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Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students.
Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders.
A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders.
Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (
This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders.
RR2-10.2196/24664
According to the World Health Organization, ischemic heart disease is the current leading cause of death worldwide [
To enable the provision of BLS maneuvers prior to the arrival of professional rescuers, first responder systems have been created in many regions of the world. These systems allow emergency medical dispatchers to send adequately trained individuals to take care of OHCA situations before the arrival of professional help. Although different technological solutions have been developed, some of which are currently used in Switzerland, most operate according to the same principles. In general, first responders receive a notification on their smartphone through a specific app. The ones who are both available and within a 3-km radius of the scene receive the exact coordinates after accepting the mission. This allows a timely provision of BLS maneuvers by adequately trained responders and, consequently, higher survival rates [
Medical students may represent an almost untapped pool of potential first responders. Previous studies have shown that first-year medical students feel that they would be expected to act in case of an emergency but feel unprepared to face OHCA situations [
The main objective of this study was to describe the impact of implementing a short motivational intervention and a blended learning path designed to motivate first-year medical and dental students to enlist as first responders. To be able to enlist as first responders, students were required to follow an e-learning module, attend a practice session, and answer multiple questionnaires.
This was a prospective implementation study based on a research protocol published on November 6, 2020 [
A declaration of “no objection” was issued by the local ethics committee (Req-2020-01143) as this project did not fall within the scope of the Swiss Federal Act on Research involving Human Beings [
The target population consisted in a convenience sample including all UGFM first-year medical and dental students. Those who were already registered as first responders were excluded. No financial incentive was given to promote participation. The whole learning path was completely free, and students were informed that they would be granted a specific BLS-AED certificate upon a successful completion of the training program. This certificate had a 1-year validity and only allowed them to register on the
Two senior medical students presented the project to all these students on January 14, 2021. The presentation, which was originally intended to take place live in an auditorium at the beginning of a lecture about atherosclerosis, was held online because of restrictions linked to the COVID-19 pandemic. It was broadcasted as part of this lecture through the university’s web-based platform on which all courses could be followed live or on-demand. The presentation included an overview of the project and the learning path, an estimate of its duration, and a presentation of the
A specific web-based study platform was developed using the Joomla 3.9 [
The URL provided to the students led to an introductory page designed to determine whether they were already registered as first responders, which was the first of the two exclusion criteria (
Students who refused to participate were prompted to give a reason and were nevertheless allowed to access the e-learning module (
Those who did not meet the exclusion criteria and agreed to participate were redirected to a short registration form, which was composed of 3 fields only: first name, last name, and email address. The students’ identities were collected to allow the creation of nominative certificates. Email addresses were used to directly contact the participants, give them information regarding the practice sessions, and send them their BLS certificate provided they had successfully completed the whole learning path. The participants were informed that they could withdraw from the study at any time.
After registration, the participants were asked to fill out a precourse questionnaire (
Screening questionnaire and consent form (survey page number 1).
Survey field and question | Type of question | |
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Already a first responder? | Yes/no |
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Student at UGFMa? | Yes/no |
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If no: current professional status? | Open |
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Agree to participate? | Yes/no |
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If no: reasons for refusal? | MAQb |
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If no: access to the e-learning module? | Yes/no |
aUGFM: University of Geneva, Faculty of Medicine.
bMAQ: multiple answer question.
Precourse questionnaire.
Survey page, field, and question | Type of question | |
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Year of birth | Open (Regexa) |
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Gender | MCQb |
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Medical, biomedical, or dental medicine student | MCQ |
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Former student or graduate of another health care profession | MCQ |
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Target specialty | MCQ |
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Ever heard of BLS or ACLSd before | Yes/no |
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Meaning of AEDe,f | Open |
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Year of the last BLS guidelines update | Open (Regex) |
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Phone number of the emergency medical communication centerf,g | Open |
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Prior BLS training | MAQh |
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Wish for additional BLS training | Yes/no |
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Criteria used to recognize OHCAf,g,i | MAQ |
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BLS-sequencef,g | Ordering |
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Artery for pulse assessmentf | MCQ |
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Compression depthf,g | MCQ |
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Compressions: ventilation ratiof | MCQ |
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Compression ratef,g | MCQ |
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Compression-only CPRf,g,j | Yes/no |
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Foreign body airway obstructionf | MCQ |
aA Regex validation rule was used to avoid invalid entries.
bMCQ: multiple choice question (only one answer accepted).
cBLS: basic life support.
dACLS: advanced cardiovascular life support.
eAED: automatic external defibrillator.
fItems used to calculate the 10-point score (initial BLS knowledge).
gItems used to calculate the 6-point score (essential BLS knowledge).
hMAQ: multiple answer question (more than one answer accepted).
iOHCA: out-of-hospital cardiac arrest.
jCPR: cardiopulmonary resuscitation.
After completing this questionnaire, participants were granted access to an interactive e-learning module developed under Storyline 3 (Articulate Global, LLC). This e-learning was adapted from a similar module used to teach BLS-AED procedures to second-year UGFM students. It was designed to last 30 minutes, but no time limit was set for its completion.
The objectives of this e-learning module were designed according to the Swiss Resuscitation Council guidelines for the training of BLS-AED providers [
After completing the e-learning module, the participants were able to register for the practice sessions. These sessions lasted 1 hour and were limited to 4 participants according to the regional COVID-19 regulations in effect at the time [
The participants who successfully completed the practice sessions were sent an email inviting them to fill a postcourse questionnaire (
Postcourse questionnaire.
Survey page, field, and question | Type of question | |
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Appreciation | Yes/no |
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If yes: positive thoughts | MAQa |
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If no: negative thoughts | MAQ |
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General comments | Free text |
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Precourse confidence for OHCAb management | Likert scale (1-5) |
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Postcourse confidence for OHCA management | Likert scale (1-5) |
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Factors contributing to confidence | Likert scale (1-5) |
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Factors contributing to lack of confidence | Likert scale (1-5) |
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Other comments on confidence | Free text |
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Intention to register as first responder | Yes/no |
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If yes: contributing factors | Likert scale (1-5) |
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If no: impeding factors | Likert scale (1-5) |
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Other factors | Free text |
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Suggestion for improvement | Free text |
aMAQ: multiple answer question.
bOHCA: out of hospital cardiac arrest.
The research protocol had to be adapted to cope with unforeseen realities. First, since the course during which the study was presented was web-based, a QR code was not created, and a short URL was displayed. Second, Joomla 3.10 had not been released at the time this study started, and the platform was developed under Joomla 3.9. In addition, we added a postcourse questionnaire after the publication of the research protocol to evaluate the participants’ confidence and gather information regarding the practice sessions. Therefore, minor modifications were made to the second questionnaire for consistency purposes. Furthermore, in line with the previous study by Sturny et al [
The primary outcome was the number of first-year students who had enlisted as first responders on the
Even though the web-based platform was thoroughly tested before study inception, we could not rule out the occurrence of technical difficulties. Therefore, all technical difficulties were recorded and reviewed. Free comments were also analyzed.
Data were extracted to comma-separated value files, and Stata 17.0 (StataCorp LLC) was used for data curation and statistical analysis. The curated data file is available as
In addition to the preplanned analyses, we performed a qualitative analysis of the comments obtained through the postcourse questionnaire. The participants were able to leave free comments in 4 different sections (
A total of 529 medical and dental students were registered at UGFM at the time this study started (8 more than that stated in the original study protocol).
The characteristics of the 162/529 (30.6%) students who completed the first questionnaire are detailed in
Of the 124 participants who completed the e-learning module, 28 (22.6%) reported problems with the component used to register for practice sessions. Help was provided by email, and all problems were solved manually by the study team. Moreover, 10/107 (9.3%) students who had registered for a practice session did not show up. They were all contacted to determine the reason preventing them from attending the practice sessions, but none of them answered our request for information.
Most of those who attended the practice sessions answered our postcourse questionnaire (90/97, 92.8%). There was a significant increase in confidence regarding OHCA management skills after following the learning path (4.2, SD 0.6 vs 2.1, SD 0.9;
Those who felt more confident after the course were more likely to register as first responders (registrants had a mean confidence of 4.3, SD 0.5 vs 4.0, SD 0.6;
All the students who completed the postcourse questionnaire had a positive opinion of the learning path (90/90, 100%) and all of them would have recommended this course to other first-year students. Moreover, 30/90 (33.3%) students left a total of 40 comments in the dedicated sections of the postcourse questionnaire. Most were positive feedbacks regarding the project (29/40, 72.5%). Three other themes were identified, which were course duration, integration of the course in the standard curriculum, and availability of a face-to-face course during the COVID-19 pandemic. Many students (15/40, 37.5%) thought that the course was too short and that there was not enough time for hands-on practice. One student commented, “1 hour is too short! Sessions scheduled for a little longer (1h30-2h) would allow us to be less stressed by time and to practice better.“ Some students (5/40, 12.5%) considered that such a course should be mandatory during the first year of their curriculum. Finally, a few students (3/40, 7.5 %) declared that attending this course had been a unique occasion to have face-to-face training during the COVID-19 pandemic. A student commented that “It was really super interesting and rewarding!!! And it was really nice to be able to do some practice,” while another wrote that it was “A pleasure to see people in these times.”
Study flowchart. AED: automatic external defibrillator; BLS: basic life support.
Characteristics of the 162 participants who answered the first questionnaire.
Characteristics | Enlisted as FRa (n=48) | Did not enlist as FR (n=114) | ||
Age (years), mean (SD) | 20.3 (4.1) | 20.1 (4.7) | .88 | |
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.71 | |||
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Male | 14 (29.2) | 30 (26.3) |
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Female | 34 (70.1) | 84 (73.7) |
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Other | 0 (0) | 0 (0) |
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.95 | ||
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Medical | 46 (95.8) | 109 (95.6) |
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Dental | 2 (4.2) | 5 (4.4) |
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10-point score | 5.1 (1.7) | 4.9 (1.6) | .56 |
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6-point score | 2.6 (1.0) | 2.4 (1.1) | .19 |
Already followed a BLSb course, n (%) | 38 (79.2) | 80 (70.2) | .24 | |
Wishes for more BLS training, n (%) | 48 (100) | 114 (100) | N/Ac |
aFR: first responder.
bBLS: basic life support.
cN/A: not applicable.
Factors contributing to an increased confidence in resuscitation skills.
Factors limiting student confidence in resuscitation skills. CPR: cardiopulmonary resuscitation.
Factors motivating students to enlist as first responders. CPR: cardiopulmonary resuscitation.
Factors preventing students from enlisting as first responders. CPR: cardiopulmonary resuscitation.
This implementation study shows that less than 9.1% (n=48) of first-year UGFM medical and dental students enlisted as first responders after following a short motivational intervention and being offered the opportunity of following a blended learning path including an asynchronous e-learning module and hands-on practice. This proportion was slightly lower than the 10% target we had aimed at according to our original protocol [
Numerous reasons might explain this lower-than-expected result. First, even though the presentation was a success with almost half the promotion connecting to the platform, it took place rather late in the academic year, and practice sessions were scheduled even later. Therefore, because these junior students are under considerable pressure given the high failure rate, many might have elected to prioritize their revisions for the final exams over joining the first responder system regardless of their interest. Future studies will need to assess whether earlier inception can lead to higher registration rates. Second, while we strived to shorten the practice sessions in an attempt to increase the participation rate, some students might have felt that these sessions were too short to allow them to master BLS procedures. This might have prevented some participants from registering as first responders. Finally, a rather high proportion of students experienced technical difficulties with the registration component. Despite the help provided by email, this issue may have increased attrition at this stage.
The restrictions linked to the COVID-19 pandemic context may have played a role in our study. As all faculty courses were web-based, our first intervention was aired on the university streaming platform allowing students to skip it at will. This format also prevented us from interacting with the students and from answering their questions right away, and all further communications were carried out by email. While these elements might have contributed to a lower participation rate, the fact that we offered one of the few face-to-face courses might have played in our favor. Indeed, some comments showed that the students who participated suffered from a lack of social interaction and felt that the practice session was an almost unique occasion to discover the university premises and to directly talk to their peers. To assess the impact of these changes in the academic curriculum and given the relatively high enthusiasm showed by some students, this learning path will be offered once again during the academic year 2021-2022.
The confidence of the participants regarding their resuscitation skills was significantly improved, and the contributing factor most often reported by the students was a better knowledge of the subject. In our study, a higher confidence was associated with a higher probability of registering as first responder. However, less than two thirds of the students who completed the whole training process and obtained a course completion certificate had enlisted as first responders at 6 months. Interventions further strengthening student confidence in their resuscitation skills could help increase this proportion, and their impact should be assessed through further studies. Nevertheless, since people who feel more confident in their abilities are also more likely to act when faced with a stressful emergency [
In the past few years, the development of web-based courses has been expanding quickly, and the COVID-19 pandemic has increased this phenomenon even further [
Apart from our main limitation (ie, the adaptation of our study to the pandemic context with the subsequent limited interaction with first-year UGFM students), other limitations must be acknowledged. First and foremost, our design did not include a comparator, the lack of which prevented us from determining whether a certain type of motivational intervention would have been more effective than another. In addition, the type of learning path could also influence the intention of registering as first responder. Nevertheless, this study was carried out in accordance with our original protocol, and the limited number of first-year UGFM students would have limited the power of our study had a comparator been included. Moreover, 6 months represent a rather long delay between the initial intervention and the assessment of the number of UGFM students who had enlisted as first responders. However, more than 3 months had elapsed between the initial intervention and the last practice sessions, and it is improbable that elements other than our learning path would have prompted medical students to enlist as first responders given the high workload associated with their end-of-year exams, which were scheduled less than 2 months after the last practice session had been completed.
There is also bias in the answers to the questionnaires as the students participating in the study were interested beforehand and could not fully represent the knowledge of the whole promotion. Furthermore, we asked the participants about their confidence during the postcourse questionnaire, which is a recollection bias, as the students may have had a misperception of their confidence, overestimating or underestimating their abilities.
Our initiative is in line with the concept of “systems saving lives” developed by the ERC [
After following a short motivational intervention, less than 10% of first-year medical and dental students enlisted as first responders after completing a blended learning path including an asynchronous e-learning module and hands-on practice. Including these future health care professionals in the first aid system early in their career and increasing the sheer number of potentially available first responders could help enhance survival and neurological outcomes in those having a cardiac arrest and participate in the building of their professional identity as a secondary benefit. Further studies are needed to understand the low proportion of medical and dental students finally enlisting as first responders and to determine whether different or additional teaching methods could increase this proportion.
Email sent to all first-year students.
Screening questionnaire and consent form.
Disclaimer on the website's main page.
Additional information regarding the study.
Precourse questionnaire.
Postcourse questionnaire.
Original data (in CSV and DTA formats).
automatic external defibrillator
basic life support
cardiopulmonary resuscitation
European Resuscitation Council
out-of-hospital cardiac arrest
University of Geneva, Faculty of Medicine
None declared.