Objective: Results of prehospital pediatric continuing education using train-the-trainer and CD-ROM training methods were compared to each other and to a control group. The null hypothesis was that no differences would be found in pretraining and posttraining measurements of knowledge and performance by either training method.
Methods: This was a prospective trial involving 12 sites. Random selections were made from ambulance service lists provided by 3-state emergency medical services (EMS) agencies. Preintervention and postintervention (12-month) measurements included a written examination and 2 performance scenarios videotaped for independent panel evaluation. Training was either an interactive CD-ROM or standard classroom instruction using a train-the-trainer model. Mean differences in written, performance, and combined scores were analyzed.
Results: Differences were noted in the combined and performance scores for the CD-ROM intervention group. No differences were noted in written measurements between or among the groups.
Conclusion: In this small sample, interactive CD-ROM training shows promise for improving performance. The research design, with additional guards against sample size attrition, may provide a model for multisite EMS education research.
Since the introduction of the emergency medical technician (EMT)-Basic National Standard Curriculum in 1970, much of the initial training and continuing education for prehospital providers have used a train-the-trainer model. In this model, an "expert" trains others who have demonstrated or are assumed to have clinical competence in the topic who, in turn, train their peers or new students. Other health-related agencies and organizations have followed a similar approach.
There appears to be a wide variation in dissemination of a "standardized" curriculum in a train-the-trainer model. The reasons for these variations are not fully known. Differences in professional and personal obligations by the newly trained trainer may impact the frequency of training. Additionally, the new trainer may not have the local support to carry out the training as it was intended. Instructional inconsistencies have been cited as justification for using technology to standardize instructional delivery.1,2
Other methods of instruction have evolved or have been proposed as alternatives to the train-the-trainer model.3 However, most of these efforts have received little formal evaluation. Recent research suggests that alternative instruction methods that largely remove the on-site trainer produce promising but variable results.4-6
Reducing the need for an on-site trainer permits the emergency medical services (EMS) field to take advantage of one of the greatest strengths of distance education: reaching a large, widely scattered population with consistent, quality instruction without requiring student travel to an education center.1,7-9 Asynchronous instruction further allows the student to choose when and where to take training.
There is limited research on the effectiveness of teaching methods for prehospital emergency care providers, either in initial training or continuing education. Although certification courses require testing upon completion, traditional lecture-type continuing education is often presented with no measurement of effectiveness. However, some types of pretests and posttests are usually conducted when an alternate training method is being attempted,10 or when training comparison studies are undertaken. Frequently, these studies compare technology to the traditional classroom model.
A limited number of studies have examined specific technology programs that rely on self-study, such as the interactive videodisc or a computer simulation program.5,11,12 These studies found no significant difference when comparing the technology to traditional classroom training using pretests and posttests.
In spite of a growing body of literature that confirms the effectiveness of alternative training delivery models, much of the initial and ongoing training of prehospital care providers continues to be based on a train-the-trainer model.