Resuscitation 80 (2009) 238–243 Contents lists available at ScienceDirect Resuscitation journal homepage: www.elsevier.com/locate/resuscitation Simulation and education paper The significance of clinical experience on learning outcome from resuscitation training—A randomised controlled study  Morten Lind Jensen a,* , Freddy Lippert b , Rasmus Hesselfeldt a , Maria Birkvad Rasmussen a , Simon Skibsted Mogensen a , Michael Kammer Jensen c , Torben Frost d , Charlotte Ringsted a a Centre for Clinical Education, Copenhagen University Hospital, Rigshospitalet, Denmark b Head Office, The Capital Region of Denmark, Denmark c Danish Institute of Medical Simulation, Copenhagen University Hospital, Herlev, Denmark d Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark article info Article history: Received 26 May 2008 Received in revised form 13 September 2008 Accepted 13 October 2008 Keywords: Cardiopulmonary resuscitation (CPR) Advanced Life Support (ALS) Training Education Emergency treatment Megacode training abstract Context: The impact of clinical experience on learning outcome from a resuscitation course has not been systematically investigated. Aim: To determine whether half a year of clinical experience before participation in an Advanced Life Support (ALS) course increases the immediate learning outcome and retention of learning. Materials and methods: This was a prospective single blinded randomised controlled study of the learning outcome from a standard ALS course on a volunteer sample of the entire cohort of newly graduated doctors from Copenhagen University. The outcome measurement was ALS-competence assessed using a validated composite test including assessment of skills and knowledge. Intervention: The intervention was half a year of clinical work before an ALS course. The intervention group received the course after a half-year of clinical experience. The control group participated in an ALS course immediately following graduation. Results: Invitation to participate was accepted by 154/240 (64%) graduates and 117/154 (76%) completed the study. There was no difference between the intervention and control groups with regard to the imme- diate learning outcome. The intervention group had significantly higher retention of learning compared to the control group, intervention group mean 82% (CI 80–83), control group mean 78% (CI 76–80), P = 0.002. The magnitude of this difference was medium (effect size = 0.57). Conclusions: Half a year of clinical experience, before participation in an ALS course had a small but statistically significant impact on the retention of learning, but not on the immediate learning outcome. © 2008 Elsevier Ireland Ltd. All rights reserved. Introduction Resuscitation training is an increasingly popular component of undergraduate and postgraduate medical education curricula. As simulation-based courses represent a substantial cost 1 the educational effectiveness should be determined as a part of the implementation in curricula. 2,3 Learning theories indicate that learning from simulation-based training may rapidly decay over time 4–6 and that is generally supported by experimental studies on cardiopulmonary resuscitation training of health professionals. 7–11  A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.10.026. * Corresponding author. Tel.: +45 26833400; fax: +45 35454437. E-mail addresses: morten.lind.jensen@gmail.com, morten@avpu.dk (M.L. Jensen). It is therefore important to identify strategies that maximize the retention of learning from resuscitation courses. One area of concern is the timing of resuscitation training in relation to clinical experience. 12 The maximum learning outcome from a training programme is obtained when content, methods and strategies fit participants’ characteristics such as prior knowledge and skills. 13 In theory, clinical experience prior to a resuscita- tion course might influence the participants’ understanding of the subject 5 and perceived need for training and intention to learn, which might increase the learning outcome. 14 Supporting this is a study by Semeraro et al., who found that senior anesthesiologists retain knowledge gained in a resuscitation course better than junior anesthesiologists. 15 In addition a study by Wayne et al 16 on resi- dents in internal medicine found a 14 months retention of learned resuscitation skills. However, a consistent finding in other studies is that the acquired competence declines to a significantly lower level within a year after the course 8,10,11 , and a previous study by 0300-9572/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2008.10.026