Journal of Educational Evaluation for Health Professions

Research articles

Development and validation of the student ratings in clinical teaching scale in Australia: a methodological study: Pin-Hsiang Huang, Anthony John O’Sullivan, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:26. Published online September 5, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.26

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Abstract PDF: Purpose
This study aimed to devise a valid measurement for assessing clinical students’ perceptions of teaching practices.
Methods
A new tool was developed based on a meta-analysis encompassing effective clinical teaching-learning factors. Seventy-nine items were generated using a frequency (never to always) scale. The tool was applied to the University of New South Wales year 2, 3, and 6 medical students. (Exploratory factor analysis (EFA] and confirmatory factor analysis (CFA), respectively) were conducted to establish the tool’s construct validity and goodness of fit, and Cronbach’s α was used for reliability
Results
In total, 352 students (44.2%) completed the questionnaire. The EFA identified student-centered learning, problem-solving learning, self-directed learning, and visual technology (reliability, 0.77 to 0.89). CFA showed acceptable goodness of fit (chi-square P<0.01, comparative fit index=0.930 and Tucker-Lewis index=0.917, root mean square error of approximation=0.069, standardized root mean square residual=0.06).
Conclusion
The established tool—Student Ratings in Clinical Teaching (STRICT)—is a valid and reliable tool that demonstrates how students perceive clinical teaching efficacy. STRICT measures the frequency of teaching practices to mitigate the biases of acquiescence and social desirability. Clinical teachers may use the tool to adapt their teaching practices with more active learning activities and to utilize visual technology to facilitate clinical learning efficacy. Clinical educators may apply STRICT to assess how these teaching practices are implemented in current clinical settings.

Effect of an interprofessional simulation program on patient safety competencies of healthcare professionals in Switzerland: a before and after study: Sylvain Boloré, Thomas Fassier, Nicolas Guirimand; J Educ Eval Health Prof. 2023;20:25. Published online August 28, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.25

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Abstract PDF Supplementary Material: Purpose
This study aimed to identify the effects of a 12-week interprofessional simulation program, operated between February 2020 and January 2021, on the patient safety competencies of healthcare professionals in Switzerland.
Methods
The simulation training was based on 2 scenarios of hospitalized patients with septic shock and respiratory failure, and trainees were expected to demonstrate patient safety competencies. A single-group before and after study was conducted after the intervention—simulation program, using a measurement tool (the Health Professional Education in Patient Safety Survey) to measure the perceived competencies of physicians, nurses, and nursing assistants. Out of 57 participants, 37 answered the questionnaire surveys 4 times: 48 hours before the training, followed by post-surveys at 24 hours, 6 weeks, and 12 weeks after the training. The linear mixed effect model was applied for the analysis.
Results
Four components out of 6 perceived patient safety competencies improved at 6 weeks but returned to a similar level before training at 12 weeks. Competencies of “communicating effectively,” “managing safety risks,” “understanding human and environmental factors that influence patient safety,” and “recognize and respond to remove immediate risks of harm” are statistically significant both overall and in the comparison between before the training and 6 weeks after the training.
Conclusion
Interprofessional simulation programs contributed to developing some areas of patient safety competencies of healthcare professionals, but only for a limited time. Interprofessional simulation programs should be repeated and combined with other forms of support, including case discussions and debriefings, to ensure lasting effects.

Implementation strategy for introducing a clinical skills examination to the Korean Oriental Medicine Licensing Examination: a mixed-method modified Delphi study: Chan-Young Kwon, Sanghoon Lee, Min Hwangbo, Chungsik Cho, Sangwoo Shin, Dong-Hyeon Kim, Aram Jeong, Hye-Yoon Lee; J Educ Eval Health Prof. 2023;20:23. Published online July 17, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.23

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Abstract PDF Supplementary Material: Purpose
This study investigated the validity of introducing a clinical skills examination (CSE) to the Korean Oriental Medicine Licensing Examination through a mixed-method modified Delphi study.
Methods
A 3-round Delphi study was conducted between September and November 2022. The expert panel comprised 21 oriental medicine education experts who were officially recommended by relevant institutions and organizations. The questionnaires included potential content for the CSE and a detailed implementation strategy. Subcommittees were formed to discuss concerns around the introduction of the CSE, which were collected as open-ended questions. In this study, a 66.7% or greater agreement rate was defined as achieving a consensus.
Results
The expert panel’s evaluation of the proposed clinical presentations and basic clinical skills suggested their priorities. Of the 10 items investigated for building a detailed implementation strategy for the introduction of the CSE to the Korean Oriental Medicine Licensing Examination, a consensus was achieved on 9. However, the agreement rate on the timing of the introduction of the CSE was low. Concerns around 4 clinical topics were discussed in the subcommittees, and potential solutions were proposed.
Conclusion
This study offers preliminary data and raises some concerns that can be used as a reference while discussing the introduction of the CSE to the Korean Oriental Medicine Licensing Examination.

Experience of introducing an electronic health records station in an objective structured clinical examination to evaluate medical students’ communication skills in Canada: a descriptive study: Kuan-chin Jean Chen, Ilona Bartman, Debra Pugh, David Topps, Isabelle Desjardins, Melissa Forgie, Douglas Archibald; J Educ Eval Health Prof. 2023;20:22. Published online July 4, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.22

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Abstract PDF Supplementary Material: Purpose
There is limited literature related to the assessment of electronic medical record (EMR)-related competencies. To address this gap, this study explored the feasibility of an EMR objective structured clinical examination (OSCE) station to evaluate medical students’ communication skills by psychometric analyses and standardized patients’ (SPs) perspectives on EMR use in an OSCE.
Methods
An OSCE station that incorporated the use of an EMR was developed and pilot-tested in March 2020. Students’ communication skills were assessed by SPs and physician examiners. Students’ scores were compared between the EMR station and 9 other stations. A psychometric analysis, including item total correlation, was done. SPs participated in a post-OSCE focus group to discuss their perception of EMRs’ effect on communication.
Results
Ninety-nine 3rd-year medical students participated in a 10-station OSCE that included the use of the EMR station. The EMR station had an acceptable item total correlation (0.217). Students who leveraged graphical displays in counseling received higher OSCE station scores from the SPs (P=0.041). The thematic analysis of SPs’ perceptions of students’ EMR use from the focus group revealed the following domains of themes: technology, communication, case design, ownership of health information, and timing of EMR usage.
Conclusion
This study demonstrated the feasibility of incorporating EMR in assessing learner communication skills in an OSCE. The EMR station had acceptable psychometric characteristics. Some medical students were able to efficiently use the EMRs as an aid in patient counseling. Teaching students how to be patient-centered even in the presence of technology may promote engagement.

Development of a character qualities test for medical students in Korea using polytomous item response theory and factor analysis: a preliminary scale development study: Yera Hur, Dong Gi Seo; J Educ Eval Health Prof. 2023;20:20. Published online June 26, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.20

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Abstract PDF Supplementary Material: Purpose
This study aimed to develop a test scale to measure the character qualities of medical students as a follow-up study on the 8 core character qualities revealed in a previous report.
Methods
In total, 160 preliminary items were developed to measure 8 core character qualities. Twenty questions were assigned to each quality, and a questionnaire survey was conducted among 856 students in 5 medical schools in Korea. Using the partial credit model, polytomous item response theory analysis was carried out to analyze the goodness-of-fit, followed by exploratory factor analysis. Finally, confirmatory factor and reliability analyses were conducted with the final selected items.
Results
The preliminary items for the 8 core character qualities were administered to the participants. Data from 767 students were included in the final analysis. Of the 160 preliminary items, 25 were removed by classical test theory analysis and 17 more by polytomous item response theory assessment. A total of 118 items and sub-factors were selected for exploratory factor analysis. Finally, 79 items were selected, and the validity and reliability were confirmed through confirmatory factor analysis and intra-item relevance analysis.
Conclusion
The character qualities test scale developed through this study can be used to measure the character qualities corresponding to the educational goals and visions of individual medical schools in Korea. Furthermore, this measurement tool can serve as primary data for developing character qualities tools tailored to each medical school’s vision and educational goals.

Enhancement of the technical and non-technical skills of nurse anesthesia students using the Anesthetic List Management Assessment Tool in Iran: a quasi-experimental study: Ali Khalafi, Maedeh Kordnejad, Vahid Saidkhani; J Educ Eval Health Prof. 2023;20:19. Published online June 16, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.19

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Abstract PDF Supplementary Material: Purpose
This study investigated the effect of evaluations based on the Anesthetic List Management Assessment Tool (ALMAT) form on improving the technical and non-technical skills of final-year nurse anesthesia students at Ahvaz Jundishapur University of Medical Sciences (AJUMS).
Methods
This was a semi-experimental study with a pre-test and post-test design. It included 45 final-year nurse anesthesia students of AJUMS and lasted for 3 months. The technical and non-technical skills of the intervention group were assessed at 4 university hospitals using formative-feedback evaluation based on the ALMAT form, from induction of anesthesia until reaching mastery and independence. Finally, the students’ degree of improvement in technical and non-technical skills was compared between the intervention and control groups. Statistical tests (the independent t-test, paired t-test, and Mann-Whitney test) were used to analyze the data.
Results
The rate of improvement in post-test scores of technical skills was significantly higher in the intervention group than in the control group (P˂0.0001). Similarly, the students in the intervention group received significantly higher post-test scores for non-technical skills than the students in the control group (P˂0.0001).
Conclusion
The findings of this study showed that the use of ALMAT as a formative-feedback evaluation method to evaluate technical and non-technical skills had a significant effect on improving these skills and was effective in helping students learn and reach mastery and independence.

Suggestion for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination: a survey-based descriptive study: Kyunghee Kim, So Young Kang, Younhee Kang, Youngran Kweon, Hyunjung Kim, Youngshin Song, Juyeon Cho, Mi-Young Choi, Hyun Su Lee; J Educ Eval Health Prof. 2023;20:18. Published online June 12, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.18

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Abstract PDF Supplementary Material: Purpose
This study aims to suggest the number of test items in each of 8 nursing activity categories of the Korean Nursing Licensing Examination, which comprises 134 activity statements including 275 items. The examination will be able to evaluate the minimum ability that nursing graduates must have to perform their duties. Methods: Two opinion surveys involving the members of 7 academic societies were conducted from March 19 to May 14, 2021. The survey results were reviewed by members of 4 expert associations from May 21 to June 4, 2021. The results for revised numbers of items in each category were compared with those reported by Tak and his colleagues and the National Council License Examination for Registered Nurses of the United States. Results: Based on 2 opinion surveys and previous studies, the suggestions for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination in this study are as follows: 50 items for management of care and improvement of professionalism, 33 items for safety and infection control, 40 items for management of potential risk, 28 items for basic care, 47 items for physiological integrity and maintenance, 33 items for pharmacological and parenteral therapies, 24 items for psychosocial integrity and maintenance, and 20 items for health promotion and maintenance. Twenty other items related to health and medical laws were not included due to their mandatory status. Conclusion: These suggestions for the number of test items for each activity category will be helpful in developing new items for the Korean Nursing Licensing Examination.

Brief report

Comparing ChatGPT’s ability to rate the degree of stereotypes and the consistency of stereotype attribution with those of medical students in New Zealand in developing a similarity rating test: a methodological study: Chao-Cheng Lin, Zaine Akuhata-Huntington, Che-Wei Hsu; J Educ Eval Health Prof. 2023;20:17. Published online June 12, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.17

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Abstract PDF Supplementary Material: Learning about one’s implicit bias is crucial for improving one’s cultural competency and thereby reducing health inequity. To evaluate bias among medical students following a previously developed cultural training program targeting New Zealand Māori, we developed a text-based, self-evaluation tool called the Similarity Rating Test (SRT). The development process of the SRT was resource-intensive, limiting its generalizability and applicability. Here, we explored the potential of ChatGPT, an automated chatbot, to assist in the development process of the SRT by comparing ChatGPT’s and students’ evaluations of the SRT. Despite results showing non-significant equivalence and difference between ChatGPT’s and students’ ratings, ChatGPT’s ratings were more consistent than students’ ratings. The consistency rate was higher for non-stereotypical than for stereotypical statements, regardless of rater type. Further studies are warranted to validate ChatGPT’s potential for assisting in SRT development for implementation in medical education and evaluation of ethnic stereotypes and related topics.

Research articles

Relationships between undergraduate medical students’ attitudes toward communication skills learning and demographics in Zambia: a survey-based descriptive study: Mercy Ijeoma Okwudili Ezeala, John Volk; J Educ Eval Health Prof. 2023;20:16. Published online June 1, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.16

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Abstract PDF Supplementary Material: Purpose
This study aimed to detect relationships between undergraduate students’ attitudes toward communication skills learning and demographic variables (such as age, academic year, and gender). Understanding these relationships could provide information for communication skills facilitators and curriculum planners on structuring course delivery and integrating communication skills training into the medical curriculum.
Methods
The descriptive study involved a survey of 369 undergraduate students from 2 medical schools in Zambia who participated in communication skills training stratified by academic year using the Communication Skills Attitude Scale. Data were collected between October and December 2021 and analyzed using IBM SPSS for Windows version 28.0.
Results
One-way analysis of variance revealed a significant difference in attitude between at least 5 academic years. There was a significant difference in attitudes between the 2nd and 5th academic years (t=5.95, P˂0.001). No significant difference in attitudes existed among the academic years on the negative subscale; the 2nd and 3rd (t=3.82, P=0.004), 4th (t=3.61, P=0.011), 5th (t=8.36, P˂0.001), and 6th (t=4.20, P=0.001) academic years showed significant differences on the positive subscale. Age showed no correlation with attitudes. There was a more favorable attitude to learning communication skills among the women participants than among the men participants (P=0.006).
Conclusion
Despite positive general attitudes toward learning communication skills, the difference in attitude between the genders, academic years 2 and 5, and the subsequent classes suggest a re-evaluation of the curriculum and teaching methods to facilitate appropriate course structure according to the academic years and a learning process that addressees gender differences.

Adequacy of the examination-based licensing system and a training-based licensing system for midwifery license according to changes in childbirth medical infrastructure in Korea: a survey-based descriptive study: Yun Mi Kim, Sun Hee Lee, Sun Ok Lee, Mi Young An, Bu Youn Kim, Jum Mi Park; J Educ Eval Health Prof. 2023;20:15. Published online May 22, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.15

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Abstract PDF Supplementary Material: Purpose
The number of Korean midwifery licensing examination applicants has steadily decreased due to the low birth rate and lack of training institutions for midwives. This study aimed to evaluate the adequacy of the examination-based licensing system and the possibility of a training-based licensing system.
Methods
A survey questionnaire was developed and dispatched to 230 professionals from December 28, 2022 to January 13, 2023, through an online form using Google Surveys. Descriptive statistics were used to analyze the results.
Results
Responses from 217 persons (94.3%) were analyzed after excluding incomplete responses. Out of the 217 participants, 198 (91.2%) agreed with maintaining the current examination-based licensing system; 94 (43.3%) agreed with implementing a training-based licensing system to cover the examination costs due to the decreasing number of applicants; 132 (60.8%) agreed with establishing a midwifery education evaluation center for a training-based licensing system; 163 (75.1%) said that the quality of midwifery might be lowered if midwives were produced only by a training-based licensing system, and 197 (90.8%) said that the training of midwives as birth support personnel should be promoted in Korea.
Conclusion
Favorable results were reported for the examination-based licensing system; however, if a training-based licensing system is implemented, it will be necessary to establish a midwifery education evaluation center to manage the quality of midwives. As the annual number of candidates for the Korean midwifery licensing examination has been approximately 10 in recent years, it is necessary to consider more actively granting midwifery licenses through a training-based licensing system.

Factors influencing the learning transfer of nursing students in a non-face-to-face educational environment during the COVID-19 pandemic in Korea: a cross-sectional study using structural equation modeling: Geun Myun Kim, Yunsoo Kim, Seong Kwang Kim; J Educ Eval Health Prof. 2023;20:14. Published online April 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.14

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Abstract PDF Supplementary Material

Purpose
The aim of this study was to identify factors influencing the learning transfer of nursing students in a non-face-to-face educational environment through structural equation modeling and suggest ways to improve the transfer of learning.
Methods
In this cross-sectional study, data were collected via online surveys from February 9 to March 1, 2022, from 218 nursing students in Korea. Learning transfer, learning immersion, learning satisfaction, learning efficacy, self-directed learning ability and information technology utilization ability were analyzed using IBM SPSS for Windows ver. 22.0 and AMOS ver. 22.0.
Results
The assessment of structural equation modeling showed adequate model fit, with normed χ2=1.74 (P<0.024), goodness-of-fit index=0.97, adjusted goodness-of-fit index=0.93, comparative fit index=0.98, root mean square residual=0.02, Tucker-Lewis index=0.97, normed fit index=0.96, and root mean square error of approximation=0.06. In a hypothetical model analysis, 9 out of 11 pathways of the hypothetical structural model for learning transfer in nursing students were statistically significant. Learning self-efficacy and learning immersion of nursing students directly affected learning transfer, and subjective information technology utilization ability, self-directed learning ability, and learning satisfaction were variables with indirect effects. The explanatory power of immersion, satisfaction, and self-efficacy for learning transfer was 44.4%.
Conclusion
The assessment of structural equation modeling indicated an acceptable fit. It is necessary to improve the transfer of learning through the development of a self-directed program for learning ability improvement, including the use of information technology in nursing students’ learning environment in non-face-to-face conditions.

Citations

Citations to this article as recorded by

The Mediating Effect of Perceived Institutional Support on Inclusive Leadership and Academic Loyalty in Higher Education
Olabode Gbobaniyi, Shalini Srivastava, Abiodun Kolawole Oyetunji, Chiemela Victor Amaechi, Salmia Binti Beddu, Bajpai Ankita
Sustainability.2023; 15(17): 13195. CrossRef

Students’ performance of and perspective on an objective structured practical examination for the assessment of preclinical and practical skills in biomedical laboratory science students in Sweden: a 5-year longitudinal study: Catharina Hultgren, Annica Lindkvist, Sophie Curbo, Maura Heverin; J Educ Eval Health Prof. 2023;20:13. Published online April 6, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.13

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Abstract PDF Supplementary Material: Purpose
It aims to find students’ performance of and perspectives on an objective structured practical examination (OSPE) for assessment of laboratory and preclinical skills in biomedical laboratory science (BLS). It also aims to investigate the perception, acceptability, and usefulness of OSPE from the students’ and examiners’ point of view.
Methods
This was a longitudinal study to implement an OSPE in BLS. The student group consisted of 198 BLS students enrolled in semester 4, 2015–2019 at Karolinska University Hospital Huddinge, Sweden. Fourteen teachers evaluated the performance by completing a checklist and global rating scales. A student survey questionnaire was administered to the participants to evaluate the student perspective. To assess quality, 4 independent observers were included to monitor the examiners.
Results
Almost 50% of the students passed the initial OSPE. During the repeat OSPE, 73% of the students passed the OSPE. There was a statistically significant difference between the first and the second repeat OSPE (P<0.01) but not between the first and the third attempt (P=0.09). The student survey questionnaire was completed by 99 of the 198 students (50%) and only 63 students responded to the free-text questions (32%). According to these responses, some stations were perceived as more difficult, albeit they considered the assessment to be valid. The observers found the assessment protocols and examiner’s instructions assured the objectivity of the examination.
Conclusion
The introduction of an OSPE in the education of biomedical laboratory scientists was a reliable, and useful examination of practical skills.

Improvement of the clinical skills of nurse anesthesia students using mini-clinical evaluation exercises in Iran: a randomized controlled study: Ali Khalafi, Yasamin Sharbatdar, Nasrin Khajeali, Mohammad Hosein Haghighizadeh, Mahshid Vaziri; J Educ Eval Health Prof. 2023;20:12. Published online April 6, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.12

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Abstract PDF Supplementary Material

Purpose
The present study aimed to investigate the effect of a mini-clinical evaluation exercise (CEX) assessment on improving the clinical skills of nurse anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Methods
This study started on November 1, 2022, and ended on December 1, 2022. It was conducted among 50 nurse anesthesia students divided into intervention and control groups. The intervention group’s clinical skills were evaluated 4 times using the mini-CEX method. In contrast, the same skills were evaluated in the control group based on the conventional method—that is, general supervision by the instructor during the internship and a summative evaluation based on a checklist at the end of the course. The intervention group students also filled out a questionnaire to measure their satisfaction with the mini-CEX method.
Results
The mean score of the students in both the control and intervention groups increased significantly on the post-test (P<0.0001), but the improvement in the scores of the intervention group was significantly greater compared with the control group (P<0.0001). The overall mean score for satisfaction in the intervention group was 76.3 out of a maximum of 95.
Conclusion
The findings of this study showed that using mini-CEX as a formative evaluation method to evaluate clinical skills had a significant effect on the improvement of nurse anesthesia students’ clinical skills, and they had a very favorable opinion about this evaluation method.

Citations

Citations to this article as recorded by

Comparing Satisfaction of Undergraduate Nursing Students`: Mini-CEX vs CIM in Assessing Clinical Competence
Somia Saghir, Anny Ashiq Ali, Kashif Khan, Uzma Bibi, Shafaat Ullah, Rafi Ullah, Zaifullah Khan, Tahir Khan
Pakistan Journal of Health Sciences.2023; : 134. CrossRef

Brief report

Training and implementation of handheld ultrasound technology at Georgetown Public Hospital Corporation in Guyana: a virtual learning cohort study: Michelle Bui, Adrian Fernandez, Budheshwar Ramsukh, Onika Noel, Chris Prashad, David Bayne; J Educ Eval Health Prof. 2023;20:11. Published online April 4, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.11

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Abstract PDF Supplementary Material: A virtual point-of-care ultrasound (POCUS) education program was initiated to introduce handheld ultrasound technology to Georgetown Public Hospital Corporation in Guyana, a low-resource setting. We studied ultrasound competency and participant satisfaction in a cohort of 20 physicians-in-training through the urology clinic. The program consisted of a training phase, where they learned how to use the Butterfly iQ ultrasound, and a mentored implementation phase, where they applied their skills in the clinic. The assessment was through written exams and an objective structured clinical exam (OSCE). Fourteen students completed the program. The written exam scores were 3.36/5 in the training phase and 3.57/5 in the mentored implementation phase, and all students earned 100% on the OSCE. Students expressed satisfaction with the program. Our POCUS education program demonstrates the potential to teach clinical skills in low-resource settings and the value of virtual global health partnerships in advancing POCUS and minimally invasive diagnostics.

Research article

Comparison of nursing students’ performance of cardiopulmonary resuscitation between 1 semester and 3 semesters of manikin simulations in the Czech Republic: a non-randomized controlled study: Vera Spatenkova, Iveta Zvercova, Zdenek Jindrisek, Ivana Veverkova, Eduard Kuriscak; J Educ Eval Health Prof. 2023;20:9. Published online March 31, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.9

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Abstract PDF Supplementary Material: Purpose
This study aimed to assess the effect of simulation teaching in critical care courses in a nursing study program on the quality of chest compressions of cardiopulmonary resuscitation (CPR).
Methods
An observational cross-sectional study was conducted at the Faculty of Health Studies at the Technical University of Liberec. The success rate of CPR was tested in exams comparing 2 groups of students, totaling 66 different individuals, who completed half a year (group 1: intermediate exam with model simulation) or 1.5 years (group 2: final theoretical critical care exam with model simulation) of undergraduate nursing critical care education taught completely with a Laerdal SimMan 3G simulator. The quality of CPR was evaluated according to 4 components: compression depth, compression rate, time of correct frequency, and time of correct chest release.
Results
Compression depth was significantly higher in group 2 than in group 1 (P=0.016). There were no significant differences in the compression rate (P=0.210), time of correct frequency (P=0.586), or time of correct chest release (P=0.514).
Conclusion
Nursing students who completed the final critical care exam showed an improvement in compression depth during CPR after 2 additional semesters of critical care teaching compared to those who completed the intermediate exam. The above results indicate that regularly scheduled CPR training is necessary during critical care education for nursing students.

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