New initiative to improve undergraduate teaching in acute care

Many trainee doctors in the United Kingdom do not know enough about acute care. Rhona MacDonald finds out more about an initiative that aims to change that and outlines how you can get involved

The recently launched Acute Care Undergraduate Teaching (ACUTE) project aims to develop recommendations for a national curriculum for healthcare students to promote teaching in the safe care of acutely ill patients, including cardiopulmonary resuscitation. It has the formal support of the UK Resuscitation Council and the Intercollegiate Board for Training in Intensive Care Medicine and has an advisory group of many stakeholder organisations including the deans of medical schools, and the National Patient Safety Agency. Although the proposal is primarily directed at medical undergraduates, many components of the core curriculum are also relevant to the training of nurses, dentists, and physiotherapists.

Gavin Perkins, project coordinator and specialist registrar in critical care medicine, explains why this initiative is needed: "The care of the acutely ill patient in hospital is often suboptimal. This is frequently due to a failure to provide simple aspects of acute care--those involving the patient's airway, breathing and circulation, oxygen therapy, fluid balance and monitoring." He continues: "The ability to recognise that a patient is at risk of critical illness, combined with the skills and knowledge to manage these patients until senior assistance arrives, is an essential prerequisite for the transition from medical student to doctor." Yet despite this, the proposal (www.resus.org.uk/acute/Overview.pdf) states that resuscitation and critical care medicine are poorly represented in the undergraduate curriculum and many trainee doctors don't know enough about acute care. In addition, UK medical schools have only recently managed to deliver universal training in basic life support. Anecdotally, the 150 emails I received agreeing with Nicola Cooper's article "Medicine did not teach me what I really needed to know" emphasises the need for more teaching in acute care.¹

The first step of the initiative is a modified Delphi survey. Participants can suggest through a website (www.resus.org.uk/acute/welcome.htm) up to 10 items around knowledge, skills, and attitudes related to the safe care of the acutely ill or arrested patient that they consider the most important to include in the undergraduate curriculum. They can also state at what stage of the curriculum they consider these elements should be included and can suggest the best way of teaching these elements. The survey will close at the end of 2004.

Consultant anaesthetist and member of the initiative's steering group Jerry Nolan says: "We want to hear from anyone who has ideas on what aspects of resuscitation and care of the acutely ill patient should be taught to medical undergraduates. This will include, but is not restricted to, doctors and nurses of all disciplines, medical students, undergraduate teachers, and resuscitation officers. We intend to compile a set of core competencies (attitudes, skills, or knowledge). We certainly welcome relevant anecdote, but where possible we will translate this into competencies. Anecdotes on the same theme from several individuals will indicate areas we need to consider carefully." He continues: "We will be treating all responses equally, irrespective of who they are from."

SCOTT TOMPKINSON/SPL

The next step is to form a nominal expert group from within the steering committee to produce the first draft of the curriculum, and then to post it on the website for consultation. Jerry Nolan explains further: "The expert group will be responsible for distilling the comments and opinions from all contributors. The output from the expert group will then be posted on the website, enabling further input from all the contributors--this will then shape the final product." The first draft will be reposted on the website in the autumn.

Meanwhile, the group will review the literature of best practice in teaching acute care skills, the content of existing acute care courses (such as ALERT, Immediate Life Support, and Advanced Life Support) and comments from the Delphi survey to come up with the best way of integrating the proposals into the undergraduate curriculum. The group then plans to publish the new acute care curriculum at the end of this year and circulate it to the undergraduate deans, along with their review of teaching materials and examples of good practice.

Chris Smith, an intercalating medical student at Birmingham University and a member of the initiative's advisory group, said, "The very nature of acute medicine means that teaching understandably comes second to caring for patients. Hopefully, this scheme will highlight the importance of providing good teaching to medical students and will help equip students with the necessary skills to practise modern day emergency care with confidence."

Gavin Perkins adds: "We hope that through the ACUTE initiative we will improve patient care by developing recommendations for a national curriculum for resuscitation and care of the acutely ill patient."

1. Cooper N. Medicine did not teach me what I really needed to know. BMJ 2003;327(suppl):S190.