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Early cardiopulmonary resuscitation and prompt defibrillation markedly increase the survival rate in the event of out-of-hospital cardiac arrest (OHCA). As future health care professionals, medical students should be trained to efficiently manage an unexpectedly encountered OHCA.
Our aim was to assess basic life support (BLS) knowledge in junior medical students at the University of Geneva Faculty of Medicine (UGFM) and to compare it with that of the general population.
Junior UGFM students and lay people who had registered for BLS classes given by a Red Cross–affiliated center were sent invitation links to complete a web-based questionnaire. The primary outcome was the between-group difference in a 10-question score regarding cardiopulmonary resuscitation knowledge. Secondary outcomes were the differences in the rate of correct answers for each individual question, the level of self-assessed confidence in the ability to perform resuscitation, and a 6-question score, “essential BLS knowledge,” which only contains key elements of the chain of survival. Continuous variables were first analyzed using the Student
The mean score was higher in medical students than in lay people for both the 10-question score (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7;
Although junior medical students were more knowledgeable than lay people regarding BLS procedures, the proportion of correct answers was low in both groups, and changes in BLS education policy should be considered.
Basic life support (BLS) maneuvers and use of automated external defibrillators (AED) have been shown to greatly increase the survival rate after out-of-hospital cardiac arrests (OHCA) [
In Switzerland, most regions lack a systematic BLS training program for the general population, even though more than 8000 OHCA occur every year in the country [
Medical students might unexpectedly encounter OHCA cases outside of the hospital or university environment and might, given their status, be expected to take care of the situation. Many studies carried out in different medical education systems around the world have however concluded that BLS knowledge among health care students is generally limited [
Since the first BLS training session for medical students of the University of Geneva – Faculty of Medicine (UGFM) only takes place during the second of their 6-year curriculum, our hypothesis was that they might lack critical knowledge regarding BLS prior to this course. These medical students might, however, be unpredictably faced with OHCA and be expected to respond swiftly and adequately given their chosen profession [
A cross-sectional, web-based, questionnaire study compliant with the CHERRIES guidelines was carried out between October 2019 and April 2020 [
An internet platform was developed using the Joomla 3.9 content management system (Open Source Matters, New York, NY). The Community Surveys Pro component version 5 (CoreJoomla, Hyderabad, India) was used to create the questionnaire.
A structured online questionnaire containing 19 questions requiring either open or closed answers was created on the platform (
Survey structure and questions.
Survey page and field, Question | Type of question | |
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N/Aa | N/A |
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Year of birth | Open (Regexb) |
Gender | MCQc | |
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Ever heard of BLS or ACLSe before | Yes/No |
Meaning of “AED”f,g | Open | |
Year of the last BLS guidelines update | Open (Regex) | |
Phone number of the emergency medical services dispatch centerg,h | Open | |
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Current or past student of a health care profession, BLS instructor, or professional rescuer | MAQi |
Prior BLS training | Yes/No | |
Wish to be trained, or more trained, in BLS procedures | Yes/No | |
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Criteria used to recognize OHCAg,h,j | MAQ |
BLS sequenceg,h | Ordering | |
Artery for pulse assessmentg | MCQ | |
Compression depthg,h | MCQ | |
Compression:ventilation ratiog | MCQ | |
Compression rateg,h | MCQ | |
Compression-only CPRg,h,k | Yes/No | |
Treatment of a choking patient, conscious, unable to either cough or talkg | MCQ | |
Self-assessed confidence in the ability to perform resuscitation | 1-10 scale |
aN/A: not applicable.
bRegex: regular expression validation.
cMCQ: multiple choice question (only one answer accepted).
dBLS: basic life support.
eACLS: advanced cardiovascular life support
fAED: automated external defibrillator.
gQuestions used to compute the primary outcome (score out of 10 questions).
hQuestions used to compute the “essential BLS knowledge” secondary outcome.
iMAQ: multiple answer question (more than one answer accepted).
jOHCA: out-of-hospital cardiac arrest.
kCPR: cardiopulmonary resuscitation.
As the UGFM BLS-AED course is based on a “flipped classroom” teaching format, medical students must complete an institutional, interactive, electronic learning (eLearning) module prior to attending their first 2-hour BLS-AED workshop. A link was therefore embedded in the very first slide of the eLearning module (
The control group was composed of lay people attending a first aid course. These participants were recruited thanks to the Association Genevoise des Sections de Samaritains (AGSS), a Red Cross–affiliated training center. The AGSS agreed to send a single mailing (
Information regarding the study was displayed along with an electronic consent form before the questionnaire could be started [
No incentive was given to promote participation, which was not required to attend either course.
Electronic learning (eLearning) slide inviting medical students to participate in the study.
All questions had to be answered, and pages were to be entirely filled before participants could proceed to the following part of the survey. Answer consistency was checked using regular expression (regex) validation rules, and participants were warned whenever an inconsistent answer was identified. Participants could change their answers using a “back” button until the questionnaire was finalized.
Data were stored on an encrypted MySQL compatible database (MariaDB 5.5.5, MariaDB Foundation, Wakefield, MA) located on a Swiss server. As this was a closed survey, with the link only provided either on the first eLearning slide or in the emails sent by the AGSS, no specific tracking identifier (cookies or IP address) was used.
The primary outcome was the between-group difference on the 10-question quiz score. Each question was equally weighted and could only be considered as correct or incorrect. Thus, the total score was computed for each participant by summing all correct answers. Secondary outcomes were the differences in the rate of correct answers for each individual question and in the level of self-assessed confidence in the ability to perform resuscitation. We also computed a score dubbed “essential BLS knowledge,” which is the sum of 6 critical questions related to BLS (
The original data have been deposited to Mendeley Data [
Statistical analysis was carried out using STATA 16.1 (StataCorp LLC, College Station, TX). Incomplete questionnaires, as well as those completed by BLS-AED instructors or already certified health care professionals, were excluded from the analysis.
The scores of the answers to the 10 predefined questions were added to compute the overall quiz score defined as the primary outcome (minimum = 0; maximum = 10). No differential weighting was applied, and each individual question was worth 1 point. The “essential BLS knowledge” score was computed in the exact same way (minimum = 0; maximum = 6).
Normality was assessed both graphically and by the Kolmogorov-Smirnov test. Analysis of continuous variables was first performed using the Student
A subgroup analysis to identify a potential effect of having attended a BLS course prior to taking the survey was decided post hoc. A sensitivity analysis excluding medical students who had prior training as health care students or who were already certified rescuers was also performed.
The participation rate was higher (
Participants were older in the control group (mean 34.0 years, SD 12.7 years) than in the medical students’ group (mean 22.5 years, SD 4.4 years). There was a majority of women in both groups (49/74, 66% in the control group and 58/80, 73% in the medical students’ group) with no significant difference between groups (
The mean score on the 10-question composite outcome was higher in medical students (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7;
Medical students also scored better than lay people on the 6-question “essential BLS knowledge” score (mean 3.0, SD 1.1 vs mean 2.0, SD 1.0;
Lay people who had already attended a BLS course before participating in the survey did not perform better than those who had not (mean 4.5, SD 1.6 vs mean 3.8, SD 1.7,
Medical students felt more confident than lay people in their ability to perform resuscitation (mean 4.7, SD 2.2 vs mean 3.1, SD 2.1,
Excluding medical students who were either former nursing students or certified rescuers neutralized the effect of age on the 10-question score and on the confidence but did not significantly change the magnitude or direction of the other results.
Study flowchart for (A) lay people and (B) medical students. AED: automated external defibrillator; BLS: basic life support.
Scores on the 10-question composite outcome by group.
Question | Lay people (n=62), n (%) | Medical students (n=80), n (%) | |
Phone number of the emergency medical services dispatch centrala | 51 (82) | 75 (94) | .06 |
Meaning of “AED”b,c | 27 (44) | 42 (53) | .31 |
Criteria used to recognize OHCAd | 5 (8) | 16 (20) | .06 |
BLSe sequence | 2 (3) | 0 (0) | .19 |
Artery for pulse assessment | 50 (80) | 50 (63) | .03 |
Compression depth | 9 (14) | 29 (36) | .004 |
Compression:ventilation ratio | 21 (34) | 62 (78) | <.001 |
Compression rate | 15 (24) | 41 (51) | .002 |
Compression-only CPRf | 39 (63) | 75 (94) | <.001 |
Treatment of a choking patient, conscious, unable to either cough or talk | 43 (69) | 75 (94) | <.001 |
aAccepted answers: 112, 144, and 911, which all work in Geneva, Switzerland; 144 is the official Swiss number.
bAED: automated external defibrillator.
cAll answers containing “defibrillator” in English or in French were considered as correct (not case sensitive, spelling mistakes accepted).
dOHCA: out-of-hospital cardiac arrest.
eBLS: basic life support.
fCPR: cardiopulmonary resuscitation.
In this study, second-year medical students performed somewhat better than lay people, though neither group scored high on a simple 10-question quiz assessing BLS knowledge. The difference might arise from different grounds. First of all, medical students might indeed be more interested in this domain given their chosen profession. Moreover, though our regional policies have evolved little with regard to BLS training promotion, private initiatives have progressively surfaced in an attempt to increase general awareness regarding OHCA. As medical students were more than a decade younger than the control group, they might have been more exposed to such campaigns and therefore more interested in this topic.
Our findings highlight weaknesses in the first 3 links of the chain of survival [
Although lay rescuers, either trained or untrained, have not been expected to check for a pulse since the publication of the 2010 CPR guidelines [
Even though emergency medical systems have evolved to overcome as much as possible the lack of BLS training [
However, months, if not years, might elapse before any change in public health policies can be accomplished, and modifying the undergraduate medical curriculum might take just as long. Therefore, to enhance the awareness of UGFM junior medical students regarding BLS issues, a team of senior medical students and faculty members developed an accelerated first aid course [
The results of our post hoc analysis regarding the effect of having attended a BLS course prior to taking the survey are cause for concern. Indeed, participants who declared having attended such a course in the past did not perform significantly better than those who did not, regardless of the study group. While a change in the guidelines between a prior course and the moment of the survey could be hypothesized, the young age of the participants, particularly in the medical students’ group, makes it unlikely. Low scores were indeed recorded regarding key elements that were already part of the 2010 guidelines (ie, the criteria used to recognize OHCA [
This study has other limitations that should also be acknowledged. First, owing to the study design and to the impossibility of sending email reminders, the participation rate was rather low, particularly among lay rescuers. This might have led to an overestimation of BLS knowledge in both groups due to selection bias. The method of recruitment has been shown to significantly alter the participation rates [
In addition, we were unable to determine whether the questionnaire had actually been completed before the course. Nevertheless, medical students were required to complete the eLearning module with the embedded invitation slide before attending their first BLS course, and lay people were sent the invitation email at least 2 weeks before attending their course.
Another limitation is that our control group cannot be considered as a true surrogate of the general population. Indeed, as participants were rather young and as BLS training initiatives have progressively increased, it is to be expected that BLS knowledge would actually be lower in a more representative sample of the general population. Another limitation is linked to the specificities of the UGFM curriculum. In our curriculum, medical students and dental medicine students share a common study path until the end of their second year of undergraduate training. Around one-fifth of second-year UGFM students are actually dental medicine students. There is however little reason to believe that their interest in BLS procedures should be different for these students compared to medical students whose interest is not in an acute medicine specialty. In addition, most junior medical students have not yet decided upon a specific career at this stage [
Although medical students were more knowledgeable than lay people regarding BLS-AED procedures, their proportion of correct answers was still low. As OHCA recognition and high-quality chest compressions are paramount to increasing survival rates, a change in the curriculum, as well as a global transformation in the way the general population is educated regarding first aid maneuvers, could help improve outcomes.
Questions and expected answers: original (French) version and English translation.
Text sent in the invitation e-mails (dispatched on our behalf by the Association Genevoise des Sections de Samaritains).
automated external defibrillator
Association Genevoise des Sections de Samaritains
basic life support
cardiopulmonary resuscitation
electronic learning
out-of-hospital cardiac arrest
University of Geneva Faculty of Medicine
The authors would like to thank the Association Genevoise des Sections de Samaritains (AGSS) and particularly Mrs Véronique Volken for having dispatched invitation emails on their behalf.
None declared.