Five-Year Outcomes of an Undergraduate General-Education First Aid Course: A Ten-Semester Multi-Domain Evaluation of Knowledge, Skills, and Readiness

Background: University students are a scalable population for strengthening community first-aid capacity, but evaluations beyond CPR/AED outcomes remain limited. We assessed a general-education first-aid course using knowledge, observed skills, self-efficacy, and readiness-to-act outcomes. Methods: We conducted a repeated-cohort, single-group pre–post evaluation of an undergraduate elective course at Sun Yat-sen University (Guangzhou, China) across 10 consecutive semesters (2021– 2025). Outcomes included pre/post theoretical knowledge (0– 100), end-of-course four-station OSCE performance rated on a DOPS-based 1– 5 scale, self-efficacy (five 1– 5 Likert items; composite as mean), and willingness/intention (paired yes/no items). Pre/post changes were analyzed using paired tests appropriate to outcome type. Results: Among 446 undergraduates (51.8% men; 28.0% medical-related majors), knowledge increased from 36.9 (SD 6.5) to 80.9 (SD 4.3) (mean difference 44.0, 95% CI 43.3– 44.7; p < 0.001), with consistent gains across all five domains (all p < 0.001). Overall observed skills were satisfactory: the composite OSCE score was 3.52 (SD 0.42) and 77.8% passed all four stations. Station competence rates were 71.7%– 80.7%, whereas completion of all critical actions was lower (58.3– 74.0%). Self-efficacy increased from 2.3 (SD 0.4) to 4.0 (SD 0.3) (mean difference 1.8, 95% CI 1.7– 1.8; p < 0.001). Willingness and intention also improved, including willingness to perform CPR on a stranger, use an AED if available, and prepare a home first-aid kit within 1 month (all p < 0.001). Conclusion: This university general-education first-aid course was associated with substantial end-of-course gains in knowledge, satisfactory observed competence, and improved confidence and readiness to act. These findings support embedding multi-domain first-aid training beyond CPR/AED within university general education as a scalable approach to strengthen community emergency preparedness. Keywords: first aid education, undergraduate students, self-efficacy, willingness to act