Comprehensive Cardiopulmonary Life Support (CCLS) represents a critical facet of emergency medical care, playing an indispensable role in enhancing survival rates and outcomes for patients experiencing cardiac arrest or other life-threatening cardiovascular incidents. CCLS encompasses a broad spectrum of vital interventions, including Cardiopulmonary Resuscitation (CPR), defibrillation, advanced airway management, medication administration and post-resuscitation care. These interventions form the cornerstone of initial responses to cardiac emergencies, emphasizing the need for promptness, precision and proficiency in their execution. The efficacy of CCLS relies heavily on the rigorous training and comprehensive knowledge of healthcare providers, making their competency in these life-saving techniques a paramount concern [1-3].

Interns, as emerging healthcare professionals, occupy a crucial position in the medical hierarchy. Their role often involves being the first responders in emergency situations, where their ability to promptly recognize symptoms, initiate appropriate life-saving measures and stabilize patients is vital. The proficiency of interns in executing CCLS can significantly impact patient survival rates and overall clinical outcomes. Despite the recognized importance of CCLS, there exists a notable variability in awareness and proficiency among medical interns, influenced by factors such as the quality and frequency of training, practical exposure and accessibility to up-to-date guidelines and protocols [3-5].

Pt Jawahar Lal Nehru Government Medical College in District Chamba, Himachal Pradesh, serves as a pivotal healthcare institution, addressing the medical needs of the region. The geographic and demographic characteristics of Chamba, characterized by its remote and mountainous terrain, often limit access to immediate advanced medical care. In such settings, the role of interns becomes even more critical, as their knowledge and skill in CCLS can bridge the gap between immediate emergency care and advanced medical intervention. Robust training and proficiency in CCLS among interns are essential to enhancing patient outcomes in this region.

Previous studies have consistently highlighted gaps in knowledge and skills related to CCLS among healthcare providers, including interns [6-10]. These deficiencies are frequently attributed to inadequate training programs, irregular updates on resuscitation guidelines and limited practical exposure. Addressing these gaps is imperative to ensure that interns are well-prepared to manage cardiovascular emergencies efficiently and effectively. Enhancing their training and knowledge in CCLS can lead to improved patient outcomes, reduced mortality rates and better overall quality of emergency medical care.

This study aims to assess the awareness and knowledge of CCLS among the interns of Pt Jawahar Lal Nehru Government Medical College. By identifying the current knowledge levels and potential areas for improvement, this research seeks to contribute to the enhancement of CCLS training programs. The ultimate goal is to elevate the overall quality of emergency medical care provided by interns in District Chamba. The findings of this study will be instrumental in guiding targeted educational interventions and policy formulations, thereby strengthening the emergency response capabilities of medical interns in this region and beyond.

Objectives of the Study

The primary objective of this study is to assess the level of awareness and knowledge regarding Comprehensive Cardiopulmonary Life Support (CCLS) among the Interns Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: At Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh.

• Study Duration: Between January 2024 to May 2024

• Study Population: The study's target population encompassed Interns who had been working in Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh

• Sample Size: A robust sample size of 100 was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Comprehensive Cardiopulmonary Life Support (CCLS), a precise 10% absolute error margin and a conservative 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Comprehensive Cardiopulmonary Life Support (CCLS) was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Comprehensive cardiopulmonary life support (CCLS). One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (< 8) = poor

• Validity of Tool: By the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the Interns at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 100 responses were collected

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The study included 100 interns from Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh. The participants were assessed on their socio-demographic characteristics and their knowledge of Comprehensive Cardiopulmonary Life Support (CCLS).

The socio-demographic profile of the interns is detailed in Table 1. The vast majority of the participants were under the age of 25, with 95 out of 100 interns falling into this category. Only a small fraction, 5 interns, were aged 25 years and above. Gender distribution showed a predominance of males, with 56 male interns compared to 44 females. The distribution of months of experience varied slightly due to the uniform start date of internships, with 34 interns having 1-2 months of experience, 36 with 3-4 months and 30 with 5-6 months.

Table 1: Socio-Demographic Variables of Interns (N = 100)

Table 2 summarizes the interns' responses to 20 structured questions assessing their awareness and knowledge of CCLS. The results show a high level of knowledge among the interns on several key aspects of CCLS. For instance, 89 interns correctly identified what CCLS stands for and 75 knew the first step in CCLS. Knowledge about the correct compression-to-ventilation ratio for adult CPR was evident in 70 interns, while 66 knew the appropriate depth for chest compressions. A significant number of interns (80) were aware of the recommended rate of chest compressions per minute. Other notable responses included 84 interns correctly identifying the first action to take when witnessing a collapse and 78 understanding the function of an Automated External Defibrillator (AED). However, some areas showed room for improvement, such as the frequency of CCLS training refreshers, with only 51 interns answering correctly.

Table 2: Awareness and Knowledge Questions on CCLS (N = 100)

The overall CCLS knowledge scores are presented in Table 3. The interns' knowledge levels were categorized into four groups: Very Good (16-20 correct answers), Good (12-15 correct answers), Fair (8-11 correct answers) and Poor (<8 correct answers). The data revealed that 44 interns fell into the Very Good category, demonstrating a strong understanding of CCLS. Another 35 interns were classified as Good, indicating a satisfactory level of knowledge. Fair scores were observed in 13 interns, while 8 scored Poorly, highlighting areas where substantial improvement is needed.

Table 3: Overall CCLS Knowledge Scores (N = 100)

The univariate analysis of factors associated with CCLS knowledge, as summarized in Table 4, reveals significant relationships between various socio-demographic variables and knowledge levels. There was a notable difference in CCLS knowledge levels related to age (chi-square = 11.87, p = 0.025). Among interns aged less than 25 years, 42 scored Very Good, 33 scored Good, 12 scored Fair and 8 scored Poor. For those aged 25 years and above, 2 interns scored Very Good, 2 scored Good, 1 scored Fair and none scored Poor. This indicates that younger interns tend to have a better grasp of CCLS concepts. Gender also showed a significant association with CCLS knowledge levels (chi-square = 9.34, p = 0.037). 

Among male interns, 26 scored Very Good, 20 scored Good, 6 scored Fair and 4 scored Poor. Female interns had 18 scoring Very Good, 15 scoring Good, 7 scoring Fair and 4 scoring Poor. This suggests some differences in knowledge levels between male and female interns, with males generally performing slightly better. The months of experience showed a significant association with CCLS knowledge (chi-square = 11.49, p = 0.024). Interns with 1-2 months of experience had 17 scoring Very Good, 11 scoring Good, 3 scoring Fair and 3 scoring Poor. Those with 3-4 months had 15 scoring Very Good, 13 scoring Good, 5 scoring Fair and 3 scoring Poor. Finally, interns with 5-6 months had 12 scoring Very Good, 11 scoring Good, 5 scoring Fair and 2 scoring Poor. This data suggests that knowledge levels tend to vary with the duration of experience, with a general trend indicating that more months of experience correlate with higher CCLS knowledge scores.

These findings collectively highlight significant socio-demographic factors that influence the CCLS knowledge levels among interns, emphasizing the need for tailored educational interventions to address these disparities.

Table 4: Univariate Analysis of Factors Associated with CCLS Knowledge

The present study aimed to assess the awareness and knowledge of Comprehensive Cardiopulmonary Life Support (CCLS) among interns at Pt Jawahar Lal Nehru Government Medical College, District Chamba, Himachal Pradesh. The findings provide a comprehensive understanding of the current state of CCLS knowledge among interns and highlight areas requiring targeted educational interventions.

The socio-demographic profile of the study participants reveals a predominantly young cohort, with 95% of the interns being less than 25 years of age. This age distribution is reflective of the typical demographic for medical interns, who usually start their internships shortly after completing their MBBS degrees. The gender distribution showed a slight predominance of males (56%) over females (44%), which aligns with gender distributions in medical education in various regions. Marital status analysis indicated that most interns were single (69%), a common characteristic among interns who are in the early stages of their professional careers. The distribution of months of experience among the interns varied slightly, with groups having 1-2, 3-4 and 5-6 months of experience, reflecting the ongoing nature of internship programs.

The assessment of CCLS knowledge among the interns revealed a generally high level of understanding of key CCLS components. For instance, 89% of interns correctly identified what CCLS stands for and 75% knew the first step in CCLS. These results are consistent with findings from other studies, which reported similar levels of basic CCLS knowledge among healthcare providers [11-13]. However, specific areas showed room for improvement, particularly the frequency of CCLS training refreshers, with only 51% answering correctly. This finding is echoed by past studies, who emphasized the importance of regular training and updates in maintaining high levels of competency in life support skills [13,14].

The categorization of overall knowledge scores into Very Good, Good, Fair and Poor provided a clear indication of the competency levels among the interns. With 44% of the interns falling into the Very Good category and 35% in the Good category, it is evident that a majority possess a solid understanding of CCLS. These findings are encouraging and reflect positively on the existing training programs at the institution. However, the 13% of interns categorized as Fair and the 8% as Poor highlight the need for continued education and training efforts. Similar trends have been observed in earlier studies, where continuous training and periodic assessments were recommended to address identified gaps in knowledge and skills [13,15].

The study found a significant difference in knowledge levels related to age (chi-square = 11.87, p = 0.025). Interns under 25 years showed higher proficiency in CCLS compared to those aged 25 and above. This trend suggests that younger interns, who are more recently graduated, may be more familiar with the latest guidelines and protocols. This aligns with findings by past stuides, which noted that recent graduates tend to retain more up-to-date knowledge due to their recent educational experiences [14-17].

Gender also showed a significant association with knowledge levels (chi-square = 9.34, p = 0.037). Males generally performed better than females, with 26 males scoring Very Good compared to 18 females. This disparity might be reflective of differences in training opportunities or engagement levels, as suggested by studies that highlight gender differences in clinical skills acquisition. Addressing these disparities through tailored educational programs could help bridge this gap [14,16].

The association between months of experience and CCLS knowledge was significant (chi-square = 11.49, p = 0.024). Interns with more months of experience tended to have higher knowledge levels, indicating that practical exposure and hands-on experience play crucial roles in reinforcing theoretical knowledge. This supports the findings of previous studies, who highlighted the importance of clinical experience in enhancing life support skills [15-18].

The findings of this study have important implications for practice and policy at Pt Jawahar Lal Nehru Government Medical College and similar healthcare institutions. The high level of CCLS knowledge among the majority of interns is encouraging and should be maintained through regular refresher courses and updates on the latest resuscitation guidelines. For those with Fair or Poor scores, targeted training programs should be developed to address specific gaps in knowledge and skills.

The significant associations between socio-demographic variables and CCLS knowledge suggest that training programs should be customized to address the unique needs of different groups. For instance, younger interns and those with less experience may benefit from more frequent hands-on training sessions and simulations. Additionally, gender-specific training approaches might be considered to ensure that both male and female interns receive the most effective instruction.

Limitations

This study has several limitations that should be acknowledged. Firstly, the use of a cross-sectional survey design limits the ability to infer causality between the identified factors and CCLS knowledge levels. Longitudinal studies would be more effective in establishing causal relationships. Secondly, the reliance on self-reported data through a Google form questionnaire may introduce response bias, as participants might overestimate their knowledge or provide socially desirable answers. Thirdly, the study was conducted at a single institution, which may limit the generalizability of the findings to other settings with different demographic and educational profiles. Additionally, the sample size, although robust, might not capture the full diversity of the interns' experiences and backgrounds. Lastly, the questionnaire, while pre-tested, might not encompass all aspects of CCLS knowledge and skills, potentially overlooking critical areas that require attention.

In conclusion, this study provides valuable insights into the current state of CCLS knowledge among interns at Pt Jawahar Lal Nehru Government Medical College in District Chamba, Himachal Pradesh. The findings highlight a generally high level of awareness and understanding of CCLS, with a significant portion of the interns demonstrating very good and good knowledge levels. However, gaps in specific areas, such as the frequency of CCLS training refreshers, underscore the need for ongoing education and targeted training interventions. The significant associations between socio-demographic factors and CCLS knowledge suggest that customized training programs, addressing the unique needs of different demographic groups, could enhance the effectiveness of these interventions. Ensuring regular updates on resuscitation guidelines and providing hands-on training sessions are essential steps towards maintaining and improving CCLS proficiency. By addressing these gaps and tailoring training to meet the diverse needs of interns, healthcare institutions can enhance their emergency response capabilities, ultimately improving patient outcomes in cardiovascular emergencies. The findings of this study will inform future educational strategies and policy formulations aimed at strengthening the emergency care provided by medical interns in similar settings.

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