|Year : 2015 | Volume
| Issue : 1 | Page : 42-46
Theoretical knowledge of cardiopulmonary resuscitation among clinical medical students in the University of Port Harcourt, Nigeria
Kelechi E Okonta1, Boma A. N. Okoh2
1 Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
2 Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||17-Mar-2015|
Kelechi E Okonta
Department of Surgery, University of Port Harcourt Teaching Hospital, PMB 6173, Rivers State, Port Harcourt
Source of Support: None, Conflict of Interest: None
Aim: To assess the knowledge of cardiopulmonary resuscitation (CPR) among clinical medical students of the University of Port-Harcourt. Materials and Methods: A cross-sectional study on the knowledge of CPR among clinical medical students (4 th -6 th year classes) of the University of Port Harcourt. The data collected were analyzed using the Epi info version 7 statistical packages and Chi-square test was used to compare proportions with P < 0.05 considered significant. Results: Two hundred and forty-five questionnaires were distributed with 177 (72.2%) duly filled. The male to female ratio was 1.5:1, the age range was 19-40 years with a mean of 24.50 2.79 years. The 6 th year class had 109 (61.6%) respondents, 5 th year had 49 (27.7%) and 4 th year had 19 (10.7%). Forty-six (26.0%) of students had some form of CPR training and 11 (6.2%) admitted having performed CPR. Of the 46 students that had CPR training, 39 (84.8%) did so because it was given to them at some point in their medical training, while 7 (15.5%) acquired the training due to personal interest. One hundred and two (74.6%) students scored <50%, while 45 (25.4%) scored >50%. The number of students scoring >50% increased with increasing class level (P < 0.001). Students with some prior training in CPR (50.0%) scored above average compared to the students without CPR training (16.8%) (P < 0.001). Conclusion: There is a need to periodically and constantly organize CPR for the medical students and incorporating the training in their medical curriculum to enhance better understanding of the procedure.
Keywords: Cardiopulmonary resuscitation, clinical medical students, medical curriculum, Port Harcourt
|How to cite this article:|
Okonta KE, Okoh BA. Theoretical knowledge of cardiopulmonary resuscitation among clinical medical students in the University of Port Harcourt, Nigeria. Afr J Med Health Sci 2015;14:42-6
|How to cite this URL:|
Okonta KE, Okoh BA. Theoretical knowledge of cardiopulmonary resuscitation among clinical medical students in the University of Port Harcourt, Nigeria. Afr J Med Health Sci [serial online] 2015 [cited 2019 Mar 26];14:42-6. Available from: http://www.ajmhs.org/text.asp?2015/14/1/42/153391
| Introduction|| |
Cardiopulmonary resuscitation (CPR) is a life-saving procedure that consists of the use of chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest.  The American Heart Association described CPR as a component of a "chain of survival". This chain is a sequence of actions that help to give a person with cardiac arrest the greatest chance of survival.  About 92% of out-of-hospital cardiac arrest subjects lose their lives due to the unavailability of immediate CPR by persons who are knowledgeable in the art of administering of CPR.  The knowledge of basic life support (BLS) and the practice of simple CPR techniques ensures the survival of the patient long enough till experienced medical help arrives and this, in most cases, is itself sufficient for survival.  Ideally, everyone should know about BLS and CPR, and its awareness to medical personnel should be a prerequisite for advancing into higher levels of training. Newly qualified doctors are expected to take part in resuscitation programs from their 1 st day as medical doctors.  This is important to ensure they are competent before going into the furor of managing patients who may develop cardiac arrest on the ward or outside the hospital.
Previous reports on CPR showed that both the senior and the junior medical staff were lacking in the essential BLS skills. ,, Similarly, studies on medical students', ability to provide competent BLS showed that both the training and the ability were severely deficient. , Majority of the studies carried out to assess knowledge of CPR among medical students, or other populations were carried out in the developed countries. A study  carried out on 6 th year medical students in Japan showed that 84% of them could not actually perform standard CPR. In a study  among medical students in Pakistan, significantly less number of students knew about the skills for BLS (21% P < 0.05). Another study  among Polish medical students showed that the students' own estimation of their ability to perform CPR was very high, but did not correlate with their knowledge and skills. The researchers concluded that there was a need to improve the art and knowledge of CPR with a refresher course in both theory and skills at least once a year for medical students. The few studies that were conducted in Nigeria on the knowledge of CPR were done amongst doctors,  radiographers,  anesthetists  etc. The aim of this study is to explore the level of knowledge of CPR among clinical medical students in the University of Port Harcourt, with the aim of providing a template for incorporating CPR training into the medical school curriculum.
| Materials and Methods|| |
The study was a cross-sectional study conducted among clinical medical students of the University of Port Harcourt in July 2013. Questionnaires were distributed among all the clinical medical students of the institution from the 4 th to 6 th year class, who had given a verbal consent to be part of the study. The questionnaire was semi-structured. It was self-administered, anonymous, and prepared in English language. It inquired about basic bio-data of the subjects and information on previous CPR training and performance. It also included 13 practical test questions on CPR knowledge and skill. The practical questions covered areas on BLS abbreviation, recommended order of CPR technique, location, rate and depth of chest compression, how to give rescue breaths and coordinate with chest compressions and removal of airway foreign body obstruction. The purpose of the study was explained prior to filling the questionnaires. A total of 245 questionnaires was distributed among all the clinical students who gave verbal consent to participate in the study and 177 retrieved, giving a response rate of 72.2%. The retrieved questionnaires were analyzed using the Epi info version 7 statistical package. The Chi-square test was used to compare proportions and a P < 0.05 was considered significant.
| Results|| |
A total of 177 respondents participated in the study, 105 males and 72 females, giving a male to female ratio of 1.5:1. Their age range was from 19 to 40 years with a mean of 24.50 ± 2.79 years. [Table 1] shows the age group and sex distribution of the study subjects. The highest number of respondents 109 (61.6%) were from the 6 th year class and the lowest 19 (10.7%) from the 4 th year class. The respondents from the 5 th year class were a total of 49 (27.7%).
A total of 46 (26.0%) of all the students attested to have had some form of training in CPR in the past and 11 (6.2%) admitted having ever performed CPR. The 6 th year class had the highest proportion of people who had received prior training in CPR (42 [38.5%]) and had participated in CPR performance (10 [9.2%]) compared to other classes [Table 2]. Majority (32 [70.0%]) of the 46 students who had some form of CPR training, received this training in the teaching hospital, while the others received theirs in other medical services and trainings. Thirty-nine (84.8%) of the students who received CPR training did so because it was given to them at some point in their medical training, while the other 7 (15.5%) acquired their training due to personal interest and other reasons.
[Figure 1] shows the percentage of students who gave correct responses to the individual test questions asked in the questionnaire. The students performed better in theory questions such as BLS abbreviation (88.1%) and acceptable alternatives for mouth-to-mouth ventilation (98%). They however did not perform so well in more practical questions like location of chest compression in adults (22%) and infants (31.3%) and method of rescue breathing in infants (28.2%). [Figure 2] shows the score frequency of the students. The line graph of the score frequency of the students is similar to a Gaussian pattern, with the majority of the students scoring between 4 and 6 points out of 13 questions.
|Figure 1: Percentage correct responses to test questions (please arrange in ascending order)|
Click here to view
The percentage score of each student was calculated based on the number of correct responses given to the 13 questions asked. The students' scores ranged from 0% to 84.6% with a mean score of 39.33 ± 16.96% and the median of 38.46%. A total of 132 (74.6%) of the students scored <50%, while 45 (25.4%) scored above 50%. As shown in [Table 2], the number of students scoring above 50% increased with increasing class level. This observed trend was statistically significant (χ2 for trend = 18.69, df = 2, P < 0.001). Twenty-one (29.2%) out of the 72 female students scored above 50% compared to 24 (22.9%) out of the 105 male students scoring above 50%. This observation was, however, not statistically significant (χ2 = 0.90, df = 1, P = 0.344).
[Table 3] shows the relationship between the percentage score of the students and prior training in CPR. A larger proportion of students with some prior training in CPR (50.0%) scored above average compared to the students without CPR training (16.8%) [Table 4]. The observed difference was statistically significant (χ2 = 19.80, df = 1, P < 0.001). Three (27.3%) out of the 11 students who had ever performed CPR scored above average compared to 42 (25.3%) 166 students who had never performed CPR. The observed difference was not statistically significant (χ2 = 0.02, df = 1, Fisher exact = 0.563).
|Table 3: Relationship between percentage score of students and year of study (what of 50%)|
Click here to view
|Table 4: Relationship between the percentage score of students and prior CPR training (what of 50%)|
Click here to view
| Discussion|| |
This study showed a markedly deficient knowledge of CPR among clinical medical students in the University of Port Harcourt, Nigeria. The mean score was 39.33 ± 16.96% with the majority (74.6%) of the students scoring below the average of 50%. This is probably as a result of the low percentage (26.0%) of the study subjects that had been exposed to any form of CPR training. A similar deficient knowledge of CPR was observed in other studies among medical students, , health care professionals ,, and laymen.  In a study  among Pakistani medical students, only 18% provided correct answers to skills on CPR. In another survey among Indian medical, dental nursing students and doctors, majority of the respondents (84.82%) scored <50% to questions asked regarding BLS. As shown in other studies, , there was improved knowledge of CPR with increasing number of years of study among medical students in this study. This may be due to the fact that medical students are only exposed to CPR as they advance in their clinical years of study on the ward rounds. Also with advancing year of study, it is more likely that their knowledge of CPR may have been updated frequently due to increasing encounters with the subject matter as they advance in a clinical study.
The low percentage of students (26%) who had some form of prior training in CPR is similar to that observed in other studies. The low percentage observed in this study is probably due to the fact that formal CPR training and re - training is not strictly incorporated into the medical curriculum in the University of Port Harcourt. In a study in medical students in India,  only 14.7% had attended CPR training, while only 22% had received training within a period of 5 years, in another study among health care professionals in Nepal.  In a study conducted among Junior Nigerian anesthetists,  on the other hand, a higher number (55.6%) of the anesthetists had received some training in CPR compared to this study though this proportion is still unacceptably low in such highly trained medical professionals. This is contrary to what is seen in the most developed countries such as New Zealand, where up to 74% of a lay adult population had received prior training in CPR.  The General Medical Council of the United Kingdom states that preregistration house officers should have training in BLS before they begin their first posting and that they should receive advanced life support training during the 1 st year.  In Poland, structured training in CPR is integrated into the medical school curriculum.  Although basic knowledge and skills in resuscitation is outlined as part of the guidelines for minimum standards of medical and dental education in Nigeria,  there is no compulsory structured periodical training for medical students in CPR. Also, resuscitation training is not synchronized in Nigeria as there is presently no resuscitation council in the country.  The fact that structured training in CPR is not formally incorporated into the medical school curriculum in the University of Port Harcourt may account for this unacceptably low level of prior training in CPR in the medical students observed in this study.
This study showed a significantly higher percentage of students (50%) with prior CPR training scoring above average when compared to the students (16.8%) without CPR training. This is similar to the finding among health care professionals in Nepal  where those who had received CPR training within 5 years obtained the highest mean score of 8.62 ± 2.49 out of 15 questions, whereas those who had the training more than 5 years back or no training obtained a mean score of 5.54 ± 2.38 and 6.1 ± 2.29 respectively (P = 0.001). Also in a study among medical students in South India, comparison of students who had undergone training with those who had not undergone training revealed that training improved knowledge of CPR.  Little or no training in CPR will, therefore, result in medical students, and ultimately, doctors who are not competent in performing basic CPR. Basic and advanced life support knowledge and skills deteriorate in as little as 3-6 months after a training exercise especially when not frequently practiced.  The European Resuscitation Council, therefore, recommends the use of frequent assessments to identify those individuals who require refresher training to help maintain their knowledge and skills. 
The very low percentage of students (6.2%) who had ever participated in CPR in this study is comparable to that seen in a study among medical students in South India  where 8.3% had attempted CPR and among regular University students in Saudi Arabia  where 14% had participated in CPR. It however contrasts sharply with the 85% who ever administered CPR in a study among medical interns in Mangalore, India.  The higher percentage seen in the Mangalore study may be due to the fact that the study population were interns who have a higher knowledge of CPR and regularly come in contact with sudden cardiac arrest situations in their jobs requiring CPR, unlike medical students.
In this study, it was observed that a higher percentage of students who had ever performed CPR scored above average on the questions assessing knowledge of CPR when compared to those that had never performed CPR, but the difference was not statistically significant. This finding is mirrored in some other studies ,, among medical practitioners. Desalu et al.  found that among doctors attending a resuscitation course, those who provided CPR more frequently by nature of their specialty such as the anesthetists had higher pretest scores than other specialties. Among health care professionals in Nepal,  it was also observed that those who were involved in resuscitation frequently had a higher median score of 8 in comparison to those who were seldom involved or not involved at all (P < 0.001).
| Conclusion|| |
The poor knowledge of CPR among clinical medical students is a serious issue because these potential junior doctors, who are required to be competent in CPR, will be graduating with insufficient knowledge and skill in CPR. After graduation, there is no compulsory forum in Nigeria for structured CPR training before internship, where the intern will be exposed to situations requiring CPR frequently. There is a need, therefore, to incorporate a structured practical training in CPR into the undergraduate medical curriculum in Nigeria as is done in some other countries.
| Acknowledgments|| |
Dr. Linda Ireogbu for preparation and administering of the questionnaires to some of the students.
All clinical medical students (2013) who took part in filling the questionnaires in the hospitals.
| References|| |
Steen PA, Kramer-Johansen J. Improving cardiopulmonary resuscitation quality to ensure survival. Curr Opin Crit Care 2008;14:299-304.
Thwaites BC, Shankar S, Niblett D, Saunders J. Can consultants resuscitate? J R Coll Physicians Lond 1992;26:265-7.
Skinner DV, Camm AJ, Miles S. Cardiopulmonary resuscitation skills of preregistration house officers. Br Med J (Clin Res Ed) 1985;290:1549-50.
Morris F, Tordoff SG, Wallis D, Skinner DV. Cardiopulmonary resuscitation skills of preregistration house officers: Five years on. BMJ 1991;302:626-7.
Casey WF. Experience of medical students in cardiopulmonary resuscitation. Lancet 1983;1:1444-5.
Hunskaar S, Seim SH. Experiences of medical students in cardiopulmonary resuscitation. Lancet 1983;1:1113.
Suzuki A, Suzuki Y, Takahata O, Fujimoto K, Nagashima K, Mamiya K, et al.
A survey of 3,303 6th-year medical students from 36 universities concerning knowledge of resuscitation - more than 80% of medical students can not perform standard cardiopulmonary resuscitation?. Masui 2001;50:316-22.
Zaheer H, Haque Z. Awareness about BLS (CPR) among medical students: Status and requirements. J Pak Med Assoc 2009;59:57-9.
Grzeskowiak M. The effects of teaching basic cardiopulmonary resuscitation - A comparison between first and sixth year medical students. Resuscitation 2006;68:391-7.
Osinaike BB, Aderinto DA, Oyebamiji EO, Dairo MD, Diya KS. Evaluation of knowledge of doctors in Nigerian tertiary hospital about CPR. Niger Med Pract 2007;52:16-8.
Edomwonyi NP, Egbagbe EE. The level of awareness of cardio-pulmonary resuscitation (CPR) amongst radiographers in Nigeria. J Med Biomed Res 2006;5:29-35.
Ibironke D, Olanrewaju OO, Olutola JO. Training and confidence level of junior anaesthetists in CPR-Experience in a developing country. Indian J Anaesth 2008;52:297-300.
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.
Zamir Q, Nadeem A, Rizvi AH. Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan. J Pak Med Assoc 2012;62:1361-4.
Roshana S, Kh B, Rm P, Mw S. Basic life support: Knowledge and attitude of medical/paramedical professionals. World J Emerg Med 2012;3:141-5.
Al-Turki YA, Al-Fraih YS, Jalaly JB, Al-Maghlouth IA, Al-Rashoudi FH, Al-Otaibi AF, et al.
Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia. Saudi Med J 2008;29:1306-9.
Harsha Kumar HN, Upadhya PS, Ashok PS, Chowdari GA, Niranjan GM, Dinesh B. A cross-sectional study on awareness and perception about basic life support/cardio-pulmonary resuscitation among undergraduate medical students from coastal South India. Int J Med Public Health 2013;3:146-50.
Larsen P, Pearson J, Galletly D. Knowledge and attitudes towards cardiopulmonary resuscitation in the community. N Z Med J 2004;117:U870.
Phillips PS, Nolan JP. Training in basic and advanced life support in UK medical schools: Questionnaire survey. BMJ 2001;323:22-3.
Chojnacki P, Ilieva R, Kolodziej A, Królikowska A, Lipka J, Ruta J. Knowledge of BLS and AED resuscitation algorithm amongst medical students - Preliminary results. Anestezjol Intens Ter 2011;43:29-32.
The Medical Curriculum: Guide lines on Minimum standards of Medical Education. In: The Red Book Medical and Dental Council of Nigeria Guidelines on Minimum Standards of Medical and Dental Education in Nigeria. Revised edition. Nigeria: MDCN; 2006. p. 26-95.
Desalu I, Adeyemo WL, Erhenede O, Bello B, Ehioze-Osifo AA. Evaluation of CPR skills of doctors after resuscitation training in a tertiary hospital in Lagos Nigeria-does specialty matter? Anaesth Online 2010; Priory Lodge Education Limited.
Soar J, Monsieurs KG, Ballance JH, Barelli A, Biarent D, Greif R, et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010;81:1434-44.
Sharma R, Attar NR. Adult basic life support (BLS) awareness and knowledge among medical and dental interns completing internship from Deemed University. Nitte Univ J Health Sci 2012;2:2249-7110.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]