Feasibility of Self-Directed Learning of Cardiopulmonary Resuscitation Skills Using Interactive Video in SimZone 0: Pilot Randomized Educational Trial

Abstract Background The SimZones model is an organizational framework for simulation-based education that structures learning across 5 progressive zones, from self-directed preparatory activities (zone 0) to team-based clinical scenarios (zones 1‐4). However, empirical evidence on the impact of zone 0 regarding procedural skill acquisition and retention remains limited. Objective The present pilot study aimed to build on this evidence gap by examining whether the addition of a structured zone 0 self-directed preparatory phase, delivered through interactive video (IV), could enhance cardiopulmonary resuscitation (CPR) competence acquisition, skill retention, and CPR quality among nursing students when combined with conventional instructor-led zone 1 training, while also assessing the feasibility and acceptability of the intervention. Methods A total of 52 nursing students from San Pablo CEU University (Madrid, Spain) were randomly assigned to an experimental group (n=33, SimZone 0 IV followed by SimZone 1 instructor-led seminar) or a control group (n=19, SimZone 1 instructor-led seminar only). CPR competence acquisition, skill retention, CPR quality, and feasibility were assessed immediately after zone 1 training and at 3 and 6 months. Results In the self-directed zone 0 phase, 73% (24/33) of experimental group students achieved competence. After zone 1 training, 100% (28/28) of the experimental group achieved competence vs 84% (16/19) of the control group ( P =.06, Fisher exact test). At 3 months, competence was 96% (23/24) vs 71% (10/14; P =.05), and at 6 months, 96% (22/23) vs 62% (8/13; P =.02). Mean CPR quality scores were consistently higher in the experimental group across all time points (zone 1: 94%, SD 11.8% vs 90%, SD 16.4%; 3 months: 92%, SD 10.9% vs 90%, SD 12.1%; and 6 months: 92%, SD 10.9% vs 85%, SD 17.8%). The intervention was feasible, well accepted, and free of adverse events or technical issues. Conclusions Self-directed IV learning as a preparatory phase before instructor-led training is feasible, acceptable, and is associated with preliminary signals of enhanced CPR skill acquisition and retention among nursing students. These findings should be interpreted with caution given the pilot nature of the study and the small sample size.