The work of an expert Emergency Clinician has been divided into 12 Speciality learning Outcomes. Although Emergency Medicine is a team-based activity, an EM consultant must be able to take a leadership role in each of the activities outlined. They must be able to act without supervision-to be an independent practitioner. By dividing the work of an EM consultant in this way the progress of learners to independent, expert practise, in each of these areas of work can be considered.
Eight of these outcomes relate to activities that happen on shift in the ED. These activities include direct patient care. Each has a comprehensive description of the steps taken from entry to training to independent practise. At key thresholds in training an entrustment decision is made. This is a predication by the training faculty who have worked alongside that learner of whether they are ready to move into the next stage of training and shoulder the additional responsibility that is required.
Work in each of these Speciality learning Outcomes is focussed on making learners ready. That requires hard work, a readiness to seek out and accept and reflect on honest constructive feedback by trainees and the drive and commitment to support learners to experience clinical situations that are challenging where learning is at its richest.
Each of the Specialty learning Outcomes has Generic Professional Capabilities that underpin them and these are listed.
They also have a number of Key EM capabilities. These provide focus, emphasis and clarity as to what is required in providing the particular aspect of professional work the Outcome describes. These relate directly to Decision making about readiness to progress. These Key EM Capabilities are given further detailed context in a list of knowledge skills and attitudes that relate to them.
There are 11 ACCS Learning Outcomes that are followed in core training. Thereafter there are 12 RCEM SLOs that cover the whole of training in the RCEM curriculum. The progression in training from ACCS Learning Outcomes to RCEM SLOs is shown in Table 2.
Table 2. Progression from ACCS LOs to RCEM SLOs
| ACCS LO | RCEM SLO | Note |
| 1. Care for physiologically stable adult patients presenting to acute care across the full range of complexity | 1. Care for physiologically stable adult patients presenting to acute care across the full range of complexity | Continuous |
| 2. Make safe clinical decisions, appropriate to level of experience, knowing when and how to seek effective support | 2. Support the ED team by answering clinical questions and making safe decisions | Increased sophistication and acknowledgement of the need to support others from intermediate training onwards |
| 3. Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop | 3. Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop | Continuous |
| 4. Care for acutely injured patients across the full range of complexity | 4. Care for acutely injured patients across the full range of complexity | Continuous |
| 5. Provide safe basic anaesthetic care including sedation | Content moves to SLO 3 and 6 in Intermediate and Higher Training | |
| 5. Care for children of all ages in the ED, at all stages of development and children with complex needs | Begins in intermediate training as a requirement, although experience and feedback can be accrued in Core Training | |
| 6. Deliver key procedural skills | 6. Deliver key procedural skills | Continuous |
| 7. Deal with complex and challenging situations in the work place | 7. Deal with complex and challenging situations in the work place | Continuous |
| 8. Manage patients with organ dysfunction and failure | Content moves to SLO 3 and 6 in intermediate and Higher Training | |
| 8. Lead the ED shift | Requirement from intermediate training onwards | |
| 9. Support, supervise and educate | 9. Support, supervise and educate | Continuous |
| 10. Participate in research and managing data appropriately | 10. Participate in research and managing data appropriately | Continuous |
| 11. Participate in and promote activity to improve the quality and safety of patient care | 11. Participate in and promote activity to improve the quality and safety of patient care | Continuous |
| 12.Manage, Administer and Lead | Requirement from intermediate training onwards |
The ACCS Learning Outcomes
In ACCS training the ACCS Learning Outcomes are common to all four parent specialties. They reflect both the continuity of training for learners following the RCEM curriculum in full, and the need for learners in the other ACCS specialities to be able to transfer seamlessly to parent programmes.
There are 11 ACCS Learning Outcomes, eight relating directly to patient care (Clinical ACCS Learning Outcomes), and three to generic activity required in speciality training (Generic ACCS Learning Outcomes), mapped to the GPCs. The Clinical ACCS Learning Outcomes include content relating to basic anaesthetic care and intensive care medicine. Beyond ACCS, this content becomes part of the RCEM SLOs.
RCEM Specialty Learning Outcomes
Eight of the RCEM SLOs are ‘patient facing’ and relate directly to patient care or activity in the clinical work place. These are the ‘Clinical SLOs’. The remaining four relate to supporting activities that take place away from the ED clinical areas but are also essential to the development of a specialist in EM. These are the ‘Supporting SLOs’. The expectations on trainees in each are clearly described and reflect the growing sophistication of the EM clinician in training.
The RCEM SLOs and ACCS Learning Outcomes are listed below. Where these are the same, the Key ACCS capabilities and descriptors are listed within the individual RCEM Specialty Learning Outcomes.
In the curriculum requirements we state that by the end of Higher Training an EM clinician ready for independent practice will be ‘expert’ in the Key Capabilities of Clinical SLOs. For these purposes an expert is a clinician who can:
- Take on the most difficult and complex cases
- Supervise and evaluate the performance of others in such clinical cases
- Do the above whilst maintaining departmental oversight
This details the 11 generic and clinical ACCS LO with expected levels of performance, mapping to relevant GPCs and the evidence that may be used to make an entrustment decision.
KEY
| ACAT | Acute care assessment tool | ALS | Advanced Life Support |
| CbD | Case-based discussion | DOPS | Direct observation of procedural skills |
| GCP | Good Clinical Practice | RCEM App | App based WPBA tool for directly observed episodes |
| FEG | Faculty Educational Governance statement | ESR | Educational Supervisor report |
| Mini-CEX | Mini-clinical evaluation exercise | MCR | Multiple consultant report |
| MSF | Multi source feedback | PS | Patient survey |
| QIAT | Quality improvement project assessment tool | TO | Teaching observation |
| IAC | Initial assessment of anaesthetic competence | ESLE | Extended Supervised Learning Event |
| ACAF | Applied critical appraisal form | JCF | Journal Club Form |
Generic ACCS Learning Outcomes
The three generic ACCS LOs cover universal requirements of all specialties as described in the GPC framework that are not exemplified by day to day activity in the work place. Assessment of the generic LOs will be underpinned by the descriptors from the relevant GPC domains and evidenced against the performance and behaviour expected at that stage of training. Satisfactory sign off will indicate that there are no concerns before the trainee can progress to the next part of the assessment of clinical capabilities. In order to ensure consistency and transferability, the generic ACCS LOs have been grouped under GPC-aligned categories.
For each generic ACCS LOs there are a set of descriptors of the observable skills and behaviours which would demonstrate that a trainee has met the minimum level expected. The descriptors are not a comprehensive list and there may be more examples that would provide equally valid evidence of performance.
Supporting Speciality Learning Outcomes
In intermediate training these become the Supporting SLOs, reflecting a greater degree of EM specific content and the addition of a further SLO for leadership, administration and management