EVALUATION OF CARDIOPULMONARY-RESUSCITATION SKILLS OF GENERAL-PRACTITIONERS USING DIFFERENT SCORING METHODS

In this study we evaluated the practical performance of 70 general pra ctitioners in cardiopulmonary resuscitation (CPR) before and after ins truction and compared checklist-based scores to mechanical recording s cores in order to investigate which scoring method is preferable. Both checklist and recording strip-based scores showed significant improve ment after instruction, but only 37% were judged proficient according to the American Heart Association standards (checklist scoring), and 4 7% according to the recording print-based scoring system, while raters judged 97% as satisfactory by general impression. Interrater reliabil ity was highest for the recording print (0.97) and lower for the check list (0.79), especially for CPR performance (0.56). Comparison of chec klist and recording print showed that the checklist was specific but n ot very sensitive in identifying poor performance for cardiac compress ion rate, since observers overestimated performance. The correlation f or CPR performance between checklist score and recording strip score w as low (0.45), indicating that candidates were ranked differently. The correlation between diagnosis and performance score was low for check list as well as recording print (0.22), indicating that the score on d iagnosis was a poor predictor for the score on performance of CPR. The se results support the use of the recording manikin as compared with t he use of a checklist for formative evaluation of basic life support s kills. However, as proficiency in diagnosis and performance in CPR are poorly correlated, assessment of diagnosis using a checklist must be included. Therefore we strongly recommend the combination of assessmen t by observers using a checklist for diagnostic procedures and the rec ording strip of the manikin for performance of CPR, as employed in mos t evaluation schemes. (C) 1997 Elsevier Science Ireland Ltd.