The RCEM curriculum has a clear and stated purpose based on the scope of practice, service, and the patient and population needs.
The purpose of the RCEM Curriculum is to train doctors to be EM Consultants, able to provide urgent and emergency care to all undifferentiated patients attending ED nationwide, 24/7, 365 days every year. This includes leading the multi-professional resuscitation of sick and injured patients of all ages (from birth to advanced age and frailty) in addition to managing, leading and supporting all elements of care delivered by the multi-disciplinary teams throughout the full spectrum of acute illness and injury, physical and mental health needs that present to a modern day ED. They must be able to provide strategic leadership and set the culture within the ED, improve quality, teach and supervise and deliver key administrative tasks. EM trainees using this curriculum will be trained to manage any situation, however complex or challenging, by making those challenges explicit and by supporting their individual development to meet them.
The need for doctors to follow this training programme is clear. There is an on-going increase in demand for UK ED services. In 2016-17 there were 27,329,874 attendances at all types of UK EDs and 18,205,538 in type 1 EDs alone 1. Between 2006-07 and 2016-17 the number of attendances increased by 12.20% or 1.22% per annum. The rise in demand in part reflects the growing number of older patients with complex co-morbidity. This group of patients attend the ED in greater proportion than any other group. EM Consultants are responsible for the care of more than 27.3 million patients per year. This means that in a given year 1 in 2.4 of the UK population will attend an ED. At present these trends show no signs of abating suggesting that future demand will continue to rise.
Whilst current workforce transformation seeks to widen the multi-disciplinary team delivering emergency and unscheduled care the training and supervision of all these other Allied Health Professional roles lies with EM Consultants and so the training as well as service burden continues to rise. There is therefore a continuing need to train individuals and to expand the number of EM Consultants as those with the broadest skill set benefitting the greatest number of patients of any discipline in modern medicine.
The aims of the RCEM curriculum
This curriculum seeks to provide a flexible, attractive training programme for doctors training in EM, ensuring trainees have the opportunity to develop the full range of skills and knowledge they need to meet the standard required of a consultant in EM.
The curriculum provides a framework for training, articulating the standard required to work at consultant level and at key progression points, as well as encouraging the pursuit of excellence in all aspects of clinical and wider practice.
Trainees using this curriculum will be able to develop and apply innovative approaches to teaching and research. They will be required to ensure that they are up to date in their practice, and that they promote and implement research and evidence-based medicine for the benefit of patients. They will be committed to the highest standards of care and of ethical and professional behaviour both within their specialty, and within the medical profession as a whole.
By achieving their CCT, all EM trainees will have demonstrated that they can be trusted to independently deliver each of the SLOs that define the specialty, and also to support and develop others in key areas of EM practise. These SLOs fully incorporate the GPCs, thus also demonstrating that trainees have met the GMC’s requirements. In this way we can demonstrate that on completion of training according to this curriculum a newly qualified consultant in EM can be trusted to lead the line on day one.
The scope of EM practise
EM Consultants are required to display a wide range of knowledge, skills, behaviours and attributes, reflecting the broad nature of this specialty in practice. This is reflected in the depth and breadth of the curricular content. By the point of attaining the CCT, trainees will be skilled in caring for patients, both children and adults, with acute illness, injury, mental health problems, frailty and indeed the many and varied difficulties that may befall humanity leading to an ED attendance. They will have expertise in practical procedures related to the clinical care of such patients, will be expert communicators with strong interpersonal skills, strong emotional awareness and be adept at the management of potentially highly complex situations.
These core areas ensure that doctors in training and beyond CCT can provide safe care whilst working in a range of EDs with a varied case load and staffing skill mix. Our learners’ GPCs and EM specific clinical skills and knowledge will be developed and evidenced through achievement of SLOs across twelve domains. These advance in complexity and sophistication as learners progress through the training programme.
RCEM Specialty 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 acute physical or 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||1,2,3,126.96.36.199||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 development of learners in these SLOs is sequenced in the curriculum to reflect a growing level of responsibility. This is reflected in the structure of training. It is divided into three parts with distinct waypoints. Progression is competency based and training duration therefore, indicative.
Structure of Training
Core training (Indicative two years): Following selection into the specialty trainees will enter core training. Trainees will develop the skills and knowledge to care for individual adult patients in core training. This is within ACCS training, shared with anaesthetics, acute medicine and intensive care medicine. At the end of core, trainees will be able to identify sick adult patients and resuscitate and stabilise as part of the wider hospital team. They will be able to deliver key elements of management, including advanced airway skills and circulatory support. There are entrustment decisions at the end of core training to ensure learners can deliver such care before moving to the next stage of training.
Intermediate training (Indicative one year): The aims of intermediate training are twofold. Learners will develop and refine paediatric EM specific skills and knowledge. They will also be supported to start to take a leadership role in the multi-professional resuscitation team and also begin to develop the skills and knowledge to lead and support the wider EM team in general. At the completion of intermediate training the trainee will be entrusted to function safely as the most senior clinician overnight.
Higher training (three years): In Higher Training learners develop further as leaders, refining the skills needed to lead the whole ED shift, as well as dealing with the most challenging cases that may present, not infrequently in parallel. They will also develop mastery of allied administrative, teaching, supervision, and research skills to ensure they can act as leaders in the ED more widely, setting the standards for clinical care and developing strategy.
The framing of a curriculum of SLOs, or activities that a trainee must be entrusted to deliver as a consultant level clinician, encourages holistic judgement as to the trainee’s overall capability, and support the move away from a `presentation-based’ structure to one that describes a specialty exemplified by the need to attend the broadest range of clinical activity, often simultaneously.
Flexibility and transferability
The curriculum considers interdependencies across related specialties and disciplines. It demonstrates that it has addressed the expectations of the service and healthcare system.
EM interfaces with all aspects of the primary and secondary care. We have sought extensive review from within our college, held a wide ranging consultation with EM trainees and trainers and sought feedback from patients on what is important to them in the doctor that sees them in the ED, in developing our SLOs and we have iterated them based on feedback received.
We have worked with ACCS partners to refine the SLOs that are relevant to this stage of training. The SLOs in core training are designed to meet the needs of all partners and will allow trainees to follow the higher curriculum of each ACCS specialty as efficiently as possible.
The curriculum takes into account the recent development of allied health provider roles, such as Physician Associates and Advanced Care Practitioners. We have made explicit within our programme the need to be able to supervise, answer questions, to lead, support and to train a multi-disciplinary team in the ED. The implementation of this curriculum represents a step change in developing these key elements of EM consultant work.
The curriculum supports flexibility and the transferability of learning. EM shares direct transferability with the other specialties that make up ACCS training. Trainees in each of these parent disciplines can apply to transfer directly to training schemes of each of the other disciplines on completion of ACCS.
Introducing GPCs will undoubtedly aid transferability. Our SLOs are also largely generic in nature, describing the technical skills and human factors that underpin acute care, supporting learners to develop insight into their leadership and team working skills. These will be directly transferable to other roles within the acute care spectrum.