All doctors will eventually experience a medical emergency. Complex, important decisions are required urgently, often with inadequate information. To manage an emergency well, a clinician needs both technical competence (medical knowledge, procedural skill), and the so-called ‘soft’ skills (communication, leadership and decision-making).
These skills are teachable. Doctors in acute-care specialties have focused training on management of medical emergencies and have more frequent exposure, resulting in greater confidence and competence in those situations. Doctors in other specialties may receive minimal or no such training.
Current training is often hospital-focused and can be rigid in structure and content. However, a spectrum of needs should be recognised. A general practitioner in the Kimberley has very different needs to a Perth teaching hospital registrar. Furthermore, maintenance of professional standards is now under detailed scrutiny, recognising the need for lifelong learning. Evidence-based medicine is required to ensure patient safety, so appropriate training in emergency management is a pressing need.
Adult learners have specific needs in acquiring new knowledge and skills. Existing knowledge must be recognised to get the best out of the learner. Content must align with adult learning goals and be presented in a manner relevant to the learner, fostering autonomy in developing durable knowledge and skills. The focus for adult learning should be practical and problem-centred and should relate to the learners’ professional lives.
As with other professions, doctors benefit from multidisciplinary and multimodal teaching environments, providing perspectives from all members of the healthcare team. Diversity enhances problem solving and improves decision making. It helps develop communication skills, with a positive impact on adaptability, teamworking and patient safety.
Given this background, we must examine whether the educational opportunities available meet doctors needs and societal expectations. Medical schools have advocated for inclusion of the Australian Resuscitation Council (ARC) accredited Advanced Life Support 1 (ALS1) course into their curricula. ALS1 provides expertise beyond Basic Life Support, including the skills to recognise and intervene in clinical deterioration, and in-hospital cardiac arrest management.
The ARC also provides the more advanced ALS2 course. ALS2 providers can lead a cardiac arrest team, can deal with special circumstances (e.g. pregnancy), and consider post-resuscitation care and end-of-life decision-making. Standardised ALS1 and ALS2 training is available in WA from various providers listed on the ARC website.
The ALS courses focus on in-hospital deterioration and provide an excellent, standardised and evidence-based approach. Among doctors, ALS1 and ALS2 are the most popular training choice. Many other standardised courses (e.g. Advanced Paediatric Life Support and Emergency Management of Severe Trauma) all have an important role in training. Some colleges require these qualifications for specialist training.
For non-specialist healthcare providers and others in first-responder settings, there are a variety of ‘off the shelf’ courses in first aid and basic life support, generally delivered by TAFE and RTO providers.
Despite the assortment of courses on offer, some difficulties are apparent. Most courses are structured without the ability to modify the teaching to suit the audience. However, doctors work in a variety of nuanced settings, with major differences in location, populations, resources and backup.
In order to meet proscribed training standards, a medical practitioner may not receive training that is actually relevant or tailored to their needs. As previously discussed, adult learning is predicated on the relevance and applicability of content to the learners’ actual role.
Regional health services deserve special consideration. Limited access to training presents a particular challenge, with demand currently outstripping supply. Most courses provide certification for a limited time only, so clinicians subject to mandatory recertification must often travel to metropolitan centres, which is costly and places demand upon stretched regional services. The delivery of regional courses should be considered by existing public and commercial providers, tailored to local circumstance.
Although multiple providers are delivering high-quality training in WA, the environment could be enhanced by introducing modifiable content into existing courses.
The delivery of a bespoke educational offering, co-designed for the target audience, is a necessity moving forward. This will align education with adult learning requirements, improving learning outcomes. Tailored education caters for diverse learning styles, provides relevant content, and allows the flexibility, inclusivity and scalable education that medical practitioners need. This can be achieved with existing expertise but requires a change in education mindset.
Key messages
- Emergency skills are necessary and teachable
- Current courses while very useful can be rigid
- Bespoke offerings focusing on the needs of target audience are needed.
Author competing interests – nil