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Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study

Johan Creutzfeldt12*, Leif Hedman13 and Li Felländer-Tsai12

Author Affiliations

1 Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Stockholm, 141 86, Sweden

2 Center for Advanced Medical Simulation and Training, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

3 Department of Psychology, Umeå University, Umeå, Sweden

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:79  doi:10.1186/1757-7241-20-79

Published: 6 December 2012



Multiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students’ retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.


Three groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.


The 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).

At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.


This study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

Assessment; Avatars; Cardiopulmonary resuscitation; Educational technology; e-learning; MVW; Virtual learning environments; Patient simulation; Students; Young adults