Pediatrics · Medical Literature
Comparing video-based and four-step simulation training in paediatric basic life support: a pilot randomised controlled study.
Abstract
We conducted a pilot randomised controlled trial in two teaching hospitals in Tunisia to compare video-based instruction and four-step low-fidelity simulation for paediatric Basic Life Support (BLS) training among interns and nurses. Knowledge was assessed using a 15-item multiple-choice questionnaire adapted from European Resuscitation Council course materials, practical skills were evaluated through a standardised SimBaby paediatric cardiac arrest scenario and learner satisfaction was measured using a 5-point Likert scale. 60 participants were enrolled (33 interns, 27 nurses). Both training modalities resulted in significant immediate improvements in knowledge and skills (p<0.001). No statistically significant differences were detected between video-based and simulation-based training immediately after training. At 3 months, retention assessment demonstrated a significant decline in knowledge and skills across both groups. Exploratory subgroup analyses suggested higher skill scores among nurses trained with simulation compared with video-based instruction. All participants reported high satisfaction, with no differences between groups. Both video-based instruction and low-fidelity simulation improved paediatric BLS knowledge and skills in this pilot study; subgroup findings were exploratory. Larger multicentre studies are warranted.
Clinical relevance
In hospital interns and nurses in a low-resource setting, does video-based instruction produce equivalent immediate and 3-month-retained paediatric basic life support (BLS) knowledge, practical skills, and learner satisfaction compared with four-step low-fidelity simulation training? __SNAPSHOT__ {"studyDesign":"Pilot randomised controlled trial","setting":"Two teaching hospitals, Tunisia (low- to middle-income country context)","sampleSize":"n=60 (interns: 33, nurses: 27; group-level allocation not reported in abstract)","population":"Hospital interns and nurses with no reported prior BLS certification status; mixed professional background (medical and nursing trainees)","intervention":"Video-based instruction for paediatric BLS","comparator":"Four-step low-fidelity simulation training using a SimBaby manikin for a standardised paediatric cardiac arrest scenario","primaryOutcome":"Not formally designated in abstract; outcomes assessed were: (1) BLS knowledge via 15-item multiple-choice questionnaire adapted from European Resuscitation Council materials, (2) practical skills via standardised SimBaby scenario, and (3) learner satisfaction via 5-point Likert scale — at immediate post-training and 3-month retention timepoints","followUp":"3 months (immediate post-training plus one retention assessment at 3 months)","fundingSource":"Not reported"}
Key findings
Both training modalities produced statistically significant improvements in knowledge and practical skills scores immediately after training compared with pre-training baselines (p<0.001 for both groups; effect sizes, absolute score changes, and confidence intervals not reported in the abstract). No statistically significant between-group difference in knowledge scores, skill scores, or learner satisfaction was detected at the immediate post-training assessment. At 3 months, a statistically significant decline in both knowledge and skills scores was observed across both groups (direction and magnitude of decline, p-values, and confidence intervals for the retention comparison not reported in the abstract). An exploratory subgroup analysis suggested higher skill scores at some timepoint(s) among nurses trained with simulation versus video-based instruction; however, this finding was exploratory, no inferential statistics are reported, and it must be interpreted with caution given the small sample and post-hoc nature. All participants reported high satisfaction with no statistically significant difference between groups (Likert-scale means and confidence intervals not reported). No adverse events or safety data were reported. NNT/NNH: not calculable from available data.
Practice implications
This pilot RCT establishes proof-of-concept that both video-based instruction and four-step low-fidelity simulation can produce significant, immediate gains in paediatric BLS knowledge and skills among hospital trainees in a resource-limited setting. However, the study did NOT establish: (1) superiority of either modality overall; (2) adequacy of 3-month retention with either method, since both groups showed significant skill and knowledge decay—a clinically important concern for real-world resuscitation performance; (3) whether observed differences in nurses' skill scores with simulation represent a true differential effect, as the subgroup analysis was exploratory and underpowered. Findings are most applicable to interns and nurses in teaching hospital settings in low- to middle-income countries where high-fidelity simulation is unavailable. The study was not powered to detect meaningful between-group differences and was explicitly framed as a pilot; results cannot be used to recommend one modality over the other or to guide refresher training intervals. Clinicians in high-income, high-fidelity simulation environments should not extrapolate these findings. IMPORTANT NOTE: This summary is based exclusively on the published abstract; full methods, randomisation procedures, allocation concealment, blinding details, baseline balance, and complete statistical outputs were not available for review. __LIMITATIONS__ Pilot study with n=60, severely underpowered to detect clinically meaningful between-group differences in knowledge, skills, or satisfaction,Abstract does not report whether a formal primary outcome was pre-specified, raising risk of outcome reporting bias,Group-level sample sizes and allocation concealment details not reported in abstract,Blinding of assessors not described; performance on a standardised scenario is susceptible to assessment bias without blinding,Mixed learner population (interns and nurses) with different baseline competencies, professional roles, and learning needs, which may dilute or confound group-level results,Subgroup analysis comparing nurses across modalities was exploratory and post-hoc; no correction for multiple comparisons reported,Single-country, two-hospital setting in Tunisia limits generalisability to other healthcare systems, training cultures, and resource environments,Only one retention timepoint (3 months); decay trajectory between immediate and 3-month assessments is unknown,Learner satisfaction (Likert scale) is a low-level Kirkpatrick outcome; no patient-level or system-level outcomes assessed,Funding source not reported; cannot assess risk of industry or institutional sponsorship bias,Full statistical reporting (means, SDs, CIs, effect sizes) not available from abstract alone __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this small pilot RCT from Tunisian teaching hospitals, both video-based instruction and four-step low-fidelity simulation produced equivalent, statistically significant immediate improvements in paediatric BLS knowledge and skills among interns and nurses, with high satisfaction in both groups. Critically, both modalities showed significant skill and knowledge decay at 3 months, underscoring the need for structured refresher training regardless of modality. These preliminary findings support the feasibility of video-based instruction as a low-resource alternative to simulation, but the study is insufficiently powered to guide definitive training policy; a adequately powered confirmatory trial is needed.