Casalino 2015.

Methods	Controlled before‐after study of two training variants
Participants	N = 120, 63% nursing students, 37% medical students Age 21.2 +/‐ 3.5 years, 35% male The authors did not present demographic data per group Location: Paris (France), Lima (Peru), and Guadalajara (Mexico), in December 2014 and January 2015 with no previous training in PPE use, with no special intention to be involved in Ebola care.
Interventions	Intervention: There were two intervention groups that only differed in type of PPE used: 1.Basic PPE + reinforced training (N = 30); basic PPE consisted of boots, goggles, surgical mask, surgical cap, impermeable apron (11 pieces of equipment) with 6 steps for donning and 13 steps for doffing. 2.Enhanced PPE + reinforced training (N = 30); enhanced PPE consisted of boots, full body impermeable suit, hood with surgical cap and mask, double gloves, impermeable apron (9 pieces of equipment) with 6 steps for donning and 12 steps for doffing. Training for all participants consisted of 60 minutes of theoretical course including 10 minutes of donning instruction and 20 minutes of doffing instruction. In addition, there were three practical training sessions per two students who mutually assisted each other observed by a specialist trainer who intervened in case of non‐compliance. The sessions were held with 3 days intervals. Compared to the control group the additional intervention was that the specialist trainer "repeated aloud each of the steps and technical skills or processes necessary" to comply with the standard during the practical training sessions. The sessions were also reviewed comprehensively. Control group: There were two control groups that differed in type of PPE used just as in the intervention groups: 1.Basic PPE + conventional training (N = 30), 2.Enhanced PPE + conventional training (N = 30). These groups received the same training as the intervention group but the specialist‐trainer did not repeat aloud the necessary steps.
Outcomes	Primary outcome: number of errors per person for donning and for doffing and the number of persons with one or more errors measured by the specialist trainer. The authors also measured critical errors, which were those where there was contact between skin and potentially contaminated PPE, but we did not consider this a valid measure of contamination and disregarded this. We took measurement of the errors at the last training session as the effect of the intervention. We disregarded the error measurements at earlier training sessions. Secondary outcomes: errors for doffing of the gown, full body suit and boots; duration of donning and doffing in minutes at the last training session.
Notes	Country: France, Peru Mexico; no funding reported; no conflict of interest reported The first author, Enrique Casalino, answered some of our questions regarding the study, but we were unable to retrieve more information on the group allocation and therefore classified the study as non‐randomised.
Risk of bias
Bias	Authors' judgement	Support for judgement
Confounding NRS	Unclear risk	None of the confounders mentioned
Selection Bias NRS	Low risk	Students were randomly chosen and did not have any experience or intention to use the knowledge and skills.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding not possible but students could be motivated to perform better because of knowing that they are in the intervention group and not as a result of the oral instructions.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Providers are also the assessors of the compliance. We asked authors for more information but did not get any information that increased our confidence in the outcome assessment
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not reported if all data were available
Selective reporting (reporting bias)	Low risk	All outcomes in methods section reported; no protocol available
Other bias	Low risk	No other biases assessed