|Year : 2021 | Volume
| Issue : 3 | Page : 68-73
Effectiveness of short-term resuscitation training programming among medical trainees of a peripheral medical college and practicing professionals
Rohini Sharma1, Arvind Kumar1, Upendra Baitha1, Neeraj Kumar Swarnkar2, C Prasanth Unnikrishnan2, Abhinav Kumar3, Upendra Kumar4, Vishwajeet Singh5, Vishal Kumar Vishwakarma6, Piyush Ranjan1, Naveet Wig1
1 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of CTC, All India Institute of Medical Sciences, New Delhi, India
3 Department of Trauma Surgery, All India Institute of Medical Sciences, New Delhi, India
4 Consultant Orthopedic and Organising Secretary, BOACON 2020, Bettiah, Bihar, India
5 Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
6 Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||14-Feb-2021|
|Date of Decision||25-Feb-2021|
|Date of Acceptance||04-Apr-2021|
|Date of Web Publication||29-Sep-2021|
Dr. Arvind Kumar
Department of Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Background: Resuscitation in trauma and nontrauma patients (RTNTP) is essential for prompt recognition, timely prevention, and effective management of life-threatening emergencies (LTEs). Optimal knowledge and skills of health-care providers (HCPs) are most important. Structured resuscitation training programs are lacking in peripheral districts and medical colleges to the best of our knowledge. Materials and Methods: A 3-day short training program on RTNTP was conducted in the month of February 2020 at the Bihar Orthopedic Association Conference, in which trainees from the peripheral medical colleges of the districts and practitioners participated. A preformed study questionnaire consisting of 20 questions on general awareness, knowledge, and skills was used for pre- and posttest training assessment in RTNTP among 37 participants. Results: The knowledge of resuscitation among participants improved from a score of 10.8–89.1% (range: 78.3, median: 51.3 with an interquartile range [IQR] of [16.2–68.8] 52.6) to 94.5%–100%. The same for general awareness and skill improved from scores of 5.4–91.8% (range: 86.4, median: 37.8 with an IQR of [27–72.9] 45.9) to 91.8%–100% and for skills 18.9%–67.5% (range: 48.6, median: 27 with an IQR of [67.5–18.9] 48.6) to 94.5%–100%, respectively. The availability and accessibility of RTNTP trainings are critically limited in India. Conclusion: By introducing short-term training courses regularly in the academics (wherever lacking, more so in peripheries) to HCPs, their skills for effectively managing the LTEs can be enhanced and stable changes can be made for quality care in LTEs.
Keywords: Awareness, health-care providers, knowledge, nontrauma, resuscitation, skills, trauma
|How to cite this article:|
Sharma R, Kumar A, Baitha U, Swarnkar NK, Unnikrishnan C P, Kumar A, Kumar U, Singh V, Vishwakarma VK, Ranjan P, Wig N. Effectiveness of short-term resuscitation training programming among medical trainees of a peripheral medical college and practicing professionals. J Prim Care Spec 2021;2:68-73
|How to cite this URL:|
Sharma R, Kumar A, Baitha U, Swarnkar NK, Unnikrishnan C P, Kumar A, Kumar U, Singh V, Vishwakarma VK, Ranjan P, Wig N. Effectiveness of short-term resuscitation training programming among medical trainees of a peripheral medical college and practicing professionals. J Prim Care Spec [serial online] 2021 [cited 2021 Oct 27];2:68-73. Available from: http://www.jpcs.com/text.asp?2021/2/3/68/327057
| Introduction|| |
Basic life support (BLS) skills are coined as medical procedures which can be performed in cases of emergency. Resuscitation in trauma and nontrauma patients (RTNTP) comprises knowledge and skills which are meant to perform to rescue the victim under life-threatening emergencies (LTEs). Knowledge, skills, and its prompt application for cardiopulmonary resuscitation (CPR) are an essential part of emergency medical care. Sensible delivery of resuscitation saves life. Basic RTNTP skills include CPR, airway, breathing, and circulation management., Occurrence of LTE related to trauma or otherwise can take place any time anywhere to anyone; besides trauma emergencies, people already with comorbidities are at increased risk of LTEs requiring resuscitation at unwarranted places and time.
It is mandatory for all the frontline health-care providers (HCPs) and paramedical staffs to know about the basics of resuscitation as they mostly encounter LTE in their route in duties. As per the recommendation of the American Heart Association (AHA, 2004), all the medical student teachers and other frontline medical staff should be trained in BLSs. However, periodic resuscitation training is not practiced in rural parts of many developing countries like India, which results in poor survival outcomes in LTE. It should be mandatory to get required resuscitation training by all medical professionals., This needs to be addressed in a country like India. Thus, the current study was planned and conducted to assess the general awareness, knowledge, and skills involved in RTNTP among medical trainees and doctors and to know the effectiveness of short-term training for the same.
| Methodology|| |
Short-term training on RTNTP was conducted in the month of February 2020 at West Champaran, Bihar, as a part of annual state-level academic conference conducted by the Bihar Orthopedic Association Conference (BOACON) 2020. Data of the conference were analyzed at the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi.
Selection of participants
The training program was carried out among the delegates comprising the medical trainees of the Government Medical College, Bettiah, Bihar, permitted by the organizers and practicing orthopedicians who opted to take this training program through the conference [Figure 1].
|Figure 1: Graphical abstract this figure is a ©Copyright of Vishal Kumar Vishwakarma, Rohini Sharma, and corresponding author of All India Institute of Medical Sciences, New Delhi|
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The resource persons from AIIMS, New Delhi, participated in the conference to conduct the training program after invitation from the organizers of the BOACON 2019 and getting approval from the competent authorities from the institute for the same. The purpose of the short training program on RTNTP was explained to each and every individual. After assessing these criteria, a total number of 37 participants were included in the training. This program consisted of role-playing, didactic lectures, demonstration, and hands-on experiences on manikins in the field of RTNTP. Adapting from available literature and available study materials, a set of 20 multiple-choice questionnaires on perception, knowledge, and skill was prepared by the resource faculty providing the training program.
Questionnaires were scored as correct answers were given 1 point, while incorrect answers and “do not know” responses were given 0 point. During 3 days of RTNTP, participants were assessed by conducting, pretest with a questionnaire consisting of 20 questions on theoretical and practical knowledge of the participant on previous experience and exposure to BLS and existing knowledge on resuscitations, followed by training through the said program, followed by posttest (using the same questionnaire). Participant pre- and posttest responses were evaluated and analyzed.
The proposed study proposal was ethically approved by the Institutional Ethics Committee of AIIMS, New Delhi (ethical no IEC-1201/04.12.2020, RP-33/2020), and also by the organizers of the society organizing the BOACON 2019. The detailed information and aim of the proposed training were given to all the participants. The data of participants were analyzed to see the outcome of the training.
Evaluation of obtained data was performed using STATA 14 (Stata Corp, College Station, TX, LP Version). The Wilcoxon signed-rank test was used to compare the improvement of participants' performance before and after the training. The results were considered statistically significant with P < 0.05. The conclusions were drawn based on the result analysis.
| Results|| |
Before initiating the RTNTP training program, the study questionnaires were divided into subclass of general awareness (40%), knowledge (45%), and skills (15%), which were further used for pre- and posttest during training sessions to assess the improvement among participants. Among all the recruited study participants, majority of them were males (51.3%) as compared to females (48.7%). The impact of the short-term RTNTP training program among participants was significant [Table 1] in almost all components of the study questionnaire. During the evaluation of participants' performance in their pretest toward the study questionnaire about knowledge of resuscitation, participants scored between 10.8% and 89.1% (range: 78.3, median: 51.3 with an interquartile range [IQR] of [16.2–68.8] 52.6). The performance level in posttest participants' score increased to 94.5%–100%, and the overall mean performance in knowledge improved from 53.3% (pretest) to 97.2% (posttest) [Figure 2]. Whereas in pretest outcome for the questions related to general awareness, it was observed that most of the participants were found to be unacquainted and scored between 5.4% and 91.8% (range: 86.4, median: 37.8 with an IQR of [27–72.9] 45.9), but participants showed their positive attitude and overwhelming response in posttest and scored 91.8%–100%, and the overall mean performance in general awareness improved from 42.2% (pretest) to 97.2% (posttest). While assessing the skills for CPR in pretest, participants scored 18.9%–67.5% (range: 48.6, median: 27 with an IQR of [67.5–18.9] 48.6), and on the other hand, in posttest, they scored 94.5%–100%. The overall mean performance in skills improved from 38% (pretest) to 94% (posttest).
|Table 1: Results of the questionnaire survey to evaluate participants' general awareness, knowledge, and skills toward cardiopulmonary resuscitation|
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|Figure 2: Participants' general awareness toward resuscitation in trauma and nontrauma patients. QGA: Question related to general awareness toward cardiac resuscitation|
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During assessment for the pretest toward questions related to general awareness in resuscitation, it was observed that participants were found to be less familiar with certain important aspects of RTNTP, such as only 5.4% of the participants were well versed about airway placement, and breath to chest compression ratio. Whereas 27% of the participants had suboptimal awareness in prompt response in an unresponsive victim, as well as when to stop CPR. Further, in the same contrast, 29.7% of the participants were found to be aware toward preferred method for opening the airway when patients had head or neck injury. During the posttest assessment for the same questions, participants' response improved to 94.5% and 100% [Figure 2]. In some of the very important aspects of resuscitation, participants in their pretest scored more than 80%, such as evaluating the pulse of an unresponsive victim (91.8%), and 86.4% of the participants responded well in the assessment of a traumatic patient after airway is established (in posttest assessment, their responses was found to be 100%). Overwhelming response of the participants was observed in assessment of knowledge of first evaluation in trauma patients and first drug of choice in cardiac arrest, where they scored 89.1% and 56.1%, respectively, which improved to 100% during posttest. It was observed that only 10.8% of the participants responded rightly on timing of pulse evaluation, followed by 13.5% in rate of chest compression and 18.9% in knowledge of new guidelines of CPR along with recommended BLS sequence. Whereas, on assessing the posttest outcomes of the study participants, their responses improved to 81%, 94.5%, and 100%, respectively. Participants' response toward operating automated electric defibrillator in pretest was found to be 21.6%, which later on increased to 78.3% during posttest evaluation [Figure 3]. On the other hand, in skill segment of questionnaire, only 18.9% of the participants knew about first maneuver in case of chest injury, followed by 27% of the participants responded well on switching roles while performing two-rescuer CPR; later on, participants were found to be improved during posttest assessment to 100% and 86.4%, respectively [Figure 4] and [Figure 5]. The understanding of CPR training and the participants' attitude toward CPR were found to be much better in the posttraining assessment. To conclude, the composite result of the whole set of questionnaires was overwhelming which showed the existing mean response of 44.2% to a mean of 95% during the posttest assessment.
|Figure 3: Participants' knowledge toward resuscitation in trauma and nontrauma patients. QK: Knowledge-related questions toward cardiac resuscitation|
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|Figure 4: Participants' skills toward resuscitation in trauma and nontrauma patients. QS: Question related to skills toward cardiac resuscitation|
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|Figure 5: Participants' performance in pre- and posttest assessment during resuscitation in trauma and nontrauma patient training|
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| Discussion|| |
The present study was planned to evaluate the general awareness, knowledge, and skills of medical trainees from Government Medical College, Bettiah, West Champaran, Bihar, and practicing doctors, before and after a short-term training program on RTNTP. Periodic surveillance of rural health-care facilities is somehow at a back, and evaluating the performance related to CPR is mostly found to be suboptimal. Cardiopulmonary arrest is the most critical medical and surgical emergency, as it is proven to be the most common health issue worldwide and especially common underprivileged rural areas with inadequate medical care and facilities. Hence, the era demands the medical, nonmedical, and paramedics to be mastered in first aid, BLS, and resuscitation protocol. The training in BLS is an essentially required qualification among all HCPs in many countries., There are adequate resources and logistics available in urban health-care settings, which helps to deliver on spot emergency care during LTEs. The rural health-care settings are lacking in an optimal system of health-care facilities at the time of LTEs. Performing CPR is an important critical life-saving maneuver for all the frontline HCPs, including medical and paramedics, as they are the ones encountering LTEs the most. The success of of resuscitation depends on the various factors such as condition of the patient, duration of cardiac arrest, performing high quality and if delivered properly to curb mortality rate., As to increase the knowledge about cardiac resuscitation, periodic training sessions are mandatory to have an update about the newer policies, guidelines, and implementation. In general, most of the resource-constrained rural health-care facilities are lacking infrastructure and empowerment in optimal resuscitation during LTEs., During the evaluation of pretest outcomes among all the respondents, the study found that only 44.2% of the participants were acquainted with RTNTP. Similarly, a finding from East Africa from Eritrea reported that 55% of the medical staff were lacking in knowledge of BLS. The participants were lacking in the general awareness and skills about the BLS, probably because of the fact that the need of the same is not very well exerted in rural areas and also because of unawareness of the recent changes in the sequence advocated by the AHA., The present study spotted out that only 5.4% of the participants were aware about advanced airway, 27% of the participants had expertise on when to stop CPR along with assessment of an unresponsive victim, and only 29.7% of the participants knew preferred method for opening the airway in a victim with head injury. A study from Istanbul by Oktay et al. reported 24% of unsatisfactory baseline knowledge level of CPR among rural physicians, agreeing with our study. The participants' awareness in cardiac resuscitation gradually increased toward 94.5%–100% during posttest assessment. Studies done so far are supporting the positive outcome with great impact and improved knowledge levels among medicos and nonmedicos in posttraining assessment; similar observations were made by Abbas et al., Somaraj et al., and Howell et al. from Pakistan, India, and West Indies, respectively, as they are in agreement with the present study findings. In the present study, the respondents scored 95% in posttest assessment; a study conducted in Pakistan showed a 90% increase in knowledge of trained students; this is in agreement with the present study which also emphasizes that regular training is prudent to enhance the medical, nonmedical, and paramedic's self-esteem and self-efficacy toward BLS and resuscitation in LTEs.
Despite the deficiencies in overall general awareness, knowledge, and skills detected in pretest, it must be noted that the participants reported overwhelmingly positive attitudes toward CPR training in addition to their readiness to spread the knowledge they would acquire to peers. This willingness could facilitate both the development of future training sessions and the inclusion of CPR education within medical curricula as participants were eager to learn which is similar to other studies conducted by Indian researchers Bhoi et al., Aroor et al., and Chandran and Abraham and from rural China by Hu et al. For prompt CPR knowledge among students, periodic training sessions for RTNTP and BLS are crucial as they will help to enhance the awareness, knowledge, and skills. A study from Nepal by Dixit et al. concluded that most of the respondents (72%) agreed that lack of professional training of HCPs in their academics was responsible for their deficiency in BLS knowledge. A study by Zahid et al. concluded that the practicing doctors and other HCPs with prior training for BLS during their graduations (6–10 years before) were found to be a significant predictor with adequate knowledge during multivariate analysis. The present study findings are focusing in the assessment of knowledge and practical skills among rural physicians in RTNTP. The level of general awareness, knowledge, and skills was suboptimal during pretest assessment despite participants' positive commitment suggesting stakeholders to intertwine adequately to uplift the same. The level of CPR knowledge of our rural health-care facilities is shallow as compared to the knowledge of urban medical care facilities. The limitation of the present study was less no of participants. However, looking out on the outcomes of the training, it seems a much-needed step in enhancing the resuscitation protocols in rural health-care facilities. A study by Khademian et al. reported that the training outcome was significantly higher after the intervention (8.22 ± 1.65) as compared to the performance before the training (0.8 ± 0.77), as their findings are fully agreeing with the present study. Prompt and accurate delivery of RTNTP is highly recommended among HCPs working in rural areas of medical care facilities. The impact of short-term RTNTP training program gradually increases the knowledge and enhances the awareness to take up the responsibility to help others and upsurges self-confidence to perform bystander CPR during LTEs.
| Conclusion|| |
Basic resuscitation training is not only mandatory for all primary care physicians but also its motive is to train other rescuers who can perform all the maneuvers with periodic short training sessions. The knowledge, awareness, and skill acquisition in resuscitation during LTE can be improved with short-term training program. The training in resuscitation is not very well protocolized and needs to be robust if at all it exists at peripheral and rural health-care settings of India and the same is realized to be true in many developing countries. The investment done and the training acquired from concerned apex bodies of like AHA and American College of Surgeons by resource person at central medical institutes of India could easily be percolated to the peripheries by this kind of short-term training program at very low cost. This will strengthen and homogenize the protocol base standard care during RTNTP and empower each health-care worker. However, persistent reinforcement by other shorter efficient means cannot be undermined to sustain the skill and would need further exploration. The findings support the need of structured training program on resuscitation during LTE at rural medical care facilities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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