The ACCS Programme
Poole Hospital
Prepared by Dr Gary Cumberbatch
ACCS Lead Poole Hospital
(Updated June 2011)
Contents
Summary of ACCS posts in Poole
Educational supervision
Acute Medicine
Anaesthetics
Emergency Medicine
Intensive Care Medicine
Work place based assessments
Preparation for the ARCP
Portfolios
Summary of ACCS posts in Poole
You will be rotating through the 4 ACCS specialities whilst here with 6
months in each post. You may start in any speciality first and this may
not necessarily be in your base speciality. At the end of your 2 years you
should gain sufficient skills and experience to be able to competently
commence the management of most acutely ill or injured patients.
You will be offered a third year which will be spent doing your base
speciality: for Acute Medicine trainees this will be in a CT3 post for 1
year in Poole doing 12 months in Medicine at SHO level; for Anaesthetic
trainees this will be a further 12 months in Anaesthesia at CT2 level and
may be at another hospital within Wessex; for Emergency Medicine
trainees this will be for 12 months at CT3 level at Southampton or
Portsmouth where there will be a 6 month focus on Paediatric Emergency
Medicine.
You should have an Educational supervisor in your base speciality who
advises you on your career path and a Clinical supervisor who is
responsible for your clinical supervision whilst in the speciality you are
doing. You should ideally meet with your Educational supervisor once
every 6 months and 3 times with your Clinical supervisor in each
speciality (initial, midpoint and final appraisals).
The lead educational supervisor for each speciality is as follows:
Acute Medicine
Dr Elizabeth Williams
Elizabeth.williams@poole.nhs.uk
Telephone ext
Anaesthetics
Dr Naeem Ahmed
Naeem.ahmed@poole.nhs.uk
Telephone ext 2385
Emergency Medicine
Dr Gary Cumberbatch
Gary.cumberbatch@poole.nhs.uk
Telephone ext 2815
Intensive Care Medicine
Dr Spike Briggs
spike.briggs@poole.nhs.uk
Tel 07973149615
Dr Gary Cumberbatch is the Lead Consultant for the ACCS programme
in Poole and you are encouraged to meet with him to discuss any
problems regarding the rotation eg desire to swap when you do
specialities, the gastro vs respiratory job in Medicine etc. Please liaise
with him using the contact details above.
We hope that you will thoroughly enjoy your 2 years with us and any
feedback you have about ways we can improve things would be
welcomed. We would be grateful if you find any details within this
document to be incorrect (as the jobs do change a little with time) to
inform the speciality lead so that we can amend it so it remains up to date.
Emergency Medicine
You will spend almost all your time working within the Emergency
Department and we encourage you to wear the Emergency Department
(ED) scrubs. These are available to you via the sewing room and we
would advise you to obtain these prior to starting with us.
Induction
You will be provided with an induction pack which you can again pick up
before you start from the ED secretaries and this has all the details you
need including your working rota; a Welcome booklet detailing how the
Department works etc; an SHO handbook specifically written on how to
manage the variety of cases that present to the ED (only available on the
intranet); a small booklet on how to thrombolyse MIs.
It is essential that you meet or email Debbie Cook, our lead receptionist
well in advance of your start date to decide which rota you wish to do
(debbie.cook@poole.nhs.uk). Your annual leave is already booked as a 2
week block so to get the annual leave you want you need to choose a
specific rota. Those trainees who ask late get what’s left!
On your first day you have to attend the Trust induction in the morning if
this is your first post in Poole and from lunchtime the induction for the
ED –the agenda for this will be in your induction pack.
Supervision
You will have Consultant presence prospectively within the ED between
8am -8pm Monday to Friday and for 3 to 4.5 hours each on Saturday and
Sunday morning. We will hold “Board rounds” at 8am , 12 noon/ 2pm
and 4 pm where you will need to present patients to us (or to a registrar
out-of-hours).
The number of middle grades (SpRs/ ST4 and above/ Clinical fellows)
varies from 6-8. There will always be a middle grade present within the
Emergency Department for 24 hours.
Dr Cumberbatch will be your Educational supervisor for this post and if
you are an Emergency Medicine trainee , he will be your supervisor for
the entire 2 years.
Teaching
There is a formal teaching programme which is in protected time from
13:30 to 16:00 every Tuesday afternoon. The programme for this is in the
induction pack. You will be expected to present a topic that you have
chosen from a list provided.
There will be informal teaching at the Board rounds and obviously on
patients you have seen and discussed.
Appraisals
It is essential that you meet with Dr Cumberbatch 3 times in the six
month period (first within first 2 weeks; midpoint and in the last
month).We will review your portfolio and go through courses/ audits you
may need as well as ensure you have completed the necessary work
place based assessments.
Acute Medicine
There are two posts and they are in Respiratory Medicine with Dr
Mallawathantri and Gastroenterology with Dr Snook. You will have to
liaise with your other ACCS colleague AND Dr Mallawathantri /Dr
Snook to determine which post you wish to do. If for example you have
already done a Respiratory post as F1 or F2 , you may wish to do the
gastroenterology job – or the converse.
You will have your specific duties for each team explained to you when
you start and when on call you will be responsible for receiving Medical
referrals from the Emergency Department and GPs.
The Gastroenterology ACCS job
The Team
You will be part of the Gastroenterology team, made up of the following
medical staff:
4 Consultants: Drs Snook, Sharer and Parry/Williams (who both work 4
days and cross cover each other)
2 SpRs
3 SHOs (1 is ACCS)
3 F1s
The Consultants have their offices based on A5 where most of their
patients are but there are patients on almost all of the other Medical wards
(Ansty, A4, C4, Portland). Two of the Consultants are ward-based at any
one time. The third Consultant who is not ward-based may however
admit patients from their clinic. Dr Parry does not work Mondays, and Dr
Williams does not work Fridays. Each of the Consultants on the ward has
a SpR.
The SHOs and F1s are paired for the whole six months, such that one
SHO should always be working with the same F1. In general each pair
will rotate every two months in turn from being floater, to one wardbased Consultant and then the other ward-based Consultant. This ensures
continuity with juniors, however does mean changing Consultants. Due to
leave and nights, there are usually gaps on either Consultant’s side, so
these are filled by whoever is on floater at that time. The Consultants
know who their SHO is and will bleep them when they are not wardbased if they wish to admit one of their patients from clinic.
Induction
Dr Masding, Consultant in Acute Medicine/ diabetes (or in his absence
one of the other Consultants), does induction at the beginning of the job
which includes EPR, requesting investigations and your timetable. There
is no specific induction for the Gastro job – you go to ward A5 and
collect your bleep and start! There is however a written information pack
for the Gastroenterology job and you should arrange to meet your
Educational Supervisor within the first week or so. The F1s have the
patient lists.
SHO Duties (9am -5pm)
Monday
AM
SHO Ward round with the F1
PM
Ward jobs
Tuesday
AM
Dr Snook ward round
Dr Parry ward round (alternate weeks)
Dr Sharer ward round
Lunch
Journal club 12.30pm
PM
Ward jobs
Dr Parry ward round (alternate weeks)
Wednesday
AM
SpR Ward round
Dr Sharer clinic (alternate weeks)
Lunch
Core Medical SHO teaching at 13.00
PM
Ward jobs
Thursday
AM
SHO ward round with F1
Dr Parry ward round
Lunch
The Grand round (lunch from 12.30pm, GR at 13.00)
PM
Ward jobs
Friday
AM
Dr Snook Ward round
Dr Sharer ward round (alternate weeks)
Lunch
X-ray meeting joint with surgeons at 12.45pm
PM
Ward jobs
Dr Sharer ward round (alternate weeks)
Dr Williams normally bleeps her SHO or F1 to organise when to see her
patients: this is on Mondays and Wednesdays. Dr Sharer alternates his
ward round on Fridays to either am or pm, as does Dr Parry on
Tuesdays.
Clinics
There are no scheduled clinics for the SHO for Dr Snook, however you
will be expected to cover the SpR if they are absent on that day. There is
also plenty of opportunity to clinics for planned SpR absences, these are
entirely optional and can the booking pattern can be set up to suit your
experience, you should discuss whether you think this additional clinic
experience would be relevant/appropriate with your educational
supervisor. It is very useful to attend the clinic as you will learn a lot
there and it also helps break up the routine of ward work.
Dr Sharer’s SHO has an SHO clinic on alternate Wednesday mornings.
There is also an opportunity to go to other Medical clinics as long as the
all the ward jobs are completed for your own Consultant eg Endocrine
clinics on Thursday PM
Ward work
This involves the following:
1) Reviewing patients with the F1
2) Reviewing patients the nurses have highlighted as “sick”
3) Supervise and support the F1
4) Carry out procedures such as ascetic drains, LPs and chest drains
Although there is not always a SpR there for support, the other
gastroenterology SHOs may have more medical experience than you and
can be called upon if you need support. Obviously the Consultants
themselves are contactable if no-one else is able to support you.
On Call
You are given the on call Consultant rota at the beginning of the job and
you are essentially on call whenever your Consultant is on call. The
SHOs are expected to divide the on calls between themselves as the
Gastroenterology Consultants do like their SHO to be on call with them
and this works out at about one on call every 10 days.
On the on call day:
1) You must collect the on call bleep (0322) from the night SHO at 0900
hours
2) You will need to accept/ clerk in referrals from GPs and the
Emergency Dept
3) You will be part of the Cardiac Arrest team and will be expected to
immediately
attend these and lead the team if there is no SpR present.
4) You will need to handover to the night SHO at 20:30 hours
5) You will be expected to take part in the Post Take ward round the next
day,which starts at 0800 hour.
The SpR is on call and around for any problems/ advice but they will also
be doing their routine day work at the same time so rarely get involved in
clerking patients in the morning, but should be available in the afternoon.
Similarly the F1 on call will be doing their routine day work but will be
available to clerk in patients after they have done their “jobs”.
You usually do not get time to help on the ward when you are on call.
Weekends
These are split and you are generally on call with your own Consultant.
You will be with one of the F1s and SpR for this.
You either do the Friday with Post Take ward round (PTWR) on the
Saturday morning at 0800 AND the Sunday (with the PTWR on the
Monday at 0800)
OR
You do the Saturday with the PTWR on Sunday at 0800.
The weekends will have to be divided between the 3 SHOs and works out
at about 4 weekends in 6 months.
Nights
These are seven consecutive nights starting from a Friday 20:30 to 08:00.
You will be on with your own SpR and F1. The duties are the same as the
on call day work. The nights are divided between the 3 SHOs and works
out at about 2 or 3 weeks in the 6-month period.
Ansty weeks
You will work purely on Ansty for 2 or 3 separate weeks in the 6-month
post.
There is an acute medicine take parallel to the general medical take daily.
Ansty is for patients who are expected to be in hospital for 48 hours or
less.
During the Ansty week you are expected to attend the daily PTWR with
the Acute Medicine Consultant, the Ansty F1 and the Acute Medicine
SpR and then carry out any jobs for this. It can be a lot of “paperwork”
but is also a good opportunity for procedures like LPs.
Whilst on Ansty week you may NOT take leave, and should not be doing
on-calls. As the remaining gastro team are usually short-staffed, the
Consultants prefer you not to take leave if one of the other SHOs is on an
Ansty week.
The Medical Investigation Unit
This is based on C4 and patients come in for a variety of infusions;
elective ascitic taps etc. The SHO is expected to help the F1 clerk these
patients in and carry out the necessary investigations or treatments.
Annual Leave
You are entitled to 14 working days plus lieu days in your 6-month
period and 7.5 days study leave. The Consultants are normally happy to
sign off any leave as long as there is enough cover on the ward between
SHOs and F1s. As said above, they prefer not to allow leave when one
SHO is on Antsy, but one SHO may take leave during a set of gastro
nights, since this tends to be the quietest period.
Grand Round/Journal Club
Each Consultant will be responsible for Grand Round in turn: this will
usually be based around a case, which one of the team will present,
followed by a talk on a specific part of the case. It is a good idea to find
out in plenty of time when your Consultant’s turn is coming up! For
Journal club, one of the team should be responsible for presenting an
interesting journal article. This rota, and the grand round rota are
available in the post-graduate office.
The Respiratory ACCS Job
You will be working for Dr Sugamia Malawathantree who is one of three
Respiratory consultants at Poole. The following information will help you
arrange your time and understand the commitments of the job.
Induction
This is arranged by medical staffing. You may have to contact them 1
week before change over if in the second half of the year to find out when
induction for medicine is. I would recommend that you also ask for a
copy of the on call rota early from medical staffing.
The Respiratory Firm
Dr Crowther (SDC)
Dr Allenby (MIA)
Dr Mallawathantri (SMW)
2 speciality registrars, 3 SHO’s and 3 F1 doctors.
Secretaries are located on A4 ward: Christine Waller - SDC, Maureen
Collacott – MI, Harriet Truslove – SMW.
Cross cover between teams is expected to cover sickness, annual leave
and study leave.
On call
On average you will undertake about one on call per week. When on call
you should not be expected to undertake other commitments. The on call
rota is available from medical staffing or the secretaries offices. When not
on call you have a normal working day 9-5. The exception is the day after
on call when you will be expected to attend at 8am to partake in the post
take ward round.
On call is from 9am until 8.30pm. Night handover prompt at 8.30pm on
Ansty. The on call rota is coded as per consultant, SDC= Crowther,
MIA= Allenby, SMW= Mallawathantri. The on calls are split between
the three SHO grade doctors and cover the above codes, ie the respiratory
consultants. It is recommended but, neither possible or essential, that the
SHO doctor doing the on call belongs to the consultant for that day.
It is important to decide at the beginning of your 6 months post your on
call commitments by allocating your name or a colour coding to the rota,
this must be done in conjunction with the other SHO doctors in
respiratory. Give a copy of this to the consultant secretaries above. Night
shifts run from Friday to Friday ie. 7 nights. You will be expected to do
two over the 6 months. Weekends are no different from week on calls and
again on average you will do about two weekends in the 6 months. On
call bleep 0322.
Ward work
Most respiratory patients will be on A4. It is highly likely you will also
have patients on other wards. To locate your teams’ inpatient list use
EPR. Ensure consultant Mallawathntri is selected in drop down box, and
next drop down box is selecting all wards. This is the inpatient list. Note
this will not show patients under other teams who the team has under
review. Therefore current practice is to have a separate F1 maintained list
on the computer that is regularly updated with list of jobs and review
patients.
Below is the time tables for Dr Mallawathantri and Dr Crowther.
Colour code.
Red is essential and expected. Thus ward rounds, teaching. Note
consultant ward rounds are twice weekly- on Monday or Tuesday and
Thursdays AM or PM
Yellow is recommended. For example respiratory investigation reporting
on Monday lunchtime is recommended but not necessarily expected. It
should be encouraged that you attend at least one session in the first half
of the 3 months. This will equip you with some basic knowledge of
respiratory investigation. This skill will be required in the clinics.
.
Wednesday morning is the F1 ward round. You should be available via
bleep for advice and attendance to sick patients. You may wish to shadow
the F1 and give feedback or you can use this time to undertake an audit or
further curricula work such as clinic attendance in area of interest. You
must however be available to the F1 in case problems are encountered.
Dr Crowther Timetable
MONDAY
TUESDAY
Consultant
09.30 WARD ROUND
Alternating Weeks
SHO ward
round
AM
or
10.00 THORACOSCOPY
or
09.30
Consultant
WARD ROUND
WEDNESDAY
THURSDAY
FRIDAY
SHO ward round
F1 ward round ST1
audit, admin, ward
support
09.00 OPD
PHFT /
WIMBORNE
alt weeks
SHO ward
round
12.30 Respiratory Investigation reporting 12.00Journal
12.30 SHO Teaching
13.30 Xray
session
Club
meeting
13.00 Grand
14.00 BRONCHOSCOPY
Round
Endoscopy Suite (x 2939)
13.00 Lung
Cancer meeting
14.00 Consultant
WARD ROUND
PM
14.30 – 15.30
SDC student
Teaching
Dr Mallawathantri
MONDAY
TUESDAY
WEDNESDAY THURSDAY
FRIDAY
0900-1200
WARD ROUND
(when covering SDC)
or
THORACOSCOPY
0830-1230
WARD ROUND
Cystic Fibrosis
(when covering
MIA)
0900-1230
0900-1300
Ward Round
(when covering
SDC)
0830-1230
CYSTIC FIBROSIS
MDT
& WARD ROUND
(when covering MIA)
1230-1400
Lung function
reporting
1415-1715
OPD CLINIC
1230-1430
Lung MDT
12.30 SHO teaching
1300-1400
Grand Round
1330-1400
X-RAY MEETING
1430-1730
BRONCHOSCOPY
(alternate weeks)
1330-1730
SWANAGE OPD
(alternate weeks)
1400-1730
OPD CLINIC
(Yellow) x 2220
Clinics.
There are no Clinics for the SHOs to do for the Crowther team. You are
expected to cover the clinics in red on the Mallawathantri team. This
should be arranged between the SHOs. I recommend that you decide who
does what clinic one month in advance and inform Harriet. Of course
there is flexibility here but disputes do occur on who will attend and thus
preparation in advance is advised.
Ansty Week
Over the time of acute medicine you will be expected to spend Monday to
Friday 9am to 5pm on the acute medical admissions ward; also known as
Ansty. This is expected on two occasions and again is on the on call rota
under respiratory team. This should be decided between the respiratory
ST doctors. This is a ward based job you are expected to see the triaged
patients on the 9 am ward round with the acute medical consultant. The
Ansty F1 and yourself will undertake the jobs from the ward round. This
is often a good opportunity to undertake extra assessments in practical
skills ie DOPs. The standard of care offered via the respiratory team is
currently high. The free time should always be used to ensure discharges
are planned, information is at hand and the ward round runs smoothly. If
you have any questions Dr Crowther will be more than happy to answer
them if possible. He is approachable and requires involvement in all areas
of patient care that may be difficult and beyond your current skills. Of
course you speciality registrar will also be available but when not Dr
Crowther will expect you to keep him up to date with important matters,
for examples new diagnosis of lung cancers.
Hopefully this will help you get started. There is plenty of flexibility here.
You can if you wish attend bronchoscopy or thoracoscopy. This should
happen at least once as you may be required to explain the procedure and
consent the patient. Teaching is recommended and with the new teaching
room for the respiratory team regular presentations from the team, PORT
team, and medical students should be taking place.
The most important thing is to enjoy this placement. If you are used to an
hectic job then you will find that things tend to be quieter. This will allow
you to have some free time within the working days, use this wisely,
consider for example doing you college exam near the end of the 6
months, or an audit.
A few contact numbers for you
christine.waller@poole.nhs.uk EXT 8154
harriet.truslove@poole.nhs.uk EXT 2162
sugamya.mallawathant@poole.nhs.uk
simon.crowther@poole.nhs.uk
SDC team bleeps F1 0064, F1 0176, SHO 0189, SPR 0915
MIA/SMW bleep F1 0167, SHO 0180, SHO 0867, SPR 0728
Teaching
There is regular teaching within Medicine which you should attend:
Core Medical teaching programme from 1300-1400 each Wednesday
Grand round – 1300-1400 every Thursday (your team may be presenting)
Journal Club – 1230-1330 every Tuesday
Clinical Governance meetings- which occur monthly (you/ your team
may present audits etc )
Competences
These are different for those wishing to achieve level 1 General
Internal Medicine(GIM) competency and those not needing it.
Level 1 GIM is only required for:
1) ACCS trainees whose base speciality is Acute Medicine
2) Any other trainee who may wish later to dual accredit in their base
speciality and Acute Medicine
Level 1 GIM is NOT required for:
1) ACCS trainees in Anaesthesia or Emergency Medicine unless they
wish to dual accredit in Acute Medicine
2) Intensive Care Medicine
The specific competences and WPBA (work place based assessments) for
Medicine are specified in the document we will email you titled
“Summary of the ACCS curriculum requirements” .
Anaesthetics
Introduction
The anaesthetic department provides service and training for East Dorset,
at both Poole Hospital and The Royal Bournemouth Hospital. Whilst
service aspects of the post for ACCS trainees will only be carried out in
Poole, your anaesthetic training will be delivered in both hospitals. The
two hospitals provide complimentary aspects of training in anaesthesia
and most consultants and all trainees work across both sites. Excellent
training opportunities are also provided in community hospitals such as
Wimborne and St Ann’s. A means of transport between the two main
Trusts essential, and it is desirable to have a means of transport to the
community hospitals.
Induction and Administration
On your first day you have to attend the Trust induction in the morning
and from lunchtime the induction for anaesthesia –the agenda for this will
be in your induction pack.
You will be provided a departmental handbook on your first day. You
will meet with Mrs. Jackie Boyd, our departmental administrator who
will explain the rota (both weekly and on-call) , as well as details of list
start times and relevant policies etc. Whilst Jackie deals with the weekly
rota administration, the on-call rota and leave booking system is carried
out through Dr Tamsin Dodd, consultant anaesthetist. You will be given
an explanation of how to book leave through this system, which is
administered on-line. There are minimum numbers allowed away at any
one time and sufficient notice must be given if you want to guarantee
your leave, Requests for “not-on-call” will not be accepted and you must
ensure that you arrange your own swaps with colleagues if you wish to
take leave on a day when you were rostered on-call. The weekly rota will
be emailed out to all anaesthetists in advance. Please ensure that Jackie
has an up-to-date and correct email address for you and you must ensure
that any swaps you have made with colleagues are fully communicated
and agreed with her.
Those ACCS trainees whose base specialty is anaesthesia must register
with the Royal College of Anaesthetists as soon as possible.
Supervision
For your first 3 months you will only administer anaesthetics under the
direct supervision of a consultant anaesthetist. During this time you will
be undergoing workplace based assessments in practical skills (DoPS),
and case management (anaesthetic-CEX and CBDs). Only once you have
been assessed as competent after this period of training will you be
allowed to anaesthetise patients without direct supervision by a consultant
and will you be able to participate in the evening or night shift rota
without direct supervision. Even at this point you are only qualified to
anaesthetise patients of ASA Grade 1 or 2 without direct supervision and
you will be expected to discuss case management with a more
experienced anaesthetist before you embark on an anaesthetic. You must
ensure at all times that you have unimpeded access to a consultant for
advice or assistance. During evening and night shifts you will have at the
very least, a more experienced trainee anaesthetist resident in the hospital
for immediate advice or assistance.
Training Programme
Initial Assessment of Competence
The initial 3-month period of training is the “Initial Assessment of
Competence.” During this training you will be expected to gain the
knowledge and skills essential to safe anaesthetic practice. This must
include
a) a working knowledge of
 Equipment: including breathing systems or “circuits”, the
anaesthetic machine, ventilators, airway devices including
endotracheal tubes, laryngoscopes, laryngeal masks, facemasks,
Bag-Valve Mask systems, oxygen supplies and safety checks of all
equipment;
 Drugs: including induction agents, sedating agents, muscle
relaxants, analgesics, gaseous anaesthetic agents
 Essential safety standards e.g. monitoring, anaesthetic assistance
 Basic anatomy for anaesthetists (airway, cannulation sites etc)
 Starvation policies
 Pre-operative assessment including airway assessment
 Management of post-operative acute pain
 Management of anaesthetic critical incidents including failed
intubation drill
b)





Essential skills including
Bag-valve mask ventilation
Basic airway manoeuvres
Use of airway adjuncts
Insertion of laryngeal mask airway
Endotracheal intubation, cricoid pressure and Rapid Sequence
Induction
 Basic anaesthetic techniques (spontaneous ventilation and IPPV)
 Management of induction and emergence
 Good practice in infection control
You are encouraged to “shadow” competent trainee anaesthetists on the
evening shifts as much as possible prior to going onto the shift rota.
Teaching
There is a formal anaesthetic teaching programme held in protected time
on Thursday mornings. Whilst sessions are facilitated by consultants you
will be expected to read around the subject in advance and present a topic
that has been allocated to you by the teaching co-ordinator. Teaching may
be at either Poole or Bournemouth hospitals and so you must check your
rota in advance.
You will have at least one Simulator training session in your 6 months for
Rapid Sequence Induction and Critical Incident Management.
There will be opportunities for informal, practical –based teaching on
every theatre list. Please take every opportunity to ask questions and get
teaching from your consultants as well as completing Workplace Based
Assessments as often as you are able. It is also imperative that you turn
up on time for each teaching list and see the patients beforehand. This is
not only courteous to the patient and consultant, but more importantly is
integral to your training in anaesthesia in pre-operative assessment,
equipment and drug checking and formulating anaesthetic care plans. The
more actively involved in the patients’ care you are, the more you will
gain in terms of learning and enjoyment.
Clinical Governance meetings are held monthly at either Poole or
Bournemouth. As well as having educational value, these meetings also
provide an opportunity for you to present any projects or audits you may
have undertaken in the department, or to present interesting cases.
Morbidity and mortality meetings are also held in the evenings,
approximately monthly. These are a friendly, informal and sociable way
to present M&M and are usually followed by a meal out.
Appraisals
During your anaesthetics attachment you will be allocated an Educational
(Clinical) Supervisor within anaesthetics, irrespective of your base
specialty. You must meet with your anaesthetic Educational Supervisor
within 2 weeks of the beginning of your post to establish a “learning
agreement”. After this you must arrange to meet again at 3 and 6 months.
At 6 months you will have a formal appraisal when you will receive
formal feedback about your anaesthetic knowledge, skills and attitudes as
judged by consultants. Please ensure that you arrange a date for appraisal
with your Educational Supervisor and bring all relevant paperwork. This
will include an anaesthetic case logbook, completed workplace based
assessments, your portfolio and any details of audits, projects, exams or
courses undertaken during your placement. This information is essential
for your Educational Supervisor to be able to complete your ARCP report
accurately.
Intensive Care Medicine
Introduction
There are two ACCS posts in Intensive Care Medicine, for a period of
six months. You will be part of the staff rota for the unit during that time,
and the rota is administered by the anaesthetic department. It is essential,
as always, to make sure your leave requests go in early, as there is a limit
on how many can be away at any one time. Precedence always goes to
those who book first. Details are included in the section on Anaesthesia
(above) regarding the details for this process.
Induction
Each August, there is a comprehensive induction day to both the Trust,
the Anaesthetic Department and Intensive Care. Trust induction takes
place during the morning of the first day, and then to Anaesthesia and
Intensive Care in the afternoon.
There is an Intensive Care Handbook for trainees, and it is essential that
you start to work your way through this book on your arrival. It contains
the structure of how the unit runs, and details of the many procedures and
equipment that we use on the unit.
Over the first two weeks of your arrival, the Intensive Care Consultants
provide lectures covering the essential topics that will be the basis for
your work on Intensive Care. These include:







Inotropes
Ventilation
Cardiovascular monitoring
Analgesia and sedation
Renal support
Nutrition
Head injuries
These topics will be covered a number of times during your time with us.
Supervision
Your educational supervisor whilst on the unit will be Dr Briggs, to
whom you should refer if you encounter any problems.
You will either be directly supervised, or have immediate access to the
Intensive Care Consultant at all times during the day. There is also
usually a Staff Grade doctor on the unit as well, who should have
sufficient experience to supervise ACCS trainees. You will not be
expected to practice independently on the Intensive Care Unit, and nor is
it appropriate for you to do so.
Your normal working day will start at 0800 with a handover ward round.
There is the main ward round at 1030 with the Consultant and Senior
Nurse on the unit. Your working day will usually finish at 1730, but
occasionally you will finish at 2000. Between these hours, the level of
supervision is reduced, but you will have access to the ‘senior’ registrar /
Anaesthetic Consultant in theatre, and the on-call Intensive Care
Consultant.
Teaching
There is a formal teaching program on the unit, which takes place every
Wednesday afternoon at 1600, in the Intensive Care seminar room. You
are encouraged to attend these teaching sessions, as they provide a
comprehensive introduction to Intensive Care Medicine, and during the
six months, most major topics will be covered. You may be asked to
prepare a short outline for a particular topic.
In addition, there is much teaching that takes place at the bedside should
the opportunity present itself, and also during the ward rounds. There are
usually many procedures taking place on the unit, from intubation of sick
patients, to insertion of all types of lines. These are very good
opportunities to complete DOPS, mini-CEX and CBD forms. Completion
of these forms is your responsibility, and ideally you should ask to be
assessed and get the forms signed as you go along. Presenting a number
of forms several weeks after the event is not acceptable.
There is also a competency booklet, covering clinical practice of
Intensive Care Medicine. As with the work-place assessment forms, these
should be completed as you progress on the unit. All competencies must
be completed by the end of your time on the unit. If you feel you are
falling behind, please inform Dr Briggs, and we will endeavour to
improve your exposure and experience. Intensive Care is an excellent
environment for training, presenting many opportunities, but it is your
responsibility to take advantage of them.
Whilst on the unit, we are very keen that you complete at least one audit,
and present it at either the monthly departmental clinical governance
meetings, or at the bi-annual ACCS training days. There is an on-going
list of projects, but we welcome suggestions from you as well, if there is a
particular project that interests you.
Appraisals
It is essential that you have an appraisal meeting within two weeks of
arrival on the unit with Dr Briggs. You should also have an appraisal
meeting after three months, and again at six months. These appraisals will
comprise a systematic review of how far you have progressed, and will
examine the work-place assessments and competencies completed.
We will also examine your involvement in audits and other projects,
together with courses attended and exams, either sat or to be sat. You
should also maintain an Intensive Care logbook covering patients with
whom you have had direct contact, not every single patient you see on a
ward round.
WORK PLACE BASED ASSESSMENTS
These have to be trainee driven. Trainers need to be asked to do them and
you need to be clear beforehand that the case is a WPBA, not requested
retrospectively. These should be done evenly over the 6 month period and
not done as a last minute exercise as it is unfair on trainers to do many in
a short period.
The exact WPBAs for each speciality are specified in the document you
will be emailed titled “Summary of Requirements” and summarises the
requirements of the ACCS Curriculum 2010.
The idea of these assessments is to encourage greater interaction between
you and your trainers (these include SpRs who have had training in
assessments). They are designed to improve your training and are only
useful if you and your trainers perceive them as such – they are not a tick
box exercise and you will always gain some added knowledge or skill
having done it.
PREPARATION FOR YOUR ARCP
The annual review of competence progression (ARCP) is a mandatory
process whereby a panel of trainers who are Consultants in Wessex from
the specialities you have done/doing, review the paperwork (electronic
ultimately) you have completed. If you have successfully completed all
the requirements you may not necessarily need to attend the meeting (eg
on annual leave ) but generally we encourage you to go as there is added
value with a face-face interaction.
The “checklist” below lists the exact requirements for each speciality:
Wessex ACCS ARCP CHECKLIST (Updated March 2011)
GENERIC:
Registered with your base speciality College
Y
N
CT1: Achieved 50% of the 25 Core competences to level 2 *
Y
N
CT2: Achieved > 50% of the 25 Core competences to level 2
Y
N
MEDICINE
Ed supervisor completed and signed structured training report
Y
N
Completed a personal development plan for identified deficiencies **
Y
N
3 Mini CEX
Y
N
3 CBD
Y
N
3 ACATs
Y
N
5 DOPS
Y
N
Successfully completed at least 2 Major presentations
Y
N
Successfully completed at least 10 Acute presentations as WPBAs
Y
N
Completed at least 9 other Acute Presentations using other means ***
Y
N
Completed a satisfactory logbook of cases seen in Medicine
Y
N
No patient identifiable material in logbook
Y
N
Completed a MSF with a summary by the Ed Supervisor (> 11 replies)
Y
N
Completed an audit and ideally closed the loop(not essential)
Y
N
Completed a patient safety project
Y
N
demonstrate plan to sit/resit the exam
Y
N
In date for all appropriate Life Support courses
Y
N
Completed a minimum of 14 WPBAs as follows:
For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR
EMERGENCY MEDICINE
Ed supervisor completed and signed structured training report
Completed a personal development plan for identified deficiencies **
Completed a minimum of 13 WPBAs as follows:
4 Mini CEX
3 CBD
1 ACAT-EM
5 DOPS
-4 Mandatory DOPS: Airway maintenance
Primary survey trauma patient
Wound management
Fracture/ joint manipulation
Successfully completed at least 2 Major presentations with Consultant
Successfully completed at least 5 Acute presentations with Consultant
-Mandatory 5 APs:
Abdominal pain
Breathlessness
Chest pain
Head Injury
Mental Health
Completed a minimum of 10 Acute presentations using WPBAs
Completed a minimum of 9 Acute presentations using other means ***
Completed a satisfactory logbook of cases seen in the ED:
Seen a minimum of 750 cases
No patient identifiable material in logbook
Logbook divided or made clear the case mix (Resus/Majors/ambulatory)
Logbook divided or made clear the age range (Paeds vs adults)
Completed an MSF with a summary by the Ed Supervisor (> 11 replies)
(only necessary if not done in Medicine)
Completed an audit and ideally closed the loop (not essential)
(only necessary if not done in Medicine)
Completed a patient safety project (if not done in Medicine)
For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR
demonstrate plan to sit/resit the exam
In date for all appropriate Life Support courses
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Y
Y
Y
Y
N
N
N
N
Y
N
Y
N
Y
N
Y
Y
N
N
*These 25 core competences are individually listed in the structured training reports and need to be ticked off by
your Ed supervisor at your final meeting.
**Deficiencies may have been identified within the multisource feedback or in the Educational supervisor’s report.
This may also be apparent because of inability to complete any/some of the above requirements in the timeframe
expected.
It is essential that you demonstrate insight into these areas of concern by describing how you intend to address
them in your personal development plan (on eportfolio or written for those where this is not available
electronically).
***”other means” is by reflective entries in your portfolio (written/electronic) with a recorded learning outcome;
successfully completed e-learning modules; teaching done/attended on the subject; audit or patient safety project
done on the subject
Wessex ACCS ARCP CHECKLIST (Updated March 2011)
GENERIC:
Registered with your base speciality College
Y
N
CT1: Achieved 50% of the 25 Core competences to level 2 *
Y
N
CT2: Achieved > 50% of the 25 Core competences to level 2
Y
N
INTENSIVE CARE MEDICINE
Ed supervisor completed and signed structured training report
Y
N
Completed a personal development plan for identified deficiencies **
Y
N
Achieved Basic Level competence in ICM
Y
N
Successfully completed a minimum of 13 WPBAs as follows:
3 Mini CEX
Y
N
4 CBDs
Y
N
6 DOPS
Y
N
Successfully completed at least 2 Major presentations
Y
N
Completed a satisfactory logbook of cases seen in ICM
Y
N
Cases documented in the logbook have an appropriate case-mix
Y
N
No patient identifiable material in logbook
Y
N
Completed an audit and ideally closed the loop (not essential)
Y
N
Completed a patient safety project or some form of PS activity
Y
N
For CT1 trainees, attended a one day patient safety day
Y
N
Completed a MSF with a summary by the Ed Supervisor (> 11 replies)
Y
N
Y
N
For Anaesthetic trainees to consider when they might sit the Primary FRCA Y
N
For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR
demonstrate plan to sit/resit the exam
In date for all appropriate Life Support courses
Y
N
ANAESTHETICS
Ed supervisor completed and signed structured training report
Y
N
Completed a personal development plan for identified deficiencies **
Y
N
Successfully gained a Certificate of Initial Assessment of Competency
Y
N
Completed a minimum of 17 WPBAs as follows:
5 Mini CEX
Y
N
7 CBD
Y
N
5 DOPS
Y
N
Have also completed additional WPBAs OR have recorded learning outcomes in each of the
following:
Anaesthesia for emergency surgery
Conscious sedation
Regional anaesthesia
Completed a satisfactory logbook of cases
Have documented an appropriate case-mix
No patient identifiable material in logbook
Completed an audit and ideally closed the loop (not essential)
(only necessary if not done in ICM)
Completed a patient safety project or activity (if not done in ICM)
Completed an MSF with a summary by the Ed Supervisor (> 11 replies)
(only necessary if not done in ICM)
For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR
demonstrate plan to sit/resit the exam
For Anaesthetic trainees to consider when they might sit the Primary FRCA
In date for all appropriate Life Support courses
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
If you have not completed all the requirements the panel will decide
whether or not you need additional training time. This will be based on
not only what you’ve completed but also on your supervisor’s report.
It is a supportive process and we are here to not only train and assess you
but also to support you if you are having any difficulties be these
professional and/or personal.
Your clinical supervisor would be your first port of call. In the rare
instance where you do not feel comfortable discussing problems with
your clinical supervisor, you should discuss them with your educational
supervisor (ie the Consultant of your base speciality). Where your clinical
supervisor is also your educational supervisor you should confide in one
of the other Consultants in the speciality with whom you have a good
rapport.
PORTFOLIOS
You should be registered with the College of your base speciality. For
Emergency Medicine and Acute Medicine trainees this will allow you to
have an eportfolio with your respective Colleges. For the EM trainees this
will be the nhseportfolio. We will now expect all EM trainees to do all
their “paperwork” electronically. Acute Medicine trainees will need to
have the RCP eportfolio.
Anaesthetic trainees will need to keep everything as paper-based until
such time as the RCoA will have finished the Anaesthetic eportfolio.
Your portfolio should be reviewed at each of the meetings you have with
your clinical supervisor to ensure you are completing the listed
requirements.