Teaching the ABCDE approach: lecture vs. video-based instruction
Mathijs Binkhorst1, Marjolein Linders1, Jos M.T. Draaisma2, Arno F.J. van Heijst1, Marije Hogeveen1

1 Department of Neonatology, 2 Department of Paediatrics, Radboud University Medical Centre Amalia Children’s Hospital, Nijmegen, The Netherlands

Abstract (298 words)
Purpose	
The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is a widely accepted, expert-based algorithm for the management of emergencies in all age categories. Our aim was to evaluate whether video-based instruction is more effective than traditional lecturing in teaching the ABCDE approach. 

Materials and methods
A randomised controlled simulation study was performed. Neonatal healthcare providers participated in multiple neonatal advanced life support (NALS) simulation scenarios, using a high-fidelity manikin and realistic training environment. All simulations were videotaped for later assessment. For each training occasion, the instruction method was randomised to an instructional video or a conventional lecture. A researcher, blinded to the received instruction type, evaluated the adherence to the ABCDE approach with an assessment tool specifically designed and tested for this study. The primary outcome was the difference in individual adherence to the ABCDE approach, expressed as percentage score, between groups. Secondary outcomes were the scores of each profession category (nurses, residents/nurse practitioners/physician assistants, fellows/neonatologists) independent of the study groups, and the scores for the domains (A, B, C, D, and E) of the algorithm.

Results
Seventy-two participants were assessed, resulting in 65 percentage scores (the performance of the 2 nurses in each scenario was combined). Overall mean (SD) percentage score was 31.5% (19.0). The video-based instruction group (28 participants, 22 scores) performed the ABCDE approach significantly better than the lecture group (44 participants, 43 scores), with a mean (SD) score of 38.8% (18.7) and 27.8% (18.2), respectively (p=0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B (p=0.023) and C (p=0.007). Residents/nurse practitioners/physician assistants demonstrated better adherence than neonatal nurses.

Conclusions	
Video-based instruction was more effective than traditional lecturing in teaching the ABCDE approach during NALS training. Overall adherence to the ABCDE algorithm was low.

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