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>From: Fred Cartwright <[log in to unmask]> > > Yes, they will. The FACEM carries a significant > > Paediatric component in both the writtens and > > clinicals. > > >What format are the clinicals. Having seen too many >surgeons make it through to consultant level without >being very good at operating I am somewhat cynical >about the colleges assessment criteria. I accept that >it is changing, but it has been a long time coming. > > The clinical is 1 long case (usually adult), 4 short cases (one of which will be a paed) and 6 structured vivas (of which 1-2 will be paediatric) I accept entirely your comment about consultants - but I personally (putting on fire proof underware) believe (in EM anyway) it is more of a problem in the UK than Australasia. A number of consultants with no interest or experience in resuscitation have been grandfathered in to the UK Faculty - and as such all consultants are not equal. I certainly dont mean that in an insulting way - it just explains why there is such as spectrum. > > > But the difference at least at a superficial level > > is stark. Having worked in SHO driven units and > > Consultant driven units without a doubt Id rather be > > sick in a consultant driven one - now clearly your > > data does not support that - but would you rather > > have your resus run by a consultant (following > > guidelines and with knowledge to work around the > > edges of guidelines - and all their additional > > practical skills) or the ED/Medical SHO (following > > the guidelines). Especially if there is anything > > atypical about your arrest or trauma. > > >It depends if you mean sick or in need of resus. I >suspect our figures show no difference between grades >(consultants were no worse, but didn't seem to confer >any advantage) is that resus is a team sport. It is no >good having a star player if the rest of the team are >hopeless. As for the additional knowledge/skills of >consultants there are certain individuals of that >grade that I wouldn't let anywhere near me or mine! >Certainly if I was having my femur nailed in my >hospital then I know who I'd want to do it and it >wouldn't be any of the consultants - who haven't done >one in ages! But you can say that for any medical speciality or situation. I work in a hospital where the bulk of the resus's are consultant led - and Id prefer them over the ED SHO or medical registrar. Again if your in a one consultant unit and they never venture into resus, then obviously I wouldnt let them near me. > > Guidelines are a thorny issue too. Having observed > > the development of some national guidelines, I have > > lost a lot of faith in the concept of them > > reflecting best practice - safe practice perhaps, > > but certainly not best practice. A combination of > > "experts" from a number of specialities offering > > their interpretation of the available evidence and > > reaching a consensus that they (or a more accurately > > a majority) believe reflect best practice in > > accordance with the evidence. I think the uncritical > > acceptance of EBM guidelines is becoming more of a > > problem. You only need to look as far as the > > AHA/ILCOR antiarrythmic and medical management of > > USA guidelines to see the face of these problems IMO > > >I wouldn't agree with respect to ALS & ATLS >guidelines. They are certainly not just what the >experts think is best. Issues such as high dose >adrenaline, amiodarone, effectiveness of atropine etc. >have been subjected to clinical evaluation. The >results of the research are fed back into the >guidelines and then re-evaluated. A good example of >the audit cycle IMHO. The ATLS guidelines were even >changed to say not everyone needs their c-spine >x-rayed. Surely a major step for a US lead course. :-) > Again I would disagree on this one. Id didnt say it was just expert consensus, its an expert consensus interpretation of the literature - and compromises are made to keep everyone happy. The new ATLS guidelines 2001/02 certainly look like an improvement, from what Ive seen of them, but the 1997 guidelines are riddled with inconsistencies and sub-optimal practice. Equally there are a number of problems with ALS - or simplifications. Im not saying they are not useful - obviously they are immensely valuable. But I have to say the more Ive learnt and the more experience Ive got, the more frustrated I get with resus guidelines - and there often somewhat superfical dealing with a very complex area of medical research. > > The skill retention issue is also very complicated. > > We have done a number of studies using simulation > > looking at this. The main recurring theme is not the > > frequency of exposure, or time since initial > > teaching ( which are still important), the main > > issue is quality of initial teaching. This has > > become a recurring theme - we have tried a number of > > different teaching formats, and certain teaching > > formats had the highest correlation with 6 month > > performance. Very interesting stuff. > > >What teaching format came out top? Seperate medical and nursing teaching of the same material, with subsequent joint filmed and debriefed scenarios - the video feedback certainly seems to be very important. cheers Craig _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp