Modular continuing professional development for emergency physicians - the MNSHA masterclass programme.

INTRODUCTION: Emergency physician (EP) training in the Netherlands is currently a 3-year competency-based programme. Upon its completion, many Dutch EPs feel that they lack some of the skills and the knowledge necessary to be fully prepared for the challenges of emergency medicine. We perceived a need for new methods to deliver continuing professional development (CPD). METHODS: A needs analysis survey was conducted to ascertain whether our perceived need for a new CPD programme was genuine. A new course was developed, incorporating innovative learning methods. The results of the needs analysis were incorporated into the programme. Another survey was held among participants of the first two editions of the programme. RESULTS, DISCUSSION AND CONCLUSION: Modular CPD for Emergency Physicians (Dutch: MNSHA) is a modular programme that aims to deliver CPD to Dutch EPs. It combines innovative educational methods, such as asynchronous learning in a flipped classroom, with web-based mentoring. The aim is for participants to develop effective, individualized and sustainable methods to gain and maintain knowledge and skills as a part of their ongoing professional education. The participant survey showed encouraging results, strongly suggesting an improvement in confidence. A more robust study would be required to better assess the outcomes of our programme.

Alternating providers during continuous chest compressions for cardiac arrest: every minute or every two minutes?

Studies have shown that the quality of chest compressions for cardiac arrest decreases markedly after only a brief time. This is thought to be an important contributor to an adverse outcome of resuscitation, which has led to recommendations to alternate chest compression providers. This study compared alternating rescuers every 1 min versus every 2 min in a manikin simulation. Forty pairs of rescuers were randomly assigned to either scenario. The main outcome measure was the number of effective compressions. The results were analysed using one-way analysis of variance. Over the full 8 min, no significant difference was found in the number of effective chest compressions (p=0.707). Furthermore, no significant difference was found when comparing each 2 min block. An explanation for this may be that the compressions lost due to fatigue in the 2 min scenario are approximately offset by compressions lost due to the practicalities of changing over. Power calculations with these results show that an unfeasibly large number of scenarios would be needed to definitively demonstrate the superiority of one of the scenarios. It seems reasonable to alternate chest compression providers every 2 min, to prevent the loss of effective compressions due to fatigue and to minimise interruptions of chest compressions. The ideal time to do this would be during the rhythm and pulse check as dictated by current guidelines.