SLO 6 – Proficiently deliver key procedural skills needed in Emergency Medicine

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

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

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

  • Performed observed procedural sedation on a patient under the direct supervision of an ED Consultant

Programme of assessment

  • Logbook record
  • DOPS assessment of observed practice on patient if intermediate DOPS was a simulation

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
  • Log book 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

End of intermediate training:

Level of entrustment

  • Level 3

Programme of learning

  • e-learning module on NIV
  • Observed or simulated practice of NIV initiation

Programme of assessment

  • Certificate of completion of e-learning module
  • DOPS assessment

End of higher training:

Level of entrustment

  • Level 4

Programme of assessment

  • Log book record of skill maintenance

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

End of higher training:

Level of entrustment

  • Level 4

Programme of learning

  • Observed practice
  • Observed instruction of technique

Programme of assessment

  • DOPS assessment of observed practice on patient if intermediate DOPS was a simulation
  • Logbook record of skills maintenance

End of intermediate training:

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

  • Simulated practice

Assessment

  • DOPS assessment

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

  • Simulated practice

Assessment

  • DOPS assessment

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

Programme of assessment

  • Logbook record

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

Programme of assessment

  • Logbook record

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

  • Simulated practice

Programme of assessment

  • DOPS assessment

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

  • Splints (e.g. pelvic sling, traction splint) – Level 4
  • Tourniquet – Level 4
  • Haemostatic agents – Level 4

Programme of learning

  • Observed practice
  • Observed instruction of technique

Programme of assessment

  • DOPs assessments for observed practice on patients of relevant techniques and teaching
  • Logbook record of skill maintenance

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

Programme of assessment

  • DOPS assessment
  • Logbook record

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

  • Simulated practice

Programme of assessment

  • DOPS assessment

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

Programme of assessment

  • >DOPS assessments for relevant observed practice of various techniques and teaching
  • Logbook record of skill development and maintenance

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

  • Maintenance of skills throughout HST

Programme of assessment

  • Logbook record

End of intermediate training:

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

  • Log Book record
  • DOPS assessments
  • Educational supervisor review of logbook regarding progress towards sign off when competent?

Level of entrustment

  • Level 3

End of higher training:

  • Pneumothorax
  • Shock assessment

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

  • Log Book record
  • DOPS assessments

Level of entrustment

  • Level 4

Educational supervisor review of logbook and sign off by the end of HST 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 log book throughout training. Maintain log book for each modality when scanning independently

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