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I recently spent three days and £600 of my study leave allowance, not including expenses, to attend an APLS (advanced paediatric life support) course. This followed an email instructing all consultants at the children's hospital where I work as a consultant anaesthetist that this was now mandatory training. After 13 years as a consultant, I thought it was time to bite the bullet and go for a refresher. I was also interested to see if the reliance placed on APLS courses as a mark of the competent practitioner was well placed. So, after completing the online, compulsory, multiple choice questionnaire (MCQ), I joined the course with 31 other fresh faced but apprehensive young colleagues all eager to pass the course and enter it on to their CVs and thus on to job applications. I was told by many that this course and other such courses were now mandatory for successful career progression. They told me that the course fee almost emptied their annual study leave budget (£600-800 (€880-1170; $1160-1550) a year) and therefore it was not possible to do more than one per year, and little else.
So, what do you get for the handsome sum of £600 kindly donated to the ALSG (advanced life support group) charity. Well, in true APLS style, let's look at the positives first. You get a course that is generally well organised, a large ring binder folder containing a 380 page manual (thrilling reading, although not with new guidelines), a large faculty of APLS enthusiasts, lots of didactic lectures and workshops reinforcing the message, and the opportunity to be examined (and embarrassed). Some sessions were enjoyable, such as the basic life support training and some of the trauma management teaching—things I don't do on a regular basis.
What about the negatives? The workshops were mixed. Some were well led, but others involved simplistic activities to identify symptoms and signs from a plastic envelope and others involved role play. The days were long, and I had the feeling at times that I was in a strange religious cult, all of us trapped until we finally submitted to the will of the APLS movement and embraced the teaching. Many “advanced skills” were taught on plastic manikins—so proper intubation technique was not possible. Many other techniques, such as cricothyrotomy, needle thoracentesis, and femoral line insertion, were demonstrated using adult equipment. The scenarios were set by the faculty, and individuals were put on the spot. The course ends with testing of all the participants in scenarios and MCQs. Failure to pass either of these results in the need to resit either immediately or at a later date. This is extremely stressful for participants who desperately need this qualification on their résumé. I had to wonder if all the testing was really necessary. It took away any enjoyment and gave many the impression that failure to adhere strictly to the protocols would have dire effects, which is, of course, rubbish (after all, the protocols change every few years). Passing implied competence and failing, incompetence.
So did I benefit from the experience? It was nice to feel like a trainee again and experience the camaraderie of the exam-sitting fraternity and . . . I passed! I am, therefore, an APLS provider (for four years, anyway; then I must renew the qualification). Or am I? In the same folder with my little provider card is a Disclaimer issued by the ALSG. This states that although I have successfully passed the course, the certificate “does not constitute a certificate of competence.” What?! It also states: “Employers are themselves directly responsible for establishing that their staff have the capabilities requisite to their clinical setting . . . Accordingly, they must not rely to any extent on the holding by an individual of a certificate of qualification.” This I agree with. It is the employer's responsibility to ensure that all staff are properly trained in resuscitation, and not just the few sent on these courses.
These courses are expensive and must make a healthy surplus. Also, we mustn't forget about the participant's expenses and any locum payments that trusts may have to cover during this leave.
So, is the reliance on these courses well placed? Nothing is taught on APLS that could not be taught at base hospitals. Basic life support and cardiac arrest training can be, and should be, part of all doctors' annual mandatory training and should be provided by resuscitation departments at no cost to either the individual or the study leave budget. Experienced staff in the operating theatre, the intensive care unit, and elsewhere in hospitals are all capable of teaching resuscitation. They may not be APLS trained, but does that really matter? We can teach the same protocols, and offer real experience of airways and intubation—an excellent confidence builder. Problems, such as status asthmaticus, that require advanced management could be provided by a well designed tutorial system for trainees in different specialties.
Let's stop emptying the study leave coffers and jump off this bandwagon. Leave the trainees with money to spend on courses that stimulate them and interest them in their base specialty. And, hey, the NHS might save a bit of dosh along the way.
Competing interests: None declared.