EditorWe are concerned about the provision of ALS training for junior doctors. Junior doctors perceive performing cardiopulmonary resuscitation (CPR) as a stressful experience and many feel inadequately trained for the task.1 New recommendations for staff with responsibility for resuscitating patients include: (i) cardiopulmonary arrest should be managed according to national guidelines; and (ii) staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles.2 Senior house officers (SHOs) working within critical care and medicine attend the majority of cardiac arrests.3
We performed two surveys. The first assessed the advanced life support (ALS) training of junior medical staff involved in our Hospital at night scheme using a standard questionnaire. The second assessed the resuscitation skills of all SHOs (current ALS instructors exempt) rotating through our 20-bedded adult critical care unit (ITU/HDU) against current ALS guidelines. Trainees underwent a refresher seminar followed by a compulsory CPR competency assessment observed by two ALS instructors. The trainees were assessed on basic life support (BLS), defibrillator safety and ALS skills in a scenario-based format. Only the candidates who passed each section were assessed on the next. All the trainees assessed in both surveys were members of the hospital cardiac arrest teams.
In the first survey, 50 questionnaires were completed and returned. Most respondents were PRHOs/SHOs (43/50). Only 14% (2/14) of the PRHOs had ALS. Of the SHOs, 25/29 were in the first or second SHO training year. In total 69% of medical SHOs had obtained the ALS qualification, however 46% did not achieve this until after the completion of their first SHO year. The reasons for not holding an ALS certificate included lack of funding and a lack of locally available places with some doctors (44%) choosing to prioritize their study leave on postgraduate examinations before sitting ALS. Over 95% of junior doctors felt that ALS training should be compulsory and 94% (47/50) thought ALS training should occur before commencing SHO posts.
In the second survey, we assessed 32 trainees, of whom 25 (78%) held a valid ALS certificate. BLS was inadequate in 2/32 (6%). Safety of defibrillation was failed by 7/30 (23%) trainees. A full CPR scenario was given to 23 trainees. Of these 7/23 (30%) failed the scenario. Of the group as a whole 16/32 (50%) required further training and re-testing. Of those candidates who held a valid ALS certificate 10/25 (40%) failed the competency-based assessment and required further training and re-testing.
ALS is the gold-standard for CPR training. We feel adequate ALS training should be a compulsory requirement for all junior medical staff before full registration and financial support should be provided. Furthermore, junior medical staff require regular scenario-based CPR training. Our survey suggests that skills acquired during ALS training are not retained and regular competency-based assessment is required.
Middlesbrough, UK
References
1 Scott G, Mulgrew E, Smith T. Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors. Hosp Med 2003; 64: 4258[ISI][Medline]
2 Standards For Clinical Practice And Training. Resuscitation Council (UK), 2004
3 Hudsmith L, de Bono J, Davies R, Hampton J. Cardiopulmonary resuscitation: the thought and the deed. Clin Med 2001; 1: 517