I think we should be careful not to offend those who put as much effort as
is the norm into ALS/ATLS teaching. Even if someone on the list think the
system is not ideal, there are kinder ways whereby he could introduce a
better system, rather than just make rude comments about the 4-stage
technique or anything else.

There IS evidence for the system. Even in the absence of such evidence,
there would still be no better system with evidence to support IT. There is
also evidence about the failure of other systems. Despite the fact that I
think the ATLS "way" is a good one, I am not foolish enough to think it is
the ONLY way nor that it will never be improved.

To claim that practise makes perfect is irrelevant, since it is still up to
a good teacher and system to make the difference between perfectly good and
perfectly bad. Everyone agrees, for example, that throwing people at the
deep end will rapidly build up frequently-practised habits, but not
necessarily good ones.

Anyone who refers to a "silent" run through has not been instructed fully
and/or has missed the point. I would advise such persons to make friends
with one of the educationalists or another knowledgeable person and have the
system explained to them once again. Certainly they should do this before
attempting to teach with it.

Ditto if you think that "Set" means "open" or "closure" means "close". The
analogy to a surgical abdominal procedure actually demonstrates this - you
cannot just OPEN an abdomen and consider that a surgical approach. There is
WAY more to set than just opening. And I could (off list to avoid wasting
people's time) provide a generous list of reasons for why having questions
before a summary is a logical idea.

The fact that you cannot learn to drive by just watching a driver is
irrelevant. You will certainly now be able to at least recognise a driver or
the act of driving, have an idea of what to expect would happen next and be
able to anticipate the fact that a driver might require a steering wheel,
for example. This is what you are being taught in the observational initial
stage. You will certainly learn less about driving by merely being TOLD or
READING that such a thing exists...

...I could go on for 10-20 KBytes on why certain other negative comments
about ATLS/ALS teaching should not have been made this way, have no evidence
backing them and show lack of insight into the system. I believe that on
this sort of list there are probably a few dozens of people with A LOT more
knowledge and experince in teaching and medicine than I have and the last
thing they would wish to see is a prolonged debate on this. There are other
sources through which any misconceptions about these principles can be
explained.

Let us all remember that there are many dedicated professionals on the list
and be polite and respectful of their efforts.

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