RCEM Speciality learning Outcomes
|Specialty Outcome||Generic Professional Capabilities||Description|
|1. Care for physiologically stable adult patients presenting to acute care across the full range of complexity||1,2,3,4,6,7||Care for patients presenting with physical ill health, mental health concerns and be able to manage the most complex presentations|
|2. Support the ED team by answering clinical questions and making safe decisions||1,2,3,4,5,6,7||Support the clinical team with a safe and comprehensive approach as an expert diagnostician|
|3. Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop||1,2,3,4,5,6,7||Resuscitate and stabilise critically ill adults, lead resuscitation teams, know when resuscitation is inappropriate or should be stopped and care for ED patients at the end of their life|
|4. Care for acutely injured patients across the full range of complexity||1,2,3,4,5,6,7||Manage all injured patients presenting to the ED, including major incidents|
|5. Care for children of all ages in the ED, at all stages of development and children with complex needs||1,2,3,18.104.22.168||Care for and resuscitate children in the ED|
|6. Deliver key procedural skills||1,2,3,4,5,6,7||Proficiently provide the full range of technical skills needed in Emergency Medicine|
|7. Deal with complex and challenging situations in the work place||1,2,3,4,5,6,7||Be able to manage the wide variety of challenges, posed personally and to the ED team on the ED shift|
|8. Lead the ED shift||1,2,3,4,5,6,7||Provide leadership to the whole ED and link with the wider health community on shift|
|9. Support, supervise and educate||1,2,3,5,6||Support, supervise, mentor and educate the ED team|
|10. Participate in research and managing data appropriately||1,2,3,5,8||Understand and be able to utilise and participate in EM research|
|11. Participate in and promote activity to improve the quality and safety of patient care||1,2,3,9||Be able to deliver quality improvement in the ED|
|12. Manage, Administer and Lead||1,2,3,4,5,6,7||Deliver administrative tasks within the ED and as part of the wider NHS. Provide leadership and help set the culture in the ED|
The RCEM training programme will take a novice through to independent practice in each of the SLOs. During medical training in the NHS, the trainee will cross several key thresholds to take a new, greater level of responsibility. Being as sure as reasonably possible that a trainee is ready to cross these thresholds is vitally important for patient safety, and also for the safety and professional wellbeing of the trainee.
The Programme of Assessment recognises these thresholds, and is geared to ensure they are crossed safely. The RCEM curriculum clearly lays out trainees’ professional responsibilities at each threshold. Each of the SLOs has Key Capabilities. These describe the essential activities within each of the SLOs at the three key stages of EM training. Helping trainees to develop towards these, and deciding if they have met the requirements, forms the basis of the RCEM assessment programme.
Assessment, as an integral part of curriculum, is intended to:
The purposes of the Programme of Assessment fall into three broad categories:
- demonstrate trainees have acquired the Generic Professional Capabilities and meet the requirements of Good Medical Practice
- ensure that trainees possess the essential underlying knowledge required for their specialty
- provide robust, summative evidence that trainees are meeting the curriculum standards during the training programme
Regulating progression & targeting remediation:
- assess trainees’ actual performance in the work place
- inform the ARCP, identifying any requirements for targeted or additional training where necessary and facilitating decisions regarding progression through the training programme
- identify performance concerns and ultimately trainees who should be advised to consider changes of career direction
Fostering self-regulated learners:
- enhance learning by providing formative assessment, enabling trainees to receive immediate feedback, understand their own performance and identify areas for development
- drive learning and enhance the training process by making it clear what is required of trainees and motivating them to ensure they receive suitable training and experience
- to identify and encourage excellence
The RCEM assessment strategy seeks to fulfil those purposes by:
The purposes above have driven the design of the RCEM assessment strategy from start to finish. We have sought to define a fully integrated and complementary programme of assessment that recognises the strengths and limitations of its constituent parts to deliver a programme as a whole. The programme of assessment is made up of three major elements.
- A suite of formal RCEM examinations
- A programme of work place based assessments (WPBAs)
- A programme of regular, panel-based, information-rich, individualised judgements that regulate each trainee’s progression and remediation (where necessary)
The formal RCEM examinations prioritise assurance for all stakeholders including trainees. Consequently the design focus is on reliability and a nationally consistent hurdle with transparent standards. The suite of examinations provides assurance that trainees have achieved a standard of knowledge and basic technique. The MRCEM, in particular, aims to assess not only the attainment of learning, but also the potential to develop and thrive as an independent leader and practitioner following training.
Work Place Based Assessments (WPBAs)
The work place based assessment programme is designed to foster self-regulated learners and to provide the all-important information that will regulate trainees’ progression through the programme.
WPBA provides a structure for observing the individualised and contextualised application of learning. By providing feedback and encouraging reflection it also helps trainees develop self-regulated learning skills. The transparent links between the WPBA judgements, the entrustability judgements made by Faculty Education Group panels, and the levels of independence expected at each of the thresholds are critical for orienting learners to what is expected of them; this gives them both the stimulus and the data that they need to regulate their own learning.
Despite compromises in reliability, WPBA offers a better prediction of day-to-day performance than formal examinations with all the complexity that EM work includes. In particular, the RCEM instruments have been designed to make it easy for supervisors and others to flag up concerns about any given trainee. Conventional WPBA questions allow clear concerns to remain unshared, and this would create problems both for patients, trainees and services.
The WPBA programme is designed to be used throughout training, and so offers the opportunity for pertinent developmental feedback and the highlighting of concerns at regular intervals through training when there is a chance to define plans to support learning.
FEG statements work with the ARCP process to provide regular, panel-based, information-rich, individualised judgements that regulate each trainee’s progression and remediation (where necessary). Like the WPBA programme, they are designed to foster self-regulated learners and to regulate trainees’ progressionthrough the programme. The faculty will consider the trainee’s work place performance and provide a summative recommendation about whether a trainee has met the standard in the SLOs relevant to their stage of training. This information is combined with other evidence in a Structured Training Report (STR) that is completed by the trainee’s Educational Supervisor at the end of a block of training. This, in turn, is reviewed by the ARCP panel who will make a decision regarding progression. These elements are phased, reflecting the growing knowledge and experience of trainees. At key thresholds in training the work place based assessment and RCEM examinations are co-ordinated to enable ARCP panels to adjudge readiness to cross a threshold in training. This approach acknowledges the complementary nature of the component parts of the assessment programme.
Background to the programme assessment
In 2015, RCEM developed a new approach to work place based assessment. It had become clear that:
1. Asking trainees and trainers to complete too many WPBAs meant that few of them were done properly
2. Sampling a comprehensive list of presentations using WPBAs led to a tick box approach
3. We could find no evidence that variation in performance (case specificity) was condition specific…
4 …and therefore WPBA was best used to cover generic, tacit aspects of cases. (But this required the instruments and the sampling approach to be redesigned)
We introduced the concept of using independence as the anchor for assessor feedback in WPBA, as this had been shown to yield more reliable and meaningful data in a wide range of contexts1. We stopped asking for summative pass/fail data on individual cases, but introduced a requirement that the training faculty offered summative evidence about whether a trainee is ready to progress based on the entirety of their performance in post. The training faculty used all their knowledge of the trainee in the work place to come inform their opinion. This allowed for individualised decision-making and attention to progress (direction of travel) and profile (pattern of strengths and weaknesses) as well as ‘overall’ attainment.
RCEM also introduced a novel technique for assessing the generic aspects of being trainee in EM, in particular the non-technical skills (NTS). The Extended Supervised Learning Event (ESLE) tool was structured around an observed period of clinical activity in the ED, with detailed feedback structured around a validated inventory of EM NTS, yielding psychometrically reliable judgements.2
These ESLE episodes, and the wider experience of the training faculty working alongside the trainee, were triangulated by a department in a Faculty Educational Governance statement. This was summative evidence made available to the ES, for consideration at ARCP, about whether the trainee is recommended to the progress to the next year of training.
1. Crossley J, Jolly B Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people. Medical Education 2012 46(1):28-37
2. Townend, Will et al. The Extended Supervised Learning Event (ESLE): Assessing Nontechnical Skills in Emergency Medicine Trainees in the Workplace. Annals of Emergency Medicine, Volume 74, Issue 5, 670 – 678
How are these being extended in 2021?
The 2021 RCEM assessment strategy builds on this, to meet its stated purposes, in a number of ways.
- The Training Faculty’s entrustment decisions about progression are directly linked to the Clinical SLOs – offering clear guidance to trainees and trainers as to the standards required
- The Educational Supervisor’s assessments of SLOs that do not involve direct patient care (Generic SLOs) are based on evidence collated by the trainee. Clear guidance over standards ensures consistency whilst allowing for individual variation
- There is no ‘number’ of WPBA or a list to tick off. Trainees are given a clear description of the standard and advice on how that may be evidenced. It is for them to seek and reflect on feedback, encouraging the development of self-regulatory approach for consultant life
The flow of information in the new programme of assessment is shown in Figure 1.
- The Training Faculty will deliver a summative recommendation on each of the Clinical SLOs that are relevant to the trainee’s stage of training, i.e. have they met the standard for entrustment. This is summarised within a FEG Statement.
- The Educational Supervisor reviews the evidence collated for each of the Generic / Supporting SLOsand offers a judgement on progress in these. A matrix providing guidance for Educational Supervisors in the Generic SLOs is available.
- The Educational Supervisor also reviews WPBAs, Multi-Source Feedback and other relevant data, such as case load, critical incidents, reflections, log books and considers and offers insight on flags of concern. This allows for an integrated and individualised collation of diverse evidence.
These three elements form the basis of the Educational Supervisor’s STR. This, in turn, is reviewed by the ARCP panel. The panel will have access to all the relevant source material and will be able to provide oversight and ensure a nationally consistent approach and standard. The ARCP panel will make the final summative decision about progression.When an ARCP occurs at a threshold in training (Threshold ARCP), the data held within the Educational Supervisor’s report will be combined with RCEM examination data to arbitrate on whether a trainee can cross the threshold, either into Higher Training, or to complete.
Figure 1. Information flow in assessment