title: Long-term intended and unintended experiences after Advanced Life Support training.
abstract: OBJECTIVE
  Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intended and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course.
  
  
  METHODS
  Semi-structured interviews were conducted by telephone with a purposive sample of prior ALS-course participants. A constructivist grounded theory approach was used to analyze the data.
  
  
  RESULTS
  Seventeen former participants were interviewed. The main themes related to context adaptation, communities of practice and to transfer of skills. Interviewees described challenges in adapting to the structured simulation setting and going back to the uncertain and unstructured clinical world. In part, a result of the several conflicting communities of practice - one being the ALS-community and the others relating to professional roles. Despite reporting transferring a more systematic approach to managing patients in emergency situations and during ward rounds, surgery, and in their teaching, participants also reported poor transfer in emergency situations where not all team members had the same ALS-structured approach.
  
  
  CONCLUSIONS
  The result from this study indicates that the efficiency dimension of ALS competence is taught well in ALS courses, but that the form and content of these highly structured/model courses are insufficient in training the innovative dimension of competence that is needed for transfer of skills in unstructured, emergency situations.
authors.affiliation: Centre for Clinical Education, CEKU, University of Copenhagen, Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen, Denmark. mariabirkvad@gmail.com
authors.forename: Maria Birkvad
authors.initials: MB
authors.lastname: Rasmussen
authors.forename: Peter
authors.initials: P
authors.lastname: Dieckmann
authors.forename: S
authors.initials: S
authors.lastname: Barry Issenberg
authors.forename: Doris
authors.initials: D
authors.lastname: Østergaard
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
authors.forename: Charlotte Vibeke
authors.initials: CV
authors.lastname: Ringsted
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D004521:Educational Measurement; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors