Revamping Ayurveda Education: Assessing the Effect of Hands-on Basic Life Support Training on Learning Outcomes among Ayurveda Student-A Pre-Post Assessment Study

Revamping Ayurveda Education: Assessing the Effect of Hands-on Basic Life Support Training on Learning Outcomes among Ayurveda Student-A Pre-Post Assessment Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Revamping Ayurveda Education: Assessing the Effect of Hands-on Basic Life Support Training on Learning Outcomes among Ayurveda Student-A Pre-Post Assessment Study R Sunil Kumar Devaki, Rajimunnisa Begam Shaik This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6541692/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Reforms in Ayurveda education made theoretical knowledge and practical skills better aligned. Also, importance has been given to closing the gap in integrating life-saving skills that enhance students' preparedness for emergency clinical situations. Sudden cardiac arrest is one such emergency condition that can come across at any time. Basic Life Support (BLS)—comprising skills such as emergency response, cardiopulmonary resuscitation (CPR), and AED usage—is a fundamental aspect of emergency resuscitation in cardiac arrest patients that is to be learned by everyone, in particular by all healthcare professionals. Due to its importance, BLS training has become a part of the institutional teaching curriculum for Ayurveda students. Methods 82 Ayurveda Students of the 1st profession were trained by the instructor during the induction program via didactic mode, followed by Hands-on practice with manikins. A Pre- Post assessment of knowledge on BLS among students was assessed through multiple-choice questionnaires. Results The pre-test mean ± SD was 58.29 ± 23.76, whereas the post-test mean ± SD = 72.2 ± 14.99. There was a high statistical significance between Pre & Post-test (p < 0.001) scores, indicating their knowledge enhancement. A larger than moderate effect size was observed (Cohen’s d = 0.74; Hedges’ g = 0.734). Conclusion This study had a significant impact on enhancing the level of knowledge. Furthermore, students reported improved confidence and willingness to perform CPR in real-case scenarios. Improving methods for teaching skills and assessments that show a direct impact on clinical practice should be an ongoing field of study. Hands-on Training Basic Life Support Cardiopulmonary resuscitation Ayurveda Curriculum Figures Figure 1 Figure 2 Introduction Sudden cardiac arrest (SCA) is said to be an abrupt loss of heart function, leading to a sudden cessation of cardiac activity, resulting in loss of consciousness, no normal breathing, and no signs of circulation. (1) Cardiac arrest is often fatal if appropriate steps aren’t taken immediately. Such an event can happen to a person who may or may not have been diagnosed with heart disease. However, cardiac arrests can occur suddenly or in the wake of other symptoms. Cardiac arrest can happen at any time and any place. Alone in the United States, over 350,000, i.e., 80%, of cardiac arrests occur outside the hospital. (2) Recent studies revealed that the COVID pandemic had multiple effects on the incidence of Outside Hospital Cardiac arrest (OHCA). An increase in the incidence was reported by a study conducted in New York City that states OHCA attended by EMS (March 1-April 25, 2020) was 3-fold times compared to the same period in the earlier year. (3) If appropriate life support is given immediately when it is witnessed outside the hospital, the chance of survival increases by 2–3 times. (4) Cardiac arrest being a major cardiovascular event requires large-scale public awareness along with CPR skills. In developing countries like India, only 2% of people have the knowledge to perform CPR, which is far below the global average of 30%. (5) With the rise of sudden cardiac arrests among the Indian population in recent times, (6) there is a definite need for BLS training among general populations and particularly in the medical community at the initial stage of entry into the medical profession itself. As per new reforms in the Ayurveda institutional education by the National Commission for Indian System of Medicine (NCISM), first-year/professional students are being given early clinical exposure where students are exposed to real-life clinical scenarios at the in-patient bedside. Students aware of such life-saving skills will be prepared to handle emergency conditions that may arise in hospital or outside hospital cases of cardiac arrest. A study done by Pande et al. on the evaluation and retention of BLS training suggested that the right time for incorporation of BLS knowledge and skills for medical students is from the 1st year itself, and that study also highlights the importance of repetition of training for its retention. (7) With such an aim and vision to inculcate Basic Life Support skills among young Ayurveda students, NCISM has included BLS training as a part of areas of interest to be trained under the Induction Programme for 1st-profession Ayurveda students. Various research has also shown that the knowledge and skills acquired in BLS training tend to be deprived over time. (8) To overcome this, BLS training was included in the curriculum at various points of academics to retain and enhance the skills learned by the students. (9) However, these reforms in the integration of life-saving emergency skills and the impact of the adoption of newer methodologies of teaching among Ayurveda students should be an ongoing process of research. Aim of the Study : To assess the effect of Hands-on BLS Training with Manikins to 1st Profession Ayurveda students on their learning outcomes. Objectives of the Study : 1. To assess the knowledge of BLS among 1 st Profession Ayurveda Students. 2. To evaluate the understanding of BLS Knowledge among Ayurveda Students after a didactic lecture and Hands-on Training. 3. To evaluate the learning outcomes by Hands-on training of BLS on Manikins by Ayurveda students. Materials and Methods Study Population : A total of 82 Ayurveda 1st Profession students of Shri Gavisiddeswara Ayurveda Medical College, Koppal, Karnataka, who have given consent as participants, were included in the study. Study Methods : A pre-test and post-test questionnaire was prepared, comprising 5 MCQ questions each and adhering to the guidelines of the American Heart Association 2020. These questionnaires were made using Google Forms with all the question responses made as required fields. A positive response was allotted 20 marks, and there was no negative scoring for negative responses. Students received a link through their official student WhatsApp group during the instructor-led course delivery. Also, the QR code of questionnaires was displayed on the screen to contribute to a paper-free setting. Participants were strictly monitored for fair practices during their responses. Participants were restricted from the use of any other source of materials. A stipulated time of 5 minutes each for pre and post-test assessment was given as the deadline for submission. Statistical Analysis: Descriptive Stastics : Mean, Standard Deviation, Median, Mode, Range, Kurtosis, and Skewness. Inferential Statistics :Paired T test, Wilcoxon Signed Rank Test, Cohen’s d and Hedges’g Correction. Results The data was analyzed using IBM SPSS Statistics software version 30.0.0.0(172).(Copyright IBM Corporation 1989, 1989,2024). Table 1 : Showing the number of participants and questions. The pretest questionnaire was prepared to assess basic knowledge of BLS, whereas the post-test assessment questionnaire was conducted to assess the knowledge retention soon after a didactic mode of lecture, demonstration, and Hands-on practice using manikins. Table 1 Pre Test and Post Test Assessment Questions. S.NO Assessment Frequency Questions 1. Pre Test n = 82 1. On scene safety 2. Activating emergency services. 3. On Compression depth in adult CPR. 4. Full form of CPR 5. Full form of BLS 2. Post -Test n = 82 1. Rate of Chest Compressions 2. Depth of Chest Compressions in Adult 3. Compression to Ventilation Ratio during Adult CPR 4. Technique of Airway Opening Maneuver in Adult 5. Full form of AED. Table 2 shows descriptive analysis for both the pre-test and the post-test. The Pre-test score mean ± s.d. is 58.29 ± 23.769, whereas the Post-test score mean ± s.d. is 72.20 ± 14.992. In the post-test, the mean was 14 points higher, i.e., a 24% improvement compared to the pre-test mean. There was decreased variability from pre-test to post-test scores, as indicated by the reduced standard deviation (S.D.) and standard error (S.E.), showing that post-test scores were consistent among participants. The median and mode from pre-test to post-test shifted from 60 to 80, showing that more students scores were higher after the intervention. The range was decreased from 100 in the pre-test to 60 in the post-test, showing that this training had a positive impact even on students who scored very low in the pre-test. Kurtosis was -0.36, and skewness was -0.193 in pre-test scores, whereas in post-test scores it was -0.007 and -0.476, respectively. Based on these values, the data can be interpreted to be distributed approximately normally. Fig. 1: Box Whisker Plot shows the distribution of scores with Series 1 (pre-test scores) and Series 2 (post-test scores). The narrower box in post-test scores shows the consistency of training and its positive impact on students. Table 2 : Pre - Post Score Descriptive Analysis Results Mean S.E S.D Median Mode Range Kurtosis Skewness Pre Test (n= 82) 58.29 2.625 23.769 60 60 100 -0.36026 -0.19338 Post Test (n=82) 72.20 1.656 14.992 80 80 60 -0.00741 -0.47604 Table 3: Showing the Paired Samples T-test. The results were highly significant, showing p < 0.001, which is far below the standard of 0.05. This suggests that Hands-on training had a high impact on the participants through knowledge enhancement. Table 3: Paired Samples T test Pre - Post Test Scores (n=82) Paired Differences t df Significance Mean S.D Mean S.E 95% C.I of the Difference One Sided p Two- Sided p Lower Upper 13.902 18.775 2.073 9.777 18.028 6.705 81 <0.001 <0.001 Table 4 shows that Cohen’s d point estimate was 0.74, which was way higher than the moderate effect (0.5) standard Cohen benchmark. (10) Even after Hedges’g correction the corrected point estimate was 0.734, which is nearer to the value of 0.74. This shows that there was a larger than moderate effect, even practically, on the study population, along with statistical significance. Fig. 2: Demonstrate the point size estimate and effect size visualization on the participants after an instructor-led BLS training. Table 4: Paired Samples Effect sizes Pre - Post Test Scores (n=82) Effect size Type Standardizer a Point Estimate 95% Confidence Interval Lower Upper Cohen’s d 18.775 0.740 0.494 0.983 Hedges correction 18.951 0.734 0.490 0.974 a. The denominator used in estimating the effect sizes. In Table 5, the Wilcoxon -Signed Rank test was presented. The test statistics revealed Z = -5.425 and p < 0.001, confirming its statistical significance. Among 82 study participants, 50 participants had positive rank differences (the positive ranks median is 31.26 and the sum is 1563.00), and 9 had negative differences (the median is 23.00 and the sum is 207.00 for negative ranks). 23 participants showed no change, i.e., ties. These results support the point that BLS training for these study participants had a positive impact on their learning outcomes through knowledge enhancement. Table 5 The Wilcoxon-Signed Ranks Test Pre - Post Test Scores (n = 82) Ranks N Median Rank Sum of Ranks Test Statistics Positive 50 31.26 1563.00 Z =−5.425 Negative 9 23.00 207.00 Ties 23 Asmp. Sig (2-tailed) p < 0.001 Total 82 The post-test questionnaire consisted of a feedback section also, where 90.4% of participants stated that the instructor was extremely helpful in explaining the learning outcomes prior to training. The mean of participants rating the instructor being helpful was 4.82 out of 5 (1 being the least/not helpful and 5 being the best/extremely helpful). 98.8% of participants opined that sufficient mannequins had been arranged during the training session. 96.4% of participants opined that after thetraining session they are confident in identifying and handling an unresponsive patient. Furthermore, students reported an increased level of confidence. Feedback from students on instructor-led content delivery was also highly satisfactory. Discussion From the days of the Gurukula education system to the present institutional curriculum, there have been continuous reforms in Ayurveda education. Homogenization of Ayurveda institutional education throughout the country was a significant transformation, where the institutes typically offer programs such as BAMS(Undergraduate), Post Graduate(MD/MS), and Doctoral (PhD) through recognized Universities. Ayurveda education in the recent era is typically formalized and structured. Modern Ayurveda education relies on scheduled lecture and non-lecture hours, which include in- and out-of-conventional-classroom teaching. Increased access to textbooks, digital resources, and research articles was noticed among the Ayurveda Fraternity. One such recent reform is the prioritization of emergency management in the curriculum along with the scope of Ayurveda's role in it. A study published by Sharma S et al. opines that integrating traditional wisdom with modern educational techniques will be one of the potential strategies for the enhancement of Ayurveda institutional teaching. (11) One such prime integration needed is emergency cardiac care, which is to be followed during sudden cardiac arrest. There are several protocols for basic life support skills during sudden cardiac arrest being followed across the world. Among them, the American Heart Association protocol is widely followed, and these protocols are updated every 5 years after extensive research. Our study followed such basic strategies published by AHA for Adult BLS protocol. (12) All the participants in this study have not undergone any BLS training in the past. The Pre-test mean score (58.29 ± 23.76) was higher compared to other similar research. (13) As this study was a planned workshop, prior information to the students made them well-prepared with theoretical concepts from various forms of media, books, etc. These results support a study conducted in Spain that those students with prior knowledge of BLS had higher scores in both the pre-test and post-test. (14,15) This study results (Fig. 1 ) also highlight the importance of such planned activities, which will enhance students involvement and increase their understanding during the instructor-led training. As per the Millers' Pyramid for Clinical Competence, performance integrated with demonstrations and direct practice, the skills among students tend to be retained for a longer duration. (16) A 1-year longitudinal study conducted by Kochhar et al. on knowledge and skills retention among 1st-year MBBS students showed a significant skills deterioration within a 6-month period only. (8) This study also highlighted the need for the incorporation of BLS training and assessment into every semester of the MBBS curriculum for knowledge and skill retention, which directly impacts patient outcomes. Authors have also made recommendations to include BLS and other emergency life-saving skills like ATLS, ACLS protocols in medical educational curricula, which is even true and should be considered in other systems of medicine like Ayurveda. However, exposure to critically ill patients during education will have a higher impact on their preparedness and confidence levels. Ayurveda Clinical settings are different, as the prime focus and the nature of patients in hospitals differ from those in conventional medical hospitals. According to some studies, training students with high-fidelity manikins and regular mock drills can be of greater use to increase confidence and preparedness, but the frequency and methods of incorporation among Ayurveda students need extensive research. Conclusion In conclusion, our study states that BLS hands-on training among Ayurveda students had a positive impact on their learning outcomes, enhanced their knowledge, and increased their level of confidence. Our study also highlights the need for increased frequency of emergency resuscitation protocol training in the curriculum, as highlighted in previous similar studies. The need for the adoption of uniformly structured, validated protocols of BLS, ACLS, PALS, ATLS, etc. in the institutional curriculum will have a direct impact on students confidence and patient outcomes. There is a need for an increased number of skilled instructors in Ayurveda institutional education centers, or it can be through collaboration with recognized training centers and training sites. This study can be a purposeful guide for further research on new teaching methodologies adopted in the Ayurveda system of institutional teaching. The point of incorporating BLS skills among Ayurveda students should not end at the bench, but also those students should propagate such knowledge to their family members and friend groups. Limitations of the study : This study included an assessment of participants only in the cognitive domain, whereas the psychomotor skill assessment through DOPS (Direct Observed Procedural Skills assessment ) is not included due to time constraints. Advanced high-fidelity manikins can be a solution, allowing skill assessments of multiple participants through skill monitoring apps. It is a single-centered study with a small group of participants. Generalizations of the results cannot be made. Future perspectives of the study : Similar studies can be conducted among final-year Ayurveda students, interns, Post Graduate Ayurveda students. Knowledge and skill retention among them can be assessed by regular training sessions. Multi-centered studies in various Ayurveda institutes and various AYUSH systems of study can give a better understanding of attitudes and skills among different sectors of AYUSH education. Declarations Conflict of Interest: NIL Ethics and Consent: All the study participants were assured for data confidentiality and Consent was taken for the study. Source of Funding: NIL Authors Contribution: Author 1 (RSKD)trained the students, planned and executed the study, prepared the article . Author 2 (RBS) - Study Planning, Article Drafting, Statistical Analysis, and drawing conclusions from the study. Acknowledgements : The authors are thankful to the Principal and Management of Shri Gavisiddeshwara Ayurvedic Medical College for their cooperation in the conduction of the study. Data Availability Statement: The data sets that supports the results and findings of the study were available with the corresponding author. Due to restrictions the data will be considered for availability from the author upon special request. References Patel K, Hipskind JE. Cardiac arrest [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2023 Apr 7; cited 2025 Apr 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534866/ Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93–e621. doi:10.1161/CIR.0000000000001123 Sudden Cardiac Arrest Foundation. Latest statistics [Internet]. Pittsburgh (PA): SCAF; [cited 2025 Apr 20]. Available from: https://www.sca-aware.org/about-sudden-cardiac-arrest/latest-statistics Riva G, Hollenberg J. Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Intern Med. 2021;290:57–72. doi:10.1111/joim.13260 India Today. 2% of people in India know CPR, inadequate by global standards: CSI [Internet]. 2023 Jul 5 [cited 2025 Apr 20]. Available from:https://www.indiatoday.in/impact-feature/story/2-of-people-in-india-know-cpr-inadequate-by-global-standards-csi-2402193-2023-07-05 Jaiswal PB. ‘5-6 lakh people are dying due to sudden cardiac deaths in India’, finds study. The Week [Internet]. 2023 Oct 1 [cited 2025 Apr 20]; Available from: https://www.theweek.in/news/health/2023/10/01/5-6-lakh-people-are-dying-due-to-sudden-cardiac-deaths-in-india-finds-study.html. Pande S, Pande S, Parate V, Pande S, Sukhsohale N. Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training. Adv Physiol Educ. 2014;38(1):42–45. doi:10.1152/advan.00102.2013 Kochhar S, Samagh N, Sharma J, Kaur A, Verma M. Knowledge and skill retention in first-year MBBS students after basic life support training: a one-year longitudinal study. BMC Med Educ. 2024;24(1):971. doi:10.1186/s12909-024-05922-0. PMID:39238013; PMCID:PMC11378406 National Commission for Indian System of Medicine. Ayurveda syllabus [Internet]. New Delhi: NCISM; [cited 2025 Apr 20]. Available from: https://ncismindia.org/ayurveda-syllabus.php. Lindelov JK. Cohen's d Effect Size Calculator [Internet].rpsychologist.com; Available from: https://rpsychologist.com/cohend/​:contentReference[oaicite:1]{index=1} Sharma S, Lekrao OP, Moazzamiperio F, Comparitive nalysis of ancient and modern teaching methods in Ayurveda: Recommendations for enhancing contemporary education, J Ayurveda 2024; 18:245-7. DOI: 10.4103/joa_297_24. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 Oct 20 [cited 2025 Apr 22];142(16_suppl_2):S366–S468. Available from: https://doi.org/10.1161/CIR.0000000000000916. Dayana B, Shek Abdullah M, Priyadarsini A, Cecyli C, Jagadeeswari J. Effectiveness of Hands-On Training Regarding Basic Life Support (BLS) on Knowledge Among Saveetha College of Arts and Science Final Year Students. J Pharm Bioallied Sci. 2024 Jul;16(Suppl 3):S2877-S2879. doi: 10.4103/jpbs.jpbs_542_24. Epub 2024 Jul 5. PMID: 39346372; PMCID: PMC11426882. Ajjappa A, Babu CP, Gowda SS, Shashikala P. Effectiveness of BLS training in improving the knowledge and skills among Medical Interns. J Educ Res Med Tech. 2015;3:28–30. Requena-Mullor MDM, Alarcón-Rodríguez R, Ventura-Miranda MI, García-González J. Effects of a Clinical Simulation Course about Basic Life Support on Undergraduate Nursing Students' Learning. Int J Environ Res Public Health. 2021 Feb 3;18(4):1409. doi: 10.3390/ijerph18041409. PMID: 33546328; PMCID: PMC7913518. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990 Sep;65(9 Suppl):S63-7. doi: 10.1097/00001888-199009000-00045. PMID: 2400509. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6541692","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448662378,"identity":"ab77bd3e-775d-493b-8dba-0517e2c9e2f7","order_by":0,"name":"R Sunil Kumar Devaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYDCCA2BSQoaBIQHEk5ADCz4gQgsPTIsxWDCBsBYGmBaGxAYQF58WvtsHmD/z7rDgYWBPPibx44xF+vywww+BttjJ6TZg1yJ5LoFNmvcM0GE8z9Ike25I5G68nWYA1JJsbHYAuxaDMwxszLxtQC0SOcYGPB+AWmYngLQcSNyGWwvQYWAt+Z8N/3yQSDecnf6BkBYGaagtjI95bkgkyEvn4LdF8gxjm+RcoBY2nmeGj2XOSBhukM4pOJBggNsvfGeYD39421Ynx8+e/ODgm2N18vKz0zd/+FBhJ4dLCwMDYwOYYoM7FazSAJdybEC+gRTVo2AUjIJRMBIAAB72W/AMN5bDAAAAAElFTkSuQmCC","orcid":"","institution":"KLE Ayur World","correspondingAuthor":true,"prefix":"","firstName":"R","middleName":"Sunil Kumar","lastName":"Devaki","suffix":""},{"id":448662379,"identity":"c893dc25-99d6-466d-8070-f5e4b82eedbd","order_by":1,"name":"Rajimunnisa Begam Shaik","email":"","orcid":"","institution":"KLE Ayur World","correspondingAuthor":false,"prefix":"","firstName":"Rajimunnisa","middleName":"Begam","lastName":"Shaik","suffix":""}],"badges":[],"createdAt":"2025-04-27 16:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6541692/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6541692/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81954662,"identity":"5726c629-a994-4af2-bc57-8471086bdcdc","added_by":"auto","created_at":"2025-05-05 09:44:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55676,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eScores Distribution (Box Plot)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeries 1 = Pre Test Scores\u003c/p\u003e\n\u003cp\u003eSeries 2 = Post Test Scores\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6541692/v1/c423ec55a471e7273c87e2b0.png"},{"id":81954664,"identity":"f4d4dfbd-f900-49e8-acc4-71dfbd783ddf","added_by":"auto","created_at":"2025-05-05 09:44:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37150,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eEffect Size Visualisation\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eCohen’s D , Hedges,g : 0.2 = Small Effect\u003c/p\u003e\n\u003cp\u003e0.5 = Medium Effect\u003c/p\u003e\n\u003cp\u003e0.8 = Large Effect\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6541692/v1/c4da6635d8d37282b7a9dd2b.png"},{"id":96899868,"identity":"5edf6863-c03a-4102-a818-29e4d9083b71","added_by":"auto","created_at":"2025-11-27 11:08:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757366,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6541692/v1/9c4d6f4c-4569-4a32-9c1c-a772e7f3c756.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRevamping Ayurveda Education: Assessing the Effect of Hands-on Basic Life Support Training on Learning Outcomes among Ayurveda Student-A Pre-Post Assessment Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSudden cardiac arrest (SCA) is said to be an abrupt loss of heart function, leading to a sudden cessation of cardiac activity, resulting in loss of consciousness, no normal breathing, and no signs of circulation.\u003csup\u003e(1)\u003c/sup\u003eCardiac arrest is often fatal if appropriate steps aren\u0026rsquo;t taken immediately. Such an event can happen to a person who may or may not have been diagnosed with heart disease. However, cardiac arrests can occur suddenly or in the wake of other symptoms. Cardiac arrest can happen at any time and any place. Alone in the United States, over 350,000, i.e., 80%, of cardiac arrests occur outside the hospital.\u003csup\u003e(2)\u003c/sup\u003e Recent studies revealed that the COVID pandemic had multiple effects on the incidence of Outside Hospital Cardiac arrest (OHCA). An increase in the incidence was reported by a study conducted in New York City that states OHCA attended by EMS (March 1-April 25, 2020) was 3-fold times compared to the same period in the earlier year.\u003csup\u003e(3)\u003c/sup\u003e If appropriate life support is given immediately when it is witnessed outside the hospital, the chance of survival increases by 2\u0026ndash;3 times.\u003csup\u003e(4)\u003c/sup\u003e Cardiac arrest being a major cardiovascular event requires large-scale public awareness along with CPR skills. In developing countries like India, only 2% of people have the knowledge to perform CPR, which is far below the global average of 30%.\u003csup\u003e(5)\u003c/sup\u003e With the rise of sudden cardiac arrests among the Indian population in recent times,\u003csup\u003e(6)\u003c/sup\u003e there is a definite need for BLS training among general populations and particularly in the medical community at the initial stage of entry into the medical profession itself. As per new reforms in the Ayurveda institutional education by the National Commission for Indian System of Medicine (NCISM), first-year/professional students are being given early clinical exposure where students are exposed to real-life clinical scenarios at the in-patient bedside. Students aware of such life-saving skills will be prepared to handle emergency conditions that may arise in hospital or outside hospital cases of cardiac arrest. A study done by Pande et al. on the evaluation and retention of BLS training suggested that the right time for incorporation of BLS knowledge and skills for medical students is from the 1st year itself, and that study also highlights the importance of repetition of training for its retention.\u003csup\u003e(7)\u003c/sup\u003e With such an aim and vision to inculcate Basic Life Support skills among young Ayurveda students, NCISM has included BLS training as a part of areas of interest to be trained under the Induction Programme for 1st-profession Ayurveda students. Various research has also shown that the knowledge and skills acquired in BLS training tend to be deprived over time.\u003csup\u003e(8)\u003c/sup\u003e To overcome this, BLS training was included in the curriculum at various points of academics to retain and enhance the skills learned by the students.\u003csup\u003e(9)\u003c/sup\u003e However, these reforms in the integration of life-saving emergency skills and the impact of the adoption of newer methodologies of teaching among Ayurveda students should be an ongoing process of research.\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAim of the Study\u003c/span\u003e: To assess the effect of Hands-on BLS Training with Manikins to 1st Profession Ayurveda students on their learning outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eObjectives of the Study\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e1. To assess the knowledge of BLS among 1\u003csup\u003est\u003c/sup\u003e Profession Ayurveda Students.\u003c/p\u003e\n\u003cp\u003e2. To evaluate the understanding of BLS Knowledge among Ayurveda Students after a didactic lecture and Hands-on Training.\u003c/p\u003e\n\u003cp\u003e3. To evaluate the learning outcomes by Hands-on training of BLS on Manikins by Ayurveda students.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e: A total of 82 Ayurveda 1st Profession students of Shri Gavisiddeswara Ayurveda Medical College, Koppal, Karnataka, who have given consent as participants, were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Methods\u003c/strong\u003e: A pre-test and post-test questionnaire was prepared, comprising 5 MCQ questions each and adhering to the guidelines of the American Heart Association 2020. These questionnaires were made using Google Forms with all the question responses made as required fields. A positive response was allotted 20 marks, and there was no negative scoring for negative responses. Students received a link through their official student WhatsApp group during the instructor-led course delivery. Also, the QR code of questionnaires was displayed on the screen to contribute to a paper-free setting. Participants were strictly monitored for fair practices during their responses. Participants were restricted from the use of any other source of materials. A stipulated time of 5 minutes each for pre and post-test assessment was given as the deadline for submission.\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eDescriptive Stastics\u003c/strong\u003e: Mean, Standard Deviation, Median, Mode, Range, Kurtosis, and Skewness.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eInferential Statistics\u003c/strong\u003e :Paired T test, Wilcoxon Signed Rank Test, Cohen’s d and Hedges’g Correction.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe data was analyzed using IBM SPSS Statistics software version 30.0.0.0(172).(Copyright IBM Corporation 1989, 1989,2024). Table \u003cspan\u003e1\u003c/span\u003e: Showing the number of participants and questions. The pretest questionnaire was prepared to assess basic knowledge of BLS, whereas the post-test assessment questionnaire was conducted to assess the knowledge retention soon after a didactic mode of lecture, demonstration, and Hands-on practice using manikins.\u003c/p\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePre Test and Post Test Assessment Questions.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eS.NO\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eAssessment\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eQuestions\u003c/p\u003e\n \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePre Test\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003en = 82\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1. On scene safety\u003c/p\u003e\n \u003cp\u003e2. Activating emergency services.\u003c/p\u003e\n \u003cp\u003e3. On Compression depth in adult CPR.\u003c/p\u003e\n \u003cp\u003e4. Full form of CPR\u003c/p\u003e\n \u003cp\u003e5. Full form of BLS\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePost -Test\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003en = 82\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Rate of Chest Compressions\u003c/p\u003e\n \u003cp\u003e2. Depth of Chest Compressions in Adult\u003c/p\u003e\n \u003cp\u003e3. Compression to Ventilation Ratio during Adult CPR\u003c/p\u003e\n \u003cp\u003e4. Technique of Airway Opening Maneuver in Adult\u003c/p\u003e\n \u003cp\u003e5. Full form of AED.\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eTable 2 shows descriptive analysis for both the pre-test and the post-test. The Pre-test score mean ± s.d. is 58.29 ± 23.769, whereas the Post-test score mean ± s.d. is 72.20 ± 14.992. In the post-test, the mean was 14 points higher, i.e., a 24% improvement compared to the pre-test mean. There was decreased variability from pre-test to post-test scores, as indicated by the reduced standard deviation (S.D.) and standard error (S.E.), showing that post-test scores were consistent among participants. The median and mode from pre-test to post-test shifted from 60 to 80, showing that more students scores were higher after the intervention. The range was decreased from 100 in the pre-test to 60 in the post-test, showing that this training had a positive impact even on students who scored very low in the pre-test. Kurtosis was -0.36, and skewness was -0.193 in pre-test scores, whereas in post-test scores it was -0.007 and -0.476, respectively. \u0026nbsp;Based on these values, the data can be interpreted to be distributed approximately normally. Fig. 1: Box Whisker Plot shows the distribution of scores with Series 1 (pre-test scores) and Series 2 (post-test scores). The narrower box in post-test scores shows the consistency of training and its positive impact on students.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2 : Pre - Post Score Descriptive Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.E\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKurtosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkewness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003ePre Test\u003c/p\u003e\n \u003cp\u003e(n= 82)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.29\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.625\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.769\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.36026\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.19338\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost Test\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n=82)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e72.20\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.656\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.992\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.00741\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.47604\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cdiv align=\"char\"\u003eTable 3: Showing the Paired Samples T-test. The results were highly significant, showing p \u0026lt; 0.001, which is far below the standard of 0.05. This suggests that Hands-on training had a high impact on the participants through knowledge enhancement.\u003c/div\u003e\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 3: Paired Samples T test\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePre - Post Test Scores\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e(n=82)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePaired Differences\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003et\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003edf\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eSignificance\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean S.E\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% C.I of the Difference\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOne Sided p\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTwo- Sided p\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.902\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.775\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.073\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.777\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.028\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.705\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cdiv align=\"char\"\u003eTable 4 shows that Cohen’s d point estimate was 0.74, which was way higher than the moderate effect (0.5) standard Cohen benchmark.\u003csup\u003e(10)\u003c/sup\u003e Even after Hedges’g correction the corrected point estimate was 0.734, which is nearer to the value of 0.74. This shows that there was a larger than moderate effect, even practically, on the study population, along with statistical significance. Fig. 2: Demonstrate the point size estimate and effect size visualization on the participants after an instructor-led BLS training. \u0026nbsp;\u0026nbsp;\u003c/div\u003e\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 4: Paired Samples Effect sizes\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"581\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePre - Post Test Scores\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp; (n=82)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eEffect size Type\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eStandardizer\u003c/u\u003e\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePoint Estimate\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e95% Confidence Interval\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eCohen’s d\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.775\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003eHedges correction\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.951\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cdiv align=\"left\"\u003e\u003cstrong\u003ea.\u0026nbsp;\u003c/strong\u003eThe denominator used in estimating the effect sizes. \u0026nbsp; \u0026nbsp; \u0026nbsp; In Table 5, the Wilcoxon -Signed Rank test was presented. The test statistics revealed Z = -5.425 and \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001, confirming its statistical significance. Among 82 study participants, 50 participants had positive rank differences (the positive ranks median is 31.26 and the sum is 1563.00), and 9 had negative differences (the median is 23.00 and the sum is 207.00 for negative ranks). 23 participants showed no change, i.e., ties. These results support the point that BLS training for these study participants had a positive impact on their learning outcomes through knowledge enhancement.\u003c/div\u003e\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eThe Wilcoxon-Signed Ranks Test\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePre - Post Test Scores\u003c/p\u003e\n \u003cp\u003e(n = 82)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eRanks\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian Rank\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSum of Ranks\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eTest Statistics\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e31.26\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1563.00\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ =−5.425\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e23.00\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e207.00\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAsmp. Sig\u003c/p\u003e\n \u003cp\u003e(2-tailed) \u003cstrong\u003ep \u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003cp\u003eThe post-test questionnaire consisted of a feedback section also, where 90.4% of participants stated that the instructor was extremely helpful in explaining the learning outcomes prior to training. The mean of participants rating the instructor being helpful was 4.82 out of 5 (1 being the least/not helpful and 5 being the best/extremely helpful). 98.8% of participants opined that sufficient mannequins had been arranged during the training session. 96.4% of participants opined that after thetraining session they are confident in identifying and handling an unresponsive patient. Furthermore, students reported an increased level of confidence. Feedback from students on instructor-led content delivery was also highly satisfactory.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFrom the days of the Gurukula education system to the present institutional curriculum, there have been continuous reforms in Ayurveda education. Homogenization of Ayurveda institutional education throughout the country was a significant transformation, where the institutes typically offer programs such as BAMS(Undergraduate), Post Graduate(MD/MS), and Doctoral (PhD) through recognized Universities. Ayurveda education in the recent era is typically formalized and structured. Modern Ayurveda education relies on scheduled lecture and non-lecture hours, which include in- and out-of-conventional-classroom teaching. Increased access to textbooks, digital resources, and research articles was noticed among the Ayurveda Fraternity. One such recent reform is the prioritization of emergency management in the curriculum along with the scope of Ayurveda's role in it. A study published by Sharma S et al. opines that integrating traditional wisdom with modern educational techniques will be one of the potential strategies for the enhancement of Ayurveda institutional teaching.\u003csup\u003e(11)\u003c/sup\u003e One such prime integration needed is emergency cardiac care, which is to be followed during sudden cardiac arrest. There are several protocols for basic life support skills during sudden cardiac arrest being followed across the world. Among them, the American Heart Association protocol is widely followed, and these protocols are updated every 5 years after extensive research. Our study followed such basic strategies published by AHA for Adult BLS protocol.\u003csup\u003e(12)\u003c/sup\u003e All the participants in this study have not undergone any BLS training in the past. The Pre-test mean score (58.29 ± 23.76) was higher compared to other similar research.\u003csup\u003e(13)\u003c/sup\u003e As this study was a planned workshop, prior information to the students made them well-prepared with theoretical concepts from various forms of media, books, etc. These results support a study conducted in Spain that those students with prior knowledge of BLS had higher scores in both the pre-test and post-test.\u003csup\u003e(14,15)\u003c/sup\u003e This study results (Fig. \u003cspan\u003e1\u003c/span\u003e) also highlight the importance of such planned activities, which will enhance students involvement and increase their understanding during the instructor-led training. As per the Millers' Pyramid for Clinical Competence, performance integrated with demonstrations and direct practice, the skills among students tend to be retained for a longer duration.\u003csup\u003e(16)\u003c/sup\u003e A 1-year longitudinal study conducted by Kochhar et al. on knowledge and skills retention among 1st-year MBBS students showed a significant skills deterioration within a 6-month period only.\u003csup\u003e(8)\u003c/sup\u003e This study also highlighted the need for the incorporation of BLS training and assessment into every semester of the MBBS curriculum for knowledge and skill retention, which directly impacts patient outcomes. Authors have also made recommendations to include BLS and other emergency life-saving skills like ATLS, ACLS protocols in medical educational curricula, which is even true and should be considered in other systems of medicine like Ayurveda. However, exposure to critically ill patients during education will have a higher impact on their preparedness and confidence levels. Ayurveda Clinical settings are different, as the prime focus and the nature of patients in hospitals differ from those in conventional medical hospitals. According to some studies, training students with high-fidelity manikins and regular mock drills can be of greater use to increase confidence and preparedness, but the frequency and methods of incorporation among Ayurveda students need extensive research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study states that BLS hands-on training among Ayurveda students had a positive impact on their learning outcomes, enhanced their knowledge, and increased their level of confidence. Our study also highlights the need for increased frequency of emergency resuscitation protocol training in the curriculum, as highlighted in previous similar studies. The need for the adoption of uniformly structured, validated protocols of BLS, ACLS, PALS, ATLS, etc. in the institutional curriculum will have a direct impact on students confidence and patient outcomes. There is a need for an increased number of skilled instructors in Ayurveda institutional education centers, or it can be through collaboration with recognized training centers and training sites. This study can be a purposeful guide for further research on new teaching methodologies adopted in the Ayurveda system of institutional teaching. The point of incorporating BLS skills among Ayurveda students should not end at the bench, but also those students should propagate such knowledge to their family members and friend groups.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" name=\"Emphasis\"\u003eLimitations of the study\u003c/span\u003e: This study included an assessment of participants only in the cognitive domain, whereas the psychomotor skill assessment through DOPS (Direct Observed Procedural Skills assessment ) is not included due to time constraints. Advanced high-fidelity manikins can be a solution, allowing skill assessments of multiple participants through skill monitoring apps. It is a single-centered study with a small group of participants. Generalizations of the results cannot be made.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" name=\"Emphasis\"\u003eFuture perspectives of the study\u003c/span\u003e: Similar studies can be conducted among final-year Ayurveda students, interns, Post Graduate Ayurveda students. Knowledge and skill retention among them can be assessed by regular training sessions. Multi-centered studies in various Ayurveda institutes and various AYUSH systems of study can give a better understanding of attitudes and skills among different sectors of AYUSH education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eNIL\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and Consent:\u003c/strong\u003e All the study participants were assured for data confidentiality and Consent was taken for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding:\u003c/strong\u003e NIL\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u0026nbsp;\u003c/strong\u003eAuthor 1 (RSKD)trained \u0026nbsp;the students, planned \u0026nbsp;and executed the study, prepared the article .\u003c/p\u003e\n\u003cp\u003eAuthor 2 (RBS) - Study Planning, Article Drafting, Statistical Analysis, and drawing conclusions from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors are thankful to the Principal and Management of Shri Gavisiddeshwara Ayurvedic Medical College for their cooperation in the conduction of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eData Availability Statement:\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe data sets that supports the results and findings of the study were available with the corresponding author. Due to restrictions the data will be considered for availability from the author upon special request.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatel K, Hipskind JE. Cardiac arrest [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan\u0026ndash; [updated 2023 Apr 7; cited 2025 Apr 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534866/\u003c/li\u003e\n\u003cli\u003eTsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics\u0026mdash;2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93\u0026ndash;e621. doi:10.1161/CIR.0000000000001123\u003c/li\u003e\n\u003cli\u003eSudden Cardiac Arrest Foundation. Latest statistics [Internet]. Pittsburgh (PA): SCAF; [cited 2025 Apr 20]. Available from: https://www.sca-aware.org/about-sudden-cardiac-arrest/latest-statistics\u003c/li\u003e\n\u003cli\u003eRiva G, Hollenberg J. Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Intern Med. 2021;290:57\u0026ndash;72. doi:10.1111/joim.13260\u003c/li\u003e\n\u003cli\u003eIndia Today. 2% of people in India know CPR, inadequate by global standards: CSI [Internet]. 2023 Jul 5 [cited 2025 Apr 20]. Available from:https://www.indiatoday.in/impact-feature/story/2-of-people-in-india-know-cpr-inadequate-by-global-standards-csi-2402193-2023-07-05\u003c/li\u003e\n\u003cli\u003eJaiswal PB. \u0026lsquo;5-6 lakh people are dying due to sudden cardiac deaths in India\u0026rsquo;, finds study. The Week [Internet]. 2023 Oct 1 [cited 2025 Apr 20]; Available from: https://www.theweek.in/news/health/2023/10/01/5-6-lakh-people-are-dying-due-to-sudden-cardiac-deaths-in-india-finds-study.html.\u003c/li\u003e\n\u003cli\u003ePande S, Pande S, Parate V, Pande S, Sukhsohale N. Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training. Adv Physiol Educ. 2014;38(1):42\u0026ndash;45. doi:10.1152/advan.00102.2013\u003c/li\u003e\n\u003cli\u003eKochhar S, Samagh N, Sharma J, Kaur A, Verma M. Knowledge and skill retention in first-year MBBS students after basic life support training: a one-year longitudinal study. BMC Med Educ. 2024;24(1):971. doi:10.1186/s12909-024-05922-0. PMID:39238013; PMCID:PMC11378406\u003c/li\u003e\n\u003cli\u003eNational Commission for Indian System of Medicine. Ayurveda syllabus [Internet]. New Delhi: NCISM; [cited 2025 Apr 20]. Available from: https://ncismindia.org/ayurveda-syllabus.php.\u003c/li\u003e\n\u003cli\u003eLindelov JK. Cohen\u0026apos;s d Effect Size Calculator [Internet].rpsychologist.com; Available from: https://rpsychologist.com/cohend/\u0026amp;#8203;:contentReference[oaicite:1]{index=1}\u003c/li\u003e\n\u003cli\u003eSharma S, Lekrao OP, Moazzamiperio F, Comparitive nalysis of ancient and modern teaching methods in Ayurveda: Recommendations for enhancing contemporary education, J Ayurveda 2024; 18:245-7. DOI: 10.4103/joa_297_24.\u003c/li\u003e\n\u003cli\u003ePanchal AR, Bartos JA, Caba\u0026ntilde;as JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 Oct 20 [cited 2025 Apr 22];142(16_suppl_2):S366\u0026ndash;S468. Available from: https://doi.org/10.1161/CIR.0000000000000916.\u003c/li\u003e\n\u003cli\u003eDayana B, Shek Abdullah M, Priyadarsini A, Cecyli C, Jagadeeswari J. Effectiveness of Hands-On Training Regarding Basic Life Support (BLS) on Knowledge Among Saveetha College of Arts and Science Final Year Students. J Pharm Bioallied Sci. 2024 Jul;16(Suppl 3):S2877-S2879. doi: 10.4103/jpbs.jpbs_542_24. Epub 2024 Jul 5. PMID: 39346372; PMCID: PMC11426882.\u003c/li\u003e\n\u003cli\u003eAjjappa A, Babu CP, Gowda SS, Shashikala P. Effectiveness of BLS training in improving the knowledge and skills among Medical Interns. J Educ Res Med Tech. 2015;3:28\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eRequena-Mullor MDM, Alarc\u0026oacute;n-Rodr\u0026iacute;guez R, Ventura-Miranda MI, Garc\u0026iacute;a-Gonz\u0026aacute;lez J. Effects of a Clinical Simulation Course about Basic Life Support on Undergraduate Nursing Students\u0026apos; Learning. Int J Environ Res Public Health. 2021 Feb 3;18(4):1409. doi: 10.3390/ijerph18041409. PMID: 33546328; PMCID: PMC7913518.\u003c/li\u003e\n\u003cli\u003eMiller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990 Sep;65(9 Suppl):S63-7. doi: 10.1097/00001888-199009000-00045. PMID: 2400509.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hands-on Training, Basic Life Support, Cardiopulmonary resuscitation, Ayurveda, Curriculum","lastPublishedDoi":"10.21203/rs.3.rs-6541692/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6541692/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eReforms in Ayurveda education made theoretical knowledge and practical skills better aligned. Also, importance has been given to closing the gap in integrating life-saving skills that enhance students' preparedness for emergency clinical situations. Sudden cardiac arrest is one such emergency condition that can come across at any time. Basic Life Support (BLS)\u0026mdash;comprising skills such as emergency response, cardiopulmonary resuscitation (CPR), and AED usage\u0026mdash;is a fundamental aspect of emergency resuscitation in cardiac arrest patients that is to be learned by everyone, in particular by all healthcare professionals. Due to its importance, BLS training has become a part of the institutional teaching curriculum for Ayurveda students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e82 Ayurveda Students of the 1st profession were trained by the instructor during the induction program via didactic mode, followed by Hands-on practice with manikins. A Pre- Post assessment of knowledge on BLS among students was assessed through multiple-choice questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe pre-test mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was 58.29\u0026thinsp;\u0026plusmn;\u0026thinsp;23.76, whereas the post-test mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;72.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.99. There was a high statistical significance between Pre \u0026amp; Post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) scores, indicating their knowledge enhancement. A larger than moderate effect size was observed (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.74; Hedges\u0026rsquo; g\u0026thinsp;=\u0026thinsp;0.734).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study had a significant impact on enhancing the level of knowledge. Furthermore, students reported improved confidence and willingness to perform CPR in real-case scenarios. Improving methods for teaching skills and assessments that show a direct impact on clinical practice should be an ongoing field of study.\u003c/p\u003e","manuscriptTitle":"Revamping Ayurveda Education: Assessing the Effect of Hands-on Basic Life Support Training on Learning Outcomes among Ayurveda Student-A Pre-Post Assessment Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 09:44:15","doi":"10.21203/rs.3.rs-6541692/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c5b3019-6a5e-4220-935d-affc34623944","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-27T11:08:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 09:44:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6541692","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6541692","identity":"rs-6541692","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}