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Table of Contents
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 129-134

Modified learning of basic life support courses enhance attitude among professional healthcare students in Indonesia

1 Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universitas Trisakti, Indonesia
2 Conservative Department. Faculty of Dentistry, Universitas Trisakti, Indonesia
3 Oral Medicine Department, Faculty of Dentistry, Universitas Trisakti, Indonesia
4 Faculty of Dentistry, Universitas Trisakti, Indonesia
5 Faculty of Dentistry, Thammasat University, Phatumtani, Thailand

Date of Submission30-Jun-2022
Date of Decision11-Aug-2022
Date of Acceptance29-Aug-2022
Date of Web Publication15-Nov-2022

Correspondence Address:
Wiwiek Poedjiastoeti
Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universitas Trisakti
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_39_22

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Background: Cardiovascular disease is one of the main causes of death worldwide. Basic life support (BLS) actions such as adequate cardiopulmonary resuscitation (CPR) and the provision of an automated external defibrillator (AED) may handle such a medical emergency. BLS is included in the curriculum for students in healthcare-related areas; hence, healthcare practitioners are required to execute BLS competently. Objectives: The aim of this study was to determine the most effective learning methods implemented in Indonesian higher education institutions. Methods: This cross-sectional study was conducted with health science, medical, and dental students from 22 Indonesian universities. In this investigation, a validated questionnaire with 33 items was provided (20 knowledge- and 13 attitude-related items). Data were analyzed using the Kruskal–Wallis’s test. Result: Among the participants, 98.2% (982 subjects) had BLS learning in their curricula. Types of BLS learning included the combination of theory, demonstration, and mannequins; combination of theory and demonstration; and theory (72.9%, 14.9%, and 12.2%, respectively). Most participants were categorized as having high knowledge (92.6%) and high attitude (98.7%). A significant correlation between knowledge and attitude toward BLS among health science students in Indonesia was observed (P < 0.05). The BLS learning type with the combination of theory, demonstration, and mannequins exhibited the highest rank (P = 0.000). Conclusion: An effective BLS learning method includes the provision of theory followed by demonstrations and hands-on trials on mannequins by students in the health sector according to the curriculum.

Keywords: Basic life support, Indonesia, students

How to cite this article:
Poedjiastoeti W, Subrata A, Gunardi I, Sidharta AJ, Suebnukarn S. Modified learning of basic life support courses enhance attitude among professional healthcare students in Indonesia. Sci Dent J 2022;6:129-34

How to cite this URL:
Poedjiastoeti W, Subrata A, Gunardi I, Sidharta AJ, Suebnukarn S. Modified learning of basic life support courses enhance attitude among professional healthcare students in Indonesia. Sci Dent J [serial online] 2022 [cited 2023 Mar 27];6:129-34. Available from: https://www.scidentj.com/text.asp?2022/6/3/129/361158

  Background Top

Cancer and cardiovascular disease are the leading causes of death worldwide. Approximately 31% of deaths are attributed to cardiovascular disease, whereas cardiac arrest and stroke account for nearly 80%.[1],[2] Out-of-hospital cardiac arrests (OHCA) are more prevalent than in-hospital cardiac arrests.[3],[4],[5] These cardiac arrests are typically detectable and treatable in hospitals.

Basic life support (BLS) is an effort to save the life of a patient suffering from a heart attack, sudden cardiac arrest, stroke, or foreign body obstruction, which is followed by a chain of survival actions before the patient can be treated by a medical team.[6],[7] Cardiopulmonary resuscitation (CPR), control of bleeding, the Heimlich maneuver, artificial ventilation, and basic airway care are included.[7] Early recognition and activation of emergency medical service (EMS) as well as adequate CPR and defibrillation are essential.[8],[9],[10] In cardiac arrest patients, chest compression and artificial ventilation would provide oxygen to the organs. Previous studied suggested that for cardiac arrest patients, the golden period is between four and eight minutes before irreversible brain damage occurs.[3],[4]

The purpose of this study was to ensure that healthcare students graduate as qualified BLS practitioners based on their BLS proficiency. The medical emergency curriculum has been adopted in a majority of health faculty schools within the health sector, but learning continuously varies in each institution.[8],[9],[11] All prospective healthcare professionals must possess BLS skills.[12] At a minimum, the BLS program should make students aware of the importance of mastering BLS skills. It is crucial to evaluate diverse learning strategies and other educational experiences.[5],[13]

Numerous studies on BLS in healthcare professionals or the general population have been conducted with varying results.[14],[15],[16] In Indonesia, few studies examined the relationship between knowledge and attitudes toward BLS, particularly among students in various healthcare fields; therefore, the aim of this study is to determine the most effective learning methods implemented in Indonesian higher education healthcare institutions.

  Materials and Methods Top

Study design

In this study, a cross-sectional study was conducted for university students in Indonesia from January to February 2021, which involved the distribution of a questionnaire to all universities with healthcare programs in their faculties. A total of 1278 subjects were recruited from 22 universities by the convenience sampling method, which was selected owing to several restrictions during the pandemic. Each subject completed an online questionnaire comprising 27 items for knowledge and 19 items for attitude toward BLS. Ethical clearance from the Faculty of Dentistry Universitas Trisakti No.440/S3/KEPK/FKG/1/2021 was obtained.

Construction of BLS questionnaire

The questionnaire was constructed based on a systematic framework of knowledge and practice in BLS according to the common theory and practice of CPR, control of bleeding, the Heimlich maneuver, artificial ventilation, and basic airway care. This Indonesian questionnaire was validated using the Rasch model with good construct validity. The Cronbach α was 0.77; item reliability was 0.99 with a separation of 11.55; infit mean square was 0.79, outfit mean square was 0.81; infit Z standard was −0.54; outfit Z standard was −0.54; and eigenvalue score in unidimensionality was 8.98. Items for knowledge were expressed in Guttman scale, where 0 = incorrect and 1 = correct, whereas attitude was expressed in Likert scale, where 1 = totally disagree, 2 = disagree, 3 = doubtful, 4 = agree, and 5 = totally agree.


Inclusion criteria included a student in health sciences (i.e., medicine, dentistry, nursing, pharmacy, midwifery) who had completed a minimum of six semesters in the academic study program and all the students in the professional healthcare program study. Exclusion criteria included students in non-health faculties and who had completed less than six semesters in an undergraduate program.

Data collection

Demographic data; study program, faculty, or institution; BLS learning experiences or methods; history about BLS; knowledge status; and attitude status were collected using a checklist. All subjects were instructed to complete an informed consent form before beginning the questionnaire.

Statistical analysis

Nonparametric analysis was conducted by the Kruskal–Wallis’s test using SPSS software version 22 (SPSS, Chicago, Illinois). The results were expressed as frequency, percentage, and mean rank. A significant difference was determined by a score of P < 0.05.

  Results Top

A total of 1,278 subjects participated in this study. Of these subjects, 278 subjects were excluded owing to incomplete questionnaire data. Finally, only 1,000 subjects comprising 655 students from the faculty of dentistry, 254 subjects from the faculty of medicine, 69 subjects from the faculty of nursing, 21 students from the faculty of pharmacy, and 1 subject from the faculty of midwifery participated. The mean ages of males and females were 23.0 ± 2.19 years and 22.5 ± 1.67 years, respectively, with the female population being predominant (75%). Most students were enrolled in a professional program (65.5%) rather than the bachelor’s program (34.5%). Universitas Muhammadiyah Yogyakarta had the highest number of participants, followed by Universitas Trisakti and Universitas Jember. [Table 1] summarizes the baseline characteristics of the studied participants.
Table 1: Baseline characteristics of participants

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Among the participants, 98.2% (982 subjects) had BLS learning in their curricula. The BLS learning types included the combination of theory, demonstration, and mannequins (72.9%); a combination of theory and demonstration (14.9%); and theory (12,2%). Most participants were categorized as having high knowledge (92.6%) and high attitude (98.7%). [Table 2] summarizes the BLS learning methods. As can be observed in [Table 3], a significant correlation between knowledge and attitude toward BLS among health science students in Indonesia was observed (P < 0.05).
Table 2: BLS learning method

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Table 3: Nonparametric test between knowledge and attitude toward BLS

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Based on the Kruskal–Wallis’s test [Table 4], a significant difference was observed in the attitude between BLS learning types (P = 0.000). The BLS learning type with the combination of theory, demonstration, and a mannequin exhibited the highest rank. The mean knowledge and attitude scores were based on the type of faculty [Figure 1]. For instance, the faculty of dentistry exhibited the highest score for knowledge (48.56; SD = 1.94), whereas the faculty of medicine exhibited the highest score for attitude (85.74; SD = 6.00). Based on faculty, significant differences between groups (P = 0.000) on attitude were observed, with the highest rank for the faculty of medicine, followed by those of nursing, dentistry, pharmacy, and midwifery.
Table 4: Kruskal–Wallis test between knowledge and attitude variables

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Figure 1: Mean score of knowledge and attitude between faculty

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As can be observed in the subgroup of the BLS learning type according to theory, a significant difference between faculties was observed (P = 0.003). The faculty of nursing exhibited the highest mean rank, followed by those of dentistry, medicine, and pharmacy.

  Discussion Top

Of the 1000 participants, 98.2% had prior knowledge of BLS, whereas 1.8% of the participants never studied BLS [Table 2]. The BLS curriculum should commence as soon as students begin the bachelor’s program and should be repeated periodically. Regularly administered and assessed exercises can facilitate a shift in the attitude to render early performance of high-quality CPR and when necessary, rapid defibrillation.[12],[17],[18]

The most common method of BLS education included the combination of theory, demonstration, and use of mannequins (72.9%).[9],[19] It is believed that the adoption of teaching when students are enrolled in the bachelor’s degree will boost knowledge acquisition, retention, and transfer; all of these factors are related to stakeholder satisfaction. The teaching-learning methodology was selected based on andragogy to increase students’ knowledge at a higher level of the Miller pyramid and satisfy the needs of the local community.[9],[13] In India, BLS material has been implemented in the medical curriculum for first-year students. The demonstration-observation-assistance-performance (DOAP) technique is the proposed teaching-learning method for psychomotor skills of BLS. BLS is taught in a simulated environment in which students watch videos to generate interest, followed by interactive lectures on BLS. Then, students practice the skills on a model that are deconstructed by an instructor, followed by the description of steps and demonstration. The students are then assisted to acquire these skills by performing on mannequins, after which they practice and perform individually on mannequins.[9],[18],[20]

This study revealed that the students’ knowledge was high (92.6%), with high attitudes (98.7%). This result showed that the university’s teaching-learning model is successful in increasing students’ BLS knowledge and attitudes. Of the total participants, 72.9% of subjects were taught BLS using the combination of theory, demonstration, and mannequin practice. This learning method is regarded as the most comprehensive method so that students can change their attitudes from prior to learning BLS to after they acquire BLS knowledge. As can be observed in [Table 3], a significant correlation between knowledge and attitude was observed, with a correlation coefficient of 6.9% (P > 0.05) [Table 4]. Attitude is a form of evaluation or reaction to a component of the surrounding environment (experience) and serves as the basis for the formation of a person’s behavior.[21],[22] Gunardi et al.[5] reported that a person’s positive attitude is influenced by positive knowledge, and vice versa. In a study conducted in Chongqing, China, medical students were reported to have extremely limited knowledge of BLS because they were not provided with teaching materials during their lectures. Compared to research conducted by Akhlaghdoust et al.[16] on medical students in Tehran, this study shows that >70% of medical students have limited knowledge of BLS, possibly related to the subpar BLS-related curriculum materials provided in higher education.

Based on the Kruskal–Wallis’s result, no difference in knowledge between learning methods using theory and its combination was observed (P > 0.05). However, learning using a combination (theory, demonstration, and mannequins) exhibited the highest rank (P < 0.01). Learning theory alone will certainly be difficult for practical applications, especially under conditions that are rarely observed.[21],[22] Certainly, demonstrations can increase a person’s retention and psychomotor changes in response to specific stimuli, whereas the use of a model can certainly have a direct effect on a person’s attitude toward performing BLS.[12],[23] The combination of theory, demonstration, and mannequins is a traditional BLS learning method that must be modified using e-learning prior to the introduction of traditional methods, according to research conducted in Sweden in 2019.[2] According to Kolb’s theory of experiential learning, experience is the key to the success of learning. Life experiences as well as the awareness of a possible cardiac arrest regularly contribute to the acquisition of new knowledge and advancement. In addition, the use of metaverse may be one of the distance learning methods of BLS, but additional research is required.[2],[24]

Based on the faculty, no significant difference in the knowledge of BLS was observed (P > 0.05). In the attitude group, the faculty of medicine exhibited the highest rank, followed by those of nursing and dentistry. As general practitioners and nurses are at the forefront of dealing with cardiac arrest in hospitals and other healthcare institutions, the curricula of the faculties of medicine and nursing should emphasize and require students to possess fundamental skills in this area.[9],[13] In dentistry, however, cardiac arrest is uncommon, particularly if the dentist only works in a private clinic; therefore, BLS is an additional skill.

This research is limited by the fact that several universities in Indonesia have not participated; hence, the majority of students are concentrated in faculties of dentistry and general medicine. As the external validity of this study, the application of the modified learning method combining theory and practice with mannequins exhibited a good result in terms of the attitude of a health science student. Owing to several restrictions during the COVID-19 pandemic, the convenience sampling method used in this study may cause bias in the study. As recommendations for future research, this cross-sectional design should be conducted at multicenter research from various regions in Indonesia, including the West, Central, and East regions, because cardiac arrest can be caused by multiple factors, including lifestyle, dietary consumption patterns, lack of physical activity, and psychology.

  Conclusion Top

According to the curriculum, providing students in the healthcare sector with theory followed by demonstrations and hands-on practice on mannequins may be an effective BLS learning method. To improve students’ knowledge and attitudes regarding BLS, it is crucial to revise any instructional materials that have not incorporated into the above strategies. Each profession’s competency standards must be amended to accommodate the change in content.


Thank you to all Deans of the Faculty of Nursing, Faculty of Midwifery, Faculty of Medical, and Faculty of Dentistry from 22 Universities in Indonesia for permitting their students to contribute to this study.

Financial support and sponsorship

Not applicable.

Conflicts of Interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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