Resuscitation needed for the curriculum?

Resuscitation needed for the curriculum?The paper by Skinner, Camm, and Miles in this issue on the calibre of resuscitation skills found among preregistration house officers at one ofour premier teaching hospitals should provide some thought and some activity from the designers of the medical schools' curriculum (p 1549).The investigators found that a mere 55% of their preregistration house officers could perform the techniques of basic life support: clearance and maintenance of the airway, artificial ventilation by the mouth to mouth method, and external compression of the chest.Theirs is not an isolated finding.Casey found even poorer standards in a comparable group of doctors at Cambridge,' and in 1981 Lowenstein and his colleagues reported that junior residents in a big centre in the United States had similarly ineffective capabilities.2Nor are our young doctors proficient at advanced life support skills, where one might suppose they would come into their own.Skinner et al show that only one in three could pass an endotracheal tube-and that they took an inordinately long time about it.None would have passed the American Heart Association's advanced cardiac life support examination.Clearly, then, the standards of resuscitation performance among the junior medical staff in Britain leave a lot of room for improvement.Since the general educational standard of our graduates is extremely high in other respects, the fault must surely lie in medical schools not placing sufficient emphasis on this subject.A survey by questionnaire sent to 30 medical schools in Britain by Smith and Hill from the Southampton Anaesthetic Department produced 18 replies (personal communication).Of these, two thirds offered some training in first aid, but the course was compulsory in only two.All schools claimed to offer training in resuscitation, but the course was compulsory in only eight, and the students' knowledge and ability were assessed in only four centres.Most schools did not offer any training at all until the student was well into the clinical years.