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>>> [log in to unmask] 11/28/01 06:39 >>> --- Shane Curran <[log in to unmask]> wrote: >> MY opinion is that this is what we should teach our >> trainees anyway. >Yes, but will they be assessed on it? Yes, they will. The FACEM carries a significant Paediatric component in both the writtens and clinicals. >no evidence from our audit data that having a >consultant present makes any difference to the outcome >and that applies to trauma and ALS resus. What does >make a difference is sticking to the guidelines and >our last 5 years audits have shown a dramatic >difference in survival to discharge between those >patients treated according to the guidelines and those >where the team did their own thing. The skills >retention study was even more dramatic and drop off in >performance of even relatively straight forward skills >such as defib were significant in pre-reg house >officers over 6 months. Despite them attending cardiac >arrests. I cannot argue with your audit data without seeing it. But it depends what exactly your outcomes were. 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. 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 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. Craig CC DHB Secure Mail Server ******************************************************************************** This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital and Coast District Health Board. (AC_S001) [INFO] -- Virus Manager: No Viruses were detected in this message. ********************************************************************************