- Email: [email protected]
EXPERIENCES OF MEDICAL STUDENTS IN CARDIOPULMONARY RESUSCITATION
1113 stated
on
the malformation notifications. Rates
were
derived from
comparison with the number of total births (live and still) registered in England and Wales to fathers in the respective occupations, but the results are presented as ratios due to under-reporting of occupations at malformation notificationsThe results are shown in the table. Malformation ratios for facial clefts were consistently high. "Gardeners and groundsmen" (005) showed increased ratios for spina bifida, anencephaly, and facial clefts, and "agricultural workers" for spina bifida and facial clefts. The difficulty in the interpretation of occupational analysis from this data base is discussed elsewherebut it is believed that such consistent excess ratios for clefts in particular requires explanation. The process of self-selection into occupation is by itself unlikely to lead to a genetic predisposition sufficient to explain the ratios for clefts in all the units studied. Also those classified in these units would have varying exposure to many agents besides phenoxyacids and related
resuscitation (see table). 76 students (89%) replied. They had a mean of 5 -5of the seven procedures, the range being 1 to 7, with one-third having a full score. Only about one-fifth had a score of 4 or less. Participation in CPR and the performance of cardiac massage had a high score by the first medical clerkship, while exposure to more advanced procedures naturally increased as the clinical course proceeded. Only about half the students had used a breathing bag, and this was usually outside teaching sessions (table). Perhaps this was because the breathing bag is routinely used mainly by specially trained personnel. No more than two-thirds of them had placed an endotracheal tube-again, probably, because in real-life emergencies intubation must be done by the best qualified person present.
score
SEVENTY-SIX MEDICAL STUDENTS’ EXPOSURE TO CPR AND ACLS PROCEDURES
compounds. Medical Department, South West Thames RHA and Department of Clinical Epidemiology, St George’s Hospital Medical School, London SW17 0RE
R. BALARAJAN
Medical Statistics Division, Office of Population Censuses and London WC2
M. MCDOWALL
Surveys,
EXPERIENCES OF MEDICAL STUDENTS IN CARDIOPULMONARY RESUSCITATION i
than 40% of patients with ventricular fibrillation can be resuscitated by the prompt actions of well-trained lay people.5 The results for hospital patients have been a bit better.6 However, doctors are not always well trained in cardiopulmonary resuscitation (CPR)7-IO and training of medical students in emergency medicine has also been judged
SIR,-Outside hospital
unsatisfactory. 11I
Standards for CPR and for emergency cardiac care (or advanced cardiac life support, ACLS) have been laid down, with recommendations on training, testing, and supervision of medical personnel, including nurses and medical students.6 Basic life support and CPR can be taught to laypeople, while training in ACLS could be reserved for doctors.6,7 The present study considers students’ experiences with CPR and ACLS in medical school and in their work as stand-ins for interns. We have especially inquired into the students’ activities outside the programmed lessons and courses. The collected data provide insight into the students’ acquisition of the necessary skills and may thus give a fair estimate of newly graduated physicians’ qualifications to handle a resuscitation. In Bergen first-year medical students have a first-aid and CPR course* followed by lessons on CPR and ACLS during clerkships in the first and third years of the clinical course. They have one hour of supervised training with a recording resuscitation manikin. The defibrillator is demonstrated. During clerkships in anaesthesiology students are shown ACLS equipment and taught how to place an endotracheal tube, also on models. The chance to assist in a real clinical emergency during clerkships is incidental. We sent a questionnaire to 85 students in their last year of medical school asking them about their instruction in and experience of 4 Office of Population Census and Surveys OPCS Monitor MB3/82/1. 5. Lund I, Skulberg A Cardiopulmonary resuscitation by lay people. Lancet 1976; ii: 702-04 6 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1980, 244: 453-509. 7 Schwartz AJ, Jones DR, Ellison N. CPR training. J Med Educ 1981, 56: 878-79. 8 Nelson M A first aid and CPR course for first-year medical students. Med Educ 1982; 16: 7-11. 9. Lowenstein S, Hansbrough J, Libby L, Hill D, Mountain R, Scoggin C.
Cardiopulmonary resuscitation by medical
i
i
*(A) Percentage of students exposed to the procedure before graduating. (B) Percentage of students first exposed to the procedure during clerkships and thereafter with exposure
in
clinical
situations
(C) Percentage of students exposed outside study situations. (D) Percentage of students exposed exclusively outside study
situations.
Our observations support the view6,7,12 that medical students should be well trained in CPR and ACLS. Clearly, in Bergen medical students are often exposed to emergencies where practical skills in resuscitation are needed. The group we questioned seemed reasonably well instructed in resuscitation practices. However, individual competence cannot be assessed in real-life situations so, though we know how often students had witnessed or participated in CPR and ACLS, we have no guarantee that the necessary skills had been acquired.9>I However, the important thing is to recognise, as we have tried to, that medical students should be considered as a subgroup of the lay population which is frequently exposed to cardiac arrest victims and that, as physicians in training, they are in a suitable setting for training in CPR and related skills. Medical
Department B, Hospital, University of Bergen, Bergen, Norway Haukeland University
S. HUNSKAAR S. H. SEIM
JUVENILE DIABETES AND SOCIAL CLASS SIR,-A Lancet editorial* has discussed the evidence for and against an increased incidence of type i diabetes mellitus in children of families in higher income groups studied in North America and Denmark. A British study revealed no relation between socioeconomic group and incidence of type i diabetes, but the patients were all at least 18 years old.l In 1981 as part of a larger study, the social class of sixty-two families in Southampton health district was determined according to the Registrar General’s classification. The mean age of the index
and surgical house officers Lancet 1981; 12.
ii. 679-81. 10 Webb
i
more
DD, Lambrew CT. Evaluation of house officer resuscitation. Circulation 1977; 56 (suppl 3): 111-15.
skills in
cardiopulmonary
11 Nelson M. Evaluation of CPR performance among medical students, residents and attendings at the Mount Sinai School of Medicine. Mt Sinai J Med 1981; 48: 89-94.
G CPR training for physicians. N Engl J Med 1980, 303: Dalen J, Howe J, Membrino
455-57. Editorial Diabetes mellitus and socioeconomics class. Lancet 1982, ii 530 2 Barker DJP, Gardner MJ, Power C. Incidence of diabetes amongst people aged 18-50 years in nine British towns: a collaborative study Diabetologia 1982, 22: 421-25. 1
on
the malformation notifications. Rates
were
derived from
comparison with the number of total births (live and still) registered in England and Wales to fathers in the respective occupations, but the results are presented as ratios due to under-reporting of occupations at malformation notificationsThe results are shown in the table. Malformation ratios for facial clefts were consistently high. "Gardeners and groundsmen" (005) showed increased ratios for spina bifida, anencephaly, and facial clefts, and "agricultural workers" for spina bifida and facial clefts. The difficulty in the interpretation of occupational analysis from this data base is discussed elsewherebut it is believed that such consistent excess ratios for clefts in particular requires explanation. The process of self-selection into occupation is by itself unlikely to lead to a genetic predisposition sufficient to explain the ratios for clefts in all the units studied. Also those classified in these units would have varying exposure to many agents besides phenoxyacids and related
resuscitation (see table). 76 students (89%) replied. They had a mean of 5 -5of the seven procedures, the range being 1 to 7, with one-third having a full score. Only about one-fifth had a score of 4 or less. Participation in CPR and the performance of cardiac massage had a high score by the first medical clerkship, while exposure to more advanced procedures naturally increased as the clinical course proceeded. Only about half the students had used a breathing bag, and this was usually outside teaching sessions (table). Perhaps this was because the breathing bag is routinely used mainly by specially trained personnel. No more than two-thirds of them had placed an endotracheal tube-again, probably, because in real-life emergencies intubation must be done by the best qualified person present.
score
SEVENTY-SIX MEDICAL STUDENTS’ EXPOSURE TO CPR AND ACLS PROCEDURES
compounds. Medical Department, South West Thames RHA and Department of Clinical Epidemiology, St George’s Hospital Medical School, London SW17 0RE
R. BALARAJAN
Medical Statistics Division, Office of Population Censuses and London WC2
M. MCDOWALL
Surveys,
EXPERIENCES OF MEDICAL STUDENTS IN CARDIOPULMONARY RESUSCITATION i
than 40% of patients with ventricular fibrillation can be resuscitated by the prompt actions of well-trained lay people.5 The results for hospital patients have been a bit better.6 However, doctors are not always well trained in cardiopulmonary resuscitation (CPR)7-IO and training of medical students in emergency medicine has also been judged
SIR,-Outside hospital
unsatisfactory. 11I
Standards for CPR and for emergency cardiac care (or advanced cardiac life support, ACLS) have been laid down, with recommendations on training, testing, and supervision of medical personnel, including nurses and medical students.6 Basic life support and CPR can be taught to laypeople, while training in ACLS could be reserved for doctors.6,7 The present study considers students’ experiences with CPR and ACLS in medical school and in their work as stand-ins for interns. We have especially inquired into the students’ activities outside the programmed lessons and courses. The collected data provide insight into the students’ acquisition of the necessary skills and may thus give a fair estimate of newly graduated physicians’ qualifications to handle a resuscitation. In Bergen first-year medical students have a first-aid and CPR course* followed by lessons on CPR and ACLS during clerkships in the first and third years of the clinical course. They have one hour of supervised training with a recording resuscitation manikin. The defibrillator is demonstrated. During clerkships in anaesthesiology students are shown ACLS equipment and taught how to place an endotracheal tube, also on models. The chance to assist in a real clinical emergency during clerkships is incidental. We sent a questionnaire to 85 students in their last year of medical school asking them about their instruction in and experience of 4 Office of Population Census and Surveys OPCS Monitor MB3/82/1. 5. Lund I, Skulberg A Cardiopulmonary resuscitation by lay people. Lancet 1976; ii: 702-04 6 Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1980, 244: 453-509. 7 Schwartz AJ, Jones DR, Ellison N. CPR training. J Med Educ 1981, 56: 878-79. 8 Nelson M A first aid and CPR course for first-year medical students. Med Educ 1982; 16: 7-11. 9. Lowenstein S, Hansbrough J, Libby L, Hill D, Mountain R, Scoggin C.
Cardiopulmonary resuscitation by medical
i
i
*(A) Percentage of students exposed to the procedure before graduating. (B) Percentage of students first exposed to the procedure during clerkships and thereafter with exposure
in
clinical
situations
(C) Percentage of students exposed outside study situations. (D) Percentage of students exposed exclusively outside study
situations.
Our observations support the view6,7,12 that medical students should be well trained in CPR and ACLS. Clearly, in Bergen medical students are often exposed to emergencies where practical skills in resuscitation are needed. The group we questioned seemed reasonably well instructed in resuscitation practices. However, individual competence cannot be assessed in real-life situations so, though we know how often students had witnessed or participated in CPR and ACLS, we have no guarantee that the necessary skills had been acquired.9>I However, the important thing is to recognise, as we have tried to, that medical students should be considered as a subgroup of the lay population which is frequently exposed to cardiac arrest victims and that, as physicians in training, they are in a suitable setting for training in CPR and related skills. Medical
Department B, Hospital, University of Bergen, Bergen, Norway Haukeland University
S. HUNSKAAR S. H. SEIM
JUVENILE DIABETES AND SOCIAL CLASS SIR,-A Lancet editorial* has discussed the evidence for and against an increased incidence of type i diabetes mellitus in children of families in higher income groups studied in North America and Denmark. A British study revealed no relation between socioeconomic group and incidence of type i diabetes, but the patients were all at least 18 years old.l In 1981 as part of a larger study, the social class of sixty-two families in Southampton health district was determined according to the Registrar General’s classification. The mean age of the index
and surgical house officers Lancet 1981; 12.
ii. 679-81. 10 Webb
i
more
DD, Lambrew CT. Evaluation of house officer resuscitation. Circulation 1977; 56 (suppl 3): 111-15.
skills in
cardiopulmonary
11 Nelson M. Evaluation of CPR performance among medical students, residents and attendings at the Mount Sinai School of Medicine. Mt Sinai J Med 1981; 48: 89-94.
G CPR training for physicians. N Engl J Med 1980, 303: Dalen J, Howe J, Membrino
455-57. Editorial Diabetes mellitus and socioeconomics class. Lancet 1982, ii 530 2 Barker DJP, Gardner MJ, Power C. Incidence of diabetes amongst people aged 18-50 years in nine British towns: a collaborative study Diabetologia 1982, 22: 421-25. 1