Supplementary file 1_Effects of deliberate practice at different training frequencies on long-term retention of high-quality chest compression proficiency among novice nurses: a quasi-experimental study.docx

BackgroundNurses are pivotal first responders in in-hospital cardiac arrest (IHCA), and timely, guideline-concordant BLS substantially improves survival. While deliberate practice (DP) enhances skill acquisition, the optimal retraining interval for maintaining long-term proficiency among novice nurses remains unclear. This study aimed to compare the effects of single versus repeated DP sessions on the 6-month retention of Cardiopulmonary Resuscitation (CPR) quality and knowledge.
MethodsA quasi-experimental study enrolled 148 novice nurses allocated to Single-DP group (baseline training only) a Repeated-DP group (baseline plus a 3-month booster session). CPR quality (compression depth, rate, chest recoil, compression fraction), theoretical knowledge, and overall skill scores were assessed at baseline, immediately after training, and 6-month follow-up. Generalized estimating equations (GEE) assessed group, time, and their interaction.
ResultsA total of 148 novice nurses completed the study, with no significant differences in baseline characteristics. Immediately after training, the Single-DP group achieved higher scores in theoretical knowledge (P = 0.001) and overall skill (P = 0.011). At the 6-month follow-up, the Repeated-DP group demonstrated superior retention in raw performance metrics, maintaining significantly greater median compression depth (52.00 vs. 47.50 mm; P = 0.014) and higher overall skill scores (57.72 vs. 54.55; P < 0.001). However, GEE analysis revealed no significant group-by-time interaction at 6 months for knowledge (P = 0.344) or overall skill (P = 0.400), suggesting that the repeated intervention did not yield a statistically significant benefit in adjusted retention rates. Notably, prior real-world CPR experience was identified as a significant predictor of skill retention (P = 0.004).
ConclusionDP significantly improves CPR skill proficiency in novice nurses. However, a 3-month refresher did not enhance 6-month retention compared to single training. The finding that prior real-world experience significantly predicts retention underscores the gap between simulation and clinical practice. Therefore, to ensure high-quality patient care, CPR training programs should replace single-session instruction with high-frequency, high-fidelity simulation-based education for novice nurses.

背景
护士是院内心搏骤停（in-hospital cardiac arrest, IHCA）中关键的一线急救人员，及时且符合临床指南要求的基础生命支持（Basic Life Support, BLS）可显著改善患者生存率。尽管刻意练习（deliberate practice, DP）能够促进技能习得，但针对新手护士维持长期操作熟练度的最优复训间隔仍不明确。本研究旨在比较单次与多次刻意练习对新手护士6个月心肺复苏（Cardiopulmonary Resuscitation, CPR）操作质量与知识保留效果的差异。

方法
本项类实验研究共招募148名新手护士，将其随机分配至单次刻意练习组（仅接受基线培训）或重复刻意练习组（接受基线培训加3个月强化培训）。分别于基线培训前、培训后即刻及6个月随访时，评估受试者的CPR操作质量（按压深度、按压频率、胸廓回弹情况、按压分数）、理论知识及综合技能评分。采用广义估计方程（Generalized Estimating Equations, GEE）分析组别、时间因素及其交互作用对结局指标的影响。

结果
共计148名新手护士完成本研究，两组受试者的基线特征无显著差异。培训后即刻，单次刻意练习组的理论知识评分（P=0.001）与综合技能评分（P=0.011）均更高。在6个月随访时，重复刻意练习组的原始操作性能指标保留效果更优，其中位按压深度显著更高（52.00 vs. 47.50 mm；P=0.014），综合技能评分也显著更高（57.72 vs. 54.55；P<0.001）。然而，广义估计方程分析显示，在6个月随访时，两组在知识保留（P=0.344）及综合技能保留（P=0.400）方面均未出现显著的组间-时间交互作用，提示重复干预并未在校正后的保留率方面带来统计学显著获益。值得注意的是，既往真实世界CPR操作经验被证实为技能保留的重要预测因素（P=0.004）。

结论
刻意练习可显著提升新手护士的CPR操作熟练度。但与单次培训相比，3个月的强化复训并未改善受试者6个月的技能保留效果。既往真实世界操作经验可显著预测技能保留这一发现，也凸显了模拟培训与临床实际操作之间的差距。因此，为保障高质量的患者护理，针对新手护士的CPR培训项目应将单次课程替换为高频次、高保真的模拟培训教育。