If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Six months ago I decided to go for ALS (Advanced Life Support) certification. Why would a GP who hasn’t worked in acute medicine for more than 20 years do this, you might wonder? Because a series of events had led me to decide that I needed to improve my confidence in dealing with emergencies.
First, a man from my running club suffered a myocardial infarction at parkrun one Saturday morning last October. Then, on a very cold afternoon in January, a lady in her forties with a known cardiomyopathy collapsed at the finish line of a cross country event I was running. Finally, a man was knocked off his motorbike near my daughter’s friend’s house when we happened to be passing.
I was becoming a magnet for medical emergencies, and in each situation I was expected to know what to do purely by virtue of the fact that I am a doctor, albeit a general practitioner who hasn’t had to deal with anything more urgent than non-specific chest pain for a very long time.
I started by Googling “ALS courses” and found the Resuscitation Council website. You used to have to attend a 2-day course, but now you can do an e-ALS, with online learning modules on all of the theory followed by a one-day intensive course. The e-learning option sounded better to me and I was pleased to find a course at my local hospital that fitted in with my day off. It isn’t cheap – £400.
Prior to the face-to-face part of the course, you receive the handbook in the post and log-in details with a link to your course. Unfortunately, it was at this point that my home internet connection gave up the ghost, but I managed to do a few modules at work and read the manual cover to cover.
The day of the course arrived (1 July) and it was the hottest day of the year so far, making it incredibly unpleasant in the hospital’s education centre. Worse, I hadn’t appreciated just how “intense” the face-to-face learning would be, or how long it would last. It involves about 12 hours of practical training to get you through the CASTest (Cardiac Arrest Simulation Test) and multiple choice question test.
Unfortunately, the e-learning had not prepared me adequately for the CASTest and when I got feedback afterwards I think the examiner’s remarks that I’d looked like a “rabbit in the headlights” were an understatement. I was completely terrified. All but one other attendee worked in hospital and had done ALS before. I felt like a fish out of water. Suffice to say, I failed my CASTest twice (you get two attempts). Somehow, however, I managed to comfortably pass the MCQs at the end of a very long, hot and tiring day. I felt physically and emotionally drained by the whole experience.
I went home feeling very demoralised and like a really rubbish doctor. Why could I not tell when a mannequin was dead or alive when everyone else could? But I picked myself up, brushed myself off and started all over again. The organiser advised me re-sit the CASTest again within four weeks – you’re allowed a third and final attempt before you have to redo the whole thing. So I watched the training video over and over and played through endless scenarios in my head. Finally, the big day came and I’m relieved to say I passed.
Would I go through it all again? I’m not sure. But since I started the training I’ve gained confidence in dealing with emergencies outside of work – and I’ve already had to deal with a further three!
Find your nearest course
yes I had a similar experience a few years ago.
Its relatively easy for medics working in acute medicine but way way harder for GPs who are out of practice with that side of things.
Unless you need it for a job its not an experience I would personally recommend. Its a lot of work, an unpleasant humiliating day and can damage your general professional self confidence for no purpose
I had the same experience but I have been working in private sector since 5 years, where the hospital administration manages to rip the doctor of all the confidence and make them think, that they are merely slaves to prescribe drug charts and be in the hospital because our signatures are authorised, other wise we are useless.
With that confidence I went, failed. Now, I need to do the whole thing again, but today, my moral is really low, even though since 6 months, I've been working in acute medicine, deal with emergencies confidently. But somehow, in front of the mannequin, I was terrified.
Doctors are expected to be proficient in everything - which is not realistic given that you specialize in General practice.
- I'm not sure if you really need ALS. A BLS/ILS course may have been enough?
I can't see a passing GP intubating and gaining IO access in the scenarios you describe. In the same way, I will defer to your much greater knowledge in primary care and minor injuries and illness.
Nice to read your account Margaret. I'm doing the 1 day face-to-face course tomorrow in Doncaster. I must have got a good deal as it's only cost me £250. Your account of what happens has scarred me senseless. Oh well nothing I can do about it now. However at least I know I can have 2 attempts... Thanks for that info
Definitely not an experience i wish to go through again, though it has increased my confidence now, but when i was doing the course i felt like a rubbish doctor like you rightly said. Thank God i managed to pass the CASTest after the second attempt but i have to resit the MCQ part... I have been away from clinical practice for a while, now planning to go back, that is why i decided to do
the course. Thanks for sharing your experience, shows I am not alone.
To be honest, any doctor ought to be able to pass ALS, which is a fairly basic resuscitation course. I don't think it's unreasonable that the general public, and other doctors for that matter, would expect a GP to be able to manage an acutely unwell patient to these relatively simple standards.
My favourite comment is 'Doctors are expected to be proficient in everything - which is not realistic given that you specialize in General practice'. I'm assuming the irony is on purpose, what with GENERAL practice being the one specialism where you are meant to be at least proficient in everything, albeit not a genuine specialist in any of them.
Why is it again that the government pay GPs more than any hospital specialism, and seem to laud them at the drop of the hat despite them being vastly less qualified and competent in the most basic skills of medicine? It's ALS for god's sake. I've seen healthcare assistants pass it comfortably.
ADDED BY A READER...
I WOULD BE INTERESTED IN KNOWING YOUR BACKGROUND AND WHAT YOU BASE YOUR BIZARRE BELEIFS ON. YOU'RE HUGELY MISTAKEN IN YOUR STATEMENT THAT HCAS PASS ALS AS THEY ONLY UNDERTAKE BLS, FOR THE OBVIOUS REASON THAT THEY WOULD NEVER NEED ALS SKILLS AND BE EXPECTED TO LEAD AN ARREST SITUATION.
THE ALS COURSE IS NOT AN EASY COURSE AND NOT SOMETHING A GP WOULD EASILY PASS AS THEY DO NOT WORK IN AN ACUTE SETTING, NOR ARE THEY EQUIPT TO DEAL WITH SUCH SITUATIONS IN A GP SURGERY, FOR EXAMPLE.
IT WOULD ALSO BE IGNORANT TO DISREGARD THE FACT THAT WE ALL LEARN AND REACT DIFFERENTLY, A SIMMULATION WITH A PLASTIC DUMMY AND INSTRUCTORS GIVING YOU VITALS ETC, DOES NOT SUIT EVERYONE. OUR DAILY PRACTICE ALSO LARGELY AFFECTS HOW WE PERFORM IN ALS; THOSE NOT USED TO ACUTE SITIATIONS AND ESPECIALLY IN DEALING WITH THEM IN A SENIOR ROLE, WILL EVIDENTLY NEED TO DEVELOP THIS SKILL ALONG SIDE THE ALS KNOWLEGDE OF ALGORITHMS, DRUGS, CONDITIONS ETC COVERED.
AGAIN, WE ALL LEARN AT DIFFERENT PACES, BUT DOES THIS MATTER, OR MEAN THE INDIVIDUAL IS A SUBSTANDARD PRACTITIONER, NO. DOES IT REQUIRE OR ASSIST TO SEE SUCH NEGATIVE CONDESENDING FEEDBACK FROM THOSE WHO DONT KNOW THE BASIC FACTS, NO.
I SAY FULL PRAISE TO ANY GP WHO WISHES TO FURTHER THEIR TRAINING AND SKILLS BY UNDERTAKING THE ALS COURSE, PLEASE DONT READ THIS INDIVIDUALS POST AND NOT STRIVE TO ACHIEVE YOUR GOALS!
I have renewed ALS three times and never yet managed to pass the CASTest cleanly. I hate it. I did a year in A and E 15 years years ago, but have been well out of acute medicine for a long time. I relate to all these feelings of complete inadequacy the authors and some of these commenters describe.
One thing I did was I renewed ALS in my home trust and went along to the resus team two months beforehand and had some regular lessons in preparation for the big day. Surprisingly, a few of the juniors also joined me as they too dreaded the testing. I still did not pass cleanly but managed to get through without having to do the course again.
I am mulling over whether I do it again. I agree with the last comment that it is still a rather humiliating and demeaning process and I once tried the paediatric course and was virtually drummed off it by a very nasty instructor and I am a very enthusiastic learner (so I can take any humiliation as long as I am learning something new). But I just couldn't take what felt like the rather obsessive scrutiny and criticism I received. It is also very expensive and I rarely get my money back for the many courses and conferences I have to attend - why pay £400 to be humiliated when I don't really need it for my work.
Time to make an ALS that's a bit more friendly to those of us who don't do acute medicine all the time, I think.
I would rather feel humiliated, demoralised, etc. for failing a course, than seeing a patient die in my surgery. Don't forget, not all compromised patients go to the A&E. I must admit, I do this course regularly (every 3 years), and it still keeps me awake at night, but the satisfaction to know I can at least doe something more for someone whom collapse suddenly, whether at work, sports club, FAMILY home, is enough to endure this "suffering". So, forget the ego and get pumping. The next life you save might be the one you love.
The problem with ALS is that the instructors are self selected based on their ability to be like other instructors. It truly is the most discriminatory closed shop in the UK. If you don't think like them, act like them then you wont be selected for IC.This means that they never critique their own teaching methodologies, and simply glorify themselves in the fact that they believe that the 4 stage methodology is the only way to teach. Even when teaching and learning research has never proved that it works. It is a course designed for a specific type of person. The ideals of the course are correct but the fixed approach to training is very old fashioned and falls woefully short on creating training for a diverse workforce. It needs a serious shake up in the way it is taught. For the record my comments are not based on sour grapes because I have not passed the course,( I did with very high scores,) but rather a genuine plea to get the ALS training style changed so that more people can perform the skills safely and not leave thinking they are are stupid inferior human beings.
There are some issues with the ALS course, lack of useful feedback, poor rollout of the online component of the course.
I also noticed that some of the candidates knew the assessors from work - not uncommon probably. But these candidates benefited from much more feedback than others and also 'got away' with substandard compression work on the chest in the continual assessment part.
There was also no team-feedback which was a prescribed part of the course.
In all I had a poor experience. I managed to pass it but I left feeling demoralised all the same.
There should be improvements made to the course. There should be obligatory feedback owing the nature of the course and the facilitators should recognise that they are teaching professionals - not students. There should be some level of respect.
The course should be about empowering us both academically and practically but also giving us encouragement and confidence.
I also had reason to contact the support because the online module was not working - the response?: 'Thank you for your comments, good luck on your course'. This was sent 3 days AFTER the course. Not much in the way of support there.