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An educator’s perspective
There is a good educational case for a UK advanced trauma course. The theoretical basis for the educational component of the ATLS instructor course is rarely made explicit and in my experience, never discussed, either among the educationalists or the clinical faculty. In UK practice there is an implied theoretical perspective within the ATLS course that is not subscribed to. In this article I aim to explore this theoretical basis and contrast it with what actually happens in instructor and provider courses in the UK. In doing so the educational justification for a UK based advanced trauma course will be discussed.
THEORETICAL FOUNDATIONS OF ATLS
Despite nods in the direction of “adult education”1 and “reflective practice”,2 much of the thinking behind section III chapter 2 of the ATLS instructor course manual3 is based on the behaviourist/instructional design educational theories of Gagné.4 This, however, is not made explicit other than in this definition of learning:
“learning is a relatively permanent change in behaviour that comes about as a result of a planned experience in which learning results from the interaction between what students already know, the new information they encounter and what they do as they learn” (page 807)3
The perspective is supported by Gagné’s view that “learning is something that takes place inside a person’s head—in the brain”.4
DIFFERENCE FROM US PRACTICE
In contrast with Gagne’s view, the UK based ATLS course shows:
Attention to the needs of individuals and the groups to which they are allocated;
The development of a sense of a critical and self critical orientation towards performance;
Modelling of appropriate behaviour by members of the clinical faculty;
Opportunities to engage in practice;
Opportunities to engage in formal and informal discussion with fellow course members and faculty.
All of the above contribute to the development of a “community of practice”.5
This is based almost exclusively on my personal experience, supplemented by anecdotal evidence from clinical colleagues. It is further enhanced by attempts to theorise about the nature of the underpinnings of the ALSG generic instructor course.6
This seems to be in noticeable contrast with the provision in the US where issues of collaboration and community are subsumed to availability of faculty and the capacity for the course content to speak for itself. In this latter respect, particularly, the course becomes the manual and the manual, the course. This somewhat robotic approach is not untypical of US higher and continuing education and while it seems efficient in terms of delivering some key content messages, it does little to embed them in practice and performance.
EMERGING THEORETICAL DESIGN OF UK PRACTICE
I have been an educator with ATLS since 1997 and for a little longer with ALSG, which shares a substantial cadre of clinical trainers. What is apparent is that while there is a degree of variation of provision, depending on the medical director, the clinical faculty, and the educator, there is a strong sense of what it means to be an ATLS provider or instructor. The work of Lave and Wenger seems to underpin much of the practice that has emerged from the interactions of senior faculty groups gaining familiarity with the US model and, I would argue, subverting some of its intentions and “domesticating” it. Accordingly, I am drawn to the conclusion that a UK version of an advanced trauma course would be best described by Lave and Wenger’s “situated cognition” and its focus on the “community of learning”.7
MERIT IN CLARIFICATION OF UK DESIGN
Practice over 15 years has determined to a large extent the nature of UK ATLS provision. In the event of the UK Steering Group deciding to launch its own course, there will be the opportunity to articulate practice: to make explicit the tacit practices that have grown up. This will have a number of clear benefits:
to guarantee continuity of provision both in terms of style and content
to set a standard that will be maintained despite the differences among faculty
to acknowledge responsibility for change in provision in the light of changes in the environment.
STEPS TO DESIGN AND IMPLEMENTATION
Clearly, any attempt to create a new course, substantially based on existing UK practices and perceptions of best clinical performance, will have quite a long time scale. This, however, can be turned to advantage, allowing for, among other things, a systematic needs analysis (drawing from current activity in the Faculty of Accident and Emergency Medicine (manuscript in preparation) and a thorough exploration of stakeholder expectations. Inevitably issues of design will include an evaluation of the potential of new technologies to either supplement or replace current provision. For example, the European Resuscitation Council in collaboration with Giunti Laboratories has developed a virtual course that may lay the foundations for some aspects of this provision.
If only for the reasons of transparency and greater congruence between theory (where it is articulated) and practice, there is a good educational case for a UK advanced trauma course. Anecdotal evidence hints that US courses live out Gagné’s assertion that “learning is something that takes place inside a person’s head—in the brain”, whereas the practice that has grown up in the UK is that learning is a collaborative venture firmly located in the social.
An educator’s perspective
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