Elsevier

Resuscitation

Volume 40, Issue 3, May 1999, Pages 147-160
Resuscitation

Training needs and qualifications of anaesthesiologists not exposed to ALS

https://doi.org/10.1016/S0300-9572(99)00020-9Get rights and content

Abstract

Objectives: To establish which needs exist for specific training in Advanced Cardiac Life Support (ALS) in anaesthesiology residents and interns not exposed to structured ALS courses. Methods: 48 residents, and seven interns accepted for training in anaesthesiology, were tested in a spontaneous, blind, cross-sectional, prospective assessment using a recording manikin with validated scoring system, a questionnaire, and 35 multiple-choice questions. Results: 65% admitted not having had any CPR training within the last 2 years. The answers were correct in 55±14% of the cases, increasing significantly with the length of training (P=0.001). One-rescuer CPR skills were inadequate: only 13% (n=7) of participants scored within acceptable limits when using the Berden Scoring system (Berden et al., Resuscitation 1992;13:31–41), which assigned weighted error points to BLS skills. No correlation with skill was noted with increased length of residency, confidence, ER or ICU experience, or participation in CPR-incidents. Conclusions: anaesthesiology residents and interns were not able to demonstrate BLS skills properly even while in training and did not recognize this themselves. CPR-related knowledge is poor and increases only incidentally over the years of residency even though participants were frequently confronted with seminars and resuscitation situations, and see protocols daily. The use of multiple-choice questions and the Berden scoring system avoids difficulties in evaluating case-scenario type of tests. We suggest that trainees are motivated to take part in standardized, intensive, recognised ALS courses which emphasize BLS skills and require (re)certification.

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.

Section snippets

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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