Cardiac arrest is a common presentation in the emergency department, especially in tertiary care hospitals. Accordingly, HCPs employed in these hospitals should have mastered first aid and BLS procedures. While CPR training is obligatory for employment in healthcare fields in many countries, there is no such requirement in Egypt. Unsurprisingly, our study indicates a stark lack of proficiency in CPR among junior doctors and medical students in a representative tertiary care hospital in Upper Egypt. In spite of this lack of knowledge and thus potential proficiency, attitudes towards CPR were generally positive.
Similar knowledge deficiencies were reported among doctors and medical students in other LMICs, including South India [11], Sri Lanka [8], Jamaica [7], Nigeria [12], and Ethiopia [10]. Inadequate knowledge of CPR in such LMICs may be attributable to the lack of continuous and formal training. This is supported by our finding that junior doctors and medical students with previous formal, structured CPR training were shown to have better CPR knowledge (and thus retention). In accordance with this, a previous study from Pakistan similarly stressed the need for continuous and regular training to improve CPR knowledge among medical students [13].
Nevertheless, it should be noted that efficient CPR training may be difficult to implement in an institution lacking prior infrastructure, requiring specific and potentially costly materials and qualified tutors [14]. Restrictions due to cost can be especially problematic in underprivileged institutions with large student bodies (and high student/teacher ratios). A previous study detected significant disparities in CPR training partially attributable to financial reasons, with lower income areas in the United States lacking in bystander CPR training [15]. In line with this, Upper Egyptian governorates like Beni-Suef are the least privileged governorates in Egypt in terms of average household income and educational attainment [16]. Such financial factors may represent barriers that prevent junior doctors and medical students with relatively low incomes from receiving CPR training independently [15]. However, as this is speculative, further research regarding the barriers to CPR training in Egypt is needed.
Our study also revealed a positive correlation among medical students between knowledge of CPR and their attitudes towards CPR training. This is of particular importance considering medical students are still in the primarily educational phase of their career paths. Establishing increased knowledge and positive attitudes towards CPR increases the likelihood of students retaining this information and wanting to implement it in the future. Accordingly, it is imperative to make CPR training attractive and accessible to such student populations. Such improvements in basic CPR knowledge could be attained in numerous ways including simple lectures, seminars, and brochures.
Despite the deficiencies in knowledge detected, it must be noted that the participants reported overwhelmingly positive attitudes towards 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 both the students are eager to learn, and the potential teachers are keen to teach.
Nonetheless, some limitations of this study should be considered. First, this study reported a relatively low response rate making the results vulnerable to skewing factors including non-response bias. Second, the study evaluated CPR knowledge only via multiple-choice selection. Therefore, it is difficult to draw conclusions about functional CPR practice within the hospital as there was no assessment of practical skill and proficiency in resuscitation. Lastly, especially with resource-limited settings, we should be careful to generalize beyond the setting of the study. Beni-Suef University Hospital is an academic tertiary care hospital that accurately represents conditions seen across Upper Egypt but may not be as characteristic of more urbanized and higher income areas found in Lower Egypt such as in Cairo.
