Crossing life-saving thresholds: learning-forgetting trajectories in secondary-school basic life-support training:...

Basic life support (BLS) training in schools is a public health priority, but long-term retention of basic knowledge is poorly understood. The objective was to quantify the learning and forgetting curves of six threshold concepts (TC) of BLS in secondary school students and examine demographic moderators.

A quasi-experimental design was implemented in six randomly selected schools (N = 459; age 12-15), whose students completed a validated 20-item multiple-choice test containing six BLS "key questions" at baseline (T0), immediately after instruction (T1), and 6 months later (T2). Friedman tests and mixed linear models assessed changes over time and interactions with gender, grade, and school location.

The mean TC score increased from 40.5% (T0) to 67.3% (T1) (Δ = 26.8%, p < 0.001; d = 1.22) and decreased to 55.1% (T2) (-18.1% from T1; p < 0.001; d = 0.63). Females and 4th-year students retained significantly more knowledge (β = 0.71 ± 0.18 and β = 0.80 ± 0.17, respectively; both p < 0.001). Recognition of agonal breathing showed the most pronounced forgetting gradient (-27%), while time-critical remained stable (-9%).

BLS competence depends on a small set of transformative concepts that decay at differential rates. Quarterly micro-refreshers focused on agonal respiration recognition and AED sequencing are recommended to consolidate learning pathways beyond the liminal phase.