Advanced life support provider course in Italy : a 5-year nationwide study to identify the determinants of course success

INTRODUCTION: The advanced life support (ALS) provider course is the gold standard for teaching and assessing competence in advanced resuscitation. Outcomes over a 5-year period of European Resuscitation (ERC)/IRC ALS provider courses in Italy were investigated, and the factors associated with course success are described. METHODS: In 2008, the Italian Resuscitation Council (IRC) created a database in which every ERC/IRC ALS course was recorded. Data from courses organized from 2008 to 2012 were analysed. The data included: candidate's age and degree (medical doctor (MD) or nurse), medical specialty of MD candidates, course outcomes, duration and reference guidelines, number of instructors and course director. Relationships between the course outcomes and the courses and candidates' characteristics were analysed using logistic regression. RESULTS: A total of 13,624 candidates were evaluated from 871 courses. Among the candidates, 55% were MDs and 45% were nurses. Ninety-seven percent of candidates passed the final evaluation, while 3% failed. Candidates who passed were younger (37 [31-44] vs. 43 [37-50] years, p<0.0001) and had a greater pre-course resuscitation knowledge (multiple choice quiz (MCQ) score: 88 [83-93] vs. 80 [73-87], p<0.0001) compared to those who failed. The course pass rate was higher for MDs compared to nurses (98% vs. 95%, p<0.0001) and participants in emergency disciplines were most significantly associated with course success (χ(2) 71, p<0.0001). In the multivariate analysis, an older age (OR 0.926, 95%CI [0.915-0.937]) was independently associated with course failure, while being a MD (OR 3.021, 95%CI [2.212-4.132]), having a higher pre-course MCQ score (OR 1.033, 95%CI [1.026-1.040]) together with a higher candidate/instructor ratio (OR 1.314, 95%CI [1.067-1.618]), and having a longer course duration (OR 1.717, 95%CI [1.090-2.703]), were independently associated with success. CONCLUSIONS: Younger age, professional background, and pre-course resuscitation knowledge are the most important predictors of ALS provider course success, together with higher candidate/instructor ratios and longer course durations.