HE Eo E ACCS Training Programme An Overview

HE Eo. E ACCS Training Programme An Overview Chris Maimaris

Objectives • • Outline of ACCS Structure and supervision WPBAs Annual Appraisals-ARCP Revalidation Who to ask for advice Regional Days

CCT Pathway, 2015 curriculum CCT in EM +/- sub-specialty CCT Anaesthesia +/- sub-specialty FCEM Exit Exam FRCA Exam ST 4, ST 5, ST 6 in EM Traditional Sp. R posts MCEM Part B&C CT 3 12 months EM Paediatric EM CCT in AM or specialisms ST 3, ST 4, ST 5 ST 6 ST 7 MG posts ST 3, ST 4, ST 5, ST 6 AM and speciallties MRCP +Paces FRCA Part I CT 2 12 months Anaesthetics CT 3 12 months Medical specialties ACUTE CARE COMMON STEM MCEM A/B/C ACCS CT 1 and CT 2 MRCP I/II FRCA, ICM Exams 6/12 Emergency Medicine 6/12 Acute Medicine 6/12 Anaesthetics 6/12 Intensive Care Medicine FY 2 FY 1 Competitive Entry to ST 1 ACCS from FY 2/ equivalent by Interviews and streaming to specialty

Run-through EM training 2015 CCT EM +/- Sub-specialist – Independent specialist practitioner Sub-specialisation: PEM, PHEM + 1 Yr ICM: 2 yrs An 6/12 ICM 18/12 Post-CCT FCEM: SAQ+OSCEs ST 6 CA: ST 3+ CTR =QIP Mg=Portfolio CCT route CESR-CP combine competences in HST+ Non-Train posts ST 4, ST 5, ST 6 36 months in EM HST 3 -yrs OOPs: T, E, R, B ST 3 EM PEM Paediatrics and further EM MCEM: Part A +B: I, II 2+3+3=8 ACCS ST 2 1 year Anaesthetics + ICU 6/12 each or 9/3 ST 1 1 year EM + AM 6/12 each Core Training 3 yrs Competitive Entry: ST 1 ACCS (EM) +ST 3 FY 2 FY 1 School of Emergency Medicine Foundation Training

ACCS: EM/AM, Anaesthetics/ITU Rotations 1 Dana Shor AM Addenb EM Addenb AM WSH ICU WSH Anaes 2 Nicola Humphrys EM Addenb AM Addenb EM WSH ICU WSH Anaes 3 Frances Paine EM Addenb EM Adden. AM-ED WSH ICU WSH Anaes 4 Corrina Lea EM Adden AM-ED Addenb EM WSH ICU WSH Anaes 5 Donna Cummins EM Addenb AM Addenb ICU Addenb Anaes 6 Brendan Fletcher EM Addenb AM Addenb EM Addenb Anaes Addenb ICU 7 Yeng Yap ANAES WSH EM WSH AM WSH ICU WSH Anaes 8 Nathan Po-Hang Chu ANAES WSH AM WSH EM WSH ICU WSH Anaes 9 Rachel Phillips ANAES PDH EM PDH AM PDH anaes PDH ICU 10 Edward Davis ANAES PDH AM PDH EM PDH ICU PDH anaes 11 Nicola Koo AM PDH EM PDH AM PDH anaes PDH ICU 12 Neil Cattell EM PDH AM PDH EM PDH ICU PDH anaes 13 Sebastian Clark EM BH AM Bedford Anaes Bedford ICU 14 Chris Beng EM BH AM BH EM Bedford ICU Bedford anaes 15 Georgia Ellis ANAES L+D EM L+D Anaes L+D ICU 16 Umair Qureshi EM L+D AM L+D EM L+D ICU L+D Anaes 17 Sadia Choudhury ANAES Ipswich EM Ipswich Anaes Ipswich ICU 18 Egidija Bielskute AM Ipswich EM Ipswich ICU Ipswich Anaes 19 Michael Murphy AM Norwich EM Norwich AM Norwich ICU Norwich Anaes 20 Hannah Cox ANAES Norwich AM Norwich EM Norwich Anaes Norwich ICU 21 David Sparksman AM Norwich EM Norwich Anaes Norwich ICU 22 Christopher Christou ANAES Norwich AM Norwich EM Norwich ICU Norwich Anaes 23 Rhiannon Jones ANAES Kings. Lynn EM Norwich AM Kings. Lyn Anaes Kings Lyn ICU 24 Megan Murray-Robertson AM Norwich AM Kings. Lyn. EM Kings. Lyn ICU Kings. Lyn anaes 25 Mehul Vadher Katie Mc. Cann ANAES Kings. Lynn EM King's Lynn AM Kings. Lyn Anaes Kings. Lyn ICU 26 EM King's. Lynn AM Kings. Lyn. EM Kings. Lyn ICU Kings. Lynanaes 27 Jack Carmichael ANAES J Paget EM J Paget Anaes J Paget ICU 28 Andrew Linder EM J Paget AM J Paget EM J Paget ICU J Paget Anaes 29 Muhammad Asaria EM Lister AM Lister Anes Lister ICM 30 Omar Elsaka EM Lister AM Lister EM Lister ICM Lister Anes 31 Gisela Pereira EM Lister AM Lister Anes Lister ICM 32 Kathleen Lin AM Lister EM Lister ICM Lister Anes 33 Iryna Boubriak AM Chelmsfo EM Chelmsfo Anaes Chelmsfo ITU 34 Stephen Norris AM Chelmsfo EM Chelmsfo ITU Chelms anaes 35 Dominic Espitalier-Noel EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU 36 Frencesca Saddington ANAES Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes 37 Neil Studd EM Colchest AM Colchest Anaes Colchest ICU 38 Robert Derrick ANAES Colchest AM Colchest EM Colchest ICU Colchest An. Anaes 39 Harriet Scott ANAES Southend EM Southend An Southend ICU 40 Fiona Mendes EM Southend AM Southend EM Southend ICU Southend An 41 Samuel Davis EM Harlow AM Harlow Anaes Harlow ICU 42 Orlanda Allen EM Harlow AM Harlow EM Harlow ICU Harlow Anaes • • Norfolk/Suffolk 4 hosp Cambridgeshire 4 Beds/Herts 4 Essex 5

Eo. E ACCS Training Programme 2014 -16 Cohort of trainees DRAFT 4 ACCS ST 1 STREAM Aug-14 ACCS ST 2 Feb-15 Post Sector -Hospital Rotation Aug-15 Norfolk/Suffolk Feb-16 P 1 JP An- ACCS ANAES J Paget EM J Paget Anaes J Paget ICU P 2 JP EM-ACCS 1 JP EM 1 J Paget AM J Paget EM J Paget ICU J Paget Anaes P 3 JP EM-ACCS 2 -New ACCS 1 J Paget EM J Paget Anaes J Paget ICU P 4 JP EM-ACCS 3 -New ACCS 2 J Paget AM J Paget EM J Paget ICU J Paget Anaes P 5 KL An- ACCS 1 ANAES Kings. Lynn EM King's. Lynn AM Kings. Lyn Anaes Kings Lyn ICU P 6 KL An- ACCS 2 KL EM-ACCS ANAES King's. Lynn AM Kings. Lynn EM Kings. Lyn Anaes Kings. Lyn ICU EM Kings. Lyn. EM King's. Lynn AM Kings. Lyn ICU Kings. Lynanaes KL AM-ACCS AM King's. Lynn AM Kings. Lyn. EM Kings. Lyn ICU Kings. Lyn anaes P 9 N+N AM-ACCS 1 AM Norwich EM Norwich Anaes Norwich ICU P 10 N+N AM-ACCS 2 AM Norwich EM Norwich AM Norwich ICU Norwich Anaes P 11 N+N An-ACCS 1 ANAES Norwich EM Norwich Anaes Norwich ICU P 12 N+N An-ACCS 2 ANAES Norwich AM Norwich EM Norwich ICU Norwich Anaes P 13 N+N EM-ACCS 1 -New ACCS 3 Norwich EM Norwich AM Norwich ICU Norwich Anaes P 14 N+N EM-ACCS 2 -New ACCS 4 Norwich AM Norwich EM Norwich Anaes Norwich ICU P 15 Ipswich An-ACCS ANAES Ipswich EM Ipswich Anaes Ipswich ICU P 16 Ipswich AM-ACCS AM Ipswich EM Ipswich ICU Ipswich Anaes P 17 Ipswich EM-ACCS 1 -New ACCS 5 Ipswich EM Ipswich AM Ipswich ICU Ipswich Anaes P 18 Ipswich EM-ACCS 2 -New ACCS 6 Ipswich AM Ipswich EM Ipswich Anaes Ipswich ICU P 7 P 8 Cambs/WSH P 19 AH AM-ACCS AM Addenb EM Addenb AM WSH ICU WSH Anaes P 20 AH EM-ACCS 1 EM Addenb AM Addenb EM WSH ICU WSH Anaes P 21 AH EM-ACCS 2 EM Addenb EM Adden. AM-ED WSH ICU WSH Anaes P 22 AH EM-ACCS 3 EM Adden AM-ED Addenb EM WSH ICU WSH Anaes P 23 AH EM-ACCS 4 EM Addenb AM Addenb ICU Addenb Anaes P 24 AH EM-ACCS 5 EM Addenb AM Addenb EM Addenb Anaes Addenb ICU P 25 AH EM-ACCS 6 -New ACCS 7 Addenb EM Adden. AM-ED Addenb NCCU Addenb Anaes P 26 AH EM-ACCS 7 -New ACCS 8 Adden. AM-ED Addenb EM Addenb Anaes Addenb NCCU P 27 WSH An-ACCS 1 WSH EM WSH AM WSH ICU WSH Anaes P 28 WSH An-ACCS 2 WSH AM WSH EM WSH ICU WSH Anaes PDH An-ACCS 1 Ranjith Kandavelu LAS-EM PDH An-ACCS 1 P 29 PDH EM PDH AM PDH anaes PDH ICU PDH An-ACCS 2 PDH AM PDH EM PDH ICU PDH anaes P 31 PDH AM-ACCS PDH EM PDH AM PDH anaes PDH ICU P 32 PDH EM-ACCS 1 EM PDH AM PDH EM PDH ICU PDH anaes P 33 PDH EM-ACCS 2 -New ACCS 9 PDH AM PDH EM PDH ICU PDH anaes P 34 PDH EM-ACCS 3 -New ACCS 10 PDH EM PDH AM PDH anaes PDH ICU P 30 BEDS/HERTS P 35 Bedf EM-ACCS 1 EM BH AM Bedford Anaes Bedford ICU P 36 Bedf EM-ACCS 2 EM BH AM BH EM Bedford ICU Bedford anaes P 37 Lister EM-ACCS 1 EM Lister AM Lister Anes Lister ICM P 38 Lister EM-ACCS 2 EM Lister AM Lister EM Lister ICM Lister Anes P 39 Lister EM-ACCS 3 EM Lister AM Lister Anes Lister ICM P 40 Lister AM-ACCS AM Lister EM Lister ICM Lister Anes P 41 L+D AN-ACCS ANAES L+D EM L+D Anaes L+D ICU P 42 L+D EM-ACCS EM L+D AM L+D EM L+D ICU L+D Anaes ESSEX P 43 Chelmsf AM-ACCS 1 AM Chelmsfo EM Chelmsfo Anaes Chelmsfo ITU P 44 Chelmsf AM-ACCS 2 AM Chelmsfo EM Chelmsfo ITU Chelms anaes P 45 Chelmsf EM-ACCS EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU P 46 Chelmsf An-ACCS ANAES Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes P 47 Cholchester EM-ACCS EM Colchest AM Colchest Anaes Colchest ICU P 48 Cholchester An-ACCS ANAES Colchest AM Colchest EM Colchest ICU Colchest Ans P 49 Southend An-ACCS ANAES Southend EM Southend An Southend ICU P 50 Southend EM-ACCS EM Southend AM Southend EM Southend ICU Southend An P 51 Harlow EM-ACCS 1 EM Harlow AM Harlow Anaes Harlow ICU P 52 Harlow EM-ACCS 2 EM Harlow AM Harlow EM Harlow ICU Harlow Anaes P 53 Basildon EM-ACCS 1 -New ACCS 11 Basildon EM Basildon AM Basildon ICM Basildon An P 54 Basildon EM-ACCS 2 -New ACCS 12 Basildon AM Basildon EM Basildon An Basildon ICM

ACCS CT 1 year: Expectations • • Emergency Medicine -- 6 months Acute Medicine – 6 months (9/3 set up at AH) Curriculum: induction pack what to cover Simulation course: X 3 AH Life Support courses and teaching -GIC Audits and presentations Exams MSF

What you’ll see in A&E…. • • • Acute medicine -lots Paediatrics Fractures Minor injury Primary care Major trauma O&G Acute psychiatric Acute surgery The College of Emergency Medicine

Acute Medicine

e-portfolios • EM and AM support both years of ACCS • RCo. A only ACCS CT 2 • CS and ES Report forms • WPBAs must do CT 1 • ARCP Form

Supervision • • Educational Supervisor for whole year Usually from stream specialty Initial meeting, mid-point end of year ES structured report • Clinical Supervisor: each post 6/12 • Initial meeting, mid-point, end of 6/12 • CS report

EM WPBAs: 2015 curriculum Total 27 • • • CMP 1 - Anaphylaxis CMP 2 – Cardio-respiratory arrest CMP 3 - Major Trauma CMP 4 - Septic patient CMP 5 - Shocked patient CMP 6 - Unconscious patient CAP 7 - Chest pain CAP 1 - Abdominal pain CAP 6 - Breathlessness CAP 30 - Mental health

AM: Minimum number of assessments per 6 months • • 3 Mini-CEX 5 DOPs 3 Cbds 3 ACATs plus 1 MSF

AM DOPs: • • • Lumbar puncture Pleural tap & aspiration Intercostal drain insertion (seldinger) Intercostal drain insertion open Ascitic tap Abdominal paracentesis DC cardioversion Knee aspiration Temporary pacing (external/wire) Large joint examination

ACCS CT 2 year • • • Anaesthetics – 6/12 Intensive Care Medicine – 6/12 Initial Assessment of Competence 3/12 WPBAs Log-Book As per CT 1: LSCs, Audit, MSF, Exams,

After ACCS: 3 rd year • • Anaesthetics – 12/12 Total of 2 yrs before HST-ST 3 EM: The CT 3 year: EM+PEM AM: Additional year of Medicine: Ologies Intensive Care Medicine – 12/12

The ARCP Annual Review of competency and progression Annual Appraisal +Revalidation An Overview

Purpose of the ARCP Normally at least annually • A review and record of the trainee’s progress • Allows judgement to be made about the competences acquired by a trainee and their suitability to progress to the next stage of training • Provides final statement of trainee’s successful attainment of the competences and thereby completion of the training programme

ARCPs Applicable To: • • • All specialty trainees and core trainees Academic trainees Trainees OOP LTFT trainees FTSTAs LATs

Basic Requirements • • ES Structured report +CS reports Wp. BAS Curriculum covered MSF: minimum 10 people of different grades/groups Audit Complaints/compliments/critical incidents Enhanced Form R • All these organised through out the year

ARCP Checklist: • • Up-to-date Curriculum Vitae Completed and updated enhanced Form R Structured Educational Supervisor Clinical Supervisor report for each post – one form to be completed for each placement Registration with the relevant College WPBAs: See separate document for ARCP requirements for each post in ACCS programme DOPS, CEX, Cb. Ds, ACAT or ECAT ALS ATLS EPLS APLS prn

ARCP Checklist: • • • Multi-Source Feedback: minimum 10 mix grades Evidence of internal teaching attendance Evidence of external courses and attendance Evidence of audit or change management projects Evidence of research and publications undertaken List of sick, carer, paternal or maternity leave taken Level two child protection training certificate Evidence of compliments and thanks Personal complaints received + any reflective notes Personal concerns including Incidents reported, SUIs, any reflective notes

Meet the ARCP Panel?

The Invitation to the Trainee • Must be sent at least 6 weeks before the ARCP • Reminds them that they need to get an educational supervisors report • Reminds them to update their CV • Reminds them about the relevant JRCPTB Decision Aid(s) and sends them the link(s)

Reminder to Trainees • A reminder about the ARCP is sent if they do not reply within 10 days • The Deanery does not check the eportfolios for Educational Supervisors reports or send reminders about these (not recommended in the Gold Guide)

The Day of the ARCPs The panel convene 15 -30 minutes before ARCP agree: • Who will chair the panel • Who will complete the electronic and the handwritten records • Who will feedback to the trainee, including their training needs

ARCPs – The Procedure The eportfolio should be reviewed before inviting the trainee into the room: • Previous ARCP(s) • The educational supervisors report • The specialty curriculum, the GIM curriculum if appropriate (‘plenty of yellow, green and brown’) • Assessments, especially MSF.

Assessments • Generally formative • Try to ensure that they are done by appropriate people • The MSF can be valuable

ARCPs – The Procedure (3) The trainee is then invited into the room • Welcomed, panel members introduced • Purpose of ARCP explained • Outcome discussed (aim to be positive, supportive) • CCT date reviewed and if appropriate, Period of Grace discussed (entered in comments section on ARCP proforma in eportfolio) • Training to date and training needs discussed

Outcome 1 Satisfactory progress Fulfils all of the criteria of curriculum requirements

Outcome 2 Development of specific competences required – additional training time not required • Acceptable progress • Some competences not achieved • Not expected that overall progress (and therefore the CCT date) will be delayed • The trainee can ask for this outcome to be reviewed but cannot appeal

Outcome 3 Inadequate progress by the trainee – additional training time required • The panel considers that a period of additional training is required which will extend the duration of training • If this outcome is likely the trainee must be present. • The panel gives recommendations about the additional training. The Deanery decides the details, based on the panel’s recommendations • Usual maximum 1 year • The trainee can appeal

Outcome 4 Released from training programme with or without specified competences • Insufficient and sustained lack of progress, despite additional training • Panel should ensure that competences that have been achieved are documented • Trainee required to give up their NTN • The trainee can appeal

Outcome 5 Incomplete evidence presented – additional training time may be required • Examples include absent educational supervisor’s report, insufficient assessments, insufficient competences signed off • The trainee should submit a written explanation to the panel within 5 working days • The panel can require trainee to submit the necessary documentation by a designated date • Once documentation received, the panel can issue an assessment outcome (they don’t have to meet)

Outcome 6 Gained all required competences – will be recommended as having completed the training programme and for award of a CCT (or CESR)

Outcome 7 FTSTAs or LATs • The panel should give this outcome to FTSTAs and LATs, documenting the competences achieved

Outcome 8 Out of programme for research, approved clinical training or a career break • If the trainee is on a clinical placement, which has been prospectively approved by the GMC/PMETB, the usual documents for a clinical placement should be reviewed • If the trainee is in research the panel should receive a research supervisors report

Outcome 9 Doctors undertaking top-up training in a training post • Applies to doctors applying for a CESR where the GMC has recommended top-up training and they have been appointed competitively to a gap in a training programme. • The panel consider evidence including assessments to decide whether the objectives set by the GMC have been met

Trainees with an Adverse Outcome (2, 3, 4) Supplementary documentation should be completed by the ARCP panel and made available to: • The trainee • TPD • Educational supervisor • Medical director and Trust HR department • JRCPTB

Enhanced Form R: and Revalidation • • • Scope of practice: current jobs, Other work: locums, volunteer work, formal teach Revalidation officer: Prof Simon Gregory Revalidation Date from GMC Complaints/complements Incidents, Adverse Events Reflection on these Probity: nothing to declare? Concerns for revalidation Any concerns from ARCP reported to PG Dean

Out of Programme Research Documentation required: • OOPR return • Report from research supervisor This should indicate whether appropriate progress has been made with the research and ‘that the planned date of completion. . has not changed’

Out of Programme Research Duration of research: • Should not normally exceed 3 years • A request to exceed 3 years must be made by the research supervisor to the Dean at least a year in advance Outcome: • The panel should issue an OOP outcome, recommending continuation of the OOPR or it’s termination, with a date

Less Than Full Time Training • LTFT trainees should still have ARCPs annually • Important to review CCT date carefully taking into account LTFT training

Outcome 6

Simulation Addenbrooke’s Hospital • X 3 a year • X 10 each course • Get in touch with PGC AH: Sue East

Regional days

Emergency Medicine: Brief history Casualty - A&E - EM • • • 45 years old hospital specialty CSA 1968 part of BMA 1980 - Registrar Training 1993 Faculty -FAEM exit exam 2005 College Emergency Medicine 2008 Royal assent -- RCEM 1100+ Consultants Trainees: 440 ACCS+600 STs 220 Acute A&E hospitals 21 million attendances The College of Emergency Medicine

Emergency Medicine

Emergency Medicine Training programme for 2010 CCT in Emergency Medicine +/- sub-specialty/certification HST 3 -yrs FCEM Exit Exam ST 4, ST 5, ST 6 in Emergency Medicine Traditional Sp. R posts Sub-specialty training: dual accreditation PEM, ICM; Acute Medicine PHEM MCEM Part B&C CT 3 12 months EM + MSK T&O EM + Paediatric EM MCEM Part A Core Training - 3 yrs ACUTE CARE COMMON STEM ACCS CT 1 and CT 2 6/12 Emergency Medicine 6/12 Acute Medicine 6/12 Anaesthetics 6/12 Intensive Care Medicine Competitive Entry to ST 1 ACCS (EM) from FY 2/ equivalent by Interview and structured references FY 2 The College of Emergency Medicine FY 1

Question Time