Surgeons "knowing" ATLS

[bulgethetwine]

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As part of a project, I've had a look at several of the ATLS written tests, and several triage scenarios written by surgeons.

It is *SHOCKING* how many answers are actually wrong.

I applaud the original surgeon who developed the whole concept of ATLS, but the fact that this is run by the American College of Surgery is embarrassing. Most of the questions and triage scenarios comprise situations that are best described as undifferentiated, acute complaints - hardly exclusively the realm of the trauma surgeon. And certainly not the bread and butter for a surgical resident. It's too bad there isn't a residency in which acute, undifferentiated complains are bread and butter.... oh YEAH! Emergency Medicine!!

ATLS is a joke. I wouldn't take or recommend that course for any self-respecting, EM board-certified doc. Other than being forced by your employer (usually where an 'old-school' surgery department and the corresponding egos run the ED) I can't imagine why any of us would any longer.

Maybe some day EM will 'grow up' as a specialty and we'll have the balls to develop our own course for teaching the surgeons how emergency care is really done.

 

[Doctor Bob]

It is *SHOCKING* how many answers are actually wrong.

Such as?

 

[docB]

ATLS is a joke. I wouldn't take or recommend that course for any self-respecting, EM board-certified doc. Other than being forced by your employer (usually where an 'old-school' surgery department and the corresponding egos run the ED) I can't imagine why any of us would any longer.

We're forced to do ATLS and the other merit badges because of some insurance mandate. I've been told it's the hospital's liability insurance that requires it. None of the really senior guys in the group care to fight it because it was pretty accepted back when they cut their teeth.

 

[WilcoWorld]

I recently took ATLS because it's mandated by the ACS for Level 1 Trauma Center credentialing (how's that for a conflict of interest - It doesn't matter that you're board certified by ABEM - you have to pay the ACS $500 to take ATLS or the ACS wont let you work in the ED).

I spent a lot of the time arguing with the lecturers or cracking wise, but at the end I was identified as a "potential instructor". Go figure.

 

[Winged Scapula]

I think you also have to recognize that all such exams are inherently outdated, usuall by about 5 years or so. It was hard studying the "board answer" when you knew the real answer was something different.

Now I haven't redone ATLS in awhile, so would also be interested in hearing some examples of questions that are written wrong.

 

[JackBauERfan]

I think you also have to recognize that all such exams are inherently outdated, usuall by about 5 years or so. It was hard studying the "board answer" when you knew the real answer was something different.

Now I haven't redone ATLS in awhile, so would also be interested in hearing some examples of questions that are written wrong.

Same here I'd like to hear a few specifics. I was recently at a meeting where it was put on the table by our department chair that residency trained ED physicians should not need to have ATLS to get hired, and the surgery department was pretty much against it. But once it was voted on in our favor, they were saying if the ED doesn't have to take it, the trauma surgeons shouldn't have to take it. It was brought up that most of the state guidelines say that either you should have ATLS or equivelent training (which would be em or surgery residency). The main argument raised by the surgeons was that 'everyone should keep up with changes'. This was countered with changes in practice occur much faster than changes on a test and that appropriate changes are implemented in the ED at the time the study/document/guideline comes out.

It was brought up also in the meeting that ACEP has put a statement out that we should not be required ATLS certification after we have finished an EM residency and board certified, as that is equivalent (or higher) training.

The surgeons were not as up to date on ACS's recommendations but stated that since it is a test given by them, they probably mandate it for the trauma surgeons, but that they would get back to us on the exact suggestion by ACS.

 

[WilcoWorld]

I think you also have to recognize that all such exams are inherently outdated, usuall by about 5 years or so. It was hard studying the "board answer" when you knew the real answer was something different.

Now I haven't redone ATLS in awhile, so would also be interested in hearing some examples of questions that are written wrong.

This is a good point, and I did not mean to imply that I thought ABEM writes better questions than the ACS does...their questions can be quite ridiculous as well.

 

[Winged Scapula]

This is a good point, and I did not mean to imply that I thought ABEM writes better questions than the ACS does...their questions can be quite ridiculous as well.

No worries...I have no particular reason to defend ACS, just a recognition that wrong answers today on an exam may have been thought of as right a few years ago. Happens with all testing bodies.

I'd just like to see some examples. 🙂

 

[Arcan57]

Part of the problem is that some things that used to be cut and dried have changed secondary to what we've learned from our adventures overseas. The most obvious example would be the everyone gets 2L NS prior to starting blood, and that hypotension gets aggressively treated in everyone. Also, the c-spine, cxr, and pelvic xray on everyone involved in a trauma is overkill in a lot of patients. As one of my ED attendings used to say, "ATLS is trauma for dentists".