Papers

Training in basic and advanced life support in UK medical schools: questionnaire survey

P S Phillips, medical student ^a, J P Nolan, consultant ^b. 

^a Faculty of Medicine, Southampton University, Southampton General Hospital, Southampton SO16 6YD, ^b Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG

Correspondence to: P S Phillips seamusphillips{at}hotmail.com

Newly qualified doctors are expected to take part in resuscitation from their first day. The General Medical Council states that preregistration house officers should have training in basic life support before they begin their first post and that they should receive advanced life support training during the first year.¹ However, it places no obligation on medical schools or trusts to provide a defined standard of resuscitation training. The Royal College of Physicians has stated that advanced life support should be taught in the undergraduate course and that preregistration house officers should be "capable of instituting" advanced life support.² A recent unpublished survey found that only four out of 16 responding medical schools fulfilled the royal college's recommendations.³ We decided to assess the situation in more depth.

	Method and results

Top Method and results Comments References

A survey was devised in consultation with BMA student representatives of all medical schools in the United Kingdom, using an internet discussion forum. This survey was completed by all representatives in consultation with their medical schools. Additional information was obtained from undergraduate deans. Basic life support training was defined as training in cardiopulmonary resuscitation using a manikin. Uncertificated advanced life support training was defined as compulsory training in the airway-breathing-circulation approach, basic training in the use of a defibrillator, and an introduction to other cardiac rhythms and the use of drugs. Uncertificated courses lasted either half a day or one day. A certificated Resuscitation Council (UK) advanced life support course is a standardised course lasting two or three days with a pass or fail decision at the end.

Completed questionnaires were received from 23 of the 27 schools surveyed. Results were sent to the deans of all 27 medical schools. Replies were received from 10 schools, including one school that had not replied to the initial survey. The other three schools failed to respond both to postal reminders sent two months after the initial survey and to the mailings sent to the deans. The results are summarised in the table . 

	Comments

Top Method and results Comments References

The results show that most medical schools provide some form of compulsory advanced life support training. However, two (8%) of the medical schools do not provide any compulsory training, and it is possible that the three schools that failed to respond also provide no training. The extent of training in the remaining schools is variable. This indicates considerable room for improvement.

Doctors still seem to be expected to learn resuscitation skills in the clinical setting, where there is little opportunity to correct poor technique. Once students become preregistration house officers their time for training is limited, and they have no allocated study budget until after the preregistration year. Those who attend advanced life support courses usually do so in their own time and with their own money. As a result, most preregistration house officers receive from the trusts that employ them only non-standardised advanced life support revision courses lasting half a day.

Given this situation, and the fact that many junior doctors are not competent in carrying out effective cardiopulmonary resuscitation, ^{4 5} perhaps training in advanced life support should become a standardised and mandatory component of all medical school undergraduate curriculums.

A fundamental question is what training a preregistration house officer needs to be "capable of instituting" advanced life support, as specified by the Royal College of Physicians. Three schools in our survey put their students through a formal advanced life support course lasting two to three days, but there is no evidence that this is any better or worse than an informal course lasting one day or less. More work needs to be done in evaluating the right level of training for medical students. In 2001 the Resuscitation Council (UK) will launch an immediate life support course lasting one day; this may provide optimal standardised resuscitation training for medical students.

	Acknowledgments

The members of the BMA Medical Students Committee for 1998-9 were Lizz Corps (Chair), Malcolm Chambers, Georgina Burnham, Peter Hale, Simon Korn, Mike Moneypenny, Sian Stephens, Nicola Littlewood, Helen Neary, Emily Craft, Bushra Alam, Michael Urdang, Anusa Sabanathan, Parham Azarbod, Sarah Snowden, Katie Ward, Pedram Azarbod, Nick Jenkins, Joseph Foottit, Zoe Silverstone, Jennifer Campbell, Saul Rajak, Richard Graham, Keira Lindsay, Victoria McCormack, Jason Coventry, Séamus Phillips, Mark Haynes, Remy McConvey, Adele McKenna, Dan Atkinson, Mellissa Robson, Hannah Seymour, David Heylings, Rachel Lindlay, Andrew Jinks, and Gemma Hale

Contributors: PSP designed the questionnaire and collated the results. JPN wrote to post-graduate deans. Both JPN and PSP wrote the paper, and both will act as guarantors.

	Footnotes

Funding: The resources of the BMA Medical Students Committee were used to distribute and collate questionnaires.

Competing interests: JPN is chair of the Advanced Life Support Sub-committee of the Resuscitation Council (UK).

	References

Top Method and results Comments References

1.	General Medical Council. The new doctor: recommendations on general clinical training made under Section 5 of the Medical Act 1983. London: GMC, 1997.
2.	Royal College of Physicians of London. Resuscitation from cardiopulmonary arrest. J R Coll Physicians Lond 1987; 21: 175-182[Medline].
3.	Perkins GD, Hulme J, Shore HR, Bion J. Basic life support training for health care students. Resuscitation 1999; 41: 19-23[Medline]
4.	Skinner D, Camm A, Miles S. Cardiopulmonary skills of preregistration house officers. BMJ 1985; 290: 1549-1550.
5.	Casey WF. Cardiopulmonary resuscitation: a survey among junior hospital doctors. J R Soc Med 1984; 77: 921-924[Abstract].

(Accepted 17 January 2001)