The EM Physician will be able to perform key emergency skills that are time critical and/or life/limb saving. This includes skills that are very rarely used. It is possible that the first time some of these are delivered is after completion. This Specialty Learning Outcome defines the skillset required and includes how an EM clinician will be prepared for tasks that are rare and delivered for the first time after the end of training.
Domain 1: Professional values and behaviours
Domain 2: Professional skills
- practical skills
- communication and interpersonal skills
- dealing with complexity and uncertainty
Key ACCS capabilities
At completion of ACCS a trainee will have:
- the clinical knowledge to identify when key ACCS practical emergency skills are indicated
- the knowledge and psychomotor skills to perform the ACCS procedural skills safely and in a timely fashion
Key EM capabilities
At completion of Intermediate training a trainee will have:
- the clinical knowledge to identify when key EM procedural skills are indicated
- the knowledge and psychomotor skills to perform the ACCS procedural skills safely and in a timely fashion
with Supervisor ‘on call’ from home for queries, able to provide directions via phone and able to attend the bedside if required to provide direct supervision
At completion of higher training a trainee will have:
- the clinical knowledge to identify when key EM practical emergency skills are indicated
- the knowledge and psychomotor skills to perform EM procedural skills safely and in a timely fashion
- Will be able to supervise and guide colleagues in delivering procedural skills
and would be able to manage with no supervisor involvement
ACCS descriptors
Procedural skills-ACCS (Detailed in section 5.5.1)
- Pleural aspiration of air
- Chest drain: Seldinger and open technique
- Establish invasive monitoring (CVP and Art line)
- Vascular access in emergency- IO, femoral vein
- Fracture/ dislocation manipulation
- External pacing
- DC Cardioversion
- Point of care ultrasound- Vascular access and Fascia iliaca block
- Lumbar puncture
Point of care ultrasound- Vascular access and Fascia iliaca block
Intermediate & Higher Descriptors
Procedural skills-Intermediate &Higher Training (Detailed in section 5.5.2)
- Procedural sedation in adults
- Paediatric sedation
- Advanced airway management
- Non-invasive ventilation
- Open chest drain
- Resuscitative thoracotomy
- Lateral Canthotomy
- DC cardioversion
- External pacing
- Pericardiocentesis
- ED management of life threatening haemorrhage
- Emergency delivery
- Resuscitative Hysterotomy
- Fracture/ dislocation manipulation
- Large joint aspiration
- Point of Care Ultrasound
Procedural skills in ACCS
See ACCS website for details: https://www.accs.ac.uk/accs-curriculum/accs-los
The programme of assessment for procedural skills is under development by the intercollegiate board with the aim of transferability between ACCS specialties
EM procedural skills in intermediate and higher training
- Adult sedation
- Paediatric sedation
- Advanced airway management
- Non-invasive ventilation
- Open chest drain
- Resuscitative thoracotomy
- Lateral canthotomy
- DC cardioversion
- External pacing
- Pericardiocentesis
- ED management of life-threatening haemorrhage
- Emergency delivery
- Resuscitative hysterotomy
- Fracture / Dislocation manipulation
- Large joint aspiration
- Point of care Ultrasound
End of intermediate training
Level of entrustment – Level 3
Programme of learning
Completion of RCEM e-learning module on adult sedation
Attendance at adult sedation simulation session
Performance of observed procedural sedation patients under the direct supervision of an ED Consultant
Programme of assessment
Certificate of completion of RCEM e-learning module
Certificate of attendance at adult sedation simulation day
DOPS assessment for adult sedation (simulation)
End of higher training
Level of entrustment – Level 4
Programme of learning
Performance of observed procedural sedation patients under the direct supervision of an ED Consultant
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPS assessment of observed practice on patient if intermediate DOPS was a simulation
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
Level 3
Programme of learning
- Completion of RCEM eLearning module on paediatric sedation
- Attendance at paediatric sedation simulation session
- Performance of observed procedural sedation patients under the direct supervision of an ED Consultant
Programme of assessment
- Certificate of completion of RCEM eLearning module
- Certificate of attendance at paediatric sedation simulation day
- DOPS assessment for paediatric sedation (simulation)
End of higher training:
Level of entrustment
- Level 4
Programme of learning
Performance of observed procedural sedation patients under the direct supervision of an ED Consultant
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPS assessment of observed practice on patient if intermediate DOPS was a simulation
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training
Level of entrustment – Level 3
Emergency surgical airway
RSI
Programme of learning
IAC training during ACCS
Ongoing observed or simulated practice
Simulated skills practice including surgical airway training
ATLS or similar trauma course
Programme of assessment
IAC certificate
DOPS assessment
Logbook record
End of higher training
Level of entrustment – Level 4
Emergency Surgical airway
RSI
Programme of learning
10 Intubations a year on patients- may include
RSI activity in ED/ theatres (including as part of a multi-disciplinary team)
Simulated skills practice session including surgical airway training
Programme of assessment
Logbook record
DOPS assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed practice
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPS assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training
Level of entrustment – Level 3
Programme of learning
Understanding of National Safety Standards for Invasive Procedures (NatSSIPs) checklist
Observed or simulated practice
Programme of assessment
DOPS assessment
Log book record
Simulated practice with reflection recorded
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed practice
Observed instruction of technique
Review of guidelines/papers
Patient safety incident work
Programme of Assessment
Logbook record
DOPS assessment of observed practice on patient if intermediate DOPS was a simulation
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
Level 3
Programme of learning
- e-learning module
- Simulated practice
Programme of assessment
- Certificate of completion of elearning module
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed or simulated practice
Review of guidelines/papers
Programme of assessment
DOPS assessment
Simulated practice with reflection recorded
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module
- Simulated practice
Assessment
- Certificate of completion of e-learning module
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed or simulated practice
Review of guidelines/papers
Programme of assessment
DOPS assessment
Simulated practice with reflection recorded
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module on Broad and Narrow Complex tachycardias
- OR ALS course
- Observed or simulated practice
Programme of assessment
- DOPS assessment
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Maintenance of skills throughout HST
Observed instruction of management of tachydysrythmias
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPS assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module on bradyarrhythmias
- OR ALS course
- Observed or simulated practice
Programme of assessment
- Certificate of completion of eLearning module OR
- ALS certificate
- DOPS assessment
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Maintenance of skills throughout HST
Observed instruction of management of bradydysrythmias
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPS assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module
- Simulated practice
Programme of assessment
- Certificate of completion of e-learning module
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed or simulated practice
Review of guidelines/papers
Programme of assessment
DOPS assessment
Simulated practice with reflection recorded
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Nasal packing – Level 3
- Splints (e.g. pelvic sling, traction splint) – Level 3
- Tourniquet – Level 3
- Haemostatic agents – Level 3
Programme of learning
- e-learning module
Observed or simulated practice of direct and indirect haemorrhage control techniques including but not exclusive to;
- Wound management
- Bleeding varicose veins
- Nasal packing
- Splints (e.g. pelvic sling, traction splint)
- Tourniquet
- Use of haemostatic agents
Programme of assessment
- Certificates of completion of e-learning modules
- DOPS assessments of relevant techniques
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed practice
Observed instruction of technique
Review of guidelines/papers
Patient safety incident work
Programme of Assessment
Logbook record
DOPs assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- E-learning module
- Simulated practice
Programme of assessment
- DOPS assessment
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed or simulated practice e.g. PROMPT course or similar
Review of guidelines/papers
Programme of assessment
DOPS assessment
Simulated practice with reflection recorded
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module
- Simulated practice
Programme of assessment
-
Certificate of completion of e- learning module
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed or simulated practice
Review of guidelines/papers
Programme of assessment
DOPS assessment
Simulated practice with reflection recorded
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
Supervised practice of fracture and dislocation manipulation and splinting techniques including but not exclusive to;
- Shoulder
- Elbow
- Wrist
- Finger
- Hip
- Femur
- Lower leg
- Ankle
- Toes
- Mandible
Programme of assessment
- DOPS assessments for various fracture reduction and joint manipulation techniques
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed practice
Observed instruction of technique
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPs assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training:
Level of entrustment
- Level 3
Programme of learning
- e-learning module
- Observed or simulated practice
Programme of assessment
- DOPS assessment
- Logbook record
End of higher training
Level of entrustment – Level 4
Programme of learning
Observed practice
Observed instruction of technique
Review of guidelines/papers
Patient safety incident work
Programme of assessment
Logbook record
DOPs assessment
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
End of intermediate training
Level of entrustment – Level 3
Programme of learning
e-learning USS resources on data interpretation
Ongoing observed and simulated practice of ACCS skills
Observed and simulated practice of;
- Echo in Life Support (ELS) Is the heart contracting? Is there pericardial effusion causing cardiac tamponade? Is there evidence of right ventricular strain?
- AAA
- eFAST / Focussed Assessment for Free Fluid (FAFF)
Programme of assessment
Logbook record
DOPS assessments
Educational supervisor review of evidence and sign off by the end of Intermediate at entrustment level 3 for:
- ELS
- AAA
- eFAST/ FAFF
End of higher training
Level of entrustment – Level 4
Programme of learning
e-learning USS resources on data interpretation
Ongoing observed and simulated practice of ACCS and intermediate skills
Observed and simulated practice of;
- Shock assessment – including IVC measurement, global contractility and assessment of fluid status (including overload and hypovolaemia).
Programme of assessment
Logbook record
DOPS assessments
Educational supervisor review of evidence and sign off by the end of HST at entrustment level 4 for:
- ELS
- Shock assessment
- AAA
- eFAST/ FAFF
Entrustment based- for guidance approximate number of scans expected: ELS 10; AAA 25; Shock Assessment 25; eFAST/FAFF 25. Scans recorded in the logbook throughout training. Maintain logbook for each modality when scanning independently
OPTIONAL ADDITIONAL EVIDENCE:
Related clinical supervision
Related teaching, research or QI activity
Patient safety incident work
