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
Domain 3: Professional knowledge
Domain 4: Capabilities in health promotion and illness prevention
Domain 5: Capabilities in leadership and team working
Domain 6: Capabilities in patient safety and quality improvement

At completion of ACCS a trainee will:

  •  Have the clinical knowledge to identify when key emergency procedural skills are indicated and the psychomotor skills to perform them safely and in a timely fashion

At completion of training an EM specialist will:

  • Be able to independently deliver all EM procedural skills, including those rarely required
  • Will be able to supervise another team member to complete the skill safely and make judgements about junior colleagues’ competence in this domain
  • Airway management including endotracheal intubation
  • Adult procedural sedation
  • Pleural aspiration of air
  • Chest drain: Seldinger and open technique
  • Central line insertion
  • Vascular access in emergency- IO, femoral vein
  • Pericardiocentesis
  • Lumbar puncture
  • Fracture/ dislocation manipulation
  • External pacing
  • Point of care ultrasound- Vascular access and Fascia iliaca block

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 e-learning module on adult sedation
  • Attendance at sedation simulation day to include observed practice, evidenced by a DOPs
  • Completion of DOPs for sedation (not simulation)

Programme of assessment

  • Certificate of completion of RCEM e-learning module
  • Certificate of attendance at sedation simulation day
  • DOPs for sedation (simulation)
  • Completion of Anaesthetic Initial Assessment of Competencies (IAC)

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Performed proctored procedural sedation of patients under the direct supervision of an ED Consultant

Programme of assessment

  • DOPs for sedation (not simulated) – signed off to level of competent for independent practice
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

Level 2b

Programme of learning

  • Completion of RCEM e-learning module on paediatric sedation
  • Attendance at sedation simulation day to include observed practice, evidenced by a DOPs

Programme of assessment

  • Certificate of completion of RCEM e-learning module
  • Certificate of attendance at sedation simulation day
  • DOPs for sedation (simulation)
  • Completion of Anaesthetic Initial Assessment of Competencies (IAC)

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 for sedation (not simulated) – signed off to level of competent for independent practice
  • FRCEM final examination (SAQ and OSCE)
  • Faculty Governance Statement
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

  • Emergency front of neck – Level 2b
  • Intubation in cardiac arrest – Level 3
  • Supraglottic airway insertion – Level 3
  • RSI – Level 2b

Programme of learning

  • ALS course
  • Simulated skills practice
  • Completion of Initial Assessment of Competencies

Programme of assessment

  • ALS certificate
  • DOPs evidence of simulated practice
  • IAC

End of higher training:

Level of entrustment

  • Emergency front of neck – Level 4
  • Intubation in cardiac arrest – Level 4
  • Supraglottic airway insertion – Level 4
  • RSI – Level 4

Programme of learning

  • Maintenance of ALS provider status
  • Airway skills refresher course (e.g. TEAM course)
  • Ongoing RSI activity in ED/ theatres

Programme of assessment

  • Logbook record
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • RCEM e-learning module on NIV
  • ACCS ICM post
  • Simulated practice of NIV initiation

Programme of assessment

  • Certificate of completion of RCEM e-learning module
  • Completion of ACCS competencies for ICM
  • DOPs for simulated NIV initiation

End of higher training:

Level of entrustment

Level 4

Programme of assessment

  • FRCEM examination (SAQ and OSCE)
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice for chest drain insertion (seldinger and open)
  • APLS/ATLS/ETC course
  • Understanding of National Safety Standards for Invasive Procedures (NatSSIPs) checklist
  • Supervised practice of chest drain insertion on patient (seldinger and open)

Programme of assessment

  • APLS/ATLS/ETC certificate
  • DOPs for simulated chest drain insertion (seldinger and open)
  • DOPs for chest drain insertion (seldinger and open) – not simulated

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Maintain APLS/ATLS/ETC provider status

Programme of assessment

  • Logbook record
  • APLS/ATLS/ETC certificate
  • FRCEM examination (MSO)
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice for pleural aspiration
  • Understanding of National Safety Standards for Invasive Procedures (NatSSIPs) checklist
  • Supervised practice of pleural aspiration

Programme of assessment

  • DOPs for simulated pleural aspiration
  • DOPs for pleural aspiration – not simulated

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Maintenance of skills throughout HST

Programme of assessment

  • Logbook record
  • FRCEM examination (OSCE)
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

  • Central venous access – Level 3
  • Intra-osseous – Level 3
  • Ultrasound guided peripheral access – Level 3
  • Arterial line – Level 3

Programme of learning

  • ACCS ICM and Anaesthetic posts (central line access and arterial line)
  • ALS course (intra-osseous)
  • RCEM ultrasound e-learning modules
  • RCEM approved level 1 ultrasound course

Programme of assessment

  • Certificate of completion of RCEM e-learning ultrasound modules
  • Completion of ACCS ICM and anaesthetic posts
  • DOPs for central line insertion
  • DOPs for arterial line insertion
  • DOPs for ultrasound guided peripheral access
  • DOPs for simulated IO insertion

End of higher training:

Level of entrustment

  • Central venous access – Level 4
  • Intra-osseous – Level 4
  • Ultrasound guided peripheral access – Level 4
  • Arterial line – Level 4

Programme of learning

  • Maintenance of skills throughout HST

Programme of assessment

  • Logbook record
  • Completion of vascular access module for level 1 ultrasound
  • FRCEM examination (OSCE)
  • Faculty Governance Statement

End of intermediate training:

Level of entrustment

Level 2a

Programme of learning

  • RCEM learning module on resuscitative thoracotomy
  • Simulated practice(ideally cadaveric)

Assessment

  • Certificate of completion of RCEM e-learning module

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice

Assessment

  • Certificate of completion of simulated practice

End of intermediate training:

Level of entrustment

Level 2b

Programme of learning

  • RCEM learning module
  • Simulated practice

Assessment

  • Certificate of completion of RCEM e-learning module

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice

Assessment

  • Certificate of completion of simulated practice

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • RCEM learning module on Broad and Narrow Complex tachycardias
  • ALS course
  • Simulated practice
  • Supervised practice

Programme of assessment

  • Evidence of theoretical knowledge on the management of arrhythmias (e.g. SAQ)
  • ALS certificate
  • DOPS for DC cardioversion
  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Maintenance of skills throughout HST

Programme of assessment

  • Logbook record
  • FRCEM examination (OSCE)

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • RCEM learning module on bradyarrhythmias
  • ALS course
  • Simulated practice
  • Supervised practice

Programme of assessment

  • Evidence of theoretical knowledge on the management of arrhythmias (e.g. SAQ)
  • ALS certificate
  • DOPS for external pacing
  • 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:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice

Programme of assessment

  • Evidence of theoretical knowledge on the technique (e.g. SBA)
  • DOPS for pericardiocentesis
  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice

Programme of assessment

  • Evidence of theoretical knowledge on the technique (e.g. SAQ)
  • Evidence of practical knowledge on the technique (e.g. OSCE)
  • DOPS for pericardiocentesis
  • Logbook record

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

  • ATLS/ETC course
  • Simulated practice
  • Supervised practice

Programme of assessment

  • ATLS/ETC certificate
  • 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

  • ATLS/ETC course
  • Simulated practice
  • Supervised practice

Programme of assessment

  • ATLS/ETC certificate
  • Logbook record

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • E-learning module
  • Simulated practice

Programme of assessment

  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice

Programme of assessment

  • Logbook record

End of intermediate training:

Level of entrustment

Level 2a

Programme of learning

  • Simulated practice

Programme of assessment

  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice

Programme of assessment

  • Logbook record

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • Supervised practice

Programme of assessment

  • DOPS for fracture reduction / joint manipulation
  • 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:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice
  • Supervised practice

Programme of assessment

  • DOPS for large joint aspiration (e.g. knee)
  • 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:

Level of entrustment

Level 2b

Programme of learning

  • ATLS/ETC course

Programme of assessment

  • ATLS/ETC certificate

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • ATLS/ETC course
  • RCEM learning module on major burns
  • Simulation material

Programme of assessment

  • ATLS/ETC certificate
  • Evidence of theoretical knowledge on the technique (e.g. SBA)

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice
  • Supervised practice

Assessment

  • DOPS for lumbar puncture
  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Maintenance of skills throughout HST

Assessment

  • Logbook record

End of intermediate training:

Level of entrustment

Level 3

Programme of learning

  • Simulated practice
  • Supervised practice

Assessment

  • DOPS for suprapubic catheter re-insertion
  • Logbook record

End of higher training:

Level of entrustment

Level 4

Programme of learning

  • Simulated practice
  • Supervised practice

Assessment

  • DOPS for suprapubic catheter re-insertion
  • Logbook record

End of intermediate training:

Vascular access

  • Aortic calibre measurement
  • FAST

Programme of Learning

  • Level 1 theory training

End of higher training:

  • Pneumothorax
  • Shock assessment

Programme of Learning

  • Level 2 training

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