July 18, 2015 an MBBS doc writes about ACLS for interns

Editor’s note: I was privileged to work with Chitwan Medical College (CMC) in 2015 to train 120 MBBS interns with the 2-day course of Cardiac Life Support from CCNEPal. CMC was a terrific partner and they are now teaching this course at a high standard using their own personnel. In my view, CMC is a model for all MBBS schools in Nepal – this content needs to be shared earlier in the curriculum than  it is now. 

The 120 participants were in their “internship year” – finished with the classroom portion but not quite doctors yet. Ashutosh Jha was among the group and I asked him to share his perspective on the course. Here it is. I added the paragraph headers.

The impending epidemic of heart disease in Nepal

Adverse lifestyle changes accompanying industrialization and urbanization have contributed to a higher prevalence of cardiovascular disease. The incidence and prevalence of cardiovascular disease is rapidly rising in the developing nations. Nepal is not immune to it. Increasing use of tobacco, alcohol, sedentary lifestyle, increasing portion sizes, bad dietary practices have all contributed to a rise in atherosclerosis and coronary heart disease. It is not uncommon for hospitals in Nepal to witness more and more cases of cardiac arrest and unconscious victim. It is a daunting task for doctors, medical students, nurses and other health professional s to prevent the disease from emerging in the first place. But once coronary heart disease occurs, it is even more challenging to take care of those patients in the ER.

Just getting to the hospital is not enough

Imagine your close one having a cardiac arrest and you reach an ER in a medical college in Nepal at 3 in the night. There is a medical officer on duty who has just completed his MBBS from the same college and you rush in with your loved one. You are relieved that you got your loved one to the hospital on time and hope the doctor will take care of him. You summon the doctor and the doctor remains puzzled at what has happened and acts late. How would you feel then??

Here I believe is not the fault of the doctor, but say of the curriculum which has included ACLS on the course but has not put it into practice. The poor doctor stands puzzled not knowing what to do. Had he been through the scenario before, he could have handled the situation properly.

CCNepal’s removes this dilemma from the minds of the budding doctor and builds a sense of confidence that will enable him to tackle the situation properly. It will give him a proactive choice whether to take a decision or not. This will create a win/win situation among the healthcare provider and the patient.

Use of Simulation drills

To be successful in any outcome, we have to begin with the end in mind. The end that we want is a fruitful outcome that focuses on the enhancement of the health of the patient, saving the life of that unconscious victim that comes through the ER doors. To do this we need to put things into practice. CCNepal’s workshop helps us do that by making us go through and practice scenarios that might be encountered in day to day practice. As Aristotle one said “We are what we repeatedly do. Excellence is then not an act, but a habit.”The training focuses on making a habit out of the difficult scenarios a habit. Teaching and learning is done in a fun way, which makes the course even more interesting. There is also a short crash course on the ECG. The “six step approach” of interpreting an ECG, is essential for patient management.


Working in a group in medical practice is essential. CCNepal also promotes the principle of synergy. It enables us to act in a group and work properly on it. A group needs a leader who supervises the group from the front and guides it in difficult situations. The need for leadership in ACLS is imperative. There should be someone overseeing the actions. Group makes patient management highly effective.

The 2 day course took us through the basics of BLS and ACLS. From ambu bags to ECGs to defibrillators. But as after every battle the khukuri must be sharpened, knowledge must also be sharpened and we must continue to improve on our own.

CCNepal workshops will make it possible for us not to depend upon a “Bhideshi” to take the ACLS course but make us independent so the tradition continues. This will allow Nepal to be independent on critical care in the long term.

submitted by Ashutosh Jha, MBBS

Editor’s note: CCNEPal is on hiatus while in USA. To obtain a similar course, contact The Center for Medical Simulation.

This area of medical learning is being scrutinized. At what point in medical education should it be offered? Should it be mandatory? How can it be scaled up to be available for the thousands of nurses and doctors who need it now? What would be the overall cost for the simulation equipment that is needed? How can all this be done in a cost-effective way?

CCNEPal invites other guest contributors.


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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