|Year : 2015 | Volume
| Issue : 3 | Page : 164-168
Impact of basic life support training on the knowledge of basic life support in a group of Nigerian Dental Students
AM Owojuyigbe, AT Adenekan, AF Faponle, SO Olateju
From the Department of Anaesthesia and Intensive Care, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
|Date of Web Publication||30-Nov-2015|
A M Owojuyigbe
From the Department of Anaesthesia and Intensive Care, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State
Source of Support: None, Conflict of Interest: None
Aim and Objetive: The burden of cardiac arrest remains enormous globally. Early recognition and prompt and effective cardiopulmonary resuscitation are crucial to successful outcome following a cardiac arrest. This study assessed the impact of basic life support (BLS) training on the knowledge of a group of dental students.
Materials and Methods: Sixty-eight dental students participated in this interventional study. Using convenience sampling, pre- and post-BLS training assessment were conducted with a questionnaire.
Results: The mean score (standard deviation) for pretest was 4.7 (±1.47) with a range of 2–8 out a total of 10, while the mean posttest score was 8.04 ± 1.47 with a range of 3–10. The differences were statistically significant (P < 0.01). There was a marked improvement in the knowledge of the respondents with 88.2% of them having a posttest score of ≥7.
Conclusion: The results of this study suggest that the group of dental students' knowledge of BLS was very poor prior to the BLS training. The study also showed that the BLS training had a positive influence on the BLS knowledge of the participants.
Keywords: Basic life support, cardiopulmonary resuscitation, dental students, knowledge, training
|How to cite this article:|
Owojuyigbe A M, Adenekan A T, Faponle A F, Olateju S O. Impact of basic life support training on the knowledge of basic life support in a group of Nigerian Dental Students. Niger Postgrad Med J 2015;22:164-8
|How to cite this URL:|
Owojuyigbe A M, Adenekan A T, Faponle A F, Olateju S O. Impact of basic life support training on the knowledge of basic life support in a group of Nigerian Dental Students. Niger Postgrad Med J [serial online] 2015 [cited 2021 Jun 12];22:164-8. Available from: https://www.npmj.org/text.asp?2015/22/3/164/170740
| Introduction|| |
Cardiac arrest is the sudden cessation of effective cardiac function in an apparently healthy individual. Globally, the morbidity associated with cardiac arrest is enormous. Out of hospital cardiac arrest is the third leading cause of death in the USA. Sudden cardiac arrest is also a leading cause of death in Europe with an estimated incidence of between 350,000 and 700,000 individuals yearly. In 1960, Kouwenhoven, Knickerbocker and Jude published an article in the Journal of American Medical Association titled "Closed–Chest Cardiac Massage" which was a report of 14 cases of cardiac arrest that were successfully managed with chest compression. This report marks the birth of modern cardiopulmonary resuscitation (CPR). At the meeting of Maryland Medicals Society in Ocean City, held in the same year, the combination of chest compression and rescue breathing was introduced. In 1962, direct current monophasic waveform defibrillation was described; in 1966, the first guidelines for CPR were developed by American Heart Association (AHA). The International Liaison Committee on Resuscitation (ILCOR) was founded in 1992 to promote international collaboration with a goal of endorsing evidence-based resuscitation science that can be adopted by regional councils to formulate resuscitation guidelines. Since then ILCOR has published more than 22 scientific advisory statements including 5 yearly advisory statements with the 2010 AHA guidelines for CPR and Emergency Cardiovascular Care being the latest. To reduce the rates of morbidity and mortality from cardiac arrest, there is a need for healthcare givers to have regularly updated information of the current advisory statements.
Successful resuscitation outcome after cardiac arrest event depends on early recognition, immediate and effective CPR and rapid defibrillation may be needed if it is a shockable rhythm. The presence of a competent rescuer during life-threatening emergencies increases the chances of survival of the victims. All healthcare givers, including dental students, are expected to be trained in basic life support (BLS) which is a simple but highly effective manoeuvre because they may encounter a cardiac arrest situation at any time in the course of their career. Poor knowledge of BLS among dental students portends a great danger to community health. To achieve the goal of improving the survival rate from cardiac arrest, there is an urgent need to train dental students on BLS.
Previous studies across the world, suggest that dental students have poor knowledge of BLS., Furthermore, many dentists upon graduation have been reported to have a poor knowledge of BLS.,, This may be due to the lack of structured BLS training in the dental school curriculum. In Nigeria, data about the impact of BLS training on knowledge of dental students is scanty. Hence, this study was conducted to assess the effect of BLS training on the knowledge of a group of Nigerian Dental Students.
| Subjects and Methods|| |
The study was conducted at the 2014 National Conference of the Nigerian Dental Students Association held in Ile-Ife, Osun State, Nigeria. This was an interventional study with pre-and post-tests conducted using questions developed for the purpose. Sampling was by convenience, with all consenting dental students present at the 2014 National Conference of the Nigerian Dental Students Association included in the study. A 16-item questionnaire was extracted from the 2010 AHA guideline [Appendix 1 [Additional file 1]]. The questionnaire was pretested and validated among medical interns at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. They were asked for their views on the simplicity of each question, whether they understood the questions or not and to identify which question they would suggest to be removed. The questionnaire consisted of a demographic information section and a section evaluating the respondent's knowledge of BLS. The sociodemographic variables considered in the study questionnaire were age, sex and level of dental education. The second part involved the use of a semi-structured questionnaire containing 10 items covering respondents' knowledge of BLS [Appendix 1].
The questionnaires were administered to the dental students before and after the BLS training. The training included lectures, videos and practical demonstrations. The content of the lectures on cardiac arrest included an overview which lasted for 20 min, adult and child BLS (20 min), defibrillation (20 min) and a film show on BLS (20 min). Hands-on demonstration of chest compressions on manikins (adult and child), airway management and recovery position (45 min) were also done. The instructors of the BLS training were three Consultant Anaesthetists and a Senior Registrar in anaesthesia. Respondents were interviewed using questionnaires.
Data entry and analysis were done using the IBM-Statistical Package for Social Sciences (SPSS) software, version 20.01 (Armonk, NY: IBM Corp). The data were subjected to descriptive and inferential statistical analysis. Quantitative data were summarised in means and standard deviation and presented in frequency tables. Ten practical questions were used to assess the knowledge with each correct response carrying +1 mark while an incorrect response carried 0. The knowledge score was graded as good or appropriate (if respondent scored >7 points) and not good or poor (if the respondent score was <7 points). A paired t-test analysis of the pre- and post-training scores of the respondents was also done and the level of significance was set at P < 0.05.
| Results|| |
Sixty-eight respondents participated in the study. Four out of the 68 respondents (5.9%) were 1st year dental students, 21 (30.9%) were in 2nd year, 5 (7.4%) were in 3rd year, 13 (19.1%) were in 4th year, 9 (13.2) were in 5th year and 16 (23.5%) were in final year [Table 1]. The mean age of the participants was 23 ± 2.93 years. There were 44 males (64.7%) and 24 females (35.3%). All the participants reported having had information about CPR prior to the training, and the sources of their information are shown in [Table 2].
The minimum score obtained from the pretraining assessment on knowledge was 2 while the maximum was 8 out of 10 with a mean score of 4.7 ± 1.47 [Table 3]. In the pretest, all the respondents knew the full meaning of CPR but none had complete knowledge of BLS as shown in [Table 4]. Only 5.9% felt they had a sufficient knowledge of BLS. Whereas, 9 out of the 68 respondents (13.2%) had previous training on BLS, five of these undertook the course because it was mandatory for their graduation; three undertook it for personal benefit while one had the training because previous experience proved the importance of BLS. About 52% were able to recognise someone in need of CPR; 19.1% knew the first step to take when someone has cardiac arrest; 11.8% knew the correct sequence of steps of CPR; 67.6% knew the correct chest compression ventilation ratio; 27.9% knew the correct position of the hand during chest compression in adult CPR.
For the posttraining assessment, the respondents performed significantly better in all the 10 questions assessing their knowledge of BLS. The minimum score was 3 and the maximum 10 with a mean of 8.04 ± 1.47. The difference between the mean scores of the pre-and post-BLS training assessment was statistically significant (P< 0.01) as shown in [Table 3]. There was a marked improvement in the knowledge of the students with a score of 7 and above in about 88.2% of the students. Seventy-five percentage of the respondents claimed to have acquired sufficient knowledge following the BLS training compared to 5.9% in the pretest. Approximately, 12% of the respondents also obtained a score of 10 in the posttraining assessment. The pre- and post-test results of the various classes are shown in [Table 5]. The pretest results showed that good knowledge of BLS was highest among the 600 level after the 300 level as compared to the other classes. However, this was not statistically significant (P = 0.872, df 5). In the posttest, there was an improvement in knowledge across all the classes with better results in the lower classes (100–300 levels); though not statistically significant either (P = 0.278, df 5).
| Discussion|| |
The results suggest that the dental students' knowledge of BLS prior to the BLS training was very poor. This is similar to the findings of Laurent et al. who reported poor knowledge of CPR among final year dental students. Similar finding was also reported in 2010 by Chandrasekaran et al. among medical college students including dental students, doctors and nurses in India. In the study by Chandrasekaran et al., out of the 1,050 respondents only 19 were dental students and 89% of the dental students scored less than 50% of the marks. In a related study by Laurent et al, 53% of the final year dental students felt they were able to perform CPR compared to the 5.9% in this study who felt they had sufficient knowledge of BLS. Chandrasekaran et al. studied medical undergraduates including dental students but years of training was not stated. The respondents in this study demonstrated inadequate knowledge of appropriate actions during CPR. These results were quite similar to what was reported by Chaudhary et al. which showed poor knowledge by participants about the appropriate actions to be taken during resuscitation. This is an indication that the teaching curriculum of BLS should be improved upon, standardised and formalised so as to make the theoretical and practical component more intensive. Ehigiator et al., in a study on medical emergency education in a Nigerian Dental School, discovered that fewer than half of the class had any form of simulation which would have helped to put their theoretical knowledge into practice. This may be a pointer to a fundamental deficiency in the dental curriculum.
All the respondents in this present study claimed to have had previous information about CPR. This is far higher than the 75.9% documented by Singh et al. However, it is important to know that theoretical information on CPR does not translate to competence in the practice of CPR. Competence in CPR can be achieved through regular practical training and re-training on BLS.,,
From the pretest assessment, only 13% of the participants had undergone BLS training, which is similar to the low levels of training reported from Pakistan and UK., Post-BLS training, students' BLS knowledge improved as demonstrated by the mean scores obtained in the posttest. This is a justification of the positive influence of the BLS training. There was a trend towards improved performanceof 100–300 level students in the posttest. This may be due to eagerness and enthusiasm to learning on the part of this category of dental students. Zaheer and Haque  suggested that provision of regular BLS training and refresher training over the period of medical school will ensure retention of BLS skills by the end of the course. Pande et al. recommended the incorporation of BLS training into medical curriculum in the 1st year with reinforcement of the skill every year. Studies by Chaudhary et al. and Ruesseler et al. emphasised the importance of simulation-based intervention in improving the skills in managing life-threatening emergencies. Furthermore, Abbas et al. demonstrated the improvement of knowledge and skills of BLS following CPR training but also emphasised the need for reinforcement of the knowledge of BLS in order to produce doctors who are competent in handling medical emergencies. One limitation of the study is that the 68 students may not be fully representative of the total number of Dental Students in Nigeria. However, this study still provided useful information about the knowledge of BLS among Nigerian Dental Students and the impact of BLS training workshop on their knowledge. Another limitation was the inability to use simulators which may provide immediate and objective feedback to the participants on their BLS skills.
| Conclusion|| |
This study has demonstrated that the knowledge of BLS by a group of Nigerian Dental Students before CPR training was inadequate., This study also showed the positive influence of training on the BLS knowledge of the participants. It is, therefore, important for all dental students to have regular BLS training and yearly reinforcement which would definitely improve their knowledge and skills for the management of cardiac arrest, the ultimate medical emergency which may arise at any time in the course of their dental career.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lui FY, Davis KA. Cardiac arrest and resuscitation. In: Roberts PR, Todd SR, editors. Comprehensive Critical Care:Adult. 1st
ed. Mount Prospect, IL: Society of Critical Care Medicine; 2012. p. 139-52.
Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, et al.
Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation 2010;121:709-29.
Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997;18:1231-48.
Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA 1960;173:1064-7.
Eisenberg M. Resuscitate! How Your Community Can Improve Survival from Sudden Cardiac Arress. Seatle, WA: Univeristy of Washington Press; 2009.
Lown B, Neuman J, Amarasingham R, Berkovits BV. Comparison of alternating current with direct electroshock across the closed chest. Am J Cardiol 1962;10:223-33.
Nadkarni VM, Nolan JP, Billi JE, Bossaert L, Böttiger BW, Chamberlain D, et al.
Part 2: International collaboration in resuscitation science: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010;122 16 Suppl 2:S276-82.
Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;63:233-49.
Laurent F, Augustin P, Nabet C, Ackers S, Zamaroczy D, Maman L. Managing a cardiac arrest: Evaluation of final-year predoctoral dental students. J Dent Educ 2009;73:211-7.
Chandrasekaran S, Kumar S, Bhat SA, Saravanakumar, Shabbir PM, Chandrasekaran V. Awareness of basic life support among medical, dental, nursing students and doctors. Indian J Anaesth 2010;54:121-6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900734/
Adekola OO, Menkiti DI, Desalu I. How much do we Remember after CPR Training? Experience from a sub-Saharan Teaching Hospital. Analg Resusc Curr Res 2013;S1. Available from: http://dx.doi.org/10.4172/2324-903X.S1-009
Chaudhary A, Parikh H, Dave V. Current scenario: Knowledge of basic life support in medical college. Nat J Med Res 2011;1:80-2.
Ehigiator O, Ehizele A, Ugbodaga P. Assessment of a group of nigerian dental students' education on medical emergencies. Ann Med Health Sci Res 2014;4:248-52.
Wynne G. ABC of resuscitation. Training and retention of skills. Br Med J (Clin Res Ed) 1986;293:30-2.
Edomwonyi NP, Isesele TO, Edobor FE, Esangbedo S, Afolayan J. A survey of the knowledge of cardiopulmonary rescucitation and the impact of training on nurses at the University of Benin teaching hospital, Nigeria. West Afr J Med 2013;32:239-42.
Zaheer H, Haque Z. Awareness about BLS (CPR) among medical students: Status and requirements. J Pak Med Assoc 2009;59:57-9.
Mastoridis S, Shanmugarajah K, Kneebone R. Undergraduate education in trauma medicine: The students' verdict on current teaching. Med Teach 2011;33:585-7.
Pande S, Pande S, Parate V, Pande S, Sukhsohale N. Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training. Adv Physiol Educ 2014;38:42-5.
Ruesseler M, Weinlich M, Müller MP, Byhahn C, Marzi I, Walcher F. Simulation training improves ability to manage medical emergencies. Emerg Med J 2010;27:734-8.
Abbas A, Bukhari SI, Ahmad F. Knowledge of first aid and basic life support amongst medical students: A comparison between trained and un-trained students. J Pak Med Assoc 2011;61:613-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]