The Curriculum is designed to lay out what is required to be a specialist in EM in the UK. The Purpose Statement outlines why EM is vital to the patients of the UK and a key element of the National Health Service.
The curriculum also describes how EM trainees will be trained. It is the result of a significant exercise whereby experienced EM trainers and training and assessment experts have sought to describe an effective approach that can be delivered. The following is a description of how learners and trainers can get the best out of it.
The GMC requires all curricula to include Generic Professional Capabilities (GPCs). These are designed to foster a common set of skills, attitudes and behaviours in the trainee workforce that might be transferrable if needed.
The expertise of an EM consultant working within the NHS involves a wide range of knowledge and technical skills. The breadth of the clinical presentations, or pathophysiological processes, that need to be known by EM specialists are listed as the Clinical Syllabus. Up to date knowledge and understanding of the assessment and treatment of patients presenting to the Emergency Department (ED) is a fundamental part of training. The knowledge and understanding will be the subject of private study, departmental and regional teaching and will be assessed in the Programme of Assessment, in particular the formal examination schedule.
The clinical knowledge and understanding outlined in the Clinical Syllabus is applied in a setting of varying demands, interspersed with rare and challenging situations, delivered by a workforce with a range of experience and the need for overview and leadership from the EM specialist. The requirements of on an EM specialist in this setting are articulated in the Specialty Learning Outcomes (SLOs). The Speciality Learning Outcomes outline what an EM specialist, at the end and at key points within training, will be expected to be able to do independently.
EM specific Key Capabilities are described for each of the SLOs. These are the specific contextualised aspects of the SLOs that are fundamental to the practise of EM in the UK. The Key Capabilities form the basis of how the SLOs are assessed. Trainees will be required to demonstrate how they are developing in training against each these. The skills of self-regulation will be developed by trainees seeking and considering feedback at work in each of the Key Capabilities.
The Descriptors section of each Specialty Learning Outcome (SLO) gives examples and further guidance for trainees and assessors about what is required. The SLOs are designed to support the development of trainees in all dimensions needed to deliver expert EM care effectively. By covering the human factors at play we aim to make the implicit explicit.
The purpose of training for the SLOs is the application of clinical knowledge to patient care in the ED, RCEM’s vision for the provision of training in the work place is that it acknowledges the challenge that leadership in the ED represents. It also acknowledges that all have varying strengths and areas to improve, and that these be both refined and developed.
The best use of training in the work place for learners is to find areas of challenge and to seek and reflect on feedback from trainers. In the curriculum these are grouped within the 12 SLOs described. Eight of them relate to work caring for patients directly in the ED and four supporting SLOs relate to teaching, research and scholarship, quality improvement and patient safety and leadership and management. It is important to develop in all 12. The requirements at each stage of training are laid out in the Programme of Assessment.
A key principle underpinning the Programme of Assessment is that a tick list is not followed, or a specific number of assessments accumulated. It is rather that there is a shared understanding of where trainees need to get to, in terms of the degree of independence, at the next stage of training and that training is geared to readying them. Trainers know which situations and circumstances are demanding and can guide learners to experience these, with support, in the work place. That is the point of work place encounters that are recorded in the RCEM e-portfolio. To that end, assessment in the work place should start at the beginning of the training year and pitched at outer edges of the trainees’ ‘comfort zone’.
Expertise in EM is pivotal to the good health of communities in the UK. It is hard won, complex and requires a spread of knowledge, skills and attributes that are often called on all at once. This curriculum sets out what these are and is designed to support their development, integration and assessment. It acknowledges that there are a range of talents within those training in the speciality. The curriculum sets out a minimum requirement, but our aim is also that it is used as the map to guide the pursuit of excellence for individuals. There is scope for developing areas of interest or particular expertise within the speciality. We aim to establish practices that develop clinicians who can thrive as individuals throughout their career in the ED.