The guide to RCEM Emergency Care ACP credentialing October 2017

Transcription

1 The guide to RCEM Emergency Care ACP credentialing October

2 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. 2

3 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...31 Appendix Four: Credentialing Outcome Form...61 Appendix Five: Credentialing Feedback Form...63 Appendix Six EXAMPLE Annual progression form for trainee ACPs from a nursing background...65 Appendix Seven- RCEM ACP Academic Component - Credentialing Declaration...70 Appendix Eight - Organisation of the Personal Library in the e-portfolio

4 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 Individuals interested in applying for the credentialing process, or wishing to join the Emergency Care ACP mailing list should contact ACP@RCEM.ac.uk, likewise any questions may be sent to this address All time periods referred to within this document (and other Emergency Care ACP paperwork) are full-time equivalent 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. 4

5 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 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: eportfolio@rcem.ac.uk 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 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 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 Revalidation.pdf 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 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 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 5

6 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 A Portfolio is unlikely to be adequate if more than 30% of the evidence is from more than 3 years ago 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 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 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 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 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 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 ACP@rcem.ac.uk 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. 6

7 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 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 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 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 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. 7

8 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 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 ACPs who have successfully credentialed will be invited to the annual RCEM diploma ceremony 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. 8

9 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 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 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 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 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. 9

10 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 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 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 ACP@rcem.ac.uk 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 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 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 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 10

11 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 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 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 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 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 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) 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 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 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 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 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 11

12 needed for the supervision of all trainees of all professions 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 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. 12

13 Appendix One: Summary of formal assessments required Adult ACP Area of curriculum Common competences Area of curriculum Major presentations Acute presentations Additional acute presentations Evidence required 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 Evidence required Consultant assessment for: Anaphylaxis Cardiac arrest (or ALS) Major Trauma Sepsis Shocked patient Unconscious patient 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. 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 Number by consultant Alternatively an ACAT may be utilised which covers 3 or more presentations. 13

14 Airway management Practical procedures Multisource feedback Life support courses Audit Consultant assessment required 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) 1 MSF per year with at least 15 respondents Advanced Life Support Paediatric Basic Life Support (e.g. Trust-based training) European Trauma Course/ATLS (as a full candidate not observer) Evidence of leadership and implementation of actions from audit or quality improvement project with reflection

15 Additional paediatric competences for Adult and Paediatric ACPs Area of curriculum Common competences Paediatric Major presentations Paediatric Acute presentations Paediatric procedures Life support courses Evidence required CC19 requires certificate for safeguarding children and young people Consultant assessment for all presentations: Anaphylaxis Apnoea stridor and airway obstruction Cardiorespiratory arrest (or APLS/EPLS) Major trauma Shocked child Unconscious child 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. Consultant led assessment for: Airway assessment and maintenance Safe sedation in children Primary survey in a child* APLS/EPLS Number by a consultant

16 Paediatric ACP Area of curriculum Evidence required Number by a Common competences Paediatric Major Presentations Paediatric Acute presentations 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 Consultant assessment for: All 6 presentations Cardiac arrest may be assessed by successful completion of APLS/EPLS 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. consultant Additional acute presentations Consultant assessments for: All 5 major trauma competences. One patient may cover up to two competences if appropriate. Consultant assessments for: 8 Airway management Practical procedures Traumatic limb/joint injuries Interpretation of abnormal blood gas Abnormal blood glucose Consultant assessment required 1 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: 15 16

17 Multisource feedback Life support courses Audit 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 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) Evidence of leadership and implementation of actions from audit or quality improvement project with reflection. 17

18 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 CbD or MiniCEX led by consultant for: CC4 - time management and decision making CC8 - team working and patient safety Vulnerable adult Safeguarding certificate for CC19 18

19 Area of curriculum Evidence required In library or certificates? Major presentations Consultant assessment for: Acute presentations Additional Major Presentation Additional acute presentations Anaphylaxis Cardiac arrest (or ALS) Major Trauma Sepsis Shocked patient Unconscious patient Consultant assessment for: Chest pain Abdominal pain Breathlessness Mental health Head injury Consultant assessments for Major trauma chest Major trauma abdominal injury Major trauma spine Major trauma maxfax Major trauma burns Consultant assessments for: Traumatic limb/joint injuries Interpretation of abnormal blood gas Abnormal blood glucose Date, type of assessment and name of assessor 19

20 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 Date, type of assessment and name of assessor 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 20

21 Airway management Multisource feedback Consultant assessment for A5B 1 MSF per year with at least 15 respondents/2 consultants Life support courses Audit Adult: ALS Paediatric: Basic Life support (trust training) European Trauma Course/ATLS (as a full candidate not observer) 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: 21

22 Checklist for ACP seeing Adult and children 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 CbD or MiniCEX led by consultant for: CC4 - time management and decision making CC8 - team working and patient safety Vulnerable adult Safeguarding certificate for CC19 Safeguarding children level 3 certificate for CC19 Major presentations Consultant assessment for: Anaphylaxis Cardiac arrest (or ALS) Major Trauma Sepsis Shocked patient Unconscious patient 22

23 Area of curriculum Evidence required In library or certificates? Acute presentations Consultant assessment for: Chest pain Additional Major Presentation Additional acute presentations Abdominal pain Breathlessness Mental health Head injury Consultant assessments for Major trauma chest Major trauma abdominal injury Major trauma spine Major trauma maxfax Major trauma burns Consultant assessments for: Traumatic limb/joint injuries Interpretation of abnormal blood gas Abnormal blood glucose Date, type of assessment and name of assessor 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 23

24 Paediatric Acute presentations 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 Multisource feedback Life support courses Audit Consultant assessment for A5B 1 MSF per year with at least 15 respondents/2 consultants Adult: ALS APLS/EPLS European Trauma Course/ATLS (as a full candidate not observer) Evidence of leadership and implementation of actions from audit or quality improvement project with reflection 24

25 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 Date, type of assessment and name of assessor 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 25

26 Area of curriculum Evidence required In library or certificates? Practical procedures Consultant led assessment for: continued Airway assessment and maintenance Safe sedation in children Primary survey in a child* Date, type of assessment and name of assessor 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: 26

27 Checklist for ACP seeing children only 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 CbD or MiniCEX led by consultant for: CC4 - time management and decision making CC8 - team working and patient safety Safeguarding children level 3 certificate for CC19 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 27

28 Area of curriculum Evidence required In library or certificates? Paediatric Acute Consultant led assessment for: presentations Abdominal pain Breathing difficulties Acute life threatening event Concerning presentation Head injury Mental health Date, type of assessment and name of assessor ACAT may be utilised which covers 3 or more presentations. Additional acute presentations Airway management Life support courses 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 Consultant assessment for A5B Adult: BLs (trust training) APLS/EPLS European Trauma Course/ATLS (as a full candidate not observer) 28

29 Multisource feedback Audit Practical procedures 1 MSF per year with at least 15 respondents/2 consultants Evidence of leadership and implementation of actions from audit or quality improvement project with reflection By a consultant DOPS 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 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 Consultant led assessment for: Airway assessment and maintenance Safe sedation in children Primary survey in a child* 29

30 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: 30

31 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 History taking Physical examination Communication Descriptor of satisfactory performance 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 Detects /elicits and interprets important physical signs. Maintains dignity and privacy 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 discussionwhether 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 Descriptor of unsatisfactory performance 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 circumstancesbusy, noisy, multiple demands Failed to detect /elicit and interpret important physical signs Did not maintain dignity and privacy 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 31

32 Dimension Clinical judgmentclinical decision making Professionalism Organisation and efficiency Overall care Descriptor of satisfactory performance 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 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 Demonstrated efficiency in progressing the case 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 Descriptor of unsatisfactory performance 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 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 Was slow to progress the case 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 32

33 Emergency Care ACP Mini-CEX Summative Descriptors for Major Presentations Anaphylaxis Unconscious/Altered Mental State Shock Trauma Sepsis 1 Anaphylaxis Expected behaviours Initial approach History Examination Investigation Clinical decision making and judgement Communication 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 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 Detailed physical examination which must include physical signs that would differentiate between haemorrhagic, hypovolaemic, cardiogenic and septic causes for shock 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 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 Effectively communicates with both patient and colleagues 33

34 Organisation and efficiency Overall plan Professionalism Manages time well does not appear rushed but completes critical tasks in a timely way. Uses staff and delegates appropriately Identifies immediate life threats and readily reversible causes Stabilises and prepares for further investigation, treatment and admission Behaves in a professional manner 2 Unconscious/altered Mental Status Expected behaviour Initial approach History Examination Investigation Clinical decision making and judgement Communication Overall plan Professionalism 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 Obtains history- friends, family, paramedics- cover PMH, previous ODs etc Obtains previous notes Detailed physical examination including fundoscopy 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 Effectively communicates with both patient and colleagues Identifies immediate life threats and readily reversible causes Stabilises and prepares for further investigation, treatment and admission Behaves in a professional manner 34