The Way They Do it…: Accident and Emergency Teaching in UK Medical Schools

What are we doing in cardiopulmonary resuscitation training in Europe? An analysis of a survey

This study has analysed the status of cardiopulmonary resuscitation (CPR) training in Europe in medical schools, cities in the WHO European Healthy Cities network, and hospitals in the WHO European Health Promoting Hospitals network. Three questionnaires tested by a pilot study were sent in 1996-1997: one to medical school deans, one to the WHO Health Promoting Hospitals Network coordinators and one to the focal points of the WHO Healthy Cities Network. The glossary of terms was taken from the Utstein style guidelines. The 392 medical schools returned 168 questionnaires (43%): 167 teach CPR, 165 basic CPR, 136 advanced CPR and 114 both. The 310 hospitals returned 224 questionnaires and 202 were analysed (65%); 154 train physicians, 184 nurses and 110 nursing students. The 509 cities returned 67 questionnaires (13%); 28 train police officers and 36 fire fighters. A total of 120 institutions train paramedics and 82 lay people. The training hours in basic and advanced CPR vary between medical schools and various professional groups trained in hospitals and cities. More time is devoted to training in advanced CPR than in basic CPR and more in theory than practical training. This survey can be an important incentive for European Organisations to identify priorities in their educational efforts.

Teaching critical care in Europe: analysis of a survey

OBJECTIVE

To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe.

DATA SOURCES

Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals in each western country of the European Region of the World Health Organization and to the people responsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionnaires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article.

RESULTS

Postgraduate and undergraduate training differ widely in terms of the content of, and disciplines in charge of, the teaching of critical care. Even countries of the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic discipline of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been established in many countries. The topics in medical schools that correspond to critical care medicine do not encompass a distinct body of knowledge and are distributed among more traditional disciplines, most frequently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely between and within countries. The repetition of critical care conditions for which patients receive critical care in several disciplines, as described by the responses, leads us to wonder whether these conditions are really included in the curriculum.

CONCLUSIONS

The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.