Cardiopulmonary resuscitation training: the need for continued education and training

Introduction

Cardiopulmonary resuscitation (CPR) has a poor survival rate that may in part be due to flawed technique and training [1]. Recent recommendations for education and training have been issued for staff with responsibility for resuscitating patients [2]. These include 'staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles', and 'cardiopulmonary arrest should be managed according to national guidelines'. The use of human patient simulators has become increasingly common in medical education [3]. Their use for exposing staff to high-risk complex clinical situations such as CPR is advocated by the department of health [4].

Aims and methods

The aim of this study was to assess the resuscitation skills of all trainee junior doctors rotating through a 20-bed adult critical care unit (ITU/HDU) against current UK advanced life support (ALS) guidelines. Over an 18-month period, trainees underwent a compulsory CPR competency assessment by simulation testing, observed by two experienced ALS instructors following a refresher seminar. The trainees were assessed on basic life support (BLS), defibrillator safety and ALS skills in a scenario-based format. Only candidates who passed each section were assessed on the next. All trainees were active members of the hospital cardiac arrest teams.

Results

During the study period 32 trainees were assessed, of which 25/32 (78%) held a valid ALS certificate. BLS testing was inadequate in 2/32 (6%). Safety of defibrillation was failed by 7/30 (23%) of trainees. A full CPR scenario was given to 23 trainees. Of these 7/23 (30%) failed the scenario. Of the group as a whole 16/32 (50%) required further training and re-testing. Of those candidates who held a valid ALS certificate 10/25 (40%) failed the competency based assessment and required further training and re-testing.

Conclusions

Junior medical staff require regular scenario-based CPR training. This study demonstrates that skills acquired during life support training are not retained and regular competency-based assessment is required irrespective of previous resuscitation training. Repeated scenario-based competency assessments should be a compulsory requirement of all trainee posts.