Document Type : Original Article


1 Emergency Department, Mashhad University of Medical Sciences, Mashhad, Iran

2 Community Medicine Department, Mashhad University of Medical Sciences, Mashhad, Iran


Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students.

Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012) participated in this study. Advanced Cardiovascular Life Support (ACLS) workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA) guidelines.

Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100). This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001). Also the mean score of each station had a significant improvement (P< 0.001).

Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students.


Main Subjects

1. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Adult advanced cardiovascular life support 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122: S729-67.
2. Farah R, Stiner E, Zohar Z, Eisenman A, Zveibil F. The importance of CPR training for assessing the knowledge and skills of hospital medical and nursing
personnel. Harefuah 2007; 146(7): 529-33.
3. Diane B, Viva J, Monica J, Fudala BA, Leonard D, William C. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med 2006; 21: 251–6.
4. Ruesseler M, Weinlich M, Müller MP, Byhahn C, Marzi I, Walcher F. Simulation training improves ability to manage medical emergencies. Emerg Med J 2010; 27(10): 734-8.
5. Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, et al. Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (18 Suppl 3): S676-84.
6. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Linquist LA, Feinglass J, et al. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. Teach Learn Med 2005; 17 (3): 210-6.
7. Borimnejad L, Rasouli M, Nikbakht NasrabadiAR, Mohammadi H, Kheirati L. Effect of trained cardiopulmonary resuscitation team on the outcomes of cardiopulmonary resuscitation. J Babol Univ Med Sci 2008; 10 (3): 55-61. [In Persian]
8. Rodgers DL, Securro S, Pauley RD. The effect of high fidelity simulation on educational outcomes in an advanced cardiovascular life support course.  Simul Health 2009; 4 (4): 200-6.
9. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 2008; 133 (1): 56-61.
10. Lee CC, Im M, Kim TM, Stapleton ER, Kim K, Suh GJ, et al. Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students. J Emerg Med 2010; 38(1): 89-92.
11. Ko PY, Scott JM, Mihai A, Grant WD. Comparison of a modified longitudinal simulation-based advanced cardiovascular life support to a traditional advanced cardiovascular life support curriculum in third-year medical students. Teach Learn Med 2011; 23(24): 324-30.
12. Stefan MS, Belforti RK, Langlois G, Rothberg MB. A simulation-based program to train medical residents to lead and perform advanced cardiovascular life support. Host Pract (1995) 2011; 39(4): 63-9.
13. Wayne DB, Siddall VJ, Butter J, Fudala MJ, Wade LD, Feinglass J, et al. A longitudinal study of internal medicine residents’ retention of advanced cardiac life support skills. Acad Med 2006; 81(10): S9-12.
14. Mieure KD, Vincent WR, Cox MR, Jones MD. A high-fidelity simulation mannequin to introduce pharmacy students to advanced cardiovascular life support. Am J Pharm Educ 2010; 74(2): 22.
15. Delasobera BE, Goodwin TL, Strehlow M, Gilbert G, D’Souza P, Alok A. Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India. Resuscitation 2010; 81(2): 217-23.
16. Lo BM, Devine AS, Evans DP, Byars DV, Lamm OY, Lee RJ, et al.Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge.  Resuscitation 2011; 82(11): 1440-3.
17. Schwid HA, Rooke GA, Ross BK, Sivarajan M. Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review. Crit Care Med 1999; 27(4): 821-4.