In response to the Acute Care Undergraduate TEaching (ACUTE) initiative

Excerpt

The authors of the Acute Care Undergraduate TEaching (ACUTE) initiative should be commended for their attempt to develop an undergraduate curriculum on acute care [1]. Teaching of this subject is often ad hoc and fragmented in UK medical schools and a suitable syllabus is long overdue. However, a more questionable aspect of this initiative is the implicit expectation that newly qualified physicians will frequently be responsible for the management of critically ill patients. In our experience the management of such patients is rarely as simple as the ‘airway, breathing, circulation’ (ABC) mnemonic suggests. A successful outcome for these patients requires early intervention by experienced expert physicians [2], which unfortunately may not always happen in the UK. A recent report from the National Confidential Enquiry into Patient Outcomes and Death suggested that one in four admissions to ICUs occurs without the involvement of a consultant. Moreover, another one-fourth of patients are not reviewed by a consultant for up to 12 h after admission to the ICU [3]. Not only are these patients being deprived of expert management, but junior physicians are missing out on the opportunity for supervised training. We suggest that consultant supervision at the point of care is the best way for trainees both to be assessed and to accomplish the competencies suggested in the ACUTE initiative. In the setting of inadequate supervision of trainees by senior physicians it could be argued that the ACUTE initiative inadvertently provides tacit support to a fundamentally flawed system where the most seriously ill patients continue to be managed by the most inexperienced physicians. …