Retentie van military combat lifesaving skills

Dit onderzoek gaat iedere first responder training aan: de retentie van vaardigheden. Retentie en transfer zijn immers altijd ons doel als trainer van mensen die opereren in ‘hoog risico hoge consequenties’ domeinen. Wat hebben landman en collega’s onderzocht?

Onderzoeksvraag: wat is de retentie van combat lifesaving (CLS) vaardigheden en is er een verschil tussen een meer geïndividualiseerde training met een meer klassikale training.

Vertrouw niet op mijn interpretatie maar lees zoals altijd het artikel zelf. Hier volgen enkele quotes en onderwerpen uit het onderzoek.


We predict that the performance immediately after initial training, as well as the 2-month and 6-month retention, is better in the individualized-style training group than in the room-style training group based on the literature described above. We therefore expect higher mance quality and speed, and lower perceived mental effort and anxiety during all tests following lized-style initial training.

Waarom deze hypothese?

“Little empirical evidence is available on the effectiveness of these training styles on skills and populations comparable to CLS. Both the individualized-style training and the classroom-style training may have advantages and disadvantages.

Let op: er zijn ook voorstanders van directe frontale instructie:

According to Kirschner et al. (2006), classroom-style “direct instruction” is the most effective way to teach students new skills. Especially young military personnel may prefer and benefit from clear-cut instructions and tasks.

However, other authors have shown that, depending on the con-text of what is being learned, the retention of direct instruction can be low and that such training transfers poorly to new situations (Dean & Kuhn, 2007).

Reflecting on performance at the start of training was found to lead to better retention in basic life support skills than individualized feedback during training in medical students by Li et al. (2013).

Hamilton (2005) lists several studies on video self-instruction, which suggested that this may lead to better retention of CPR skills than instructor-led classes.

If the individualized-style training is organized well, then self-direction and reflec-tion may possibly activate and enhance CLSers’ meta-cognition, play on their individual strengths, and engage them more than classroom-style training (Kuhn, 2007; Vansteenkiste et al., 2006).”

Welk medisch protocol?

“At the time of the current study, the Dutch military used the <C> ABCDE protocol, which stands for: Catastrophic hemorrhage, Airway, Breathing, Circulation, Disability, and Environment. Since then, they have switched to the MARCH protocol to be more in line with Tactical Combat Casualty Care (TCCC) procedures used in other NATO countries.”

Resultaten (uit de discussie overgenomen)

“The results of the experiment revealed that performance of critical actions had decreased by 5% at 2 months and by 14% at 6 months compared to performance at 0 month after initial training.

The average number of critical errors per scenario increased from 3.4 at 0 month to 5.8 at 6 months, a number which could have serious consequences in operational practice.

For non- critical actions, the decline was steeper in the first 2 months, as performance at 2 months had decreased by 13% and at 6 months by 18%.”

Vergelijking tussen instructie methoden

“In the classroom-style course, all trainees receive the same classroom lessons, demonstrations, and exercises, and all trainees follow the same roster. In contrast, the individualized-style group starts out in a classical manner, but is later instead tasked with reflecting upon their progress and needs, and determining with help from the instructor which parts of the material they should spend their time on.”


“On non- critical actions, the individualized group performed significantly better than the classroom group at 0 month only, after which their performance dropped to a similar level. This suggests that individualized training leads to higher initial performance, but that this higher level of performance was not maintained.

The individualized group performed the protocol significantly faster overall than the classroom group, while they did not make significantly more critical or non- critical errors. This implies that their performance was more efficient.

The classroom group also reported a gradual increase in mental effort and anxiety for each subsequent test, whereas the individualized group did not. This suggests that the tests became more demanding over time for the classroom group, although differences between groups did not reach significance.”

Wennen aan nieuwe methoden?

“The effectiveness of the individualized-style training could possibly be improved by supporting the instructors better in organizing this style of training, which was new to them. This could also improve the instructors’ attitude toward the change, which was negative for some based on anecdotal data.”

Kritieke fouten

“The high amount of critical errors at 6 months for both styles of training led us to conclude that early refresher training for combat lifesaving skills or similar skills is advised.”

Spacing als strategie

“The 3–4 weeks available for initial training may not allow for enough time-interval or “spacing” between exercises. Spacing was previously shown to positively impact retention of medical skills, such as surgery (Cecilio-Fernandes et al., 2018), and some studies have found benefits of increased spacing for up to 60 days after the last refresher training (see Roediger, Nestojko, & Smith, 2019).”


“Nonuse may seriously affect performance in particular in high-risk professions, as acute stress impairs one’s ability to recall declarative knowledge while well-learned procedures remain relatively robust (Hancock & Szalma, 2008).”


Annemarie Landman, Daný de Vries & Olaf Binsch (2022): Retention of military combat lifesaving skills during six months following classroom-style and individualized-style initial training, Military Psychology.