Chairman for the Special Advisory Committee for Acute Internal Medicine

09.12.14

Dr Mike Jones

JRCPTB

Re: MedicALS Course (Acute Medical Emergencies Course)

Dear Mike

I was at the recent AGM conference in November at the Excel Arena in London. I was teaching acute medical emergency simulations as part of the MedicALs course I teach for the Advanced Life Support Group. MedicALS exists to teach the practical procedures necessary for effective management of acute medical emergencies.MedicALSis a 3-day course comprising of a flexible one-day on-line component (VLE) and a two-day face-to-face course. The plan for the AGM conference was for us to teach 4 or 5 simulations (see examples attached). Unfortunately due to the poor performance of delegates we ended up in teaching only one simulation over and over again.

The simulation was delivered to groups of 4-5 delegates and we rotated each person so each had a turn to take the lead role but we also ensure that we included all members in the discussion. It was very interactive but very instructor resource intensive. The length of the time allocated to the simulation was 30 minutes and the aim was for each group to perform an initial rapid A to E assessment and then progressed to a secondary assessment which would include a focussed examination, interpretation of results and then formulation of a management plan.

The performance of candidates was so poor that we only got as far as the A to E assessment and never got to the secondary assessment, interpretation of results and formulating a management plan. In many cases we only got as far as ‘C’ and in a significant proportion we only got as far as ‘A’. This confirmed to me that there is a serious issue in the ability of doctors to manage acute medical emergencies. The delegates struggled in performing a structured assessment and delivering a management plan. The delegates were of all levels from junior doctors i.e. FY1 through to hospital consultants and GPs. It was not possible to discriminate the level of the delegate based on their performance as the majority of delegates performed to consistent level, which I am afraid was poor. It confirmed to me that doctors of all levels desperately need training in acute medical emergencies simulations as they lack the knowledge and skills.

At the AGM conference apart from performing simulation teaching we also provided practical skills sessions on Seldingercentral venous line cannulation and Seldinger chest drain insertion both under ultrasound guidance. We also provided access to parts of the interactive virtual learning environment (VLE) on acute medical emergencies with 4 laptop computer terminals. The sessions were over 2 days and the feedback was very good (see attached).

One of my aims for SAM was for us to produce a series of educational courses for our members. These included:

Management course
Acute Medical Emergencies (AME)
SCE revision course

So far we have succeeded with the SCE revision course and it has been successful. We have a framework for the management course but the delivery of this will great deal of work, support and collaboration from others. With respect to the AME course if was to sit down and write one from scrap I believe that it would be almost identical to the MedicALS course. I have mapped the MedicALS course to our AIM curriculum (see Attached). As you can see it maps well to all of the 4 Emergency Presentations, all of the Top Presentations and many of the Common Competencies.

I know that I proposed SAM supporting the MedicALS course previously but there were concerns re preferentially supporting one course over another and also concerns re the commercial aspect. In view of my recent experience at the AGM conference and the fact that trainees have less clinical exposure in their day to day work; simulation exposure is vital to ensure that they develop the knowledge and skills they require.

MedicALS is run by ALSG which is a charitable organisation (i.e. not for profit) and therefore I do not think that there is an issue with the commercial aspects. I think that SAM should support and recommend the MedicALS. I also feel that the SAC for AIM should recommend it for AIM trainees. I gather that the SAC recommends IMPACT. I have instructed on IMPACT was a member of their writing group and have been a course director, however, I firmly believe that MedicALS is a superior course and more akin to the needs of our acute internal medicine trainees.

Where do I feel that MedicALS should fit in with training?

ALERT Medical Students

ALSStart of FY1

IMPACTFY2

MedicALSCMT2/ACCS3/Start of ST3

MedicALS has been running for more than 10 years. MedicALSis a 3-day course comprising of a flexible one-day on-line component (VLE) and a two-day face-to-face course (see attached factsheet). The 2-day course consists of two introductory lectures, after which the remaining 2 days of the course is taught through simulations (see attached programme) and finally ended with a simulation test.

Courses are run regularly at:

Manchester
Holland
Sweden

The total number of candidates trained so far throughout the three centres is 1351.

Other areas where courses have been run:

West Midlands
Republic of Ireland

Longterm plan for the course

I would suggest that it is initially recommended but once we get a critical mass of instructors (this will be quite easily as it would be expected that many of the ST3 trainees will achieve instructors potential) we consider it to be essential for all AIM trainees. I also think it would be essential for GIM trainees but not sure about pursuing that but would it have it as recommended for them as well. ALSG do not have a problem with running courses in other regions with support.

I hope that this letter explains my thoughts clearly. I am happy to clarify and other points.

I have in enclosed:

MedicALS factsheet
MedicALS 2-day programme
Example simulations
Feedback from the AGM conference
Mapping of the MedicALS course to the AIM curriculum
Promotional video:
Password: alsg2014

Yours sincerely

Philip Dyer