In message <002701c03c2a$5dfb09c0$f46001d5@z8v7o8>, Adrian Fogarty
<[log in to unmask]> writes
>I'm a huge cynic of the way ALS is taught although I agree
>with most of the principles on which it is based. I'm also dispirited by the
>way many people view the ALS certificate as some sort of qualification;
>several recent advertisements for A&E consultant posts listed ALS
>certification as a prerequisite for the job!! I think this is elevating a
>two day course with a 95% pass rate to a ridiculous level. I could go on but
>it depresses me too much...
Allow me to become depressed on your behalf. I've only been involved
with ALS courses for a short time but have formed the impression that
"candidates" are taught to "pass" the "exam" rather than learn anything
useful from the experience. Some staff I work with have been totally
unable to answer the most basic resus-related question a week after
succesfully completing the course. Others have been very interested and
expanded on their knowledge and skills from the course, but they are in
the minority. It seems a little strange that the core material from a
course with a very high pass rate can be so completely forgotten a week
later. Did I hear someone mention MB.BS?

Got a sneaking suspicion that the standard required by an individual
candidate is determined by that candidate's background and experience,
rather than their knowledge or performance. From a candidates viewpoint,
the ATLS seemed much more "practical" and less intimidating. Can't help
feeling that all-doctor faculty and all-doctor candidates helped. Are
the right people teaching the right stuff to the right candidates? Is it
time to sacrifice the ideal of one ALS course for all in favour of more
tailored courses for specific staff groups (shock-horror herecy)?

As for the requirement for an A&E Con to have ALS certification - why
not, and APLS and ATLS too? Or are they too good for that? Perhaps I'm
too good as well. Perhaps so too are the med/surg/paed reg that responds
to cardiacs/traumas/paed arrests. I continue to be astonished that these
staff may NOT necessarily be required to have the relevant course under
their belt as a MINIMUM requirement to take the emergency bleep. Like it
or not, in these days of governance and re-validation, some surrogate of
relevant basic clinical skills is essential for ALL grades, rather than
just taking our word for it that we are s**t-hot and have been doing
this job for X years.

These courses are not an ideal marker and certainly should not be the
only measure, but I would be concerned if I had to work with a senior
collegue who hadn't "bothered" with his/her ALS/ATLS/PALS etc. Why not?.
Am I the only one who can still remember A&E Consultants who would
freely admit that they weren't comfortable with "all that resus stuff"
but still carried the title (and salary) of an A&E Consultant? There
aren't any out there now, of course.

You mentioned a paed Anaesthetic Consultant "failing" an airway station
- why? The skills tested are basic and I would be concerned as to the
reason for not being able to perform them adequately. It's quite
dangerous to assume the course was at fault. I've worked with a
Consultant Anaesthetist  with responsibility for trauma patients on ITU
in a major teaching hospital within the last few years who might have
done some serious damage with a chest drain one day had a colleague not
wandered by at the opportune moment (patient had developed tension
pneumo on IPPV after blunt trauma). That Consultant hadn't been on an
ATLS course - but then he didn't need to of course, because he'd taken
10 years to train to be a Consultant and had full FRCA. Anyway, if he
had gone on some meaningless ATLS course, he'd probably have been failed
on his knowledge of chest drain insertion technique by some junior
upstart ;-)

Every week an incompetent colleague is pictured outside the GMC. All of
them have been KNOWN to be "quite safe" by several docs they've worked
with. Soon, we will all be required to regularly produce evidence of
maintained basic skills and knowledge. If the current courses /
assessment aren't relevant then scrap them and invent new ones.


Dr G Ray
Staff Grade
A&E
Sussex
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