QPR Boosters

How to prevent skill decay with short, targeted practice sessions.

QPR Boosters

November 23 2022

Like any skill, research has shown QPR training outcomes decay over time and that short, targeted practice sessions may help maintain gatekeeper confidence and competence in how to intervene with someone experiencing a life-threatening crisis..

Studies have shown that QPR knowledge, skills, and attitudes diminish over the months and years following initial training (Mathieu, et al., 2008, Tompkins, et al. 2011, and Cross, et al., 2011). This decay in knowledge and skills may negatively impact gatekeeper readiness to help someone quickly and effectively.

Using Mazetec we aim to reinforce Pathfinder confidence and competence to help prevent suicide.

A QPR-CPR Comparison

As illustrated in the graph below, research on CPR training knowledge, skills, and attitudes is similar to what has been found with gatekeeper training effects.

Graph showing skill decay

The decay of learning impacts following initial training in CPR have been effectively addressed in what are called “low-dose high-frequency” training sessions. These LDHF training modules constitute a competence-building approach that promotes maximum retention of knowledge, skills, and attitudes from an initial training. Low-dose high-frequency training uses brief, simulation-based learning activity spaced over time and reinforced with structured, ongoing practice sessions.

The following graphic shows the anticipated training effect from QPR Boosters.

Graph showing skill decay

Using a CPR comparison, studies conducted on the effectiveness of Resuscitation Quality Improvement training using the LDHF training model showed almost full course completion by participants (98%), large cost savings from less time used for off-site training, and a 21% increase in survival rates from cardiac arrest (Texas Health Resources hospital, Dallas, Texas). CPR and QPR are clearly not equivalents in training content, skills, or practice, but the underlying learning principles at work are identical.

The e-learning principles

QPR Boosters employs the following learning strategies:

  • Initial training to establish baseline knowledge and skill competence during original online training. This training establishes core knowledge, skills, and attitudes to permit “adaptive learning” when additional training is offered, e.g., the learner may quickly pass through scenarios covering what they already know, thus respecting the learner’s time.
  • Employment of online micro lessons and booster session simulation or scenario-based real-world modules of 2 to 10-minute duration delivered at intervals to reinforce old training and deliver new or updated content.
  • Integration of low-dose, high-frequency modules into the gatekeeper’s workday routines negates the need for expensive, hour long (or longer) training sessions or off-site seminars.
  • Reinforcement of original learning, plus the integration to new material, research, and skill practice sessions.

Thank you for your time and for learning to help people in crises.

Staff, faculty, and board of the QPR Institute


  1. Cross WF, Seaburn D, Gibbs D, Schmeelk-Cone K, White AM, et al. Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. J Prim Prev 2011;32:195–211.
  2. Matthieu M, Cross W, Batres A, Flora C, Knox K. Evaluation of gatekeeper training for suicide prevention in veterans. Arch Suicide Res 2008;12:148–54.
  3. Tompkins TL, Witt J, Abraibesh N. Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness. Suicide Life Threat Behav 2010;40:506–15