The decline of advanced life support (ALS) training for medical students and junior doctors is a growing concern, as it poses significant risks to their ability to manage medical emergencies effectively. Historically, ALS training has been a critical component in preparing medical professionals for the high-pressure scenarios they may encounter, such as cardiac arrests. However, recent changes in the medical education framework in the UK threaten to leave new doctors underprepared for life-or-death situations.
The Removal of ALS as a Mandatory Component
In 2021, Health Education England removed advanced life support from the mandatory components of foundation training, following a directive from the General Medical Council (GMC) to remove all named courses from postgraduate training. The decision was made to provide more flexibility in developing clinical competencies, replacing ALS courses with a “blended learning approach.” This approach includes simulated and on-the-job learning to reduce costs related to face-to-face training. However, concerns are mounting over whether this shift is genuinely in the best interest of junior doctors and, more importantly, patient safety.
ALS training provides essential knowledge in managing and leading cardiac arrest scenarios, including using advanced medications, airway techniques, and manual defibrillation. Unlike basic life support (BLS), ALS equips medical practitioners with the advanced skills needed to make quick, life-saving decisions during medical emergencies. The removal of mandatory ALS training leaves significant gaps in the knowledge base of newly qualified doctors, potentially compromising their ability to perform under the pressures of a medical emergency.
Financial Barriers to Training
Another issue is the financial burden that ALS training now places on junior doctors. When ALS was part of the curriculum, it was funded by Health Education England. Funding has become limited and inconsistent since it is no longer a mandatory requirement. Health Education England only partially reimbursed £275, while the full course cost is approximately £480. Many NHS trusts do not cover the remaining cost, leaving junior doctors with the dilemma of either paying the difference out of pocket or forgoing the training altogether.
This financial barrier is especially problematic given that ALS skills are still crucial for foundation-year doctors, who are often among the first responders in medical emergencies. Despite no longer being mandatory, ALS training is still highly relevant to the daily duties of junior doctors. They often serve in emergency response teams, including roles in cardiac arrest teams, without the benefit of structured advanced training. This results in a workforce potentially lacking confidence and competence when called to act in critical situations.
Declining Emphasis in Undergraduate Medical Training
The reduction of ALS training isn’t limited to foundation years. It is also becoming less emphasised in undergraduate medical education. Many medical schools do not provide intermediate or advanced life support as part of their curriculum. The limited exposure to life support training that students receive at the undergraduate level only exacerbates the problem when they transition to foundation years, where they are expected to handle emergency scenarios with limited prior hands-on experience.
During simulation sessions, clinical teaching fellows noted considerable proficiency variability among students and junior doctors. Without a structured approach to ALS training, the knowledge and skills these medical professionals bring to emergencies are often inadequate. Simulation training, which is now recommended as part of a “blended learning” curriculum, is implemented inconsistently across different NHS trusts, further contributing to a disparity in skill levels.
The Risks of Inadequate Preparation
The lack of a consistent and structured training framework for ALS creates a significant risk to patient safety. Junior doctors are often assigned to on-call shifts and may be required to participate in cardiac arrest teams soon after starting their first job. However, the preparation provided at induction is frequently limited to a basic life support refresher, with more comprehensive training—if offered at all—often scheduled for later in the year. This leaves junior doctors ill-prepared during their critical first few weeks on the job.
Evidence suggests that better knowledge of advanced life support directly correlates with improved outcomes for patients experiencing cardiac arrests in hospitals. Without adequate training, junior doctors’ ability to respond effectively to emergencies is compromised, potentially affecting patient survival rates. This raises the question of where junior doctors are supposed to acquire the skills necessary to respond effectively to the demands of their roles if ALS training is not adequately prioritised.
Possible Solutions: Integrating ALS Training into Medical Education
One potential solution is integrating ALS training into medical education before students graduate. The upcoming changes to medical degree requirements in the UK, which will include a standardised Medical Licensing Assessment, provide an opportunity to make ALS training part of the final year curriculum. By ensuring that medical students acquire ALS certification before becoming foundation doctors, we can better prepare them for their responsibilities, including roles in cardiac arrest teams.
Medical schools or NHS trusts could fund this training, ensuring that new doctors start their careers equipped with the skills necessary to handle medical emergencies. This would improve their confidence and enhance their psychological safety when responding to high-pressure scenarios. Additionally, the UK could consider following other countries that include an intern year as part of the medical degree, allowing students to develop practical skills, such as ALS, before taking on independent roles.
A Call for Patient Safety and Preparedness
The decisions surrounding the reduction in formal ALS training must be carefully considered against the backdrop of patient safety. The health education budget may be under increasing strain, but the skills required to save lives should not be considered optional. Junior doctors must be adequately trained to provide safe, effective care, and ALS should be a core competency developed before they are expected to manage real emergencies.
Failing to prepare is indeed preparing to fail, and the stakes in this context are as high as they can get—lives are on the line. The medical community must advocate for a return to structured, funded ALS training to ensure that junior doctors are fully prepared for the challenges they will face, ultimately safeguarding patient outcomes and maintaining the highest standard of medical care.