Knowledge of aspects of acute care in trainee doctors

Deficiencies in trainees' knowledge, skills, and attitudes have the potential to influence the initial assessment, treatment, and outcome of acutely ill ward patients. Knowledge of basic aspects of acute care were assessed among a group of 185 trainee doctors at six hospitals. Many were unaware of the signs of total airway obstruction, confusing them with those of partial obstruction (pre-registration house officers (PRHOs) 11%, senior house officers (SHOs) 14%) or apnoea (PRHOs 47%, SHOs 26%). Knowledge about the use of non-rebreathing oxygen masks was poor; 23% of trainees could not describe the purpose of the reservoir bag or gave answers that were unclear or incorrect. Seven trainees thought that it was involved in humidification, or carbon dioxide collection or removal. Seventeen per cent of trainees could not quote the maximum deliverable inspired oxygen concentration provided by these masks or gave values below the normal range. Thirty one per cent of trainees thought that the lower end of the normal range for pulse oximetry (S(p)O(2)) was below 95%; nine (5%) believed it to be below 90%. There was also poor knowledge of the factors influencing the function of a pulse oximeter. Similar deficits in knowledge and understanding existed in relation to the normal capillary refill time, minimum hourly urine output, the use of the AVPU scale and the role of blood glucose testing in unconscious adults. Only 22% of PRHOs and 21% of SHOs identified the correct percentage hospital survival for patients who suffer an in-hospital cardiac arrest. Knowledge of aspects of consent was unsatisfactory. It is recommended that all medical schools urgently incorporate training about common aspects of "generic" acute care in their curricula.