Training needs and qualifications of anaesthesiologists not exposed to ALS
Introduction
Knowledge of advanced cardiac life support (ALS), defined as basic life support (BLS) plus techniques such as airway management, IV-access, drug therapy, cardiac monitoring arrhythmia management including defibrillation and post-resuscitation care [1], is assumed in anaesthesiology interns and residents who form the core of resuscitation teams the world over. This assumption, however, is unsupported by evidence. Earlier studies attempting to analyze skills and knowledge in a broad professional population have been done primarily in English speaking countries with an ALS-course tradition (Table 1). These studies are difficult to compare and reported strongly divergent results. On mainland Europe standardized ALS courses have been implemented only on a very limited scale so far, making an extrapolation of these results to the needs of anaesthesiology residents and interns in a country without ALS-courses impossible. In our institutions, exposure to ‘ALS’ type training consists of an estimated 2 h within the annual continuing education sessions, with manikins always available continuously, in addition to 8 h of training preparatory to the second year national Board examinations.
This assessment was performed to assess the need for ALS training and to define factors that might influence skills and knowledge in a group frequently confronted with resuscitation situations. We describe theoretical and practical CPR knowledge and experience, using a questionnaire and multiple-choice questions in conjunction with a BLS skills session scored by a standardized technique [4]. We make suggestions for suitable training.
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Materials and methods
We programmed the assessment for a 1-h, mandatory, departmental continuing education session. Advance notice was avoided by using a nondescript title for the schedule. Each intern or resident was arbitrarily assigned a number and was subsequently assigned to one of four groups, each with a non-participating mentor. The assessment involved four successive 15-min sessions. In one session, a questionnaire was used to record experience and training in CPR, the participants’ opinion of their own
Results
Of those eligible, 55 (75%) participated in the investigation. This included seven interns who had been accepted for training and 48 residents between their 1st and 5th year. Sixty three percent of the participants were male, reflecting the male–female ratio within our department. The distribution of participants was related to leave, duty- and rotation schedules. All participants completed the entire investigation.
Discussion
This study assessed and recorded the ALS skills of anaesthesiology interns and residents’ in order to evaluate needs for a well defined training program. The study demonstrated that 55% of the multiple-choice questions were answered correctly. In the skills assessment, the Berden scoring system was employed. The findings revealed a median of 35 EP, with only 13% of the participants demonstrating satisfactory skills.
It is difficult to compare our results with those assembled in Table 1, where
Acknowledgements
This study was supported in part by Laerdal, (Brussels, Belgium) and MediScore (Bodegraven, The Netherlands). We thank H. Delooz for his constructive advice and criticism.
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