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--- Craig Ellis <[log in to unmask]> wrote: > 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. > > > I cannot argue with your audit data without seeing > it. But it depends what exactly your outcomes were. Survival to discharge. Figures were reflected right through from immediate survival onwards and corrected for ISS etc. > 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! > 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. :-) > 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? Fred. __________________________________________________ Do You Yahoo!? Yahoo! GeoCities - quick and easy web site hosting, just $8.95/month. http://geocities.yahoo.com/ps/info1