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Abstract
Introduction
Materials and Me...
Results
Discussion
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  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 86-90
 

Evaluation of knowledge and skills of MBBS interns in basic life support/advanced cardiovascular life support and their ability to retain


1 Department of Anaesthesiology and Critical Care, RMC, Ahmednagar, Maharashtra, India
2 Department of Pharmacology, RMC, Ahmednagar, Maharashtra, India

Date of Submission05-Jun-2020
Date of Acceptance17-Aug-2020
Date of Web Publication22-Feb-2021

Correspondence Address:
Dr. Priyanka B Gulve
Department of Pharmacology, RMC, Loni, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_70_20

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  Abstract 


Objectives: Cardiac arrest is a substantial public health problem. The American Heart Association recommends that those whose daily work requires knowledge and skills in advanced cardiovascular life support (ACLS) should not only be trained in ACLS but also be given a refresher course at least every 2 years. We conducted a study to find out how much knowledge and skill was improved in the participants following the workshop and also how much of it they retain after 6 months.
Materials and Methods: The study, a prospective repeated measures quasi-experimental design, was done to test the knowledge and skill about basic life support (BLS) and ACLS among MBBS Interns at the entry to internship before training, posttraining and 6 months after training. This was done using a structured questionnaire containing 25 knowledge and practice questions and a checklist containing 15 points was used to assess the skills was also assessed using the Laerdal CPRQ Manikin with skill guide using parameters compression score, ventilation score, and compression fraction.
Results: Knowledge mean total score for pretest, immediate posttest, and 6 months posttest was 10.9, 23.54, and 15.77, respectively, and skill mean score for pretest, immediate posttest, and 6 months posttest was 3.55, 12.99, and 9.06, respectively. Knowledge and skill assessed for immediate posttest was significantly higher than the pretest score. Six months posttest total score was significantly higher than the pretest total score but was significantly lower than posttest score in regard to both knowledge and skills.
Conclusion: We found that there is gross lack of knowledge and skills among interns, which needs to be looked at with proper BLS and ACLS training and periodic reinforcement of the same with trainings as there is a significant decrease in both knowledge and skills at 6 months. The skill guide can be considered for skill assessment.


Keywords: Advanced cardiovascular life support basic life support, knowledge, Laerdal CPRQ Manikin, MBBS interns, skill, skill guide


How to cite this article:
Bhavar TD, Shetti AN, Gulve PB, Yenurkar PP. Evaluation of knowledge and skills of MBBS interns in basic life support/advanced cardiovascular life support and their ability to retain. Indian Anaesth Forum 2021;22:86-90

How to cite this URL:
Bhavar TD, Shetti AN, Gulve PB, Yenurkar PP. Evaluation of knowledge and skills of MBBS interns in basic life support/advanced cardiovascular life support and their ability to retain. Indian Anaesth Forum [serial online] 2021 [cited 2021 May 9];22:86-90. Available from: http://www.theiaforum.org/text.asp?2021/22/1/86/309837





  Introduction Top


Cardiac arrest is a substantial public health problem. Data from previous studies suggest that >3 million sudden cardiac deaths occur worldwide every year,[1],[2] and survival is lower than 8%.[3] The purpose of the American Heart Association (AHA) guidelines on basic life support (BLS) and advanced cardiovascular life support (ACLS) is to establish the standards, experiences and best practices on resuscitation and those whose daily work requires knowledge and skills in ACLS be given a refresher course at least every 2 years.[4] We conducted a study to find out whether knowledge and skills were improved in the participants following the workshop and retention after 6 months.

Aims and objectives

The aim is to study the knowledge and skill about BLS and ACLS among MBBS Interns of Rural Medical College (RMC) and Hospital, Loni, Ahmednagar, Maharashtra, at the entry to internship before training, posttraining, and 6 months after training.

Study design

A prospective, repeated-measures (before and after) quasi experimental design to test participants at three prespecified time points (initial, immediately after training, and at 6 months after training).

Study population

MBBS interns who had joined internship at RMC Loni.

Outcome measures

  1. Improvement in knowledge and skills of BLS/ACLS in MBBS Interns
  2. Retention of knowledge and skills after 6 months of training.



  Materials and Methods Top


Ethical clearance was obtained from the institutional ethical committee. All MBBS interns undergo BLS and ACLS training sessions during their internship orientation week. Interns willing to participate in the study were included in the study for two consecutive years, making the total interested participants to 150 students. Confidentiality was maintained.

Study conduct

  • The training program on BLS/ACLS consisting of theory lecture, skill demonstration, instructor-led discussion, case simulation, and hands-on training as per AHA ACLS/BLS Guidelines in English was conducted in RMC Skill laboratory at the start of the internship
  • Knowledge: Theoretical and practical knowledge about BLS and ACLS, was assessed before training, immediately after training and again at 6 months after training by a structured questionnaire containing 25 knowledge and practice questions (each given 1 mark for the correct answer and 0 for wrong answer) validated by two ACLS instructors, intensivist, cardiac anesthesiologist, physician. Multiple-choice questions on adult and pediatric airway, chest compressions (rate, depth, and site), order of resuscitation, drug administration, one-rescuer and two-rescuer recommendations, recent updates about guidelines, electrocardiogram rhythms, etc., were used. Questions on knowledge was divided and analyzed separately as: 7 questions for BLS, 11 questions for ACLS and 7 questions for Update
  • Skills: The learned ability to carry out a task with predetermined results often within a given amount of time, energy, or both were assessed at the same time points as knowledge by structured observation of cardiopulmonary resuscitation (CPR) performance skills on Adult manikin by an ACLS instructor. A checklist containing 15 points was used to assess the Skills, which included steps from scene safety to identifying cardiac arrest, giving proper CPR, using bag-mask device and using defibrillator correctly. (1 mark for correct and 0 for not performing correct or not performing at all) was used. The maximum marks in skill tests were thus 15 marks.
  • Skill was also assessed using the Laerdal CPRQ Manikin with skill guide.


Derived parameters such as:

  • Compression score: Factors used for calculating the score are compression depth, rate, and release and hand position. It is expressed as a percentage with 100% as performed all the assessed
  • Ventilation score: Factors used for calculating the score are ventilation volume and rate. It is expressed as percentage with 100% as performed all the assessed
  • Compression fraction: Percentage of the session where compressions were given. Wherein considering 30 compressions to be completed in 15–18 s with ventilation time of 5–10 s the normal compression fraction works out to be 60%–78%. With values <60 signifying less compression time, whereas >78% would be noted when breathing time is <5 s or in case of hands-only CPR.
  • For ensuring greater reliability, the same scenarios, test sheets, and questionnaire would be used throughout the study. The questions used were the same for all the three tests.


Statistical analysis

All the collected data were entered into a pro forma in the Excel sheet (MS Office 2016), and statistical analysis was performed using GraphPad software inc. version 3.06 San Diego, California US. Quantitative data were assessed using two-way ANOVA test. Value of P < 0.05 was considered to be statistically significant.


  Results Top


As shown in [Table 1] and [Graph 1], the mean total score for immediate posttest was 23.54 which was significantly higher than the mean pretest score of 10.9. Six months posttest mean total score was 15.773, which was significantly higher than the mean pretest total score of 10.9 but was significantly lower than the mean posttest score. Similar findings were observed in the ACLS score, BLS score, and update score.
Table 1: Comparison of theoretical knowledge

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As shown in [Table 2] and [Graph 2], compression score/ventilation score/compression fraction and instructor skill assessed for immediate posttest was significantly higher than the pretest score. Six months posttest total score was significantly higher than the pretest total score but was significantly lower than posttest score.
Table 2: Comparison of skills

Click here to view




  Discussion Top


Despite many advances in prevention, sudden cardiac arrest remains the leading cause of death. Seventy percent of out of hospital cardiac arrest occurs in the home, 50% of them are unwitnessed, and the outcome is poor. Only 10% of adult patients with nontraumatic cardiac arrest who are treated by emergency medical services survive to hospital discharge.[5] Therefore, this study was conducted to test the knowledge and skills of MBBS interns in ACLS/BLS.

We found that pretest knowledge was significantly low in our study. A study conducted by somaraj V et al. evaluating the dental interns in a subpopulation of India showed that there was an obvious lack of knowledge related to the management of medical emergencies. Data from the study revealed that 39.89% had below-average knowledge regarding BLS.[6] Similar findings were also noted in multiple other studies.[7],[8],[9],[10],[11],[12]

We found that most of the students were not updated about recent guidelines. Similar findings were noted by Saquib et al., wherein only about 28.5% of the participants answered the correct sequence of compression, airway, and breathing[7] and study done by Aroor et al., in which only 10% of participants were updated of the new sequence.[8]

The immediate posttest knowledge in our study was significantly higher than pretest knowledge. This is the effect of workshop, in which all the required theoretical aspects were covered. Similar findings were noted in multiple other studies.[10],[11],[12]

Studies assessing the BLS skills are limited one. In this study, we used both instructor guided and skill guide information for noting the skills of our participants. We found that before training, all the participants were lacking in most of the essential skills required for saving the life of a person requiring CPR. Assessment of skills immediately after the workshop in which all the skills were made to practice, gave satisfactory results with significant improvement in the psychomotor domain of all the participants. Similar findings were noted in the study by Ajjappa et al.[11]

In this study, 6 months down the line knowledge and skills were statically better than pretest, which signifies the impact and effectiveness of the training. Similar finding about knowledge has been demonstrated in a study by Dal and Sarpkaya,[12] but they did not take into consideration skill score before the workshop. Study by Bhatnagar et al. assessed only knowledge component and did not showed any significant difference in knowledge in pretest and 6 month posttest,[13] this difference may be because of the participants included in there study were all 1st year PG students who had recently cleared the entrance exam and joined the institution.

Six month knowledge and skills were significantly lower than immediate posttest knowledge and skill, which shows the decrease in the cognitive and psychomotor domain of the participants over time and reemphasizes the need of regularly updating the same. Healthcare professionals need to have hands-on practice regularly in order to retain their skills. Similar findings were noted in multiple other studies.[12],[13],[14],[15],[16]

We assessed the skills using the skill assessment checklist and skill guide. We used Laerdal CPR Q manikin for the assessment using skill guide, this can also be used for skill assessment using little Anne and little junior using an extension cable.[17]

Using skill guide, we got compression score, compression fraction and ventilation score. It can be considered for assessing the technical skills such as the quality of compression, ventilation, and compression fraction but this lacks the ability to assess the vital steps such as scene safety, detection of cardiac arrest, and communication skills which an instructor observers during testing. For technical skills assessment, the skill guide validation needs a separate study.

Study population being interns are working in clinical setups continuously, including emergencies. Hence, regular revision of algorithms of ACLS and BLS is required. That is why there are multiple recommendations for BLS and ACLS to be reinforced with periodic training,[13],[14],[16] and AHA has recommended certification renewal after 2 years.[18]


  Conclusion Top


There is gross lack of knowledge and skills among interns, which needs to be looked at with proper BLS and ACLS training and periodic reinforcement of the same with training as there is a significant decrease in both knowledge and skills at 6 months. The skill guide can be considered for skill assessment.

Limitation

Validation and further research on skill guide are required to be used as solo assessment tool as we need to give a clinical scenario and technique will change person to person.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Boriani G, Valzania C, Diemberger I, Biffi M, Martignani C, Bertini M, et al. Potential of non-antiarrhythmic drugs to provide an innovative upstream approach to the pharmacological prevention of sudden cardiac death. Expert Opin Investig Drugs 2007;16:605-23.  Back to cited text no. 1
    
2.
Josephson M, Wellens HJ. Implantable defibrillators and sudden cardiac death. Circulation 2004;109:2685-91.  Back to cited text no. 2
    
3.
Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63-81.  Back to cited text no. 3
    
4.
Hazinski MF, Nadkarni VM, Hickey RW, O'Connor R, Becker LB, Zaritsky A. Major changes in the 2005 AHA guidelines for CPR and ECC: Reaching the tipping point for change. Circulation 2005;112:IV206-11.  Back to cited text no. 4
    
5.
Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: A graphic model. Ann Emerg Med 1993;22:1652-8.  Back to cited text no. 5
    
6.
Somaraj V, Shenoy RP, Panchmal GS, Jodalli PS, Sonde L, Karkal R. Knowledge, attitude and anxiety pertaining to basic life support and medical emergencies among dental interns in Mangalore City, India. World J Emerg Med 2017;8:131-5.  Back to cited text no. 6
    
7.
Saquib SA, Al-Harthi HM, Khoshhal AA, Shaher AA, Al-Shammari AB, Khan A, et al. Knowledge and attitude about basic life support and emergency medical services amongst healthcare interns in university hospitals: A cross-sectional study. Emerg Med Int 2019;2019:1-8.  Back to cited text no. 7
    
8.
Aroor AR, Saya RP, Attar NR, Saya GK, Ravinanthanan M. Awareness about basic life support and emergency medical services and its associated factors among students in a tertiary care hospital in South India. J Emerg Trauma Shock 2014;7:166-9.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Nambiar M, Nedungalaparambil NM, Aslesh OP. Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala. World J Emerg Med 2016;7:263-9.  Back to cited text no. 9
    
10.
George C. “Basic life support training among interns and post graduate entrants –Any difference in level of education?” IOSR J Dent Med Sci 2017;16:8-10.  Back to cited text no. 10
    
11.
Ajjappa AK, Babu CP, Gowda SS, Shashikala P. Effectiveness of BLS training in improving the knowledge and skills among medical interns. J Educ Res Med Teach 2015;3:28-30.  Back to cited text no. 11
    
12.
Dal U, Sarpkaya D. Knowledge and psychomotor skills of nursing students in North Cyprus in the area of cardiopulmonary resuscitation. Pak J Med Sci 2013;29:966-71.  Back to cited text no. 12
    
13.
Bhatnagar V, Tandon U, Jinjil K, Dwivedi D, Kiran S, Verma R. Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and retention in young doctors joining postgraduation program. Anesth Essays Res 2017;11:842-6.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Farah R, Stiner E, Zohar Z, Zveibil F, Eisenman A. Cardiopulmonary resuscitation surprise drills for assessing, improving and maintaining cardiopulmonary resuscitation skills of hospital personnel. Eur J Emerg Med 2007;14:332-6.  Back to cited text no. 14
    
15.
Morgan R, Westmoreland C. Survey of junior hospital doctors' attitudes to cardiopulmonary resuscitation. Postgrad Med J 2002;78:413-5.  Back to cited text no. 15
    
16.
Mathar Mohideen and Jay Ablao. “Utilizing Saudi Heart Association Basic Life Support Guidelines in Evaluating the Retention of Cardio Pulmonary Resuscitation Knowledge and Skills Among Nursing Students”. Acta Scientific Medical Sciences 4.2 (2020): 42-46.  Back to cited text no. 16
    
17.
Laerdal. Skill Guide w/ext. Cable; 2020. Available from: https://www.laerdal.com/in/item/123-30050. [Last accessed on 2020 Jun 05].  Back to cited text no. 17
    
18.
AHA ACLS Project Team “Testing and Remediation” American Heart Association Advanced Cardiovascular Life Support Instructor manual; 2016. p. 45-62.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2]



 

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