OBJECTIVES: To establish which needs exist for specific training in Advanced Cardiac Life Support (ALS) in anaesthesiology residents and interns not exposed to structured ALS courses. METHODS: 48 residents, and seven interns accepted for training in anaesthesiology, were tested in a spontaneous, blind, cross-sectional, prospective assessment using a recording manikin with validated scoring system, a questionnaire, and 35 multiple-choice questions. RESULTS: 65% admitted not having had any CPR training within the last 2 years. The answers were correct in 55 +/- 14% of the cases, increasing significantly with the length of training (P = 0.001). One-rescuer CPR skills were inadequate: only 13% (n = 7) of participants scored within acceptable limits when using the Berden Scoring system (Berden et al., Resuscitation 1992;13:31-41), which assigned weighted error points to BLS skills. No correlation with skill was noted with increased length of residency, confidence, ER or ICU experience, or participation in CPR-incidents. CONCLUSIONS: Anaesthesiology residents and interns were not able to demonstrate BLS skills properly even while in training and did not recognize this themselves. CPR-related knowledge is poor and increases only incidentally over the years of residency even though participants were frequently confronted with seminars and resuscitation situations, and see protocols daily. The use of multiple-choice questions and the Berden scoring system avoids difficulties in evaluating case-scenario type of tests. We suggest that trainees are motivated to take part in standardized, intensive, recognised ALS courses which emphasize BLS skills and require (re)certification.