Studies performed in countries in Asia and the Middle East found that BLS knowledge was poor among health care professionals. [6, 9, 12]. No valid previous international data testing knowledge of BLS amongst all physicians’ specialties was performed. In our study conducted in Lebanon, the average BLS knowledge has also demonstrated poor results, with only 38.90% of physicians classified as having “sufficient knowledge”. We hypothesis that this could be due to the lack of training that has not been properly imposed by the government or hospitals due to a lack of follow up in pre-existing training.
Interestingly, if we analyze extreme values, we mentioned that 12 physicians obtained 2 correct answers. These physicians did not attend any previous BLS course, all graduated before 2007 and 75% (9 out of 12) work in a remote and a non-university affiliated hospital. All of the 10 physicians who answered all questions correctly shared common criteria; all have previously attended a BLS course and graduated after 2012. 90% (9 out of 10) work in a hospital in the Beirut area. Starc et al demonstrated that first year medical students showed satisfactory BLS skills when assessed shortly after the course . In our study, when we analyzed physicians that had taken the BLS course, we found that 87.5% presented “sufficient knowledge” compared to only 21.4% of physicians who had not taken the BLS course. This is a confirmation that the more recent the training, the greater the knowledge . Hence, this emphasizes the importance of obtaining a BLS certification . Renewing this certification is as well of utmost importance due to guidelines being periodically updated. This result is consistent with that in the United States in which BLS certification has been recommended for all health care professionals . The year of graduation of the physician was found to pay an important role regarding Basic Life Support knowledge. 73.91% of physicians that graduated after 2010 have shown good BLS knowledge in comparison to only 28.86% who graduated before 2010. This shows that the more recent a physician graduated, the better the BLS knowledge. This difference might reflect the fact that BLS training has been recently incorporated in medical schools and residency programs. In addition, the BLS guidelines are also being constantly being updated which reflects the importance of renewing BLS certificates. . As anticipated, critical care physicians showed the highest good knowledge rate. This is explained by the fact that the critical care subgroup is regularly exposed to cardiopulmonary arrests, which allows the frequent practice of skills and knowledge. In contrast, the miscellaneous subgroup who are not exposed to these situations frequently were found to have lowest good knowledge rate. To our surprise, the cardiology subgroup had “sufficient knowledge” rate lower than expected, considering their frequent exposure to cardiac arrests. In regard to area of practice, physicians practicing in Beirut (central hospitals) were found to have a higher rate of BLS knowledge as opposed to peripheral hospitals. This could be explained by the sole presence of university medical centers in the Beirut area.
There can be several reasons behind these alarming results from our survey that can mainly be attributed to factors restricting physicians from receiving regular BLS training.
These include hectic residency schedules before graduation, the absence of mandatory BLS certification and training, the limited number of BLS programs offered, cost of training, and lack of interest of different specialties not confronted with frequent cardiopulmonary arrest situations.