chandrasekaran S, Kumar S, Bhat SA, Kumar S, Shabbir PM,
Chandrasekaran V, et al. Awareness of basic life support among
medical, dental, nursing students, and Saravana Kumar . Indian
J Anaesth 2010;54:121‑6.
11. Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S,
Castrén M, et al. Adult basic life support: International consensus
on cardiopulmonary resuscitation and emergency cardiovascular
care science with treatment recommendations. Resuscitation
2020;156:A35‑79.
12. Kundra P, Vinayagam S. COVID‑19 cardiopulmonary
resuscitation: Guidelines and modifications. J Anesthesia Clan
Pharmacol 2020;36(Suppl S1):39‑44.
13. Nambiar M, Nedungalaparambil NM, Aslesh OP. Is current
training in basic and advanced cardiac life support (BLS &
ACLS) effective? A study of BLS & ACLS knowledge amongst
healthcare professionals of North‑Kerala. World J Emerg Med
2016;7:263‑9.
14. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB.
Does simulation‑based medical education with deliberate
practice yield better results than traditional clinical education?
A meta‑analytic comparative review of the evidence. Acad Med
2011;86:706‑11.
15. Anderson R, Sebaldt A, Lin Y, Cheng A. Optimal training
frequency for acquisition and retention of high‑quality CPR skills:
A randomized trial. Resuscitation 2019;135:153‑61.
16. Abolfotouh MA, Manal AA, Alamin NB, Deema AA‑T,
Abdulrhman IA. Impact of basic life‑support training on the
attitudes of health‑care workers toward cardiopulmonary
resuscitation and Defibrillation. BMC Health Serv Res 2017;17:674.
17. Devi B, Khandelwal B, Das M. Comparison of the effectiveness of
video‑assisted teaching program and traditional demonstration
on nursing students learning skills of performing obstetrical
palpation. Iran J Nurs Midwifery Res 2019;24:118‑23.
18. Mayer RE. Multimedia Learning. New York, NY, US: Cambridge
University Press; 2001.
19. Roshini KN, Andrews MA. Effectiveness of video‑assisted
teaching program and traditional demonstration of mechanism
of labor on undergraduate medical students. Int J Med Sci Educ
2019;6:72‑6.
20. Grześkowiak M. The effects of teaching basic cardiopulmonary
resuscitation – A comparison between first and sixth‑year medical
students. Resuscitation 2006;68:391‑7.
21. McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI,
Lotfipour S, et al. Randomized controlled trial of simulation vs
standard training for teaching medical students high‑quality
cardiopulmonary resuscitation. West J Emerg Med 2019;20:15‑22.
22. Ramakrishnan R, Trichur Venkatakrishnan R, Vijayan P,
Cattamanchi S. ‘Video‑assisted self‑assessment of basic life
support skills in medical students. Med Ed Publish 2019;8:48.
23. Chilkoti G, Mohta M, Wadhwa R, Saxena AK, Sharma CS,
Shankar N. Students’ satisfaction to hybrid problem‑based
learning format for basic life support/advanced cardiac life
support teaching. Indian J Anaesth 2016;60:821‑5.
24. Li Y, Wang Y, Li Y, Zhong M, Liu H, Wu C, et al. Comparison
of repeated video display vs combined video display and live
demonstration as training methods to healthcare providers
for donning and doffing personal protective equipment:
A randomized controlled trial. Risk Manag Healthc Policy
2020;13:2325‑35.
25. Alqahtani ND, Al‑Jewair T, Al‑Moammar K, Albarakati SF,
ALkofide EA. Live demonstration versus procedural video:
A comparison of two methods for teaching an orthodontic
laboratory procedure. BMC Med Educ 2015;15:199. doi: 10.1186/s12909‑015‑0479‑y.
26. Sugathapala RDUP, Chandrika MGR. Student nurses’ knowledge
acquisition on oral medication administration: Comparison
of lecture demonstration vs. video demonstration. BMC Nurs
2021;20. doi: 10.1186/s12912‑020‑00527‑6.
27. Hilal Z, Kumpernatz A, Rezniczek GA, Cetin C, Tempfer‑Bentz E,
Tempfer C. A randomized comparison of video demonstration
versus hands‑on training of medical students for vacuum delivery
using objective structured assessment of technical skills (OSATS).
Medicine 2017;96:e6355.
28. Arumugom A, Chandrasekaran V. A randomized comparison
between video demonstration and verbal instruction in improving
Rota haler technique in children with persistent asthma: A pilot
study. J Clin Diagn Res 2017;11:SC05‑7.
29. Najafi Z, Barghi M, Kooshyar H, Karimi‑Mounaghi H, Rodi MZ.
A comparison of the effect of education through video versus
demonstration on fear of falling in nursing home residents of
Mashhad, Iran. Iran J Nurs Midwifery Res 2017;22:195‑200.
30. Sopka S, Hahn F, Vogt L, Pears KH, Rossaint R, Rudolph J, et al.
Peer video feedback builds basic life support skills: A randomized
controlled non‑inferiority trial. PLoS One 2021;16:e0254923. doi:
10.1371/journal.pone. 0254923.
)