SMJ 2002: 47(6) 127
Roger J White, CCrISP™ Course Director, Crosshouse
Hospital.
Consultant
in Anaesthesia and Intensive Care and Honorary Clinical Senior Lecturer
University of Glasgow, Department of Anaesthesia, Crosshouse Hospital,
Kilmarnock, Ayrshire, KA2 0BE
(roger.white@aaaht.scot.nhs.uk)
Magnus
A Garrioch, IMPACT© Programme Director, Royal College of Physicians
and Surgeons of Glasgow.
Consultant in Anaesthesia and Intensive Care and Part time Senior Lecturer University of Glasgow, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF. magnus.garrioch@virgin.net
Concern has been raised that the standard of acute or
critical care medicine practised by junior doctors is not as good as it could be
(1
)
(2)
We wish to
highlight two initiatives aimed at addressing
this issue currently underway in Scotland and the rest of the U.K.
It is common to have patients referred to Intensive
Care who have been critically ill for some time. Uncertainty about initial
management of the critically ill and failure to recognise advancing critical
illness means that patients who could benefit from early ICU intervention are
often referred late. This problem is exacerbated by the natural reticence of
trainee doctors to seek advice from their seniors. “CCrISP™” and “IMPACT©”
courses aim to tackle these problems.
The first Care of the
Critically Ill Surgical Patient (CCrISP™) course, under directorship of Mr
Iain D Anderson, Hillsborough Tutor at the Royal College of Surgeons of England,
took place in Jan 1996. CCrISP™
commenced in Scotland at Crosshouse Hospital, Kilmarnock in November 2000 with a
follow on course at the Southern General Hospital, Glasgow in May 2001. CCrISP™
is aimed at the Basic Surgical Trainee (years two and three) and is designed to
help them develop their knowledge and skills, so that they can manage the ill
surgical patient safely, timeously and effectively within the surgical unit.
There have now been 132 CCrISP™ courses at 28 centres run in the United
Kingdom (June 2002) and a total of 2112 surgical trainees have completed the
course. The course is now also running in Australia, Hong Kong and, most
recently, in the Republic of Ireland.
IMPACT© – (Ill Medical Patients,’
Acute Care and Treatment) is very similar to CCrISP™ but
is designed to address the educational needs of first or second year SHO’s in
General Medicine when faced with a critically ill patient. IMPACT©
is a new collaborative initiative endorsed by the Federation of the Royal
Colleges of Physicians. Two pilot courses have been held at the Royal College of
Physicians and Surgeons of Glasgow in October 2001 and February 2002. Further
development of the course involving the Royal Colleges of Physicians of
Edinburgh, London and the Royal College of Anaesthetists in addition to the
Glasgow College is now progressing.
The
educational format of both courses is influenced by the principles established
by the Advanced Trauma Life Support (ATLS®) course of the American
College of Surgeons
(3)
. Trainees are provided with a structured and systematic approach to
prioritising the care of the critically ill patient. Recognition and management
of life threatening conditions, full assessment of the patient, including the
results and observations, formulation of a management plan and communication
with the people necessary to implement the plan are all taught. Experienced
consultants or senior specialist registrars who have documented training and
teaching skills teach a full 2 day programme on each course.
Both
medical and surgical trainees rarely suffer from a lack of knowledge but CCrISP™
and IMPACT© improve confidence by providing a structure for
effective management plans. Each course has a series of short lectures
complemented by practical skill teaching “stations” such as insertion of
chest drains, setting up and interpretation of invasive monitoring and
arrhythmias. Due to anecdotal evidence that doctors could benefit from formal
training in communication and the breaking of bad news, both courses have
sessions on these topics. Feedback to the instructors suggests that this
training in communication is one of the most valuable (and enjoyable) parts of
the course.
The
final and concluding session of both courses consists of the simulated
management of a case scenario. Resuscitation and communication skills are
integrated and assessed. Feedback from candidates is actively encouraged for
every component of both courses. This feedback has been, and continues to be,
overwhelmingly positive.
There is no doubt that CCrISP™ is making a major
contribution to surgical training. With continued development, IMPACT©
should become a major adjunct to increasing the trainee physician’s equivalent
proficiency. Critically ill patients are intimidating and have not been well
looked after in the past. Courses like CCrISP™ and IMPACT© allow
the opportunity to improve the care of the sickest patients.
Reference
List
(1)
Smith GB, Poplett N. Knowledge of
aspects of acute care in trainee doctors. Postgraduate Medical Journal 2002;
78:335-338.
(2)
McQuillan P, Pilkington S, Allan A,
Taylor B, Short A, Morgan G et al. Confidential inquiry into quality of care
before admission to intensive care. British Medical Journal 1998; 316:1853-1858.
(3)
American College of Surgeons.
Advanced Trauma Life Support for Doctors. (ATLS) Instructor Course Manual.
Chicago: 1997.