The Syllabus

(v8.2 20190625)

The RCEM curriculum is outcome based. This means it is structured around the things that a trained EM specialist needs to be able to do. It clearly outlines the generic and speciality specific knowledge, skills behaviour and attitudes that are required. Underpinning the actions of a fully trained EM clinician is the clinical knowledge required to inform them.

The breadth of that clinical knowledge is described in this current document, the syllabus. It defines the scope of presentations or clinical conditions that an EM clinician may encounter in the workplace, and therefore need to know about.  These lists are to be used to give a context to the Programme of Learning that supports the delivery of the curriculum. Trainees are expected to develop their knowledge base in each of these presentations or conditions. This might be done in formal teaching, self-directed learning and use of on-line resources.

They will be the context for the formal RCEM examinations and learners will be expected to know about relevant basic sciences as well as relevant epidemiology, differential diagnoses, investigation and management of these conditions.

Key: paediatric specific presentations and conditions

Clinical syllabus

Clinical Presentations Condition / Issues
RP1. Acute airway obstruction RC1. Choking
RP2. Anaphylaxis RC2. Stridor
RP3. Cardiorespiratory arrest RC3. Organ donation
RP4. Major Trauma RC4. BRUE
RP5. Respiratory failure RC5. SUDIC Protocol
RP6. Sepsis
RP7. Shock
RP8. Unconsciousness
Clinical Presentations Condition / Issues
AP1. Acute allergy AC1. Drug allergy
AP2. Anaphylactoid reactions
AP3. Angioedema
AP4. Urticaria
Clinical Presentations Condition / Issues
CP1. Chest pain CC1. Acute Coronary Syndromes
CP2. Breathlessness CC2. Myocardial infarction
CP3. Palpitations CC3. Arrhythmias
CP4. Transient Loss of Consciousness CC4. Cardiac failure
CC5. Cardiac tamponade
CC6. Congenital heart disease
CC7. Diseases of the arteries, including aortic dissection
CC8. Diseases of myocardium
CC9. Hypertensive emergencies
CC10. Pacemaker function & failure
CC11. Pericardial disease
CC12. Sudden Cardiac Death
CC13. Valvular heart disease
Clinical Presentations Condition / Issues
DP1. Dermatological manifestations of systemic illness DC1. Common childhood exanthems
DP2. Rashes DC2. Cutaneous drug reactions
DC3. Eczema
DC4. Erythroderma
DC5. Infections of skin and soft tissues
DC6. Necrotising Fasciitis
DC7. Pressure ulcers
DC8. Purpuric rash including Henoch Scholein Purpura
DC9. Stevens-Johnson syndrome
DC10. Toxic-epidermal necrolysis
DC11. Urticaria
Clinical Presentations Condition / Issues
EP1. ENT foreign bodies EC1. Croup
EP2. ENT injuries EC2. Epiglottitis
EP3. Epistaxis EC3. Glandular Fever
EP4. Hearing loss EC4. LMN facial nerve palsy
EP5. Painful ear EC5. Meniere’s disease
EP6. Sore throat EC6. Nasal fractures
EP7. Vertigo EC7. Otitis externa
EC8. Otitis media
EC9. Pharyngitis
EC10. Post-tonsillectomy bleed
EC11. Tonsillitis
EC12. Tracheostomy emergencies
EC13. Quinsy

EC14. Salivary gland disease

EC15. Vestibular neuritis
Clinical Presentations Condition / Issues
ElP1. Delirium ElC1. Comprehensive geriatric assessment
ElP2.Deterioration in mobility ElC2.Acute confusion
ElP3. Falls ElC3. Ceiling of care & End of life care
ElP4. Fragility fractures ElC4. Dementia – cognitive impairment
ElP5. Frailty ElC5. Fragility fractures
ElP6. Hypothermia ElC6. Mobility
ElP7. Incontinence ElC7. Osteoporosis
ElP8. Increasing care needs ElC8. Pharmacology considerations in the older patient
ElP9. Memory loss
ElP10. Unsteadiness / balance disturbance
Clinical Presentations Condition / Issues
EnP1. Addisonian Crisis EnC1. Adrenal disorders
EnP2. Hyperglycaemia EnC2. Diabetic ketoacidosis
EnP3. Hypoglycaemia EnC3. Diabetes mellitus & complications including diabetic foot
EnC4. Hyperosmolar hyperglycaemic state
EnC5. Pituitary disorders
EnC6. Thyroid emergencies
Clinical Presentations Condition / Issues
EnvC1.Heat stroke and heat exhaustion
EnvC2. Drug-related hyperthermias
EnvC3. Hypothermia and frost bite
EnvC4. Decompression sickness
EnvC5. Near-drowning
EnvC6. Radiation exposure and safety
EnvC7. Industrial chemical incidents
EnvC8. Bites and envenomations typical for the UK
EnvC9. High altitude emergencies – cerebral and pulmonary oedema
EnvC10. Acid attacks
Clinical Presentations Condition / Issues
GP1. Abdominal and loin pain GC1. Alcohol related liver disease including withdrawal
GP2. Abdominal swelling or mass GC2. Decompensated cirrhosis
GP3. Ascites GC3. Dehydration in children
GP4. Constipation GC4. Functional bowel disorders
GP5. Diarrhoea GC5. Gastrointestinal infections
GP6. Haematemesis and melaena GC6. Hepatitis
GP7. Jaundice GC7. Inflammatory bowel disease
GP8. Anal pain and rectal bleeding GC8. Peptic ulcer disease
GP9. Nausea and vomiting GC9. Pyloric stenosis
GP10. Dysphagia
Clinical Presentations Condition / Issues
HP1. Anaemia HC1. Anti-coagulant reversal
HP2. Bruising and spontaneous bleeding HC2.DIC
HP3. Massive haemorrhage HC3. Haemophilia
HC4. ITP
HC5. Leukaemia
HC6. Lymphoma
HC7. Marrow failure
HC8. Sickle cell disease/crisis
HC9. Transfusion reactions
Clinical Presentations Condition / Issues
IP1. Fever IC1. Influenza
IP2. Pyrexia in travellers IC2. Infection in immunocompromised patients
IP3. Sepsis IC3. Infestations
IP4. Needlestick injury/exposure to blood borne viruses IC4. Kawasaki Disease
IC5. Notifiable diseases
IC6. Pyrexia of Unknown origin – different age groups
Clinical Presentations Condition / Issues
MaP1. Dental pain MaC1. Dental abscess
MaP2. Facial swelling MaC2. Facial wounds
MaP3. Avulsed or fractured teeth MaC3. Post extraction complications
MaP4. Facial bone injury MaC4. TMJ dislocation
Clinical Presentations Condition / Issues
MHP1. Aggressive or disturbed behaviour MHC1. Alcohol and substance misuse
MHP2. Anxiety/Panic MHC2. Depression
MHP3. Physical symptoms unexplained by organic disease MHC3. Eating disorders
MHP4. Self-harm MHC4. Personality disorders
MHP5. Refusal of treatment MHC5. Acute Psychosis including bipolar, schizophrenia
MHC6. Somatic symptom disorders
MHC7. Stress disorders
MHC8. Suicide
Clinical Presentations Condition / Issues
MuP1. Acute back pain MuC1. Cauda equina syndrome
MuP2. Limb pain and swelling MuC2. Crystal related arthropathies
MuP3. Neck pain MuC3. Septic arthritis
MuP4. Joint swelling MuC4. Limb pain and swelling: bursitis & tendonitis in the upper and lower limb including ruptured biceps, Achilles tendonitis, plantar fasciitis, metatarsalgia, carpal tunnel and other entrapment neuropathies plus sinister causes bone tumour, stress fracture
MuP5. Acute hot swollen joint MuC5. Spinal pain and radiculopathy
MuC6. Risks of rheumatological disease modifying drugs
MuC7. Spinal infections
MuC8. Torticollis
MuC9. Limping child
MuC10. Osteochondritis
Clinical Presentations Condition / Issues
NeoC1. Delivery and resuscitation of the newborn
NeoC2. Neonatal sepsis
NeoC3. Cyanotic/ non- cyanotic congenital heart disease
NeoC4. Jaundice
NeoC5. Feeding patterns
Clinical Presentations Condition / Issues
NepP1. Electrolyte disorders NepC1. Acute kidney injury
NepP2. Oliguria NepC2. Drugs and the kidney
NepC3. Electrolyte disorders
NepC4. Fluid balance disorders
NepC5. Renal replacement therapy
Clinical Presentations Condition / Issues
NeuP1. Acute Confusion NeuC1. Botulism
NeuP2. Headache NeuC2. Cerebral venous sinus thrombosis
NeuP3. Seizures/status epilepticus NeuC3. Febrile Convulsion
NeuP4. Speech disturbance NeuC4. Functional illness
NeuP5. Hemiparesis/hemiplegia NeuC5. Guillian-Barre
NeuP6. Gait abnormality NeuC6. Meningitis and encephalitis
NeuP7. Visual disturbance NeuC7. Multiple sclerosis
NeuP8. Weakness/paralysis NeuC8. Myasthenia gravis
NeuP9. Dizziness and vertigo NeuC9. Parkinson’s disease and other movement disorders
NeuC10. Peripheral neuropathy (acute)
NeuC11. Subarachnoid haemorrhage
NeuC12. Stroke & TIA
NeuC13. Tetanus
NeuC14. Tumours involving the brain and spinal cord
NeuC15. VP Shunts
Clinical Presentations Condition / Issues
ObP1. Pelvic pain ObC1. Ante-partum haemorrhage
ObP2. Vaginal bleeding ObC2. Bleeding in early pregnancy
ObP3. Pregnancy ObC3. Exposure to infections during pregnancy eg chickenpox
ObP4. Genital injury/Assault ObC4. Ectopic pregnancy
ObP5. Vaginal discharge ObC5. Genital injury /Female Genital Mutilation
ObP6. Foreign bodies ObC6. HELLP
ObP7. Patient in labour ObC7. Heavy menstrual bleeding
ObC8. Hyperemesis Gravidaram
ObC9. Maternal Collapse
ObC10. Post-partum haemorrhage
ObC11. Pre-eclampsia/eclampsia
ObC12. Pelvic infection
ObC13. Post menopausal bleeding
ObC14. Prescribing in pregnancy
ObC15. Rhesus D prophylaxis
ObC16. Sepsis in and following pregnancy
ObC17. Thrombosis during and following pregnancy
ObC18. Trauma in pregnancy
Clinical Presentations Condition / Issues
OncP1. Presentations of undiagnosed cancer that may be seen in the ED (including weight loss, dysphagia, pain etc) OncC1. Complications related to local tumour progression e.g. acute cord compression, upper airway obstruction, pericardial and pleural effusions, SVC compression syndrome, raised intracranial pressure
OncC2. Complications relating to cancer treatment including – neutropenic sepsis, anaemia and thrombocytopenia and immunotherapy
OncC3. Biochemical complications of malignancy- hypercalcaemia, SIADH, adrenocortical insufficiency
Clinical Presentations Condition / Issues
OptP1. Diplopia OptC1. Acute glaucoma
OptP2. Eye trauma including foreign bodies OptC2. Cranial nerve palsy
OptP3. Painful eye OptC3. Orbital & per-orbital cellulitis
OptP4. Red eye OptC4. Opthalmia neonatorum
OptP5. Sudden visual loss OptC5. Inflammatory eye disease
OptC6. Temporal arteritis
Clinical Presentations Condition / Issues
PC1. Analgesics
PC2. Non-pharmacological methods of pain management
PC3. Pain assessment
PC4. Sedation
Clinical Presentations Condition / Issues
PalP1. Advanced malignancy PalC1. Advanced care planning
PalC2. Anticipatory medications
PalC3. End stage organ failure
PalC4. Pain management
PalC5. Physical symptoms other than pain
PalC6. Psychosocial concerns including spiritual care and care of the family
PalC7. The dying patient
Clinical Presentations Condition / Issues
PhP1. Medication side effects/interactions PhC1. Overdose of prescription and non-prescription medications including legal and non-legal drugs
PhP2. Overdose PhC2. Poisoning – carbon monoxide, cyanide, organo-phosphate
PhC3. Toxidromes
PhC4. Use of antidotes
Clinical Presentations Condition / Issues
RP1. Chest pain RC1. Asthma
RP2. Breathlessness RC2. Bronchiolitis
RP3. Haemoptysis RC3. COPD
RP4. Cough RC4. Foreign body inhalation
RC5. Pertussis
RC6. Pleural effusion
RC7. Pneumonia
RC8. Pneumothorax
RC9. Pulmonary Aspiration
RC10. Pulmonary embolus
RC11. Viral induced wheeze in children
Clinical Presentations Condition / Issues
SeP1. Genital discharge SeC1. HIV infection
SeP2. Genital lesions SeC2. Sexual assault
SeP3. Emergency contraception SeC3. Sexually transmitted infections
SeP4. Post-exposure prophylaxis
Clinical Presentations Condition / Issues
SuP1. Abdominal pain SuC1. Ano-rectal abscesses
SuP2. Abdominal swelling/mass SuC2. Appendicitis
SuP3. Constipation SuC3. Bilary colic
SuP4. Diarrhoea SuC4. Bowel obstruction
SuP5. GI bleeding SuC5. Breast abscess
SuP6. Anal/rectal pain SuC6. Cholangitis
SuP7. Nausea/vomiting SuC7. Cholecystitis
SuC8. Diverticular disease
SuC9. Haemorrhoid disease
SuC10. Hernias
SuC11. Intussusception
SuC12. Ischaemic Bowel
SuC13. Lower gastrointestinal and rectal bleeding
SuC14. Pancreatitis
SuC15. Viscus perforation
SuC16. Volvulus
Clinical Presentations Condition / Issues
TP1. Head injury TC1. Compartment syndrome
TP2. Spinal injury TC2. Limb and joint injury including bony, musculo-tendinous and complications
TP3. Chest and lung injury TC3. Electrical burns
TP4. Major vascular injury TC4. Salter- Harris classification
TP5. Abdominal injury TC5. Infection – paronychia, pulp space, flexor sheath nail bed, amputations etc.
TP6. Pelvic injury TC6. Human bites
TP7. Limb and joint injury TC7. Injury to bladder, urethra, testes or penis
TP8. Burns
TP9. Inhalational injury
TP10. Wounds
Clinical Presentations Condition / Issues
UP1. Dysuria UC1. Epididymo-orchitis
UP2. Injury to bladder, urethra, testes or penis UC2. Renal stone disease
UP3. Urinary retention UC3. Phimosis/Paraphimosis
UP4. Testicular pain/swelling UC4. Priapism
UP5. Loin pain UC5. Testicular torsion
UP6. Haematuria UC6. Prosatatis
UC7. UTI/Pyelonephritis
Clinical Presentations Condition / Issues
VC1. Acute limb ischaemia
VC2. Aortic aneurysmal disease
VC3. DVT
Clinical Presentations Condition / Issues
XC1. Major Incident Management
XC2. PHEM
XC3. Safeguarding in adults
Clinical Presentations Condition / Issues
SaP1. Self-harm in children and adolescents SaC1. Conditions presenting as a symptom of NAI or psychological distress, e.g. deliberate self harm, aggression or risk-taking behaviour, recurrent abdominal pain, headaches or faints, recurrent attendances in young children.
SaP2. Concerning presentation SaC2. Roles of other systems in protecting children, e.g. Social Services, the Child Protection Plan, Police Child Protection and Domestic Violence Units, SureStart, Childline, Health Visitors, School Nurses
SaC3. Mental illness in childhood including depression, anxiety, OCD, bipolar and schizophrenia
SaC4. Sexual abuse

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