A few points:

> -----Original Message-----
> From: Robbie Coull [mailto:[log in to unmask]]

> Subject: Re: ALS
> Was that 17 years of doing ALS badly or it can be 17 years of 
> doing ALS
> well? The duration of your experience has NOTHING to do with 
> you competence
> at ALS (in fact the reverse may be true if you consider skill 
> decay).  When
> during the above elite training were you FORMALLY trained and 
> assessed in
> you ability to do ALS?

Yes, during training you are formally trained. This is why we refer to
'Basic Training' and 'Higher Specialist Training' rather than 'Marking Time
In A Post With No Educational Content'. Assessment by trainers takes place
on a daily basis. The fact that this is done when appropriate patients are
being treated rather than at scheduled times does not reduce its value.
Appraisals are done at least annually, where any problems are raised. If a
trainee has not developed appropriate skills, they fail to progress. The
point is that a trainee is assessed on their ability to treat real patients
in a real A and E department rather than on a mannequin.

> 
> That wouldn't be the locum anaesthetist that was struck off 
> yesterday for
> being erratic and dangerous, would it?  

No, it wouldn't. He was a locum who had not had on the job training and had
not worked in one place long enough for problems to be picked up. The points
the GMC made (in this case) centred around this and would not apply to a
substantive consultant

>There are a lot of experienced
> drivers out there who would fail a driving test if 
> re-examined.  Does this
> mean they have picked up bad habits or the test is at fault?
> 

It means the test is at fault. There are different ways of doing things. A
paediatric anaesthetist who audits properly and does not have nay problems
(and in today's climate, you would be hard pushed to find one who does not)
can manage a paediatric airway properly. A mannequin is at best a second
best substitute for day to day practice. (The driving test analogy: 3 point
turns and reversing round corners test low speed control. The real manouver
is parallel parking. This is not tested because of risk of damage to cars.
But someone who has been parallel parking several times a day for years
without problems has shown they can do it). There is also the problem that
in any of these courses, some elements are taught and examined by people
with limited practical experience, who can extrapolate too far (e.g. anyone
tried a surgical airway by ATLS method in a patient with tracheal tug? Can't
do it.) To fail an experienced person for using their own method you have to
be pretty sure your way is better.
I'm not saying that overall these courses are not good, just that there is
scope for them to fail competent candidates.

Matt Dunn


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