Assessment of First-Aid Knowledge Among Medical Students in Syria: A Cross-Sectional Study


 Background: Sufficient knowledge required to deal with emergencies at the accident site may not be found in most medical students due to the lack of effective first-aid training in most medical education curricula. This study aims to assess and evaluate the level of knowledge among medical students in providing first-aid care, especially first-year students.Method: This cross-sectional study was conducted in May 2020 among 1,855 medical students. The data was collected using an electronic questionnaire that was published on social media platforms. Based on the scores obtained for each clinical scenario requiring first aid, general knowledge was classified as good, intermediate, or weak. in order to obtain the best result, a number of measures were taken.Results: Statistical analysis indicated that Academic year and Academic specialization have a significant effect on the level of knowledge, whereas demographic background (gender, university, marital status, housing status, work status, financial condition), reading, hearing, or receiving training in first-aid have no effect on it.Conclusion: The level of knowledge among Syrian medical students in providing first-aid care is somewhat limited. Therefore, first-aid courses should be made more accessible to these students, and their effectiveness should be ensured and maintained through frequent updates. Moreover, more attention should be placed on publicizing first-aid knowledge in a way that makes life-saving procedures attainable to anyone, anytime and anywhere.


Background
First aid provides immediate care to people who have been injured or struck by a sudden injury until help from a specialist arrives or until the injured person recovers.
The primary goals of rst aid are to preserve life, relieve pain as much as possible, prevent further complications and stabilize the patients [1] [2]. Furthermore, anyone can be exposed to injury in various situations, whether at work or at home. It follows that the ability of providing immediate and accurate rst-aid care at the accident site is vital [3]. Based on the gathered information, we found that assessments of rst-aid knowledge among medical students and those involved in the medical sector have been commonly discussed in the Middle East but similar studies have not been conducted in Syria.
Furthermore, a large group of medical students show poor understanding of rst-aid principles and practices, especially in their early academic years. Correspondingly, this reveals the lack of su cient published researches or reports discussing the topic [4]. Therefore, we recommend placing more attention on publicizing rst-aid knowledge among all age groups and workers in society, especially those involved in the medical sector, because they are the rst line of defense against critical situations.

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Design of the study: We conducted a descriptive study to assess rst-aid knowledge among medical students in Syrian universities and colleges from all academic years. The study was conducted through an electronic evaluation questionnaire due to the current di culties in reaching all Syrian governorates. It was published among esteemed medical groups and gatherings on social media in order to reach the desired sample and achieve the best possible study.

Questionnaire:
The questionnaire was designed according to the latest British rst-aid guidelines. The questions were selected in a way that ensures a comprehensive evaluation of all the essentials of rst aid among students concerned with the medical sector, based on similar studies and standard rst-aid research.
The questionnaire consists of 29 questions directed to Syrian university and college students concerned with the medical sector. the questions were divided into two groups: 1. The rst group contained 15 questions divided into two parts. Part one included personal information such as gender, age, academic year, and marital status. The second part included a question about whether the student had taken any rst-aid courses.
2. The second group contained 14 questions aimed at assessing all major aspects of rst-aid knowledge.
An initial preliminary study was carried out before the questionnaire was nally published. It was randomly distributed to 25 students from six different medical specialties. The questionnaire was modi ed by deleting some questions and adding some options to some questions. The questionnaire was then published, and the sample participating in the preliminary study was added to the nal sample.

Results
To express the results as numbers and percentage of respondents for each question, the analysis was done by (SPSS Software Version 23.).
Initially, about 2013 questionnaires were collected. Afterwards, the sample was inspected and processed and all questionnaires that did not match the study's criteria were deleted. About 1855 questionnaires were obtained to form the nal sample. Students of various medical specialties were classi ed according to multiple measures including academic specialization, gender, academic year, university, marital status, housing status, work status and nancial condition to study their effect on the participants' rst-aid knowledge. Table No. (1) shows the basic demographic information of the sample and whether the student took any previous rst-aid courses.  Table No. (2) shows the basic medical information that forms the core of the questionnaire and the research carried out. Give the patient an aspirin 79 4.3% As for Table (2), we will display the count and percentage of each choice for each question in the second group of the questionnaire.
We have allocated one point (1) to each question from the second group of the questionnaire for each true answer and zero points (0) to the wrong answers. The questions are an integrated unit so that the existence of a gap within one answer eliminates part of the participant's nal knowledge score, thus the total score is anywhere from 0 if all answers were wrong to 14 if all answers were correct. To facilitate the comparison, three levels of knowledge were adopted, namely: Weak level: from (0) to (4).
Intermediate level: 1205 (65%). The following is the relationship of each factor in the rst group of the questionnaire with the students' level of knowledge: Statistical analysis showed that the Academic Specialization and Academic Year had an apparent effect on the research sample's knowledge level. We conducted the "Chi-Square Test" where both the P-value for the Academic Specialization (0.023) and for the Academic Year (0.000) were less than 0.05 as shown in Table ( 4). The demographic background (gender, university, marital status, housing status, work status and nancial condition) did not signi cantly affect rst-aid knowledge. Also, receiving rst-aid training, reading or hearing about rst-aid information did not signi cantly affect the total score. Table (4) shows the p-value for those independent variables and the test used:

Discussion
In this study, very few students demonstrated good knowledge of rst-aid principles, whether they had received prior training in rst-aid procedures or not. Likewise, a Peruvian study among medical students reported that 60.4% of the participants showed poor rst-aid knowledge although 52.5% of them had received prior training on how to act in an emergency. Further, a Dutch study reported that 81% of junior doctors had poor knowledge of rst-aid principles [5]. Thus, we conclude that taking courses alone is not su cient to apply the knowledge in real-life situations. Therefore, it is advisable to perform frequent knowledge assessments through out the courses to obtain the best possible result. It is also encouraged to undergo follow-up sessions every 6-12 months to ensure that the population in general, and medical students in particular, remain well-informed and updated about the latest standards of practice followed in rst-aid procedures [6].
We also note that most medical students obtained average scores on their rst-aid knowledge assessment and that only a tiny group managed to score above average. Furthermore, the largest proportion of clinical-year (senior) students were able to score well on rst-aid knowledge assessment. This indicates the urgent need to devote greater focus to the topic of rst aid among pre-clinical students [5].
In this study, 35.9% of students were correctly aware of the steps of cardiopulmonary resuscitation (CPR) as part of their overall rst-aid administration, which was a very high percentage compared to the results of a study conducted in Salem, Tamil Nadu, where it was reported to be 17.1. %. Also, in the Dutch study, only 6% of students knew and performed CPR correctly [7]. Nevertheless, except that similarly to our own, two Karachi-based studies reported that 32.2% and 38.8% of participants knew how to perform CPR correctly [4]. Moreover, the test results were similar to some studies and different from others, as we have shown previously, depending on the different causes leading to this result and the different living conditions in the countries.
Properly administering rst aid for burns was recognized by 57% of students compared to 23.2% in an Irish study, showing that our students are thoroughly informed about the concept of burns. On the other hand, the latter study reported that 30.4% of medical students had good knowledge of rst-aid management in cases of accidental ingestion of toxins compared to 21.9% in our study [3].
As for applying ambulance-aid principles to fractures, external bleeding, and cases of trauma in general, many students demonstrated good knowledge, indicating that our curricula focus relatively more on these topics. In contrast, regarding the priority of examination when viewing Injured, a low percentage of students answered correctly, comprising about 32.2% (Table 2). Moreover, based on the results obtained (Table 2), we nd that most of the students did not provide correct answers on several topics such as ankle sprain and trauma, which comprised 26% of the lack of knowledge of trauma management compared to fractures, whose rate was only about 8.1%.
Meanwhile, television advertisements can have an impact on viewers' perceptions of rst-aid procedures, especially medical students, and can be used as a means of raising awareness and disseminating knowledge. Needless to say, an increase in knowledge among medical students would result in individuals who are knowledgeable and con dent enough to handle any critical situation they might encounter. This may be especially vital for a country in the face of any natural disasters because medical students will be the future cornerstone of facing any health risk that society may be exposed to. Another bene t from training students in rst aid is that they can successfully provide rst-aid training to their peers or other bene ciaries as stated by 97.7% of medical students at Altintaş et al. [8] [9] [10].

Strengths
Similar studies regarding awareness of rst aid measures among medical students in Syria have not been done before. Our study revealed that rst-aid knowledge among students needs improvement in certain subjects, whereas in other subjects, students managed to show su cient experience to properly deal with the corresponding situation. The study was also conducted at a national level and included all public and private universities in all Syrian governorates.

Conclusion
In general, students in clinical years performed better than students in earlier years. On the whole, this study emphasizes the need to provide formal training courses for medical students, speci cally rst-aid courses, so that trained students become able to perform effective rst-aid procedures independently and spontaneously in real-life situations. We also note that there is currently no formal rst-aid training in medical curricula for students in their early years. Therefore, there is an urgent need for rst-aid training among medical students as a whole and pre-clinical students in particular. The study also identi ed areas where a lack of knowledge among students was more prevalent and therefore these areas must be the main focus of future curriculum revisions. Finally, we note that more studies should be conducted to assess rst-aid knowledge and other healthcare-related skills among medical students in Syria.