The implementation of diverse skin-toned female manikins in hospital provider basic life support training

Women are less likely than men to receive bystander cardiopulmonary resuscitation (CPR). CPR training has traditionally relied on manikins depicting a lean, white male chest, which may reinforce disparities. This quality improvement initiative evaluated healthcare staff perceptions of sex/gender differences in CPR and the impact of diverse skin-toned female manikins on provider confidence.

Six female CPR manikins representing diverse skin tones were introduced into basic life support training at two Covenant Health hospitals. Participants completed anonymous pre- and post-training surveys assessing perceptions of sex/gender disparities, confidence performing CPR across different body types, and experiences with the manikins. Data were collected from July to October 2025. Staff were grouped by years of clinical practice (1-5, 5-10, 10-20, and ≥20 years). Between-group comparisons were performed using Kruskal-Wallis tests with post hoc pairwise comparisons. Open-text responses were analyzed using summary template analysis.

A total of 573 healthcare staff participated; most were nurses (83.6%), women (85.9%), and had ≥10 years of practice (58.5%). Staff with ≥20 years of practice were less likely to believe sex differences exist in CPR administration. Fewer years of practice were associated with greater hesitation to perform CPR due to body differences (p < 0.001). Pre-training confidence differed significantly across groups, with greater confidence reported among more experienced staff (all p < 0.001). Following training, 73.1% of participants reported increased confidence performing CPR on someone with breasts.

Using manikins with breasts during CPR training increased healthcare staff confidence in providing CPR to people with breasts. Incorporating diverse female CPR manikins into hospital training may improve provider confidence and support more equitable, inclusive resuscitation education.