Saturday, June 27, 2009

Advanced Cardiac Life Support (ACLS) Training

Regular readers of this blog have probably surmised from my posts (or lack thereof) that I am starting residency now. Part of the prerequisites to starting internship is Advanced Cardiovascular Life Support (ACLS) certification. Therefore, I recently took an ACLS course and became certified.

The ACLS course I took was structured to be taught over 2 days, from 8 AM to 5 PM. At the end of the course, there was a practical and written exam. If we passed those, we received our certification, stating that we were ACLS certified for two years.

The course cost was approximately $200 (covered by my program). Additionally, one must purchase the ACLS provider manual for approximately $40 (maybe I'll be reimbursed someday?). In reality, the course ran from 8 am to about 4pm the first day, and 8am to about 1pm the second day. It could have been even shorter, but I think they were required to keep us there for a certain amount of time.

Preparing For The Advanced Cardiac Life Support Training

While preparing for the course is not 100% essential, it is very very helpful. I messed up here, because the email I received only mentioned the preparation in an attachment, not the body, of the email. Furthermore, when I called to confirm my course registration, all the person said on the other end was that I had to show up and wear comfortable clothes. Regardless, what I should have done is purchase the Advanced Cardiovascular Life Support Provider Manual published by the American Heart Association, read all the cases beforehand, and taken the pre-tests. The AHA ACLS Manual is the only official training manual for these courses, so it pays to get it early. Also, on the first day, when you register, they ask you for your pre-test scores. If you do not have passing pre-test scores, they explicitly state that they cannot guarantee that you will receive certification by the end of the two day course.

Advanced Cardiac Life Support Training Day 1

As I stated above, I arrived the first day in comfortable clothes... but without a Advanced Cardiovascular Life Support Provider Manual. I scrambled to buy one and began to read through the cases as introductions were made. Needless to say, I didn't get much out of the first hour. After introductions, the large group of us taking the course (about 30) were split into groups of 5 or 6. These small groups are where we received the bulk of our training.

The rest of the first morning was spent going over cardiopulmonary resuscitation (CPR) basics. Nowadays, this is also referred to as basic life support, or BLS. The last time I trained for BLS was in 8th grade, but I remembered a reasonable amount. Still, the ACLS course explicitly states that ACLS certification is not the same as being BLS certified. To me, that makes no sense as one cannot pass the ACLS course without showing some proficiency in BLS. The morning overall though went fairly well, as we practiced doing CPR and using an Automated External Defibrillator (AED). You have to show proficiency at both to pass the course, meaning they watch you do the entire sequence one time of CPR followed by AED use without any guidance, and then pass you.

Following lunch, we spent the afternoon going over the pulseless resuscitation pathway. The sequence has many details but the takehome point is that if they have fibrillation, then you defibrillate; otherwise, you do not. Pretty simple, right? Heh.

After Day 1, I went home and tried to cram the rest of the cases into my head, but was too tired and fell asleep.

Advanced Cardiac Life Support Training Day 2

I woke up extra early to try to finish off the cases and do the pre-tests. Unfortunately for me, I didn't finish the cases and did poorly on the pre-tests. Fortunately for you, I'm here to tell you that if you are awake and pay attention during the course instruction, you will pass the course easily. Still, it really really helps to have read the cases beforehand and memorized the drugs / doses.

Day 2 primarily consisted of going over what to do when the person does have a pulse but has a worrisome rhythm. My group was lucky to have a great instructor who basically went over all the scenarios twice for all of us during this session. He even told us that the test would be exactly the same, except that instead of making comments he would grade us. We then broke for lunch, after which we returned and took the exam. As our instructor said, it went exactly as before, except that he made no comments this time. After a short break, we took a written exam.

The written exam was 25 questions long, concerning mostly material from the ACLS provider manual. However, one could easily pass if they had just paid attention during the training. You could miss up to 4 questions and still get a passing grade. The pass rate according to the trainers was nearly 99%, and needless to say, everyone in my group passed.

Overall, it was a good experience and useful training. It surprises me though, that we are allowed to go into clinics in the US and through medical school without receiving this training beforehand. If you are still a medical student and are interested in cardiology, cardiothoracic surgery, anesthesia, or critical care, I would highly recommend that you take this course so that you look like a rockstar to your attending and teams. I feel that by being ACLS certified, I am now a more competent doctor. Now, I just have to figure out a way to remain sharp at it without ever having to use it =)

Updated 2015-12-18

Sunday, June 07, 2009

Medical School Graduation

I graduated from medical school this past week. Thank you to everyone who supported me along the way and congratulated me at the conclusion. And, thanks to you readers for being there along the journey, hopefully learning a bit when I fell and laughing with me when I rose again.

As for my absence from this blog, it's easily explained: fourth year! I was fortunate enough to get some time off after match day and travel. I spent several weeks in India, visiting family all over Rajasthan and Maharashtra, including my 88 year old grandmother. After seeing my relatives, I met up with a few friends from med school in Delhi to fly to Nepal and go trekking in the Himalayas. We spent a few days in Kathmandu (the capital of Nepal) and then took a 6 hour bus ride to Pokhara, the second largest city in Nepal, which is located in the Annapurna region of the Himalayas in western Nepal. From Pokhara, we began a 10 day trek through the Annapurna region, ending at the Annapurna Base Camp. Words cannot describe the vistas we saw, and I believe everyone in the group has memories that will last a lifetime.

Macchapuchare (Fishtail Mountain) From Tadapani

After returning, I spent a week in California, finding an apartment, and then returned home. Graduation itself was great. Everyone was excited, catching up on all their senior spring adventures and talking about the future. I think our graduation ceremony was fairly standard. There were speeches by our President and Deans, followed by our keynote speaker. Subsequently, the degrees were conferred by the President, after which we had the procession during which we were hooded by selected faculty members, and then walked across the stage to receive our diploma from our President. I forget the order a bit here, but I think after we all had our diplomas, we rose to take the Hippocratic Oath.

According to Wikipedia, "The Hippocratic Oath is an oath traditionally taken by physicians pertaining to the ethical practice of medicine. It is widely believed that the oath was written by Hippocrates, the father of western medicine, in the 4th century BC, or by one of his students." There are several modern translations of the oath, but the one we used was as follows:
I do solemnly swear, by whatever I hold most sacred: That I will be loyal to the profession of medicine and just and generous to its members;

That I will lead my life and practice my profession in uprightness and honor;

That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power, holding myself far aloof from wrong, from corruption, from the tempting of others to vice;

That I will exercise my profession solely for the cure of my patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited; far less suggest it.

That whatsoever I shall see or hear of the lives of men which is not fitting to be spoken, I will keep inviolably secret. These things I do swear.

And now, should I be true to this, my oath, may prosperity and good repute ever be mine; the opposite, should I prove myself forsworn.
After the ceremony, everyone gathered in the lobby, reuniting with family and friends to celebrate the occasion. Since then, I have been busy packing and preparing to move. Along with those preparations, I am considering the future direction of this blog. I have enjoyed working on it and developing to this point, and think I shall I continue to contribute to it. However, I am weighing several options about to how to proceed. Any comments with ideas or suggestions would be more than welcome. I hope this blog has been beneficial to you, the reader, and I thank you again for your support along the way.


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