The guide to RCEM Emergency Care ACP ... - … Guide to Emergency Care ACP... · In 2016, the Royal...

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The guide to RCEM Emergency Care ACP credentialing

October 2017

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Preface

In 2016, the Royal College of Emergency Medicine opened a pilot scheme for credentialing Advanced Clinical Practitioners in Emergency Medicine. The pilot completed in summer 2017 and the process is now an accepted part of College activity.

This guide is designed to support the trainee ACP, established ACPs who wish to credential, and supervisors who are providing the clinical and educational support for the ACP process. This guide replaces the “guide to Emergency Care ACP Credentialing project” published for the pilot scheme.

The standards and requirements for the Emergency Care Advanced Clinical Practitioner (EC-ACP) are set out in the Emergency Care ACP Curriculum, which is available on the Royal College of Emergency Medicine website and Health Education England website. The curriculum has been endorsed by the Royal College of Nursing and the College of Paramedics. A second edition of the Curriculum was approved in October 2017 and has replaced the curriculum in place for the pilot project.

Credentialing windows are anticipated to be open twice a year – in spring and autumn. ACPs planning to apply for credentialing should ensure they are following the curriculum that will be in place at the time of credentialing.

The purpose of the Reference Guide is to assist stakeholders in understanding the process and documentation to be used. The Reference Guide is as the title states, a Guide, and practices, processes and paperwork may be altered at the discretion of the Royal College of Emergency Medicine through the RCEM ACP credentialing committee.

The RCEM would like to thank Health Education England for their support and guidance in the development and implementation of the EC-ACP credentialing process .

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Table of Contents Preface ................................................................................................................................. 2

Section 1: Introduction and Overview of process .................................................................. 4

Section 2: The experience and evidence required for credentialing ..................................... 5

Section 3: Educational Supervisor guidance ........................................................................ 7

Section 4: The credentialing panel ....................................................................................... 8

Section 5: The Standard ....................................................................................................... 9

Section 6: Gaining the Required Experience ........................................................................ 9

Section 7: Working in the Department .................................................................................10

Section 8: Top Tips for developing a programme for ACP development and workforce ......10

Appendix One: Summary of formal assessments required ..................................................13

Appendix Two- checklists ....................................................................................................18

Appendix Three: Assessment Descriptors for Emergency Care Advanced Clinical Practitioners .........................................................................................................................33

Appendix Four: Credentialing Outcome Form .....................................................................63

Appendix Five: Credentialing Feedback Form .....................................................................65

Appendix Six – EXAMPLE Annual progression form for trainee ACPs from a nursing background ..........................................................................................................................67

Appendix Seven- RCEM ACP Academic Component - Credentialing Declaration ..............72

Appendix Eight - Organisation of the Personal Library in the e-Portfolio .............................73

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Section 1: Introduction and Overview of process 1.1. This Guide sets out the arrangements for the Emergency Care Advanced Clinical Practitioner (ACP) credentialing process as agreed by Royal College of Emergency Medicine (RCEM).

1.2 The credentialing process is a mechanism whereby trainee and established ACPs in Emergency Care will present evidence of their achievements and competences to be evaluated against the RCEM Emergency Care ACP curriculum. A panel of Fellows of the College and senior ACPs will review the evidence and confirm there is appropriate evidence that the standard has been met.

1.3 The standard to be met is that of an ST3/CT3 in Emergency medicine- and is defined in the Curriculum on the RCEM website.

1.4 It is important that trainee and established ACPs recognise the need for attaining a formal advanced practice qualification at Level 7, minimum of Postgraduate Diploma, before the credentialing process can commence.

1.5 The credentialing process alone does not confer a license to practice or replace the need for the ACP to maintain their professional registration and to ensure they revalidate for their whole scope of practice. The credential confirms that the ACP has reached a specified standard of clinical care in all areas of the defined curriculum, by the presentation of evidence of delivering that standard in practice.

1.6 It is not essential for an emergency care ACP to have been successfully awarded the RCEM credential for the ACP to practice clinically. The arrangements for appointment and employment of the workforce, as well as the individual scope of practice within a department is a matter for that department to determine. The credential simply confirms the described standard of practice has been observed and sufficient evidence of that standard provided. 1.7 Trainee and established ACPs will be required to collect evidence for all areas of the curriculum, through use of the RCEM e-portfolio for ACPs. It is not possible to credential without an RCEM e-portfolio account.

1.8 To access the curriculum, information about e-portfolio access and other information relating to Emergency Care ACP developments, please visit the College ACP section in Exams and Training here. :

1.9 ACPs who successfully credential against the curriculum will be awarded a certificate and their details will be held on a register of successfully credentialed ACPs held by RCEM.

1.10 Individuals interested in applying for the credentialing process, or wishing to join the Emergency Care ACP mailing list should contact [email protected], likewise any questions may be sent to this email address.

1.11 All time periods referred to within this document (and other Emergency Care ACP paperwork) are full-time equivalent.

1.12. The Medical Act – it should be remembered that the legal responsibility for the patient care ALWAYS rests with the (medical) Consultant. Therefore, an ACP working alongside a core or Foundation Trainee cannot take delegated responsibility from that Trainee. They may give advice to the junior trainee based on their own experience and their scope of practice, but the final responsibility rests with the Consultant.

http://www.rcem.ac.uk/RCEM/Exams_Training/Emergency_Care_ACP/RCEM/Exams_Training/Emergency_Care_ACP/Emergency_Care_ACP.aspx?hkey=8244ccaf-e85a-4b1e-8f8d-152484810137

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Section 2: The experience and evidence required for credentialing 2.1. Emergency Care Advanced Clinical Practitioners may be from a nursing or paramedic background; in future it may be possible for other Allied Healthcare Professionals (AHPs) to be considered for credentialing.

2.2. Advanced practitioners, whether working as a trainee or established ACP, will need to gather evidence for the credentialing process. There is no difference between the evidence required as an ACP who has recently completed training, or an established ACP who wishes to credential.

2.3 Trainee ACPs will find it easier to collect evidence in parallel with the requirements of the Higher Education Institute where they are studying for their Masters, established ACPs may find it more difficult to ring fence time to secure assessments whilst also working full time.

2.4 The evidence required is substantial, we estimate that the least time required (full time working) to collect the evidence is three years. ACPs should collect the evidence as they work, not wait until the 6 months before submission. Amassing evidence takes time.

2.5 Evidence should be collected as per the described process and curriculum requirements; all evidence must be saved on the RCEM e-portfolio. For RCEM e-portfolio technical support, please contact: [email protected]

2.6 All assessments submitted as formal evidence must be on the RCEM forms even if scanned paper copies are used.

2.7 Other evidence includes teaching plans, feedback from others, e-learning, audit, quality improvement work, reflection on cases. Further details of acceptable evidence is in the RCEM curriculum,

2.8. All competences in the curriculum, including the common competences, must have an item of evidence submitted against it. In most cases there will be more than one piece of evidence per competence. It is therefore important at the point of credentialing that the most appropriate/relevant item is identified on the checklist for consideration.

2.9. ACPs who are already practising in this role will have evidence accumulated in their CPD and professional portfolio. This may not be in the format required but may be suitable if accompanied by reflection on their current practice and development of expertise since the original evidence was gathered. Consultant assessments MUST be on the College assessment forms.

2.10. Reflection in this context is based on considering what happened, what the practitioner learnt, what they may do differently next time and what remaining learning needs they have. It is expected that the ACP will provide reflection on most elements of evidence. A helpful document on reflection in medical practice can be found at https://www.rcoa.ac.uk/sites/default/files/Reflection-CPD-Revalidation.pdf

2.11. In general terms, one piece of evidence can be used for up to 2 competences – occasionally 3, except for the ACAT-Em which can cover up to 5 competences.

2.12 An assessment for a common competence should be exclusively looking at that competence (history taking, safe prescribing etc). For example, it is not appropriate to link a CbD for an acute presentation competence to 2-3 common competences just to attain coverage of the curriculum

2.13. Retrofitting prior experience and evidence is important. ACPs may well have completed their Postgraduate qualification some 5 or more years ago. Evidence that is older than 3 years old MUST be accompanied by evidence that the learning is refreshed (previous courses for example should have an update) and reflection on what has happened since that course, how their practise has

mailto:[email protected]

https://www.rcoa.ac.uk/sites/default/files/Reflection-CPD-Revalidation.pdf

https://www.rcoa.ac.uk/sites/default/files/Reflection-CPD-Revalidation.pdf

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developed, their new skills etc. ACPs should be reminded that they were unlikely to be at the standard of an ST3 when they entered practice however many years ago. The development of the competences to the correct standard will take 3 years or more of practice as an ACP in most cases.

2.14. A Portfolio is unlikely to be adequate if more than 30% of the evidence is from more than 3 years ago.

2.15. Planning is therefore vital, in the same way as a trainee doctor needs to plan to get all the competences/WBA completed, the ACP will need to plan and anticipate the requirements.

2.16. Simulation courses including life support courses, can be used as evidence where specified. In addition, simulation for some rare competences such as anaphylaxis and temporary pacing is acceptable but the ACP MUST have led the scenario and have a completed Consultant Assessment where relevant. With regard to life support courses, reflection on how the course relates to the ACP practice is expected.

2.17. Collecting evidence in the portfolio is also useful in collecting evidence for the revalidation of the individual practitioner. We therefore recommend the portfolio to ACPs even if they do not intend to credential in the near future.

2.18 Individuals considering undertaking ACP credentialing should have support from their employers – this process is likely to require considerable time from supervisors, additional time in focused patient contact gaining competences and additional study leave time.

2.19 ACPs who wish to credential must have a named educational supervisor who is a Fellow of the RCEM and who has access to their e-portfolio. It is the ACP responsibility to identify the supervisor and to ensure access is given.

2.20 Trainee and established ACPs should review the curriculum and checklist regularly to ensure they understand the requirements, processes and paperwork. Any queries should be directed to [email protected]

2.21 Trainee and established ACPs should pay particular attention to Appendix 1, which is a checklist of assessments provided as evidence required for the credentialing process.

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Section 3: Educational Supervisor guidance 3.1 At least one individual involved in assessing trainee and established ACPs at the local department must have completed the RCEM mandatory Emergency Care ACP supervisor training. Dates are on the RCEM website.

3.2 The local individual who has had the mandatory supervisor training will be responsible for ensuring other colleagues involved in assessing the trainee ACP understand the requirements including the standard expected.

3.3 Other supervisors and assessors who are responsible for assessing the ACP in other placements for example acute medicine, ambulatory care, anaesthetics, should be made aware of the process, the standard, and given some information about the process and aims of credentialing, as well as being familiar with the tools used.

3.4 Each ACP MUST have a named educational supervisor who is a substantive consultant in Emergency Medicine and a Fellow of the Royal College of Emergency Medicine. Ideally the ES will have attended the supervisor training.

3.5 The Educational supervisor will be responsible for meeting regularly with the ACP to review progress against the curriculum, undertake some of the mandatory assessments and also has responsibility for countersigning the checklist to confirm the ACP has presented sufficient evidence to be considered for credentialing.

3.6 The Educational Supervisor (ES) is therefore a critical part of this assessment and credentialing process, and consequently are expected to demonstrate that they themselves understand the curriculum, the standard and the process for workplace based assessment.

3.7 Educational supervision of an ACP preparing to credential is likely to take as much time if not more than an EM trainee. The College recommends 0.25PA per ACP supervised in the job plan.

3.8. All consultant assessors should be approved supervisors under the GMC approval process for educational and clinical supervision.

3.9 All educational and clinical supervisors should participate in the Faculty governance statement –this includes consultant practitioners, senior ACPs and consultants in other specialties. This is a critical part of the confirmation of the standard reached and constitutes important evidence to be considered in the process.

3.10. Non-medical assessors who carry out workplace based assessments (WBA) should complete local training on the use of WBA and familiarise themselves with the curriculum. There are also many free e-learning tools for preparing to undertake the WBA available on the internet (i.e. http://www.faculty.londondeanery.ac.uk/e-learning).

3.11. The assessment tools are expected to be used in a productive, developmental way. For that reason, the interaction between the assessor and the ACP should be interrogative, not simply confirmatory. For example, the assessor is expected to ask questions such as “what if” and “why” when discussing a case in a CbD and in the MiniCEX and DOPs, there should be enquiry as to why they undertook the procedure, elicited the history or made the diagnosis. Similarly there should be enquiry as to why the clinical signs were evident (or not) and the use of the investigations.

3.11 For further information about the role of the educational supervisor, clinical supervisors etc and eligibility for the roles please see the Emergency care-ACP curriculum on the RCEM website.

http://www.faculty.londondeanery.ac.uk/e-learning

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Section 4: The credentialing panel 4.1 The evidence presented is considered by a panel of consultants (RCEM Fellows) and senior ACPs/consultant practitioners.

4.2 All credentialing panel members will be appointed and trained by the Royal College of Emergency Medicine.

4.3 The credentialing panel will be responsible for reviewing the evidence presented in the e-portfolio and agreeing an outcome.

4.4 A Panel will normally consist of 6 assessors, with a minimum of 2 Fellows in good standing of the RCEM

4.5 Applicants will be required to ensure their evidence is complete 8 weeks prior to the credentialing panel date with any evidence submitted subsequently not being eligible for consideration.

4.6 Applicants will be required to include a completed checklist in their portfolio, countersigned by their supervisor at this 8 week window.

4.7 There are two possible outcomes at the credentialing panel: Successful – credential OR Further evidence required (see Appendix – Credentialing Outcome Form).

4.8 Outcomes will be recorded on a Credentialing Outcome Form (Appendix). Those who have successfully met the curriculum requirements will receive a certificate and will be added to the register of credentialed Emergency Care ACPs.

4.9 The credentialing panel members will provide feedback to trainee ACPs via the Credentialing Feedback Form (Appendix). For those who have not met the requirements, detailed feedback, including potential timescales for re-submission, will be provided.

4.10 There is no mechanism for appeal against the credentialing panel’s decision. Candidates who have not met the credentialing requirements may re-submit the evidence in future to be considered in subsequent processes.

4.11 ACPs who have successfully credentialed will be invited to the annual RCEM diploma ceremony

4.12. At the Credentialing Assessment, the only question for the Panel is whether the evidence is sufficient. The panel are unable to assess the competence of the ACP hence the need for the ES to be closely involved in the assessments, to undertake many themselves, and to ensure assessors understand the standard required.

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Section 5: The Standard 5.1. The standard required is that of the Core Trainee at the end of CT3/ST3 in all competences described in the ACP curriculum

5.2. This standard can be described as the practitioner able to look after the majority of the cases in the Emergency Department, albeit they will require support and guidance on a significant number of cases and for most of the cases in the resuscitation room.

5.3. Many ACPs are very experienced but this experience may be in a relatively limited case mix. For new ACPs who are experienced nurses or paramedics, the shift to the clinician medical model may be a challenge. The same standard as seen in a medical trainee of cognitive reasoning, diagnostic skills and decision making must be demonstrated.

5.4. As well as the Structured training report (STR), the Educational Supervisor will be expected to complete the logbook output to rate the ACP on all of the competences. This allows the RCEM to be assured that the ES has confirmed the ACP is competent in all competences.

Section 6: Gaining the Required Experience 6.1. The RCEM recognises that the case mix in many departments is varied and getting exposure to the full range of case mix might be challenging for some ACPs, including the paediatric experience or acute medical related cases/skills

6.2. For EM trainees this is overcome by the acute medicine attachments. For ACPs therefore a secondment or placement in acute medicine, or ambulatory medicine may support the development of some skills.

6.3. Much of the anaesthetic and ITU competences for the ACCS trainees are not required for ACPs. However, there are some critical skills that are included in the curriculum and the ACP must be able to demonstrate a working knowledge of those skills even if they do not themselves regularly carry out that procedure. These competences are mostly acquired by spending time in the resuscitation room or with ACCS trainees as a short secondment.

6.4. In the portfolio, the ACP are able to identify themselves as having had “some experience”. Since we are expecting the ACP to have adequate experience in the whole ACP curriculum in order to be credentialed, use of this should be limited. “Some experience” would normally signify that the ACP does understand the competence /procedure but that they have not personally undertaken the procedure but only supported/assisted and discussed in CbD. This description will only be accepted in one or two competences - and not in any of the Major competences or those requiring consultant assessment.

6.5 In terms of procedures, selection of “some experience “ will only be accepted for those where Cbd is acceptable.

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Section 7: Working in the Department 7.1. We would recommend that ACPs are given titles such as Trainee, Junior and Senior as they progress. This helps to define their level of independence and will support, particularly in the early years, their designation as still learning. This is particularly important to avoid them being pulled into nursing duties or non-practitioner roles when the staffing gets tough.

7.2. There is no stipulation of the nature of the working pattern required – or where the ACP should work. However since the ACP role is anticipated to be 24/7, we would recommend that the ACP participates in a 24/7 rota including night shifts and the impact of this pattern of working on the individual is discussed and clarified from the start. This is a matter for local negotiation and discussion.

7.3. We would recommend that trainee ACPs are employed solely in that role. Departments have employed trainee ACPs in dual roles, such as Senior Sister 50% and Trainee ACP 50%, where they have found trainees struggle to progress.

7.4 The ACP may benefit from having specific shifts identified as “credentialing shifts” where it is made clear to the team that the ACP will be working on their assessments and competences. Likewise, where feasible in the consultant team, a shift for a named consultant to perform WBAs is helpful covering both medical trainees and ACPs.

Section 8: Top Tips for developing a programme for ACP development and workforce This section is developed from top tips from supervisors who have had extensive experience in supervising and running ACP development programmes. We are keen to receive other tips from other colleagues, please send to [email protected].

8.1. ACPs can form an important part of your substantive and permanent workforce. They are valuable! In order to attract and support ACPs, paying for MSc and/or life support courses in return for commitment to work for 3 years in the department is a fair agreement.

8.2. Developing a cohort of ACPs will take time – it is not likely that there will be large numbers of credentialed ACPs locally available for some years. Therefore a medium to long term strategy and business case will be required to develop that cohort. The department must therefore commit to the development of this workforce and the benefits that will accompany the investment. Resources required include:

• Cost of the HEI Masters course

• Back fill for the staff during the academic component

• Backfill for supervised practice at least at first

• Time for consultant educational supervision and formal workplace based assessments including ESLEs

• Time for formal education for the tACPs and their teachers

8.3 Having a learning agreement with the ACP is critical, this should define how many WBAs can be expected over a given period, how often the ES and ACP will meet as well as the objectives for the next period of practice.

8.4. A learning agreement can be translated into a “learning menu”, a list which others can access that lists what the ACP still has outstanding, this helps to focus shop floor experience and access to WBAs.

8.5. The MSF can be really useful for the ACP. This will both highlight how their new role is developing and be important as a positive reinforcement but may also shed light if the ACP is struggling with how to present themselves/manage the interaction with other specialties or the

mailto:[email protected]

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ED doctors. This may however need a robust discussion in terms of how to guide and direct future performance.

8.6 Some skills may be better achieved by attendance at clinics – for example cardiology defibrillation clinics, neurology ambulatory care for LPs. This will need exploring locally.

8.7 Rotations across regions may support development of some competences – or allow access to a different case mix. Shared induction, HR processes and teaching programmes spreads the burden of work

.8 Consideration of how to make a shift positive for all learners – so identifying with the doctors and tACPs who needs what assessments and their focused training needs – and at the end of a shift – a learning debrief – what have we learnt, what will we refresh/review for next time. This takes thought and preparation but will benefit both medical and ACP learners and develop an educational culture.

8.9. ACPs must be seen to be progressing. For many new ACPs the role is challenging as they go from being an experienced leader in their previous role to being new and challenged by the alternative approach to diagnosis, the decision making required and the need to develop independence. Being an ACP is not for everyone and the role of the ES is to manage training performance. There should be milestones and achievements built into the initial contract with the ACP which detail progression including success in the Master’s as well as the achievement of the WBAs. Credentialing is the apex of achievement but supporting the development of the skills and ability to be safe and effective on the shop floor is the core business for the ES.

8.10 The RCEM does not mandate a formal ARCP (annual review of competence progression) but we believe there are benefits in running such a process. This can be run alongside the appraisal process as a personal development and performance review. An example of a form that can be used is included in the appendices of this document.

8.11. An ES who is a recently appointed Consultant may be the perfect ES for the ACP. They will be very familiar with the RCEM portfolio having used it themselves recently and will be able to support and direct the easiest ways to link, navigate and save items.

8.12. The ACP will have a personal library. This, as with the trainees, quickly becomes unmanageable unless properly archived. We would recommend folder structures which for trainee ACPs may be usefully split into years, and should include folders for e-learning, for teaching, courses etc. A useful outline structure is included in the appendices of this document.

8.13 Evidence that is scanned in must be saved as documents/PDFs not JPEGs (which are too large). They should be named logically with the type of document, the competence covered number and text and date of achievement (not date of scanning)

8.14. Previous evidence can be helpful. However for many ACPs it is easier just to collect new evidence than to try to find the old evidence in cupboards or drawers or the attic and still then reflect.

8.15. Clinical supervision is key and the department must determine that there is sufficient capacity for clinical supervision of the ACP as well as the foundation, core and higher trainees. Trainee ACPs may benefit from a non-medical supervisor in addition to their Education Supervisor. This person may be an established ACP who is able to support and guide the trainee in their role transition.

8.16 The ACPs should be clearly visible on the rota alongside the medical trainees. This allows the total number of trainees requiring supervision on any individual shift to be known and catered for. Supervising a large number of trainees with one consultant will result in a poor experience for everyone involved including the patients.

8.17 Every time evidence is uploaded – it must be linked. A library full of evidence is not useful if it is not linked. However linking to more than 3 competences is unlikely to be appropriate

8.18. Similarly the educational supervision does take the entire proposed tariff of 0.25 PA per week, perhaps even more so than doctor supervisees. The team job plan should reflect the total time

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needed for the supervision of all trainees of all professions.

8.19 Sign off on the portfolio includes the “red man/blue man” where the ACP rates themselves and the supervisor confirms that level. This must be done for all common competences and the rest of the clinical competences. It is useful to discuss this face to face – as to why the ACP believes they are at that level and why the supervisor agrees or not. This is designed to be an interactive constructive process of developmental conversation.

8.20 Some departments have developed a “breakfast club” process of early morning meeting as a group and peer discussion and learning. This enables frank discussions of problems, peer tutoring and coaching and a sense of team development.

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Appendix One: Summary of formal assessments required

Adult ACP

Area of curriculum

Evidence required Number by consultant

Common competences

Level 2 for all CCs – confirmation by consultant and by self. ACAT-EM or ESLE led by consultant for: CC4 - Time and workload management CC8 - team working and patient safety CC19 requires certificate for adult safeguarding

2

Area of curriculum

Evidence required

Major presentations

Consultant assessment for: • Anaphylaxis • Cardiac arrest (or ALS) • Major Trauma • Sepsis • Shocked patient • Unconscious patient

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Acute presentations

Consultant assessment for: • Chest pain • Abdominal pain • Breathlessness • Mental health • Head injury Alternatively an ACAT (by a consultant) may be utilised which covers 3 or more presentations.

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Additional acute presentations

Consultant assessments for: • Major trauma chest • Major trauma abdominal injury • Major trauma spine • Major trauma maxfax • Major trauma burns • Traumatic limb/joint injuries • Interpretation of abnormal blood gas • Abnormal blood glucose

One patient – two injuries may be appropriate Alternatively an ACAT may be utilised which covers 3 or more presentations.

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Airway management

Consultant assessment required

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Practical procedures

Where the department or work environment does not offer the opportunity for the ACP to personally undertake or practice procedures, a CbD with a consultant is sufficient (one per procedure) for those marked (CbD).

• Arterial cannulation (CbD) – PP1 • Central venous cannulation (CbD) – PP3 • Lumbar puncture (CbD) – PP5 • Pleural tap and aspiration (CbD) – PP6 • Intercostal drain – Seldinger (CbD) – PP7 • Intercostal drain – Open (CbD) – PP8 • Airway protection* - PP11 • DC cardioversion – PP13 • Knee aspiration (CbD) – PP14 • Reduction of dislocation/fracture* - PP16 • Large joint examination – PP17 • Wound management* - PP18 • Trauma primary survey* - PP19 • Initial assessment of the acutely unwell – PP20 • Secondary assessment of the acutely unwell – PP21 • Peripheral venous cannulation- PP2 (by a trained assessor) • Arterial Blood gas sampling PP4 (by a trained assessor) • Basic and advanced life support PP12 (by a trained

assessor) • Temporary pacing PP15 (in sim or by a trained assessor) • Intra-osseous access PP46 (by a trained assessor)

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Multisource feedback

1 MSF per year with at least 15 respondents

Life support courses

• Advanced Life Support • Paediatric Basic Life Support (e.g. Trust-based training) • European Trauma Course/ATLS (as a full candidate not

observer)

Audit Evidence of leadership and implementation of actions from audit or quality improvement project with reflection.

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Additional paediatric competences for Adult and Paediatric ACPs

Area of curriculum

Evidence required Number by a consultant

Common competences

CC19 requires certificate for safeguarding children and young people

Paediatric Major presentations

Consultant assessment for all presentations: • Anaphylaxis • Apnoea stridor and airway obstruction • Cardiorespiratory arrest (or APLS/EPLS) • Major trauma • Shocked child • Unconscious child

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Paediatric Acute presentations

Consultant led assessment for: • Abdominal pain • Breathing difficulties • Acute life threatening event (BRUE) • Concerning presentation • Head injury • Mental health ACAT may be utilised which covers 3 or more presentations.

6

Paediatric procedures

Consultant led assessment for: • Airway assessment and maintenance • Safe sedation in children • Primary survey in a child*


• APLS/EPLS

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Paediatric ACP

Area of curriculum Evidence required Number by a consultant

Common competences

Level 2 for all CCs – self and supervisor assessment ACAT-EM or ELSE led by consultant for: CC4 - Time and workload management CC8 - team working and patient safety CC19 requires certificate for safeguarding children and young people

2

Paediatric Major Presentations

Consultant assessment for: • All 6 presentations • Cardiac arrest may be assessed by successful completion

of APLS/EPLS •

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6 consultant assessments for: • Abdominal pain • Breathing difficulties • Acute life threatening event • Concerning presentation • Head injury • Mental health Alternatively an ACAT (by a consultant) may be utilised which covers 3 or more presentations.

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Consultant assessments for: • All 5 major trauma competences. • One patient may cover up to two competences if

appropriate. Consultant assessments for: • Traumatic limb/joint injuries • Interpretation of abnormal blood gas • Abnormal blood glucose

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Airway management

Consultant assessment required

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Practical procedures

Where the department or work environment does not offer the opportunity for the ACP to personally undertake or practice procedures, a CbD with a consultant is sufficient (one per procedure) for those marked (CbD).

• Airway assessment and maintenance – PEMP2 • Safe sedation in children (CbD) – PEMP3 • Primary survey in a child* - PEMP5

Generic practical procedures to be completed:

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Arterial cannulation CbD - PP1 Central venous cannulation CbD – PP3 Lumbar puncture CbD – PP5 Pleural tap and aspiration CbD – PP6 Intercostal drain – Seldinger CbD – PP7 Intercostal drain – Open CbD – PP8 Knee aspiration (CbD) – PP14 Reduction of dislocation/fracture* - PP16 Large joint examination – PP17 Wound management* - PP18 Initial assessment of the acutely unwell – PP20 Secondary assessment of the acutely unwell – PP21

Multisource feedback

1 MSF per year with at least 15 respondents


• APLS/EPLS • Adult Basic Life Support (e.g. Trust-based training) • European Trauma Course /ATLS (as a full candidate not

observer)

•

Audit Evidence of leadership and implementation of actions from audit or quality improvement project with reflection.

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Appendix Two- checklists Checklist for Adult ACP- this must be submitted before credentialing.

Adult Emergency Care ACP: Name: Hospital site of practice: Registration number:

Area of curriculum Evidence required In library or

certificates? Date, type of assessment and name of assessor

Logbook output All competences/presentations/procedures reviewed by supervisor and are satisfactory

Please sign to confirm you have reviewed all elements

Curriculum All curriculum elements have evidence linked to them

Please sign to confirm you have reviewed and all curriculum elements have evidence presented

Common competences

Level 2 for all CCs – self and supervisor assessment ACAT-EM or ESLE led by consultant for: CC4 - time management and decision making CC8 - team working and patient safety CC19 requires certificate for adult Safeguarding

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Area of curriculum Evidence required In library or certificates?

Date, type of assessment and name of assessor

Major presentations Consultant assessment for:

Anaphylaxis

Cardiac arrest (or ALS)

Major Trauma

Sepsis

Shocked patient

Unconscious patient

Use the generic summative CBD or the specific mini-CEX for each presentation (ie mini-CEX unconscious patient)

Acute presentations Consultant assessment for: Chest pain

Abdominal pain

Breathlessness

Mental health

Head injury

Use the generic summative CBD or the specific mini-CEX for each presentation (ie mini-CEX mental health)

Alternatively an ACAT (by a consultant) may be utilised which covers these presentations.

Additional Major Presentation

Consultant assessments for Major trauma chest

Major trauma abdominal injury

Major trauma spine

Major trauma maxfax

Major trauma burns

For the Major trauma presentations above use mini-CEX major trauma and describe the case or use summative CBD

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Consultant assessments for: Traumatic limb/joint injuries

Interpretation of abnormal blood gas

Abnormal blood glucose

For these use a summative generic mini-CEX or CBD. Alternatively an ACAT may be utilised which covers these presentations.

One patient two injuries may be appropriate.

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Area of curriculum

Evidence required In library or certificates?


Practical procedures By a consultant DOPS

Airway protection* - PP11

DC cardioversion – PP13

Reduction of dislocation/fracture - PP16

Large joint examination – PP17

Wound management - PP18

Trauma primary survey - PP19

Initial assessment of the acutely unwell – PP20

Secondary assessment of the acutely unwell – PP21

By consultant using CbD or DOPS

Arterial cannulation– PP1

Central venous cannulation– PP3

Lumbar puncture– PP5

Pleural tap and aspiration – PP6

Intercostal drain – Seldinger– PP7

Intercostal drain – Open – PP8

Knee aspiration – PP14

By a trained assessor

Peripheral venous cannulation PP2

Arterial blood gas sampling PP4

Basic and advanced life support– PP12

Temporary pacing (external)– PP15 (or by sim)

Intra-osseous access– PP46

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Area of curriculum

Evidence required In library or certificates?


Airway management Consultant assessment for A5B using a CBD or mini-CEX

Multisource feedback 1 MSF per year with at least 15 respondents-or which 2 must be EM consultants

Life support courses Adult: ALS

Paediatric: Basic Life support (trust training)

European Trauma Course/ATLS (as a full candidate not observer)

Audit Evidence of leadership and implementation of actions from audit or quality improvement project with reflection

Educational supervisor name: GMC number

I confirm I have reviewed all the contents of the portfolio and the evidence presented in the checklist is present, appropriate and complete as required by the process.

Signed:

23

Checklist for ACP seeing Adult and children

Name: Hospital site of practice: Registration number:







Common competences

Level 2 for all CCs – self and supervisor assessment ACAT-EM or ESLE led by consultant for: CC4 - time management and decision making CC8 - team working and patient safety CC19 requires adult Safeguarding certificate AND level 3 safeguarding children certificate

Major presentations Consultant assessment for:

Anaphylaxis

Cardiac arrest (or ALS)

Major Trauma

Sepsis

Shocked patient

Unconscious patient

Use the generic summative CBD or the specific mini-CEX for each presentation (ie mini-CEX unconscious patient)

24



Acute presentations Consultant assessment for: Chest pain

Abdominal pain

Breathlessness

Mental health

Head injury

Use the generic summative CBD or the specific mini-CEX for each presentation (ie mini-CEX mental health)

Alternatively an ACAT (by a consultant) may be utilised which covers these presentations.

Additional Major Presentation

Consultant assessments for Major trauma chest

Major trauma abdominal injury

Major trauma spine

Major trauma maxfax

Major trauma burns

For the Major trauma presentations above use mini-CEX major trauma and describe the case or use summative CBD


Consultant assessments for: Traumatic limb/joint injuries

Interpretation of abnormal blood gas

Abnormal blood glucose

For these use a summative generic mini-CEX or CBD. Alternatively an ACAT may be utilised which covers these presentations.

One patient two injuries may be appropriate.


Consultant assessment for all presentations:

• Anaphylaxis • Apnoea stridor and airway obstruction

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• Cardiorespiratory arrest (or APLS/EPLS) • Major trauma • Shocked child • Unconscious child


Consultant led assessment for:

• Abdominal pain • Breathing difficulties • Acute life threatening event • Concerning presentation • Head injury • Mental health

ACAT may be utilised which covers 3 or more presentations.

Airway management Consultant assessment for A5B using generic summative mini-CEX or CBD

Multisource feedback 1 MSF per year with at least 15 respondents of which 2 are EM consultants

Life support courses Adult: ALS

APLS/EPLS



26



Practical procedures By a consultant DOPS

Airway protection* - PP11

DC cardioversion – PP13

Reduction of dislocation/fracture - PP16



Trauma primary survey - PP19



By consultant using CbD or DOPS

Arterial cannulation– PP1







By a trained assessor

Peripheral venous cannulation PP2

Arterial blood gas sampling PP4

Basic and advanced life support– PP12

Temporary pacing (external)– PP15 (or by sim)

Intra-osseous access– PP46

28



Practical procedures continued


• Airway assessment and maintenance

• Safe sedation in children

• Primary survey in a child*

Using generic summative mini-CEX or CBD



Signed:

29

Checklist for ACP seeing children only

Name: Hospital site of practice: Registration number:







Common competences

Level 2 for all CCs – self and supervisor assessment ACAT-EM or ESLE by consultant for: CC4 - time management and decision making CC8 - team working and patient safety CC19 Safeguarding children level 3 certificate


Consultant assessment for all presentations:

• Anaphylaxis • Apnoea stridor and airway obstruction • Cardiorespiratory arrest (or APLS/EPLS) • Major trauma • Shocked child • Unconscious child

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• Abdominal pain • Breathing difficulties • Acute life threatening event • Concerning presentation • Head injury • Mental health ACAT may be utilised which covers 3 or more presentations.


Consultant assessments for:

• All 5 major trauma competences.

One patient may cover up to two competences if appropriate.

Consultant assessments for:

• Traumatic limb/joint injuries

• Interpretation of abnormal blood gas

• Abnormal blood glucose

Airway management Consultant assessment for A5B using generic summative mini-CEX or CBD

Life support courses Adult: BLS (trust training)

APLS/EPLS


Multisource feedback 1 MSF per year with at least 15 respondents/2 consultants


31



Practical procedures By a consultant DOPS Reduction of dislocation/fracture - PP16





By consultant using CbD or DOPS Arterial cannulation– PP1








• Airway assessment and maintenance

• Safe sedation in children

• Primary survey in a child*

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Signed:

33

Appendix Three: Assessment Descriptors for Emergency Care Advanced Clinical Practitioners Mini-CEX Descriptors

This table of satisfactory and unsatisfactory indicators is provided to support feedback and development. It can be contextualized for most presentations and not all descriptors are expected to

be demonstrated for every presentation.

Dimension Descriptor of satisfactory performance Descriptor of unsatisfactory performance

History taking • Engages with the patient • Clear and focused history taking • Recognises the critical

symptoms/symptom patterns • Obtained all the important information

from the patient, not missing important points

• Elicits the history in difficult circumstances, copes with the challenge of noise, distractions, high workload

• History taking was not focused • Did not recognise the critical

symptoms, symptom patterns • Failed to gather all the

important information from the patient, missing important points

• Did not engage with the patient • Was unable to elicit the history

in difficult circumstances- busy, noisy, multiple demands

Physical examination • Detects /elicits and interprets

important physical signs. • Maintains dignity and privacy

• Failed to detect /elicit and interpret important physical signs

• Did not maintain dignity and privacy

Communication Communication skills with colleagues 1. Listens to other views 2. Involves the whole team in discussions 3. Respected the lead of others when appropriate 4. Considerate and polite to colleagues 5. Able to give clear and timely instructions 6. Clear referral discussion- whether for opinion, advice, or admission Communication with patients 7. Responsive to the concerns of the patient, their understanding of their illness and what they expect 8. Sensitive and responsive to patients unarticulated fears 9. Ensured carers/patients informed and given adequate information and education 10. Encourages patient involvement/ partnership in decision making

Communication skills with colleagues

1. Did not listen to other views 2. Did not discuss issues with

the team 3. Failed to follow the lead of

others when appropriate 4. Rude to colleagues 5. Did not give clear and timely

instructions 6. Inconsiderate of the rest of

the team 7. Was not clear in referral

process- was it for opinion, advice, or admission

8. Communication with patients 9. Did not elicit the concerns

of the patient, their understanding of their illness and what they expect

10. Did not inform and educate patients/carers

11. Did not encourage patient involvement/ partnership in decision making

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Dimension Descriptor of satisfactory performance Descriptor of unsatisfactory performance

Clinical judgment-clinical decision making

• Identifies the most likely diagnosis in a given situation • Appropriately judicial in the use of

diagnostic tests • Able to construct a comprehensive

and likely differential diagnosis • Able to correctly identify those who

need admission and those who can be safely discharged. • Recognised atypical presentation • Able to recognise the urgency of the

case • Able to select the most effective

treatments • Made decisions in a timely fashion • Decisions reflected clear

understanding of underlying principles • Reassessed the patient • Anticipated interventions and

responded with alacrity • Reviewed the effect of interventions

and took appropriate action

• Did not identify the most likely diagnosis in a given situation

• Was not discriminatory in the use of diagnostic tests

• Did not construct a comprehensive and likely differential diagnosis

• Did not correctly identify those who need admission and those who can be safely discharged.

• Did not recognise atypical presentation

• Did not recognise the urgency of the case

• Did not select the most effective treatments

• Did not make decisions in a timely fashion

• Decisions did not reflect clear understanding of underlying principles

• Did not reassess the patient • Did not anticipate interventions

and slow to respond • Did not review effect of

interventions

Professionalism • Respected confidentiality • Protect the patients dignity • Sensitive and respectful of patients

opinions/hopes/fears • Explained plan and risks in a way

the patient could understand

• Did not respect confidentiality • Did not protect the patients dignity • Insensitive to patients

opinions/hopes/fears • Did not explain plan and risks in

a way the patient could understand

Organisation and efficiency

• Demonstrated efficiency in progressing the case

• Was slow to progress the case

Overall care • Ensure patient was in a safe monitored environment

• Anticipated or recognised complications • Focused sufficiently on safe practice • Was aware of and followed published

standards guidelines or protocols • Follow infection control measures • Safe Prescription and provision of

therapeutics

• Did not ensure patient was in a safe monitored environment • Did not anticipate or recognise

complications • Did not focus sufficiently on safe

practice • Did not follow published standards

guidelines or protocols • Did not follow infection control

measures • Did not safely prescribe/provide

therapeutics

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Emergency Care ACP Mini-CEX Summative Descriptors for Major Presentations

• Anaphylaxis • Unconscious/Altered Mental State • Shock • Trauma • Sepsis

1 Anaphylaxis

Expected behaviours

Initial approach • ABCD approach, including GCS • Asks for vital signs including SPaO2, blood sugar • Requests monitoring • Recognises physiological abnormalities • Looks for obvious cause of shock (e.g. bleeding) • Secures iv access

History • Obtains targeted history from patient • Obtains collateral history form friends, family, paramedics- cover PMH • Recognises the importance of treatment before necessarily getting all

information • Obtains previous notes

Examination Detailed physical examination which must include physical signs that would differentiate between haemorrhagic, hypovolaemic , cardiogenic and septic causes for shock

Investigation Asks for appropriate tests- • arterial blood gas or venous gas and lactate • FBC, • U&Es, • clotting studies, • LFTs, toxicology, • Cross match as indicated • blood and urine culture, • CK and troponin, • ECG, • CXR, • Familiar with use of US to look for IVC compression and cardiac tamponade

Clinical decision making and judgement

Forms diagnosis and differential diagnosis including: • Trauma-haemorrhagic, blood loss control form direct pressure, pelvic splintage,

emergency surgery or interventional radiology • Gastrointestinal - upper and lower GI bleed, or fluid loss form D&V • Cardiogenic - STEMI, tachy and brady dysrhythmia • Infection- sepsis, knows sepsis bundle • Endocrine - Addison’s disease, DKA • Neurological - neurogenic shock • Poisoning - TCAs, cardio toxic drugs

Communication Effectively communicates with both patient and colleagues

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2 Unconscious/altered Mental Status

Expected behaviour

Initial approach

• ABCD approach, including GCS • Asks for vital signs including SPaO2, blood sugar • Secures iv access • Looks for lateralising signs, pin point pupils, signs of trauma, considers neck

injury • Considers opiate OD, alcoholism, anticoagulation

History • Obtains history- friends, family, paramedics- cover PMH, previous ODs etc • Obtains previous notes

Examination Detailed physical examination including fundoscopy

Investigation Asks for appropriate tests • arterial blood gas • FBC • U&Es • clotting studies • LFTs, toxicology • blood and urine culture • CK and troponin • HbCO • ECG • CXR • CT


Forms diagnosis and differential diagnosis including: • Trauma- SAH, Epidural and subdural • Neurovascular- stroke, hypertensive encephalopathy • Cardiovascular- dysrhythmia, hypotension • Neuro- seizure or post ictal • Infection- meningitis, encephalitis, sepsis • Organ failure- pulmonary, renal, hepatic • Metabolic- glucose, sodium, thyroid disease, temperature • Poisoning • Psychogenic


Overall plan Identifies immediate life threats and readily reversible causes Stabilises and prepares for further investigation, treatment and admission

Professionalism Behaves in a professional manner

Organisation and efficiency

• Manages time well – does not appear rushed but completes critical tasks in a timely way.

• Uses staff and delegates appropriately

Overall plan • Identifies immediate life threats and readily reversible causes • Stabilises and prepares for further investigation, treatment and admission


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3 Shock

Expected behaviour

Initial approach • ABCD approach, including GCS • Asks for vital signs including SPaO2, blood sugar • Requests monitoring • Recognises physiological abnormalities • Looks for obvious cause of shock e.g. bleeding • Secures iv access

History • Obtains targeted history from patient • Obtains collateral history form friends, family, paramedics- cover PMH • Recognises the importance of treatment before necessarily getting

all information • Obtains previous notes

Examination Detailed physical examination which must include physical signs that would different between haemorragic, hypovolaemic , cardiogenic and septic causes for shock

Investigation Asks for appropriate tests • Arterial blood gas or venous gas and lactate • FBC • U&Es • clotting studies • LFTs, toxicology • Cross match as indicated • blood and urine culture • CK and troponin • ECG • CXR • Familiar with use of US to look for IVC compression and cardiac

tamponade Clinical decision making and judgement

Forms diagnosis and differential diagnosis including: • Trauma-haemorrhagic, blood loss control form direct pressure, pelvic

splintage, emergency surgery or interventional radiology • Gastrointestinal - upper and lower GI bleed, or fluid loss form D&V • Cardiogenic - STEMI, tachy and brady dysrhythmia, • Infection- sepsis, knows sepsis bundle • Endocrine - Addison’s disease, DKA • Neurological - neurogenic shock • Poisoning - TCAs, cardio toxic drugs


Overall plan Identifies immediate life threats and readily reversible causes Stabilises and prepares for further investigation, treatment and admission


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4 Major Trauma

Expected behaviour

Initial approach • Knows when to activate the trauma team (based on local guidelines) • Able to perform a rapid primary survey, including care of the c

spine and oxygen delivery • Can safely log roll patient off spinal board • Able to assess disability, using AVPU or GCS • Asks for vital signs • Able to request imaging at end of primary survey • Knows when to request specialty opinion and/or further imaging

History • Obtains history of mechanism of injury from paramedics • Able to use AMPLE history

Examination After completing a primary survey is able to perform detailed secondary survey

Investigation Asks for appropriate tests • Primary survey films • CT imaging • arterial blood gas • FBC • U&Es • clotting studies • PT • toxicology • ECG • FAST • UO by catheterisation • Appropriate use of NG


Forms differential diagnosis and management plan based on: • Able to identify and mange life threatening injuries as part of primary

survey • Able to identify the airway that may be at risk • Can identify shock, know it classification and treatment • Safely prescribes fluids, blood products and drugs. • Can identify those patients who need urgent interventions or surgery

before imaging or secondary survey • Can safely interpret imaging and test results • Demonstrates safe disposition of trauma patient after secondary survey • Able to identify those patients that be safely discharged home

Communication Effectively communicates with both patient and other members of the trauma team

Overall plan Identifies immediate life threats and readily reversible causes. Stabilises and prepares for further investigation, treatment and admission


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5 Sepsis

Expected behaviour

Initial approach Initial approach based on ABCD system- ensuring early monitoring of vital signs including temperature,SPaO2, blood sugar • Can interpret early warning medical score as indicators of sepsis

(EMEWS or similar) • Aware of systemic inflammatory response criteria (SIRS), and that 2 or

more may indicate sepsis o T>38 or < 36

o HR > 90 o RR > 20 o WCC > 12 or < 4

History • Obtains history of symptoms leading up to illness • Able to take a collateral history, form paramedics, friends and family • Able to use AMPLE history • Looks specifically for conditions causing immunocompromise

Examination Able to perform a competent examination looking for 1. Possible source of infection 2. Secondary organ failure

Investigation Asks for appropriate tests • FBC • U&Es • clotting studies • ABGs or VBGs • Lactate, ScVo2 • Blood cultures • ECG • CXR • Urinalysis +/- catheterisation • Other interventions which may help find source of sepsis

o Swabs o PCR o Pus

• Considers need for further imaging

40


Form a management plan with initial interventions being: • Oxygen therapy • Fluid bolus, starting with 20 mls/Kg • IV Antibiotics, based on likely source of infection • Documentation of a physiological score, which can be repeated • Be able to reassess Recognises and is able to support physiological markers of organ dysfunction, such as:- • Systolic BP < 90 mm Hg • PaO2 < 8 Kpa • Lactate > 5 • Reduced GCS • Urine output < 30 mls/hr Demonstrates when to use invasive monitoring, specifically • CVP line • Arterial line

Demonstrates when to start inotropes, Noradrenaline v dopamine Demonstrates how to set up an inotrope infusion

Communication Effectively communicates with both patient and other members of the acute care team

Overall plan Identifies sepsis Implements sepsis bundle Stabilises patient, reassesses and able to inform and/or hand over to critical care team


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Mini-CEX Summative Descriptors for Acute Presentations

• Chest pain • Abdominal pain • Breathlessness • Mental Health • Head Injury

1 Chest Pain

Expected behaviours

Initial approach • Ensures monitoring, i.v. access and defibrillator nearby. • Ensures vital signs are measured including SpO2

History • Takes focused history (having established conscious with patent airway) of chest pain including

o site o severity o onset o nature o radiation o duration o frequency o precipitating and relieving factors o Previous similar pains and associated symptoms

• Systematically explores for symptoms of life threatening chest pain

• Assesses ACS risk factors • Specifically asks about previous medication and past

medical history • Seeks information from paramedics, relatives and past

medical notes including previous ECGs

Examination On examination has ABCD approach with detailed cardiovascular and respiratory examination including detection of peripheral pulses, blood pressure measurement in both arms, elevated JVP, palpation of apex beat, auscultation e.g. for aortic stenosis and incompetence, pericardial rub, signs of cardiac failure, and pleural rubs

Investigation Ensures appropriate investigation • ECG (serial) • ABG • FBC, U&Es • troponin and d dimer if indicated • Chest x-ray


Prescribing Able to relieve pain by appropriate prescription


Able to formulate a full differential diagnosis and the most likely cause in this case.

Overall plan Stabilises and safely prepares the patient for further treatment and investigation


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2 Abdominal Pain

Expected behaviours

Initial approach • Ensures appropriate monitoring in place and iv access • Establishes that vital signs measured

History • Takes focused history of abdominal pain including o site o severity o onset o nature o radiation o duration o frequency o precipitating and relieving factors o previous similar pains and associated symptoms

• Systematically explores for symptoms of life threatening abdominal pain • Specifically asks about previous abdominal operations • Considers non abdominal causes- MI, pneumonia, DKA,

hypercalcaemia, sickle, porphyria • Seeks information from paramedics, relatives and past medical notes

Examination Able to undertake detailed examination for abdominal pain (ensuring adequate exposure and examining for the respiratory causes of abdominal pain) including 1. Inspection, palpation, auscultation and percussion of the abdomen 2. Looks for herniae and scars 3. Examines loins, genitalia and back 4. Undertakes appropriate rectal examination

Investigation Ensures appropriate investigation- • ECG • ABG • FBC • U&Es • LFTs • amylase • erect chest x-ray • and abdominal x-rays if obstruction or perforation suspected


Able to formulate a full differential diagnosis and the most likely cause in this case


Prescribing Able to relieve pain by appropriate prescription

Overall plan Stabilises (if appropriate)and safely prepares the patient for further treatment and investigation


43

3 Breathlessness

Expected behaviours

Initial approach • Ensures monitoring, iv access gained, O2 therapy • Ensures vital signs are measured including Spa O2

History • If patient able, trainee takes focused history of breathlessness including onset,

o severity o duration o frequency o precipitating and relieving factors o previous similar episodes o associated symptoms

• Systematically explores for symptoms of life threatening causes of breathlessness

• Takes detailed respiratory history • Specifically asks about medication and past medical history • Seeks information from paramedics, relatives and past medical notes

including previous chest x-rays and blood gases

Examination On examination has ABCD approach with detailed cardiovascular and

respiratory examination including, work of breathing, signs of • respiratory distress • detection of wheeze • crepitations • effusions • areas of consolidation

Investigation Ensures appropriate investigation • ECG • ABG • FBC • U&Es • troponin and d dimer if indicated • Chest x-ray • Able to interpret chest x-ray correctly


Able to formulate a full differential diagnosis and the most likely cause in this case Knows BTS guidelines for treatment of Asthma and PE


Prescribing • Able to prescribe appropriate medication including oxygen therapy, bronchodilators, GTN, diuretics

• Able to identify which patients would benefit from NIV

Overall plan Stabilises and safely prepares the patient for further treatment and investigation


44

4 Mental Health

Mental health issues are a common problem within the ED (typically combinations of overdose, DSH, suicidal ideation but also psychotic patients). Selection of patients suitable for min-CEX assessment must be undertaken thoughtfully.

Expected behaviours

Initial approach Ensures assessment takes place in a safe environment.

History History taking covers • presenting complaint, • past psychiatric history, • family history, • work history,

• sexual/marital history, • substance misuse, • forensic history, • social circumstances, • personality.

Undertakes mental state examination covering: • appearance and behaviour • speech • mood • thought abnormalities • hallucinations • cognitive function using the mini mental state examination • insight Elicits history sympathetically, is unhurried Searches for collateral history- friends and relatives, general practitioner, past medical notes, mental health workers

Examination Ensures vital signs are measured Undertakes physical examination looks for physical causes of psychiatric symptoms- head injury, substance withdrawal, thyroid disease, intoxication, and hypoglycaemia

Investigation Ensures appropriate tests • U&E • FBC • CXR • CT • toxicology


Ensures no organic cause for symptoms Forms working diagnosis and assessment of risk- specifically of suicide and toxicological risk in those with overdoses


Prescribing Knows safe indications, routes of administration of common drugs for chemical sedation

Overall plan Identifies appropriately those who will need further help as an inpatient and who can be followed up as an out patient Is able to assess capacity Have strategies for those who refuse assessment or treatment or who abscond


45

5 Head Injury

Expected behaviours

Initial approach Ensures ABC is adequate and that neck is immobilised in the unconscious patient and those with neck pain. Ensures BM done

History • Establishes history- o mechanism of injury o any loss of consciousness and duration o duration of any amnesia o headache o vomiting o associated injuries especially facial and ocular

• Establishes if condition is worsening • Gains collateral history from paramedics, witnesses, friends/relatives and

medical notes • Establishes if taking anticoagulants, is epileptic

Examination After ABC undertakes systematic neuro examination including • GCS • papillary reactions and size • cranial nerve and peripheral neurological examination • and seeks any cerebellar signs • Looks for signs of basal skull fracture • Examines scalp • Looks for associated injuries- neck, facial bones including jaw • Actively seeks injuries elsewhere

Investigation Is able to identify the correct imaging protocol for those with potentially significant injury -specifically the NICE guidelines


Is able to refer appropriately with comprehensive and succinct summary Knows which patients should be referred to N/surgery Is able to identify those patients suitable for discharge and ensures safe discharge.


Prescribing Able to safely relieve pain in the head injured patient

Overall plan Stabilises and safely prepares the patient for further treatment and investigation or safely discharges patient


46

CbD Descriptors

Domain Descriptor

Record keeping Records should be legible and signed. Should be structured and include provisional and differential diagnoses and initial investigation & management plan. Should record results and treatments given.

Review of investigations Undertook appropriate investigations. Results are recorded and correctly interpreted. Any Imaging should be reviewed in the light of the trainees interpretation

Diagnosis The correct diagnosis was achieved with an appropriate differential diagnosis. Were any important conditions omitted?

Treatment Emergency treatment was correct and response recorded. Subsequent treatments appropriate and comprehensive

Planning for subsequent care (in patient or discharged patients)

Clear plan demonstrating expected clinical course, recognition of and planning for possible complications and instructions to patient (if appropriate)

Clinical reasoning Able to integrate the history, examination and investigative data to arrive at a logical diagnosis and appropriate treatment plan taking into account the patients co morbidities and social circumstances

Patient safety issues Able to recognise effects of systems, process, environment and staffing on patient safety issues

Overall clinical care The case records and the trainees discussion should demonstrate that this episode of clinical care was conducted in accordance with good clinical practice and to a good overall standard

47

Practical Procedures DOPs Descriptors

• Basic airway • Trauma - primary survey • Wound management • Fracture manipulation and joint reduction

1 Basic airway management including adjuncts e.g. BVM, oxygen delivery

Observed behaviour Task Completed

1. Is able to assess the adult airway and in the obstructed patient provide a patent airway by simple manoeuvres and the use of adjuncts and suction.

2. Undertakes this in a timely and systematic way.

3. Assesses depth of respiration and need for BVM.

4. Can successfully BVM.

5. Knows and can show how to deliver high flow 02

6. Knows other O2 delivery systems typically in ED- fixed concentration masks, nasal specs, Mapleson C circuits.

7. Consents the patient

2 Perform a primary survey of a potentially multiple injured trauma patient


1. Ensures safe transfer of patient onto ED trolley

2. Assesses airway, establishes if obstructed, corrects and ensures delivery of 100%O2

3. Concurrently ensures cervical spine immobilisation (using collar, sandbags and tape)

4. Exposes chest identified raised respiratory rate, chest asymmetry, chest wall bruising, air entry (anteriorly and laterally) and percussion (laterally). Identifies life threatening problems and correctly carries out associated procedures

5. Examines for signs of shock, ensures monitoring established and has gained iv accessX2

6. If shocked looks for potential sites of blood loss- abdomen, pelvis and limbs.

7. Can formulate differential for shocked patient

8. Establishes level of consciousness and seeks lateralising signs

9. Examines limbs, spine and rectum ensuring safe log roll.

48

10. Will have identified and searched for potential life threatening problems in a systematic and prioritised way

11. Reassesses if any deterioration with repeat of ABCD

12. Elicits full relevant history from pre-hospital care providers

13. Ensured appropriate monitoring

14. Will have placed lines, catheter and NG tubes as appropriate

15. Ensured appropriate blood testing (including cross match).

16. Plain radiology trauma series undertaken

17. Ensures adequate and safe pain relief

18. Directs team appropriately

19. Notes of primary survey are clear and legible

3 Wound Management


1. Wound assessment- takes history of mechanism of injury, likely extent and nature of damage, and possibility of foreign bodies. Establishes tetanus status and drug allergies.

2. Assesses the wound- location, length, depth, contamination, and structures likely to be damaged

3. Establishes distal neurovascular and tendon status with systematic physical examination

4. Consents the patient

5. Provides wound anaesthesia (local infiltration, nerve or regional block).

6. Explores wound – identifies underlying structures and if damaged or not.

7. Ensures good mechanical cleansing of wound and irrigation.

8. Clear understanding of which wounds should not be closed

9. Closure of wound, if indicated, without tension, with good suture technique. Can place and tie sutures accurately.

10. Provides clear instructions to patient regarding follow up and suture removal and when to seek help.

49

4b Reduction of a dislocated joint (e.g. shoulder, ankle)


1. Confirms correct patient, takes focused history and consents the patient.

2. Takes focused history and examination to establish that sedation is safe.

3. Undertakes examination to confirm dislocation and assesses distal neurovascular function

4. Interprets the x-ray correctly and looks for associated injuries

5. Ensures appropriate monitoring and resuscitation equipment available and another clinician to assist.

6. Gains IV access, and has correct volume of opiate, benzodiazepine or other agent e.g. Ketamine, in correctly labelled syringes.

7. Knows the pharmacology of these drugs and their antagonists

8. Explains to patient procedure and anticipated course.

9. Ensures another clinician present

10. Gives drugs in controlled way in monitored environment with patient receiving oxygen.

11. Establishes sedated- still responsive to verbal commands.

12. Undertakes reduction in gentle and controlled manner.

13. Confirms reduction by physical examination and checks distal neurovascular function

14. Immobilises - sling, pop correct patient, taken relevant history, and consented the patient. Explains to patient procedure and anticipated course

15. Gets check x-ray- checks reduced and no additional fractures detected.

16. Ensures observed and monitored until fully recovered.

17. Rechecks neurovascular function

18. Ensures well one hour post procedure, ensures post procedure analgesia and indicates when patient to return and predicted course.

50

ACAT-EM Descriptors

ACAT –EM

Assessment Domains Description

Clinical assessment and clinical topics covered

Quality of history and examination to arrive at appropriate diagnosis- made by direct observation in different areas especially in the resuscitation room.

No more than 5 AP should be covered in each ACAT and this should involve a review of the notes and management plan of the patient.

Medical record keeping

Quality of recording of patient encounters including drug and fluid prescriptions

Investigations and referrals

Quality of trainees choice of investigations and referrals

Management of patients

Quality of treatment given (assessment, investigation, urgent treatment given involvement of seniors)

Time management Prioritisation of cases

Management of take/team working

Appropriate relationship with and involvement of other health professionals

Clinical leadership Appropriate delegation and supervision of junior staff

Handover Quality of handover of care of patients between EM and in patient teams and in house handover including obs/CDU ward

Patient safety Able to recognise effects of systems, process, environment and staffing on patient safety issues

Overall clinical judgement

Quality of trainees integrated thinking based on clinical assessment, investigations and referrals. safe and appropriate management, use of resources sensibly

Instructions for Use of ACAT-EM

This tool works best if:

1. The assessment is best conducted over more than one shift (typically 2-3) as not all the domains may be observed by the assessor in one shift. The assessor should ensure that as many domains are covered as possible 2. The assessor should seek the views of other members of the ED team when judging performance 3. The clinical notes and drug prescriptions should be reviewed especially relating to patients cared for in the resuscitation room. 4. The ACAT can be used to confirm knowledge, skills and attitudes for the cases reviewed by the assessor 5. The ACAT can be used in a variety of setting within the ED- cdu ward rounds, clinics as well as major/minor/resuscitation and paediatric areas

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Mini-CEX Summative Descriptors for PEM ACP

Acute Presentations

1. Abdominal pain 2. Fever 3. Breathlessness 4. Pain

1 Abdominal pain

Expected behaviour

Initial approach • ABCD approach • Asks for vital signs

History • Obtains history-patient, friends, family, paramedics- cover PMH • Obtains previous notes

Examination • General appearance – listlessness, features of dehydration and shock • Detailed physical examination including assessment of dehydration • Abdominal examination for guarding and distention • Inguinal and testicular examination

Investigation Asks for appropriate tests • FBC, • U&Es, • LFTs, • blood and urine culture • Abdominal x-ray for those with? obstruction

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Forms diagnosis and differential diagnosis for D&V including: • Intussusception • Bacterial and viral gastroenteritis • Food poisoning • Pyelonephritiss for abdominal pain • hernia, • intussusception, • pyloric stenosis, • appendicitis, • UTI, • viral URTI, • lower lobe pneumonia


Overall plan • identifies immediate life threats and readily reversible causes • Able to classify degree of dehydration and prescribe appropriately • Stabilises and prepares for further investigation, treatment and admission. • Identifies which patients can be safely discharged


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2 Assessment of the febrile child

Expected behaviour

Initial approach • ABCD approach, including GCS • Asks for vital signs including

o SPaO2, o temperature, o blood sugar.

• Identifies patient that needs resuscitation

History • Obtains history- parents, friends, paramedics- cover PMH, • Obtains previous notes • Identifies if immune deficient/ high risk-sickle, DM, CSF shunts, cardiac patients

Examination • General appearance • Detailed physical examination focus on looking for causes of fever-

o ENT, o neck stiffness, o chest for resp and cardiac causes, o abdomen, o CNS, o joints, o Skin/rash

Investigation Asks for appropriate tests • arterial blood gas • FBC,U&Es,

o clotting studies, o LFTs, o toxicology, o blood and urine culture

• Appropriate imaging including Chest x-ray

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Forms diagnosis and differential diagnosis including: Infection Bacterial • otitis media, • UTI, • pneumonia, • meningitis, • cellulitis, • joint infection, • appendicitis Viral • chickenpox, • gastroenteritis Others • neoplastic, • salicylates, • hyperthyroidism

Demonstrates knowledge of NICE guidelines for management of febrile child

Communication Effectively communicates with both child, parents and colleagues

Overall plan Stabilizes and prepares for further investigation, treatment and admission


3 Assessment of the breathless child

Expected behaviour

Initial approach • ABCD approach focusing on o airway patency, o effort and efficacy of breathing, o effects of inadequate respiration o and cardiovascular status.

• Ensures patent airway and high flow oxygen. Ensures monitoring

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History Obtains history- parents, paramedics

Examination • General appearance • Detailed physical examination with detection of stridor & wheeze, • Signs of heart failure

Investigation • Asks for appropriate tests- o arterial blood as, o FBC, o U&Es, o clotting studies, o blood and urine culture, o blood sugar

• Appropriate imaging Cxray


Forms diagnosis and differential diagnosis including: • Stridor: croup/epiglottitis • Wheeze: asthma/bronchiolitis • Fever :pneumonia Demonstrates knowledge of guidelines e.g. NICE for management of asthma. Knows of croup scoring system

Communication Effectively communicates with both child, parents and colleagues

Overall plan Stabilises and prepares for further investigation, treatment and admission. Seeks senior help early and appropriately


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4 Assessment of the child in pain

Expected behaviour

Initial approach Recognises child in pain including behavioural and physiological changes

History • Obtains history of the condition causing pain • Elicits past history of painful experiences and successful relieving measures

Examination • Able to determine the cause of pain • Able to undertake pain assessment including the use of pain ladder and faces scale

Investigation • Appropriate to the presentation


• Ensures parent involvement • Selects most appropriate analgesic and route of administration • Demonstrates comprehensive knowledge of drugs and dosages • Calculates dosage correctly • Considers use of distractive techniques

Communication Communicates effectively to both the child and parents. Sensitive and reassuring

Overall plan Ensures effective analgesia by repeated assessment and additional treatment if needed


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Paediatric Practical Procedures DOPs Descriptors

1. Venous access 2. Airway assessment and maintenance 3. Paediatric equipment and guidelines in the resuscitation room 4. Primary survey in a child

1 Venous access in children

Trainee should identify suitable sites for cannulation in a child- specifically • the dorsum of the hand and foot, • cubital fossae, • external jugular, • scalp veins, • femoral vein, • IO. S/he should select appropriate route depending on the clinical case

For the fully conscious patient: • Should ensure adequate pain relief if appropriate- using topical anaesthetic • Should ensure clean site and use aseptic technique • Prepares equipment- cannulae, connections, steristrips, flush and blood collection bottles • Immobilisation of limb using other members of staff • Gains access, takes samples, connects, secures and flushes to ensure correct position • Splints limb • Writes up fluid to be administered (if any).

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For those undergoing resuscitation (this DOPs will be unplanned but should not stop this valuable learning opportunity from being missed) a. femoral vein cannulation

• Demonstrates correct anatomy and proposed site of puncture • Should ensure clean site and use aseptic technique • Prepares equipment- cannulae, connections, steristrips, flush and blood collection bottles • Immobilisation of limb using other members of staff • Gains access, takes samples, connects, secures and flushes to ensure correct position

b. Intraosseous insertion using either IO needle or EZ drill • Demonstrates correct anatomy and proposed site of insertion over the medial tibia.

• Should ensure clean site and use aseptic technique • Prepares equipment- IO needle, connections, flush and syringe for collection of marrow blood • Successfully inserts, confirms secure and patent. Connects to giving set and three way tap, and gives fluid bolus • Knows complications of IO insertion

If trainees cannot do IO needle insertion on real patient then they must demonstrate to their trainer they can do so using a mannequin

Basic airway manoevers in children

• Preparation- can size nasophrayngeal and oral airways • Can select appropriate BVM • On arrival assesses airway for patency • Established if obstructed or not. • Uses suction, adjuncts and positioning appropriately • Ensures patent airway • Administers high flow oxygen with appropriate mask • Supports ventilation with BVM • Ensures concurrent monitoring including SpAO2, ECG • Correctly identifies those that will need intubation • Works effectively with medical and nursing colleagues to deliver effective care

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3 Equipment and guidelines in the resuscitation room.

This is designed to ensure the trainee is familiar with and can access important paediatric resuscitation information and equipment

The trainee must demonstrate that: • Can calculate the child’s weight, defibrillation energy, ETT size, fluid bolus, dose of adrenaline, dose of 10% dextrose to correct

hypoglycaemia • Can attach paediatric defibrillation paddles to adult paddles • Can size and use o/p, n/p airways and use BVM • They can find IO needle set • That they know/ can find the normal range of physiological variables • Can immediately access and know the common paediatric protocols- for cardiac arrest, seizures and anaphylaxis • They can interpret limb x-rays- specifically recognise epiphyses, joint effusions. • That they can interpret lat cspine (age <10) • That they recognise the normal paediatric ECG and how it changes

4 Perform a primary survey in a child

Expected behaviour

Preparation phase

• Has calculated weight – prepared – defibrillation charge, ETT, fluid bolus, and dextrose (10%) • Has Broselow tape and knows how to use it

Transfer Ensures safe transfer of patient onto ED trolley

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Examination • Assesses airway, establishes if obstructed, corrects and ensures delivery of 100%O2. Appropriate use and correct sizing of airway adjuncts

• Concurrently ensures cervical spine immoblisation (using collar, sandbags and tape)- able to select and apply correct collar

• Exposes chest identified raised respiratory rate, chest asymmetry, chest wall bruising, air entry (anteriorly and laterally) and percussion (laterally). Identifies life threatening problems and correctly carries out associated procedures

• Examines for signs of shock, ensures monitoring established and has gained iv accessX2 • If shocked looks for potential sites of blood loss- abdomen, pelvis and limbs. • Can formulate differential for shocked patient • Knows protocol for fluid administration for the shocked child • Establishes level of consciousness and seeks lateralising signs • Uses paediatric GCS scale • Examines limbs, spine and rectum (if unconscious or spinal injury suspected) ensuring safe log

roll. • BM done for those with altered level of consciousness • Will have identified and searched for potential life threatening problems in a systematic and prioritised way • Ensured child is kept warm • Reassesses if any deterioration with repeat of ABCD • Elicits full relevant history from prehospital care providers, witnesses and parents

Monitoring and interventions

• Ensured appropriate monitoring • Will have placed lines, catheter and NG tubes as appropriate

Investigations • Ensured appropriate blood testing (including cross match). • Plain radiology trauma series undertaken

Prescribing Ensures adequate and safe pain relief Clinical decision making and judgement

• Directs team appropriately • Liaises with and involves parents

Overall plan Notes of primary survey are clear and legible


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Examples of good behaviour Example of poor behaviour

Man

agem

ent &

Sup

ervi

sion

Maintenance of Standards

• Notices doctor’s illegible notes and explains the value of good note keeping

• Explains importance of ensuring sick patient is stable prior to transfer • Ensures clinical guidelines are followed and appropriate pro forma is

complete

• Fails to write contemporaneous notes • Does not wash hands (or use alcohol gel) after reviewing patient • Fails to adhere to clinical safety procedures

Workload Management

• Sees a doctor has spent a long time with a patient and ascertains the reason

• Ensures both themselves and other team members take appropriate breaks

• Deals with interruptions effectively

• Fails to act when a junior is overloaded and patient care is compromised

• Focuses on one particular patient and loses control of the department • Fails to escalate appropriately when overloaded

Supervision & Feedback

• Gives constructive criticism to team member • Takes the opportunity to teach whilst reviewing patient with junior doctor • Gives positive feedback to junior doctor who has made a difficult diagnosis • Leads team through appropriate debrief after resuscitation

• Criticises a colleague in front of the team • Does not adequately supervise junior doctor with a sick patient • Fails to ask if junior doctor is confident doing a practical procedure

unsupervised

Team

wor

k &

Coo

pera

tion

Team Building • Even when busy, reacts positively to a junior doctor asking for help • Says thank you at end of a difficult shift • Motivates team, especially during stressful periods

• Harasses team members rather than giving assistance or advice • Speaks abruptly to colleague who asks for help • Impolite when speaking to nursing staff

Quality of Communication

• Gives an accurate and succinct handover of the department • Ensures important message is heard correctly • Gives clear referral to specialty doctor with reason for admission (e.g.

SBAR)

• Uses unfamiliar abbreviations that require clarification • Repeatedly interrupts doctor who is presenting a patient’s history • Gives ambiguous instructions

Authority & Assertiveness

• Uses appropriate degree of assertiveness when inpatient doctor refuses referral

• Willing to speak up to senior staff when concerned • Remains calm under pressure

• Fails to persevere when inpatient doctor refuses appropriate referral • Shouts instructions to staff members when under pressure • Appears panicked and stressed

ESLE descriptors

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Dec

isio

n m

akin

g

Option Generation

• Seeks help when unsure • Goes to see patient to get more information when junior is unclear about

history • Encourages team members’ input

• Does not look at previous ED notes/ old ECGs when necessary • Fails to listen to team members input for patient management • Fails to ensure all relevant information is available when advising

referral Selecting & Communicating Options

• Verbalises consideration of risk when sending home patient • Discusses the contribution of false positive and false negative test results • Decisive when giving advice to junior doctors

• Uses CDU to avoid making treatment decisions • Alters junior doctor’s treatment plan without explanation • Forgets to notify nurse-in-charge of admission

Outcome Review • Reviews impact of treatment given to acutely sick patient • Follows up with doctor to see if provisional plan needs revising • Ensures priority treatment has been given to patient

• Fails to establish referral outcome of complicated patient • Sticks rigidly to plan despite availability of new information • Fails to check that delegated task has been done

Situ

atio

nal A

war

enes

s

Gathering Information

• Uses Patient Tracking System appropriately to monitor state of the department

• ‘Eyeballs’ patients during long wait times to identify anyone who looks unwell

• Notices doctor has not turned up for shift

• Fails to notice that patient is about to breach and no plan has been made

• Ignores patient alarm alerting deterioration of vital signs • Fails to notice that CDU is full when arranging new transfers

Anticipating • Identifies busy triage area and anticipates increased demand • Discusses contingencies with nurse-in-charge during periods of

overcrowding • Prepares trauma team for arrival of emergency patient

• Fails to anticipate and prepare for difficulties or complications during a practical procedure

• Fails to ensure that breaks are planned to maintain safe staffing levels • Fails to anticipate and plan for clinical deterioration during patient

transfer Updating the Team

• Updates team about new issues such as bed availability or staff shortages

• Keeps nurse-in-charge up to date with plans for patients • Communicates a change in patient status to relevant inpatient team

• Notices the long wait but fails to check the rest of the team is aware • Fails to inform team members when going on a break

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Appendix Four: Credentialing Outcome Form

Emergency Care Advanced Clinical Practitioner Credentialing Outcome Form

Forename: Surname: Regulatory Body and

Membership Number:

Primary Qualification (Institution and year awarded):

Master’s Degree (Institution and year awarded):

Date of Credentialing Assessment:

List all panel members

1. 2.

3. 4.

5. 6.

Location of training/working From: (insert dates)

To: (insert dates)

Evidence considered by the panel and known to the trainee

1. ePortfolio 2. Structured Training Report

3. Checklist of evidence 4.

5. 6.

Panel Outcome

Successful - Credential

Achievement of all curriculum requirements

Further evidence required

Further evidence is required, see additional feedback form.

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If further evidence is required:

Recommended time required to achieve outstanding objectives (whole time equivalent) following discussion:

________________________________________________________________________________

Chair of Panel’s signature: Date:

Trainee ACP’s signature: Date

By signing this form the Chair of the panel is confirming that fitness to any practice issues have been considered. This document should be scanned and saved in the trainee ACP’s ePortfolio. This information will also be recorded at the Royal College of Emergency Medicine. By signing the form, the ACP is indicating that they understand and agree that the information will be shared with other parties involved in their training as outlined above. The ACP signature on the form indicates that they understand the recommendations arising from the credentialing assessment. It does not imply they accept or agree with the outcome.

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Appendix Five: Credentialing Feedback Form

Emergency Care Advanced Clinical Practitioner Credentialing Feedback Form

Forename: Surname: Regulatory Body:

Date of Credentialing Assessment:

List panel members

Feedback from Credentialing Panel – Evidence Presented

ePortfolio including supervisor reports

Faculty governance statement

Checklist of evidence

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Chair of Panel’s signature:

Date:

Trainee ACP’s signature:

Date

Feedback from Credentialing Panel – Post-Assessment

Overall Quality of Evidence

Comments on standards or missing evidence

Recommended Actions (for those in who require further evidence):

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Appendix Six – EXAMPLE Annual progression form for trainee ACPs from a nursing background this is not mandatory but is included for information

Emergency Care ACP Annual Review of Progression Summary Form

Name: Date:

NMC:

Year of training ACP: 1 2 3 N/A

Revalidation Date:

Panel:

Current Educational Supervisor:

(Evidence of progression towards revalidation for nurses)

450 practice hours or 900 if revalidating as both a nurse and midwife

35 hours CPD including 20 hours participatory learning

Five pieces of practice related feedback

Five written reflective accounts

Reflective discussion

Health and character declaration

Professional indemnity arrangements

Trust appraisal requirements (modify as required):

Appraisal form self-assessment section completed?

(should be submitted with portfolio of evidence 3-weeks prior to the meeting)

YES/NO

Trust appraisal doc also completed so all done in same meeting

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Emergency Directorate: this can be altered to site /Trust specific requirements

Health statements

Probity statement

Mandatory training (up to date)

Medical devices self-assessment form

Mentoring or training courses (up-to-date minimum 3 yearly face-to-face)

Radiation protection/IRMER certificates

(completion of on-line e-LfH modules http://www.e-lfh.org.uk/home/)

Non-medical prescribing – evidence of refresher- review

Patient feedback survey

(once as a trainee and then every 3 years)

Multi source feedback (360)

(Yearly for trainees/once every 3 years for non-trainees)

Date and copy of MSF summary

Educational supervision meetings

(Evidence of engagement x 3 annually)

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ETC/ATLS (or equivalency) provider/instructor dates completed

Dates of courses taught on

APLS/EPLS (or equivalency) provider/instructor dates completed


ALS (or equivalency) provider/instructor dates completed


Registered on RCEM e-portfolio

Number and type of WPBA performed during appraisal year

Documents/pathways/service development

Conferences attended (title and date)

Posters/ Publications

Risky business articles etc

Audit

Courses attended (title and date)

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Teaching and associated feedback

Challenging cases and associated

reflection

Thank you’s/compliments

Complaints and incidents – reflection

and learning points

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Strengths

Areas for development

Personal Development plan (PDP)

Evidence of progression towards previous years PDP

Personal development plan

Objectives set for the next 12 months that should look to meet gaps, areas for further development, specific training needs etc?

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Appendix Seven- RCEM ACP Academic Component - Credentialing Declaration

ACP name:

NMC/HCPC No.

Title of academic programme: (e.g. Advanced Clinical Practice) Awarding institution: Academic award: (i.e. PGDip/MSc/Doctorate) Modules studied:

Academic Credits:

Prescribing award (For professions who can prescribe)

Academic Level 7 ( if taken before entering the Masters programme a level 6 will be accepted)

Additional info: (if required)

Please attach learning outcomes/objectives from modules to demonstrate study at Masters level in:

• History taking and physical assessment • Pharmacology • Clinical decision making and diagnostics

Please ensure a copy of any certificates and transcripts are clearly labelled and uploaded to a folder in your portfolio title ‘Academic Award’.

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Appendix Eight - Organisation of the Personal Library in the e-Portfolio

The eportfolio has a number of ways in which one can store documents and allow others to read evidence of your progression. The structure is such that if the curriculum links are used appropriately – there is little that needs to be accessed through the personal library.

However, the panel may wish to browse or find documents in your library and you will need to have organised it appropriately to facilitate the finding of specific documents

The library has 400MB of space, this should be more than enough unless you upload videos or other space hungry items.

We recommend you create the structure of your library by creating folders before you upload anything – so that it is easy to save them in the right place.

Some top tips on using the library are as follows:

• Name the items carefully – try to put the nature of the item (e-learning, programme of a course, notes from a meeting) in the title, as well as the presentation it relates to (if relevant) and the date. For example: notes from a teaching session you went to on 12th Jan 2016 on non-invasive ventilation might be “CAP35 lesson notes 12.01.16”.

• Put only the evidence that you need to present in the library – big presentations you have given to prove you have taught are not necessary. Instead use the lesson plan and feedback from the learners.

• Think about who will access the library and what they are looking for – will they need to see everything or just specific documents not seen elsewhere? If you have linked appropriately in your curriculum, any individual item will be visible from the link within the curriculum.

• Documents not linked to the curriculum are important for others to be able to locate in your library – these should be in top level folders clearly marked e.g. Masters certificates, appraisal forms, etc.

Certificates and exams

This section in the portfolio should be for only mandatory courses (life support and safeguarding) . All other certificates are better being kept in the library rather than having multiple “other” in the certificates and exams section.

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Recommended structure of the library folders:

Please note that RCEM has now uploaded a template for the library section in the e-portfolio for new starters. Please use the RCEM format to file your documents. For those with old format e-portfolios the following structure may be useful

• Other Qualifications/Certificates o Primary qualification, other exams, o Up to date CV, o NMC/HCPC certificate, professional indemnity certificate

• Prixes, awards, grants o Credentialing checklists – checklists, Progression forms for each year if

present, • Casemix and logbook - excel spreadsheet of patients seen, one for each

attachment/year and separate log of procedures for each year /placement • E-learning certificates

o Organised by types - common competences, major presentations, acute presentations, paediatric presentations, management topics, academic topics

• Teaching delivered o Organised by year delivered

• External courses - other than Life support courses • CPD – formal training attended • Audits undertaken – each in one folder with proposal, results, report, presentation

if relevant • Quality improvement documents • Complaints and incidents involved in:

o Organised by folder for each o Remember to anonymise the original document, statement, response o If relevant - note if a reflection made (saved in reflections)

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