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Course Review: Advanced Paediatric Life Support (APLS)

Last week I completed the APLS course over 3 days.  I am an impartial educator and thought I would give my review – so what did I think?

APLS is a well organised and run course.  It covers a lot of material over 3 days.  The level is pitched at the post-graduate trainee – ideally PGY 2 -4 I think.  The days were long – 11 hours of material in a day… this is probably counterproductive.  The course could be streamlined I think without losing too much.

At ~$1900 – it is a reasonably expensive course.  For that money you get a lot of theory, manikin-based scenario training, but no animal / cadaveric models to improve your clinical skills.

The learning is largely based around lectures – not everybody’s preferred format!  I found the lectures a bit long and repetitive, especially if you had done the required pre-course reading of the manual.  The teachers were friendly and well-informed, and an effort to remain entertaining was evident.

The scenarios and skills stations were OK.  As a more experienced participant I found being put on the spot in simulation to be a strong learning tool and allowed me to identify my weaknesses and cognitive errors.  I was aware that some of the more junior participants found the live simulation a bit confronting.

The material presented is largely up-to-date, though there are some areas where there is a lack of evidence base.  For a ‘resus course’ the absence of ultrasound strategy was striking.  The preference for ETT over LMAs in resus seemed odd given recent changes in most major guidelines

The testing and scenarios were OK, but did lack some flexibility to allow more experienced clinicians to make judgement calls rather than blindly follow protocol – ie. there is some ‘lowest common denominator’ effect – I guess this is a function of running such a broad ranging course.  Good for jnior staff, but a bit frustrating if you are 10+ years into your career.

Summary:

APLS is a well run course that covers an ambitious amount of material in 3 days.  The educators are entertaining and well-versed.  I recommend it to junior doctors, and staff who are unfamiliar with Paeds patients and wanting to extend their knowledge from adult care.  For the office GP who wants to brush up their resus skills – it is OK.

If you already do a lot of Paeds, especially in ED or anaesthesia environments than this course might e aiming a bit below your educational needs.

Any one out there got experinces of the APLS to share?    Casey

Comments

  1. Todd Raine says:

    Our ED (71 000 visits a year) probably sees about 600-1000 peds cases a year. I personally see no more than 1 or 2 a week – newborn to age 16, injuries/illness/ingestion…
    While I had decent exposure as a resident (though little peds critical care), I clearly have had little since. The APLS course is a course I take every 3 years-ish just to re-invigorate my bare bones knowledge. Your critiques are spot on ( did they have you do several online modules prior to the course? I think we had to do 6).
    As a one stop shop to learn whether a kid is sick or not, and how to manage until help arrives (or you transfer) it is worth it to me. Especially since there is no alternative. PALS is too ACLS for little people, and no other wide spread course covers as much Pediatric EM.
    In my last course, most of us were experienced docs with only a few keen learners, so the course staff pushed the material a bit, allowing us a bit more appropriate learning. This is a course, like ACLS that would benefit from an Experienced Provider course in addition to the basic course.
    If you see as few kids as I do then it is well worth it.

  2. I like the idea if updating in medicine – and courses such as APLS, EMST/ATLS etc help bring a structure…

    Couple of points – at A$1900 APLS is way fheaper than the College of Surgeons EMST at A$2600….the latter includes animal lab which I reckon is invaluable but I understand there are moves afoot to drop this too from EMST

    What then is best for the experienced rural doctor? We probably would benefit froma run through on structured approach to the sick child or trauma patient…and a refresher of protocols etc.

    More importantly, a run through of clinical scenarios and discusiion of new advances would help old players gain benefit without a re-hash of the lowest common denominator/entry level material for junior docs

    See my musings on this at

    http://ki-docs.blogspot.com.au/2012/03/coursea-course-my-kingdom-for-course.html

    Any thoughts?

  3. David Wong says:

    I have done the APLS course twice, in 2006 (PGY2) and 2010 (PGY6). I am a GP in Gove at a remote NT, hospital, 25% of my work load is pediatrics both emergency and inpatient management. We see a lot of sick kids, mostly Indigenous with lots of issues failure to thrive, ex prem, resp problems, bronchiolitis, pneumonia, rheumatic & congenital heart disease, gastroenteritis, skin infections/abscesses and bronchiectasis. Maybe similar demographics to the Kimberly region. I have thought a number times that what I have dealt with in real life since working in Gove has mimicked the course scenarios…(well I felt that whilst awaiting retrieval support).

    So if you are a doc looking to work in remote Indigenous communities as a locum through eg RAHC, or longer term, APLS reinforces a structured systematic approach and will help to build confidence. Definitely useful. I am really glad I did the course before going remote.

  4. Oh look, I agree – APLS, EMST, REST (or RESP) – they all have a place and are GREAT for structure (COI – am EMST instructor/soon-to-be director)

    ..but they also have limitations, not least unwavering adherence to the ‘party line’

    You ain’t going to hear about the nitty-gritty of the Levitan/Weingart paper on emergency airway management on one of these courses, nor Minh le Cong’s ingenuity with robust, affordable equipment for difficult airways.

    Which is why we need a masterclass for rural doctors…or at least regular upskilling with experts who ‘get’ the envirnment in which we practice

    I am not sure that two weeks in an anesthetic, obstetric or emergency department will meet this

    I’ve spent time recently in all three, but was disappointed to be met with blank looks when discussing

    – timing of ABs for LSCS and use of prostaglandin for PPH management

    – use of rocuronium for RSI and the ideas of Levitasn/Weingart when doing anaesthetics

    Don;t forget anaesthetists mostly deal with elective, fasted airways – not the unfasted, vomit-laded emergency airway…and options like AFOI or waking patient up may not be realistic in Dingo Creek. I recently heard a FANZCA lecturing to a buncg of rural GP anaesthetists, stating that ‘noone should be using sevo or nitrous oxide’ and that ‘all intubations should be done with suggumadex to hand’. Maybe so in a tertiary centre, not so in the bush…yet.

    – emergency department upskilling in $2K per day for three days only – that’s three 12 hours shifts, mostly wading through chest pain, fractures and minors.

    Better to do clinical attachments AND to have a forum for discussion – these blogs are great – but could consolidate some of the collective wisdom from em-crit, resus.me, Broome docs, scan-crit and doctors.net to take on the road to rural docs

    Add in iSimulate for EMAC-on-a-budget, plus hands on with ultrasound and airway gadgets, and there’s a course worth every penny!

  5. $2000+ to sit in lectures and practice on mannikins? A goldmine for the organisers, but for the participants … meh!

  6. Richard Pincus says:

    I have booked into and paid for the APLS course in March 2015. I keep up with the science and practice in other ways. I have to get my paediatric cert renewed before I can go back to my next locum. The last Pediatric life Support Cert I got was from a very poor, start from the basics, boring course for me, but not for PGY 2 and nil experience GP docs it was aimed at.

    It was given by paramedics that knew far less than I do, and I found it very unsatisfactory.

    While I am happy to attend courses if they are good, I would be much happier to have a chance to show what I know and risk being failed and benefit by finding out what I do not know.

    I attended the UCSF High Risk Emergency Medicine Conference in Hawaii where Scott Weingart was a main, several-times speaker. I attended three of the workshops and practiced basic tubing, difficult intubations, use of video laryngoscopy, use of fibre-optic bronchoscope-guided intubation inside an LMA, changing tubes, and LMAs. The whole 5 days was I think $750 and the 6 hours of prac was $150, with 3-4 people per staff member. I even got a revisit of umbilical vein cannulation from one of the very excellent, deeply-steeped-in-practice, consultant docs doing the prac work. I got two hours of US guided stuff including cannulation of a meat dummy and a phantom. I very much doubt that forcing me to take a three-day course with lots of closely-guarded pre-work is what was intended will be i/5th as useful, but I will see.

    I start off the course with low expectations. I will post again as time passes if this site will accept an updated review.

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