ACCS-Wales
Workbook
&
ARCP Record Book
For CT1 and 2 ACCS Trainees in the Welsh School
ACCS – Wales
Version 2.7 June 2014
1
Contents
Introduction
3
Who’s Who & Contact Information
4
Trainee Representatives
5
Social Media
5
ACCS Curriculum
5
Educational Supervisors
6
Looking After Yourself (Your Health)
7
Protecting Your Patients (The Francis Report)
7
ARCP Checklist
8
Personal Details
13
Common Competences
14
Major Presentations
16
Acute Presentations
17
Advice for ACCS-EM Trainees
19
Anaesthesia for ACCS
20
Practical Procedures
22
Acute Medicine Paperwork
25
Emergency Medicine Paperwork
45
Anaesthesia Paperwork
72
Intensive Care Medicine Paperwork
92
A Career in Intensive Care Medicine?
112
2
Introduction
Since the introduction of the new ACCS curriculum in May 2010 ACCS training is
described under the headings of:
1. Common Competencies
2. Major Presentations
3. Acute Presentations
4. Anaesthesia in ACCS
5. Practical Procedures
Some of this training must be obtained in a particular module, but other competencies
can be achieved in any of the modules, provided that all are achieved by the end of year
2. This system can make it difficult for trainees and trainers to keep track of what
competencies remain outstanding, and the ACCS workbook is designed to make this
process easier.
The workbook gives trainees and trainers a central document where all the required
competencies and clinical procedures can be recorded, and correct paperwork identified.
Trainees should use the e-portfolio for their parent specialty; non-parent modules may
be completed on e-portfolio or paper, but ACCS-EM and ACCS-Medicine trainees are
encouraged to use the e-portfolio for all modules. The Anaesthesia e-portfolio only
contains anaesthesia-specific forms, so anaesthetists must use paper forms for other
modules. Each time the trainee completes a module within the ACCS programme a
Structured Training Report (StR) should be completed by the Module Supervisor. All
“paperwork” whether on e-portfolio or paper, should be summarised on the paper
checklists in this workbook. Supervisors’ signatures in the workbook are not necessary –
“see e-portfolio” etc is acceptable.
WPBAs including MSFs differ slightly between specialties, and should be completed using
the paperwork specific to the specialty being assessed, NOT the parent specialty.
Specialty-specific MSF and other WPBA forms, as well as all the specialty-specific
paperwork, can be found in this workbook.
At the ARCP the trainee should submit this workbook summarising the acquired
competencies, along with the paper or e-portfolio evidence. A detailed ARCP Checklist
can be found on pages 8-12.
3
Rachel Walpole: Training Programme Director, ACCS Wales
Who’s Who and Contact Information
Training Programme Director / Lead for ACCS Wales:
Rachel Walpole, Consultant Anaesthetist, Newport
Email: Rachel.Walpole@wales.nhs.uk
Specialty Leads
ACCS Lead for Anaesthesia: Rachel Walpole, Consultant Anaesthetist, Newport
Email: Rachel.Walpole@wales.nhs.uk
ACCS Lead for Acute Medicine: Llifon Edwards, Consultant Physician, Newport
Email: Llifon.Edwards@wales.nhs.uk
ACCS Lead for Intensive Care Medicine: Alison Ingham, Consultant Anaesthetist & Intensivist,
Bangor
Email: Alison.Ingham@wales.nhs.uk
ACCS Lead for Emergency Medicine: Robin Roop, Consultant Emergency Medicine, Wrexham
Email: Robin.Roop@wales.nhs.uk
Hospital Leads
University Hospital of Wales, Cardiff: Melvyn Jenkins-Welch, Consultant Anaesthetist
Email: Melvyn.Jenkins-Welch@wales.nhs.uk
Morriston Hospital, Swansea: Dinendra Gill, Consultant Emergency Physician
Email: Dinendra.Gill@wales.nhs.uk
Royal Gwent Hospital, Newport: Rachel Walpole, Consultant Anaesthetist
Email: Rachel.Walpole@wales.nhs.uk
Ysbyty Gwynedd, Bangor: Alison Ingham, Consultant Anaesthetist & Intensivist, Bangor
Email: Alison.Ingham@wales.nhs.uk
Wrexham Maelor Hospital: Ben Thomas, Consultant Physician
4
Email: Ben.Thomas@wales.nhs.uk
Specialty Training Manager, Deanery
Ms Lisa Bassett
Email: BassettL@cardiff.ac.uk
Trainee Representatives
There are 2 elected trainee representatives, one from CT1 and one from CT2. They represent
trainees’ views at Specialist Training Committee meetings. Please contact one of them if there are
issues you wish to bring to the attention of the STC.
CT2: Jonathan Lloyd-Evans (Cardiff)
Email: jlloydevans@gmail.com
CT1: will be elected in September 2014
Educational Supervision
Each department has an identified Educational Supervisor who takes responsibility for
ACCS trainees (see page 6). You should contact this person before you begin the
placement or as soon as possible afterwards, and arrange for an initial meeting within 2
weeks of starting in post. If you are unsure who is supervising you please email Lisa
Bassett, address above.
Social Media
There is an ACCS Wales Facebook Group and Twitter account. On Facebook, please
search for ACCS Wales and join the group, it is open to everyone. You are welcome to use
it to share information or to put questions to other members of the group. For Twitter:
follow @ACCSWales to receive information, reminders and updates.
ACCS Curriculum
The ACCS Curriculum can be found on the ACCS pages of the Welsh Deanery Website:
http://www.walesdeanery.org/index.php/en/trainees-in-training.html
5
Educational Supervisors
Wrexham Lead: Ben Thomas
Anaesthesia: Venkataravan Madhavan
ITU: Mahmoud Wagih
AM: Ben Thomas
EM: Robin Roop
Swansea Lead: Dinendra Gill
Anaesthesia: Tracey Wall
ITU: Vijay Kumar
AM: Praveen Eadala
EM: Dinendra Gill
Cardiff Lead: Melvyn Jenkins-Welch
Anaesthesia: Melvyn Jenkins-Welch
ITU: Sabine Grundler
AM: Simon Barry & Andrew Freedman
EM: Susan Allen
Newport Lead: Rachel Walpole (Anaesthesia)
Anaesthesia: Helen Jewitt
ITU: Babu Muthuswamy
Acute Med: Llifon Edwards ; Cardiology: Philip Campbell; Respiratory Med: Sara Fairbairn
EM: Tim Rogerson
Nevill Hall Lead: Ed Curtis
Anaesthesia & ITU: Ed Curtis
EM: Ella Harrison-Hansley
Bangor Lead: Alison Ingham
Anaesthesia & ITU: Alison Ingham
AM: Mahdi Jibani
EM: Leesa Parkinson
6
Looking after Yourself
Medicine is a stressful profession, and Core Training can be particularly
difficult because of frequent changes of post, a steep learning curve, and
exam pressures.
The GMC makes clear that a good doctor looks after their own health and
well-being as well as that of their patients.
If you find yourself struggling then either your Educational Supervisor or any
Consultant that you feel able to talk to should be your first source of
support. However if you feel unable to confide in a senior colleague, you
may wish to make use of the BMA helpline; it is not necessary to be a BMA
member to use it:
BMA Counselling & Doctor Adviser Service: 0845 9200169
Alternatively, Health for Health Professionals Wales offers free
Psychotherapy referral to any doctor in Wales. It is a confidential service
funded by the Welsh Government.
http://www.hhpwales.co.uk
Tel 0800 0582738 between 9am and 5pm Mon-Fri, calls free from a landline.
Protecting your Patients & The Francis Report
The Francis Report stressed that junior doctors have a duty to “blow the
whistle” if they feel that they have witnessed poor standards of patient care.
Concerns about standards should ideally be discussed with your Educational
Supervisor, the College Tutor or Clinical Director. If you do not feel able to
speak to any of these people, you can contact a member of the ACCS STC
who works outside of your own hospital (contact details on p.4).
Alternatively, the Intranet should have details of your Health Board’s
Whistleblowing Policy. (It may be “Whistleblowing”, or “Raising Concerns”
etc).
7
ACCS ARCP Checklist
Trainees should attend with their portfolio, ACCS Workbook and the following:
Enhanced Form R: should be completed and returned at least 2 weeks in advance of
the ARCP.
Absence Monitoring Declaration: this is a self-declaration of any unplanned absences
since your last ARCP. You should record any absences other than Annual Leave and
Study Leave. Examples of unplanned absences are Sick Leave, Maternity or Paternity
Leave, Compassionate Leave, etc.
Study Leave Record: This can be printed out from Intrepid.
GMC Survey: Evidence of completion.
The portfolio requirements for ACCS ARCPs are in 2 parts:
1. Competencies that can be achieved at any point during CT1 and 2 but must be
achieved by the end of CT2.
2. Competencies and evidence of satisfactory performance in each of the modules
(usually 2) undertaken since the last ARCP.
CT2 trainees should present all paperwork relating to the entire 2 years of ACCS training,
even if it has previously been presented at the CT1 ARCP.
Please note that an ARCP Structured Report must be presented for each
module of training, even if the module is incomplete (usually a June / July
ARCP for a module that ends in July).
8
ACCS ARCP Checklist
Major & Acute Presentations, Practical Procedures
The following competencies must be achieved by the end of CT2.
Trainees for CT1 ARCP should have evidence that progress is being made towards
achieving these competencies.
Common Competencies
At least 50% achieved to level 2 descriptors
Ref: Workbook p13
Definitions of descriptors can be found at:
http://www.accs.severndeanery.nhs.uk/assets/Accs/Curriculum/CommonCompetenciesfor
ACCSleveldescriptorscurriculumpage.docx
All 6 Major Presentations
Ref: Workbook p15; at least 2 during EM and 2 during AM.
28 Acute Presentations:
At least 20 of the 38 by WPBA: 10 during EM, 10 during AM.
8 further Acute Presentations covered by WPBAs including ACAT, or by e-learning,
reflective entries, teaching and audit.
Ref: Workbook p16
39 Practical Procedures:
At least 39 of the 44. Ref: Workbook p20
ALS-Provider
Mandatory for all ACCS trainees by the end of CT2. This is in addition to a WPBA for
Cardiorespiratory Arrest (see Major Presentations).
EM Trainees must be APLS and ATLS-Providers (or equivalent) by the end of CT3.
9
ACCS ARCP Checklist
Individual Module Requirements
Anaesthesia
o
ARCP Structured Report
o
Initial Assessment of Competency Certificate (IACC)
o All required WPBAs are incorporated into the IACC
o
A Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)
o
Copy of Logbook
o
Educational Agreement
Intensive Care Medicine
o
Educational Supervisor’s Report
o
Logbook
o
6 x Directly Observed Procedural Skills (DOPS)
o
4 x Case Based Discussions (CBD)
o
3 x Clinical Evaluation Exercises (CEX)
o
Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)
WPBAs Should Include:
o
2 of the 6 Major Presentations: CBD or CEX (formative)
o
Sepsis is suggested
10
ACCS ARCP Checklist
Acute Medicine
o
Educational Supervisor’s Report
o
Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)
o
Educational Agreement
WPBAs:
o
3 x Acute Care Assessment Tools (ACAT)
o
3 x Case Based Discussions (CBD)
o
3 x Clinical Evaluation Exercises (CEX)
o
5 x Directly Observed Procedural Skills (DOPS)
o A different 5 from those assessed in EM
WPBAs Should Include:
o
2 of the 6 Major Presentations: CBD or CEX (formative)
o
10 of the 38 Acute Presentations: CBD, CEX or ACAT (formative)
Please note that Multiple Consultant Reports (MCRs) are not required for ACCS, though
ACCS-Medicine trainees may choose to do them.
11
ACCS ARCP Checklist
Emergency Medicine
o
Structured Training Report
o
Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)
o
Training Agreement
o
Logbook
WPBAs:
o
o
o
o
1 x Acute Care Assessment Tools (ACAT)
3 x Case Based Discussions (CBD)
4 x Clinical Evaluation Exercises (CEX)
5 Directly Observed Procedural Skills (DOPS) using specific forms; these 5 are
suggested:
 Airway maintenance
 Primary Survey in Trauma
 Wound Management
 Fracture or Joint Manipulation
 1 other of the 44 listed practical procedures not covered elsewhere (list
below)
WPBAs Should Include:
o
2 of the 6 Major Presentations: summative* CBD or CEX; must be Consultant
assessment.
o
5 of the 38 Acute Presentations, summative* CBD or CEX; must be Consultant
assessment, these 5 are suggested:
 Abdominal Pain
 Breathlessness
 Chest Pain
 Head Injury
 Mental Health
o
5 further Acute Presentations, ACAT (formative*)
*A summative assessment has a pass/fail outcome and must be assessed by a Consultant.
A formative assessment is not a pass or fail assessment and can be performed by any
appropriate person.
12
Personal Details
Trainee’s Name
GMC Number
ACCS Parent Specialty
College Training Number
Base Hospital(s)
Parent Specialty Supervisor*
Module 1 Specialty / Dates
Module 1 Clinical Supervisor**
Module 2 Specialty / Dates
Module 2 Clinical Supervisor**
Year 1 ARCP
Date
Outcome
Date
Outcome
Module 3 Specialty / Dates
Module 3 Supervisor**
Module 4 Specialty / Dates
Module 4 Supervisor**
Year 2 ARCP
*Parent Specialty Supervisor is a Consultant in the base hospital from the trainee’s parent
specialty. This person provides continuity of support over the 3-year programme, and is a
source of careers advice, exam support etc.
**Module supervisor (Also known as Clinical Supervisor) is the person responsible for the
trainee during that module and will be the person completing the Structured Training
Report at the end of that specific module with the trainee.
13
COMMON COMPETENCES
Many of these competences are an integral part of clinical practice and as such will be assessed
concurrently with the clinical presentations and procedures assessments. Trainees should use
these assessments to provide evidence that they have achieved the appropriate level. Descriptors
of required performance at each level can be found at:
http://www.accs.severndeanery.nhs.uk/assets/Accs/Curriculum/CommonCompetenciesforACCSl
eveldescriptorscurriculumpage.docx
For a small number of common competences alternative evidence should be used, e.g.
assessments of audit and teaching, completion of courses, management portfolio. At least 50%
of Common Competences should be signed off by the end of the CT2 ACCS year.
Competency
1
Level achieved (Sign and date)
2
3
1) History taking
2) Clinical examination
3) Therapeutics and safe
prescribing
4) Time management and
decision making
5) Decision making and clinical
reasoning
6) The patient as central focus of
care
7) Prioritisation of patient safety
in clinical practice
8) Team working and patient
safety
9) Principles of quality and safety
improvement
10) Infection control
14
4
Competency
1
Level achieved (Sign and date)
2
3
11) Managing long term
conditions and promoting
patient self-care
12) Relationships with patients
and communication within a
consultation
13) Breaking bad news
14) Complaints and medical error
15) Communication with
colleagues and cooperation
16) Health promotion and public
health
17) Principles of medical ethics
and confidentiality
18) Valid consent
19) Legal framework for practice
20) Ethical research
21) Evidence and guidelines
22) Audit
23) Teaching and training
24) Personal behaviour
25) Management and NHS
structure
15
4
MAJOR PRESENTATIONS
These are seen as the cornerstone of the clinical skills of ACCS trainees and they should all be
signed off by the end of the second year. 2 must be completed during the Emergency Medicine
module and must be assessed by a Summative Assessment by a Consultant using either a CbD or
mini-CEX specifically designed for Summative Assessment (Curriculum pages 221 & 225). 2 will be
assessed in the Acute Medicine module and the other 2 can be done in any of the modules, but it
is recommended that the Septic Patient should be signed off in the Intensive Care Medicine
module.
Anapylaxis and Cardiorespiratory Arrest may be simulated – BUT an ALS Course is not a substitute
for either of these. The knowledge, skills and behaviours to be achieved for each presentation
are listed in the curriculum pp 75– 84.
Presentation
ACCS Module
AM/EM/ICM/An
Date
Modular (Clinical)
supervisor
1) Anaphylaxis
2) Cardiorespiratory Arrest
3) Major Trauma
4) Septic Patient
5) Shocked Patient
6) Unconscious Patient
16
ACUTE PRESENTATIONS
There are 38 Acute Presentations (APs). 10 should be signed off during the AM module, and 10
during the EM module. At least 8 further APs should be covered by ACAT, e-learning, reflective
entries, teaching and audit. There are 5 APs that require the trainee to complete specific
summative WPBA during the EM module (see table). Up to 5 APs can be covered by a single ACAT
in either EM or AM. The knowledge, skills and behaviours required for each presentation are
listed in the curriculum pp86-140.
Presentation
1) Abdominal Pain including
loin pain
ACCS Module
AM/EM/ICM/
An
Date
Modular (Clinical)
supervisor
EM
2) Abdominal Swelling, Mass
& Constipation
3) Acute Back Pain
4) Aggressive/disturbed
behaviour
5) Blackout/Collapse
6) Breathlessness
7) Chest Pain
EM
EM
8) Confusion: Acute/Delirium
9) Cough
10) Cyanosis
11) Diarrhoea
12) Dizziness and Vertigo
13) Falls
14) Fever
15) Fits / Seizure
16) Haematemesis & Melaena
17) Headache
18) Head Injury
EM
17
19) Jaundice
20) Limb Pain & Swelling –
Atraumatic
21) Neck pain
22) Oliguric patient
23) Pain Management
24) Painful ear
25) Palpitations
26) Pelvic pain
27) Poisoning
28) Rash
29) Red eye
30) Suicidal ideation / Mental
health
EM
31) Sore throat
32) Syncope and pre-syncope
33) Traumatic limb and joint
injuries
34) Vaginal bleeding
35) Ventilatory Support
36) Vomiting & Nausea
37) Weakness & Paralysis
38) Wound assessment and
management
18
Advice for ACCS-EM Trainees: Prepare now for your CT3 ARCP!
The ACCS Curriculum covers CT1-2 but it is worth anticipating the requirements for CT3
as it is much easier to get the competencies signed off as you see them rather than trying
to “chase” then later.
By the end of CT3 you will need the following:
All 6 Major Presentations by Summative WPBA assessed by a Consultant:


Anaphylaxis and Cardiorespiratory Arrest may be assessed by simulation
ALS-Provider status is not a substitute for this assessment
All 38 Acute Presentations:


20 of these to be covered by WPBA during CT1-2 as detailed on p17 of this
Workbook.
The remaining 18 to be covered by WPBA or by e-learning, reflection, teaching etc
o 8 by the end of CT2
o And all 18 by the end of CT3
NB: The e-learning modules are designed to help you pass MCEM; another reason not to
leave them for CT3.
All 45 DOPS:


39 by the end of CT2 as detailed on p21 of this Workbook.
All 45 by the end of CT3.
o Pacing and Cardioversion made by assessed by simulation.
19
ANAESTHESIA FOR ACCS
Within the ACCS anaesthesia module the trainee must achieve the Initial Assessment of
Competence (IAC).
The 17 WPBAs that make up the IAC are listed under Practical Procedures (see next section).
Date
Signature and name of
supervisor
Initial Test of
competency passed
20
21
PRACTICAL PROCEDURES
There is a list of 44 Practical procedures in the ACCS Curriculum; 39 should be completed by the
end of the second year. Some procedures and their assessment are specific to certain elements
of the ACCS programme and a specific type of WPBA has been recommended: these have been
indicated in brackets using the key below. These include the 17 that are associated with the
Anaesthetic Initial Assessment of Competence.
Mi, A = Mini-CEX(Anaesthetic), D = DOPs, C = CBD
Practical procedures
1. Arterial cannulation
2. Peripheral venous
cannulation
3. Central venous
cannulation
4. Arterial blood gas
sampling
ACCS
Module
WBA
type
Date
Modular (Clinical)
supervisor
ICM (D)
ICM (D)
ICM (D)
ICM (Mi,D)
5. Lumbar puncture
6. Pleural tap and
aspiration
7. Intercostal drain:
Seldinger
8. Intercostal drain: Open
9. Ascitic tap
10. Abdominal paracentesis
11. Airway protection
12. Basic and advanced life
support
EM (D)
Anaes (D)
13. DC Cardioversion
22
14. Knee aspiration
15. Temporary pacing
(external/ wire)
16. Reduction of dislocation/
fracture
EM (D)
17. Large joint examination
18. Wound management
19. Trauma primary survey
EM (D)
EM (D)
20. Initial assessment of the
acutely unwell
21. Secondary assessment of
the acutely unwell
22. Connection to a
mechanical ventilator
23. Safe use of drugs to
facilitate mechanical
ventilation
24. Managing the patient
fighting the ventilator
25. Monitoring Respiratory
function
ICM (D)
ICM (C)
ICM (C)
ICM (C)
Anaesthesia Initial
Assessment of Competence
(IAC) - as listed below from
Preoperative assessment to
Emergency surgery
26. Preoperative assessment
27. Management of
spontaneously breathing
patient
28. Administer anaesthesia
for laparotomy
Anaes (A)
Anaes (A)
Anaes (A)
23
29. Demonstrate RSI
30. Recover patient from
anaesthesia
31. Demonstrate function of
anaesthetic machine
32. Transfer of patient to
operating table
33. Technique of scrubbing
up and donning gown
and gloves
34. Basic competences for
pain management
35. Patient Identification
36. Post op N&V
37. Airway assessment
38. Choice of muscle
relaxants and induction
agents
39. Postoperative analgesia
40. Postoperative oxygen
therapy
41. Emergency surgery
42. Safe use of vasoactive
drugs and electrolytes
43. Deliver a fluid challenge
safely to an acutely
unwell patient
44. Describe actions
required for accidental
displacement of tracheal
tube or tracheostomy
Anaes (A)
Anaes (A)
Anaes (D)
Anaes (D)
Anaes (D)
Anaes (D)
Anaes (C)
Anaes (C)
Anaes (C)
Anaes (C)
Anaes (C)
Anaes (C)
Anaes (C)
ICM (Mi,C)
ICM (C)
ICM (C)
24
Acute Medicine Paperwork
Contents of this section:
 Structured Training Report form (to be completed at the end of the
module)
 Induction Appraisal Form (to be completed at the start of the module)
 ACAT Form
 DOPS form
 MiniCEX form
 CbD form
 MSF Guidelines
 MSF form
 MSF Results Summary
Please note that Multiple Consultant Reports (MCRs) are not required for
ACCS, though ACCS-Medicine trainees may choose to do them.
Recommended Reading / Useful Websites:
The Oxford Handbook of Acute Medicine
And / or
The Oxford Handbook of Clinical Medicine
Each £25-£30 available on Amazon
25
Structured Training Report for Acute Medicine Module
The clinical/modular supervisor must complete this STR, having reviewed the trainee’s learning
portfolio and WPBAs. Alternatively please substitute a print out of the STR from the Medicine e
Portfolio.
Current Placement
Base Hospital/Department
Dates
Clinical supervisor
WPBA in Current Placements
Assessment
Number
Comments
Mini-CEX
(min 3 in 6 months)
DOPs
(min 5 in 6 months)
List procedures included in DOPs and ensure
they are signed off in Practical procedures
CBD
(min 3 in 6 months)
ACAT
(min 3 in 6 months)
MSF
26
Experiential outcomes (please review evidence in learning portfolio)
Comments
Major Presentations
(at least 2 out of 6)
Acute Presentations:
WPBAs (at least 10 of
the 38)
Acute Presentations:
ACAT, e-learning,
Reflective Entries,
Teaching, Audit (at least
8 of the 38)
Log book
Clinical
Governance/Audit
Exams / Other
Educational
Achievements
Life Support Courses
27
Other Courses
Other Achievements
Other outcomes to be considered that may not be in the learning portfolio. (e.g. Critical
Incidents, Complaints)
Summary of Trainees Assessment
Supervisor to complete. Please attach evidence if available to support opinions or give examples
of behaviours.
Pen Picture of Trainee:
Clinical
Professionalism
Communication
Academic Endeavour/Learning
28
I confirm that this is an accurate description/summary of this trainee’s learning
Portfolio and WPBA, covering the period from ………………..to ……………….
Strengths of Trainee
Suggestions for improvement
Supervisor Name and Signature
Date:
Trainee Signature
Date:
Induction Appraisal Form (ACCS Acute Medicine Attachment)
Trainee:
Meeting Date:
Timetable of regular weekly fixed commitments eg ward rounds, clinics, etc
29
DAY
Monday:
AM
PM
Teaching etc
Tuesday:
Wednesday:
Thursday:
Friday:
Out of hours work:
Arrangements for senior review of admissions:
Are there any other induction considerations to be taken into account? e.g. duties of the
placement(s); arrangements for clinical supervision; academic and welfare support:
What are the objectives for the trainee, for the ACCS curriculum? What
evidence will be used to ensure these objectives have been met?
Main Curriculum Objectives and Evidence of Achievement:
These are documented fully in the ACCS handbook, but by the end of the attachment the
trainee must be able to provide a minimum of:3 x Acute Care Assessment Tools (ACAT)
30
3 x Case Based Discussions (CBD)
3 x Clinical Evaluation Exercises (CEX)
5 x Directly Observed Procedures (DOPS)
A Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)
Completed Workplace Assessments
In addition:- Assessments must include Acute Coronary Syndrome.
- Should aim to see as many of the “top 20 presentations” as possible.
Top 20 Acute Presentations:
Abdominal
Pain*
Acute Back
Pain
Blackout /
Collapse
Vomiting /
nausea
Weakness /
paralysis
Breathlessness* Chest Pain*
Confusion
Cough
Diarrhoea
Falls
Fever
Headache
Rash
Palpitations
Fits/ Seizure
Poisoning
Limb
Pain/swelling
Jaundice
Haematemesis
/ Melaena
* These presentations are required to be assessed during the EM module and so cannot
count towards the 10 required for AM.
Generic Competencies:
These are as documented in the ACCS handbook.
What learning methods will be used to meet these objectives? Is any study leave planned?
Are there any training concerns at this stage?
Supervisor's Signature
Trainee’s Signature
31
Acute Care Assessment Tool (ACAT) Instructions
ACAT Instructions:

A different observer for each assessment

Observers can be any doctor from SpR grade and above, who was responsible for
the supervision of the take you are being assessed on

The process is trainee led (choosing the take period)

An ACAT should take no longer than 15 minutes, and this includes the feedback
given over the different sections of the ACAT assessment forms
The completed ACAT forms should be entered onto the trainee’s ‘e’ portfolio.
Clinical assessment
Quality of History and Examination to arrive at appropriate
differential diagnoses
Medical record keeping
Quality of recording of patient encounters on the take, and
including drug and fluid prescriptions
Investigations and
referrals
Quality of a trainee’s choice of investigations, and referrals over
a take period
Management of
critically ill patient
Quality of treatment given to critically ill patients encountered on
the take (assessment, investigations, urgent treatment
administered, involvement of appropriate colleagues including
senior)
Prioritisation of cases and issues within the take, ensuring
sickest patients seen first and the patient’s most pressing issues
are dealt with initially.
Time management
Recognition of the quality of a colleague’s initial clerking to
inform how much further detail is needed. A full repeat clerking
is not always needed by a more senior doctor.
Management of Take /
Team working
Appropriate relationship with and involvement of other health
professionals
Clinical leadership
Appropriate delegation and supervision of junior staff.
Handover
OVERALL CLINICAL
JUDGEMENT
Quality of the handover of care of patients from the take to the
relieving team. If patients have been transferred to a different
area of care then this applies to the quality of the handover to
the new team.
Quality of the trainee’s integrated thinking based on clinical
assessment, investigations and referrals resulting in the
patients’ management plan
32
33
34
35
36
37
38
RCP Guidelines for completing a MSF assessment
Dear Colleague,
Name of ‘Rater’: Please write name of ‘rater’ here
The Royal Colleges of Physicians (UK) are now using multisource feedback (MSF),
otherwise known as 3600 assessment, to assess doctors in training. MSF assessment is a
method of assessing generic skills such as communication, leadership, team working,
teaching, punctuality and reliability. This allows objective systematic collection and feedback
of performance data on an individual, which is derived from a number of stakeholders in their
performance. This assessment method has been shown, in a UK pilot study, to provide a
reliable rating of an individual doctor. ‘Raters’ are people with whom the doctor being
assessed works and this includes nurses, other doctors, secretaries and other clerical staff and
other allied health professionals. The data from 20 ‘raters’ forms is put together to provide the
doctor with structured feedback about their performance.
You have been asked to assess: Please write name of doctor to be assessed here
What is required of you?
1. You have been selected by the trainee or their educational supervisor to assess the
trainee.
2. We would be grateful if you would complete the accompanying form about the
trainee. MSF is used to assess the behaviour, team working and communication skills
of trainees. It is NOT an assessment of knowledge or practical skills.
3. Ordinarily the trainee will not be able to identify you and will not see your
individual responses. The trainee’s educational supervisor will collate the
information from all of the MSF assessments onto a single summary form, which will
be used to give the trainee feedback. Trainees will not normally see any individual
responses/forms or scores. In the event of a legal challenge the Data Protection Act
may allow the information to be released, but should not be released until the legal
process has run its course.
4. Please score the trainee from 1 (extremely poor) to 9 (extremely good). A score of 13 would be considered unsatisfactory, 4-6 satisfactory and 7-9 would be considered
above that expected, for a trainee at the same stage of training and level of
experience. You must justify each score of 1-3 with at least one
explanation/example in the comments box, failure to do so will invalidate the
assessment. If you feel unable to comment on an aspect you may mark the ‘Don’t
know’ box.
5. If you feel, for whatever reason, that the trainee doctor falls below what you
believe to be a minimum standard for a qualified doctor who is training to be a
consultant it is important for you to make this clear on the form.
6. If you have had insufficient contact with the trainee to assess certain aspects then
please fill in the ‘Don’t know’ box.
7. Please make written comments to supplement or explain your scoring if you think
this may be helpful, you must do this for all scores of 1-3. Please write clearly.
8. When you have FULLY completed the form please return it in the envelope provided
to the trainee’s educational supervisor, NOT the
. This process will be conducted
sensitively and carefully so you should feel free to give honest answers to questions,
as this is fundamental to the success of the process.
© 2008 Royal Colleges of Physicians - modified for use in Wales
39
How to complete the form
Your completed form will be scanned to enable a quick and accurate analysis of results,
to aid this process please keep the following in mind:
1.
2.
3
4.
Try not to fold your form
Only use pens with black or dark blue ink & print firmly
Only write in allocated areas on the form - if you have any additional comments please
use a separate sheet of paper
For optimum accuracy print in capital letters / numbers (where applicable) and avoid
contact with the edge of the box. For example:
A B C D E F G H
5.
I
J K L M N O P 1 2
3
4 5 6 7
8 9
Shade circles like this:
Mark any mistakes made like
Please detach the completed MSF assessment form and put it in the envelope provided,
seal it, and either hand it to the educational supervisor or put it in the internal post to
them. Do NOT give the completed form directly to the trainee
.
Thank you for your help.
© 2008 Royal Colleges of Physicians - modified for use in Wales
41
RCP MSF feedback and summary form of trainee’s scores
This form is to be completed by the educational supervisor at the end of the 6 month module
Trainee’s GMC number:
Name of trainee:
Educational supervisor’s name:
Medicine Attachment:
Form to be completed by the educational supervisor before meeting with the trainee:
Items
Number of
“raters” who
scored item
Range of
“raters”
scores
Mean
“raters”
score
Self score
Any score of
1-3 or
“Yes”for
item 6?
Attitude to staff
Attitude to patients
Reliability and
Punctuality
Communication skills:
patients
Communication skills:
colleagues
42
Honesty and integrity,
do you have any
concerns?
Team player skills
Leadership skills
Overall professional
Competence
Grade of “raters”
Comments from “raters”
43
Future recommendations for training:
Signature:
Date:
Trainee
Educational Supervisor
44
Emergency Medicine Paperwork
Contents of this section:
 Structured Training Report form (to be completed at the end of the
module)
 Training Agreement
 Personal Development Plan
 MSF Form
 DOPS form
 Formative CbD form
 Summative CbD form
 Formative MiniCEX form
 Summative MiniCEX form
 ACAT-EM form
Recommended Reading / Useful Websites:
 The Oxford Handbook of Emergency Medicine
£25-£30, available on Amazon and elsewhere
45
College of Emergency Medicine
Structured Training Report for ACCS EM CT1
The Educational Supervisor must complete this STR, having reviewed the trainee’s e-portfolio
Trainees Name and GMC Number
Educational Supervisor name
and GMC Number
Deanery / School
Wales
Training Unit
GMC programme /Post approval number
Date of assessment
Period covered in this assessment, start and end dates
ARCP decision tool for EM CT1
Assessments and number required
Number
completed
Outcome
Comments
Common Competences CC 1-25
At least 50% to level 2 in CT1&2
Please see section below
Core Major Presentations Adult (CMP1-6)

2/6 summative in EM CT1
Core Acute Presentations CAP Adults 1-38

5/38 summative in CT1, in specified topics

X1 ACAT-EM covering 5/38 APs

Additional 10/38 using ACAT, e-learning etc
Adult Practical Procedures = 45

5 EM DOPs required (4 specified + additional)
Min assessments in EM CT1 = 13
2 MPs, 5 APs, 1 ACAT, 5 DOPs
Management and leadership
46
Examinations = MCEM A (not mandatory)
Safeguarding Children Level 1&2 (not mandatory)
ALS-Provider
Experience 800 patient in 6/12 EM
Please review trainees log book or equivalent*
MSF
Other outcomes to be considered
Activity
Date
Outcome
Comments
PDP
Educational achievements
Evidence of reflective practice
Critical incidents
Complaints
Periods of absence from the post, include sick leave
Out of programme time, but not annual leave
* trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas, e.g. resus,
majors, paeds or minors
47
Common Competencies progression
Completion of the EM WPBA tools on the e-portfolio will automatically populate the trainee’s common
competences framework. Using this framework and knowledge of the trainees competence against the
common competency curriculum the following table should describe the level at which the trainee is
working at present i.e. level 1-4.
Domain
Competence
level 1-4
Comments (if any)
History taking
Clinical examination
Therapeutics and safe prescribing
Time management and decision making
Decision making and clinical reasoning
The patient as central focus of care
Prioritisation of patient safety in clinical
practice
Team working and patient safety
Principles of quality and safety
improvement
Infection control
Managing long term conditions and
promoting patient self-care
Relationships with patients and
communication within a consultation
Breaking bad news
Complaints and medical error
Communication with colleagues and
cooperation
Health promotion and public health
Principles of medical ethics and
confidentiality
48
Valid consent
Legal framework for practice
Ethical research
Evidence and guidelines
Audit
Teaching and training
Personal behaviour
Management and NHS structure
Strengths of trainee
Weaknesses of trainee
Suggestions for development
Issues not covered elsewhere
Does the ES recommendation to ARCP panel for this trainee
to progress to next stage of training
Yes
No
If no, reasons why and specific areas that need to be addressed
ES Name and Signature
Trainee Signature
Date:
Date:
49
Training Agreement for ACCS EM and Non-EM Trainees
This is a training agreement between the CT1/2 trainees and their educational supervisors in
the emergency department.
Training agreement declaration
As a trainee
I understand and agree that I shall attend/complete the following training requirements during
my placement in the ED:
 Develop a personal educational plan with my educational supervisor at the start of my
placement.
 Read the curriculum produced by the College of Emergency Medicine (CEM)
 Complete the required Workplace based assessments: Summative assessments should
only be completed by Consultants or Associate Specialists. Formative assessments may
be completed by registrars as well as consultants.
1. 2 Summative Assessments (Mini-CEX OR CBD) by a Consultant on 2 of the Major
Presentations using the specific summative Mini-CEX or generic summative CBD
forms.
2. 5 Summative Assessments on the following 5 Acute Presentations (Chest Pain,
Abdominal Pain, Mental Health, Head Injury, Breathlessness) using the specific
summative Mini-CEX or generic summative CBD forms and completed by
Consultants.
3. The above assessments will consist of a minimum of 4 Mini-CEX and 3 CBDs.
4. 1 x ACAT-EM which may cover up to 5 additional Acute Presentations (not including
the 5 specified in point 2)
5. 5x DOPS (using specific DOPs forms to include Airway, Wound management,
Primary Survey in trauma, Joint or fracture manipulation + one other from ACCS list
of practical procedures)
6. 10 additional assessments of acute presentations using a combination or
■
■
■
e-learning
reflective entries
teaching and audit assessments
50

additional ACAT-EMs
7. 1 x MSF (minimum of 10 to include 3 Consultants)
 Participate fully in the educational programme of the ED and be prepared to spend some
of my own time on educational activities, including audit
 Complete promptly all training and assessment documentation, including my Portfolio of
evidence and log book; and participate as required in assessment meetings, i.e. ARCP
I understand that it is my responsibility to:
 Familiarise myself with the training programme
 Ensure that I request study time in good time and complete the relevant trust leave
form/online request so that suitable arrangements can be made within the ED
 Arrange my 3 meetings and sign off (Structured Training Form) with my educational
supervisor
As a trainer I understand and agree that:
 The trainee is working with a ACCS focus in the ED with appropriate supervision
 I will do my best to see that the trainee receives all the support which will enable them to
train successfully
 I will develop a personal educational plan with my trainee at the start of his/her
placement. This plan will take into account their current training needs and the time and
resources available
 I will meet with the trainee on at least 3 separate occasions, at the beginning, mid point
and end of their placement for appraisal
 I will complete a structured training report prior to the trainee's ARCP
Trainee's name and signature:
Trainer's name and signature:
Date:
51
Personal Development Plan
Trainee name:
What development needs and
goals do I have?
Explain the need and goal
Training number:
How will I address them?
Explain the action you intend to
take & what resources you will
need
Date by which I plan
to achieve the goal
Date agreed for
achieving the goal
The outcome
How will you show that you have achieved the
goal?
Completed
Completion
agreed by
Your supervisor
(date & sign)
COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)
This form is completely anonymous.
Trainee name:
Grade of assessor:
UNKNOWN
Not Observed
Date
/
/
1
2
3
4
5
Performance
Performance
Partially Meets
Expectations
Performance
Performance Exceeds
Expectations
Performance
Consistently Exceeds
Expectations
Does Not Meet
Expectations
Meets
Expectations
Good Clinical Care
1
Medical knowledge and clinical skills
2
Problem-solving skills
3
Note-keeping – clarity; legibility and completeness
4
Emergency Care skills
1-5 or UK
Comments on this doctors clinical care
Relationships with Patients
1
Empathy and sensitivity
2
Communicates well with all patient groups
3
Treats patients and relatives with respect
4
Appreciates the pyscho-social aspects of patient care
5
Offers explanations
Comments on this doctors relationships with patients
1-5 or UK
Comments
Relationships with Colleagues
1
Is a team-player
2
Asks for others’ point of view and advice
3
Encourages discussion Empathy and sensitivity
4
Is clear and precise with instructions
5
Treats colleagues with respect
6
Communicates well (incl. non-verbal communication)
7
Is reliable
8
Can lead a team well
9
Takes responsibility
10
“I like working with this doctor”
1-5 or UK
Comments on this doctors relationships with colleagues
Teaching and Training
1
Teaching is structured
2
Is enthusiastic about teaching
3
This doctor’s teaching sessions are beneficial
4
Teaching is presented well
5
Uses varied teaching skills
1-5 or UK
Comments on this doctors teaching and training skills
Global ratings and concerns
1
Overall how do you rate this Dr compared to other ST1
Drs
2
How would you rate this trainees performance at this
stage of training
3
Do you have any concerns over this Drs probity or health?
1-5 or UK
General comments
54
COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)
Trainee name:
Summary of Responses
UNKNOWN
Not Observed
Date
/ /
1
2
3
4
5
Performance
Performance
Partially Meets
Expectations
Performance
Performance Exceeds
Expectations
Performance
Consistently Exceeds
Expectations
Does Not Meet
Expectations
Meets
Expectations
Good Clinical Care
1
Medical knowledge and clinical skills
2
Problem-solving skills
3
Note-keeping – clarity; legibility and completeness
4
Emergency Care skills
1
2
3
4
5
UK
Comments
1
2
3
4
5
UK
Comments
Comments on this doctors clinical care
Relationships with Patients
1
Empathy and sensitivity
2
Communicates well with all patient groups
3
Treats patients and relatives with respect
4
Appreciates the pyscho-social aspects of patient care
5
Offers explanations
Comments on this doctors relationships with patients
55
Relationships with Colleagues
1
Is a team-player
2
Asks for others’ point of view and advice
3
Encourages discussion Empathy and sensitivity
4
Is clear and precise with instructions
5
Treats colleagues with respect
6
Communicates well (incl. non-verbal communication)
7
Is reliable
8
Can lead a team well
9
Takes responsibility
10
“I like working with this doctor”
1
2
3
4
5
UK
Comments
Comments on this doctors relationships with colleagues
Teaching and Training
1
1
Teaching is structured
2
Is enthusiastic about teaching
3
This doctor’s teaching sessions are beneficial
4
Teaching is presented well
5
Uses varied teaching skills
2
3
4
5
UK
4
5
UK
Comments on this doctors teaching and training skills
Global ratings and concerns
1
Overall how do you rate this Dr compared to other ST1
Drs
2
How would you rate this trainees performance at this
stage of training
3
Do you have any concerns over this Drs probity or
health?
1
2
3
General comments
Summarised by: ………………………………………………………………………. Educational Supervisor
56
College of Emergency Medicine
Direct Observation of procedural Skills – DOPs
Trainee name:
Assessor:
Assessor
GMC No:
Grade of assessor:
Date
/
/
Procedure observed (including indications)
Please TICK to indicate the
standard of the trainee’s
performance in each area
Not
observ
ed
Further
core
learning
needed
Demonstrates good
practice
Must
address
learning
points
highlight
ed below
Should
address
learning
points
highlighte
d below
Demonstrates
excellent practice
Indication for procedure
discussed with assessor
Obtaining informed
consent
Appropriate preparation
including monitoring,
analgesia and sedation
Technical skills and
aseptic technique
Situation awareness and
clinical judgement
57
Safety, including
prevention and
management of
complications
Care /investigations
immediately post
procedure
Professionalism,
communication and
consideration for patient,
relatives and staff
Documentation in the
notes
Completed task
appropriately
Things done particularly well
Learning points
Action points
Assessor Signature:
Trainee Signature:
58
College of Emergency Medicine
Formative Case Based Discussion CbD
Trainee name:
Assessor:
GMC
assessor No:
Grade of assessor:
Date
Not
observed
/
Presentation – please see curriculum for
number
Case discussed (brief description)
Please TICK to indicate the
standard of the trainee’s
performance in each area
/
Further
core
learning
needed
Demonstrates good
practice
Must
address
learning
points
highlighted
below
Should
address
learning
points
highlighted
below
Demonstrates
excellent
practice
Record keeping
Review of investigations
Diagnosis
Treatment
Planning for subsequent
care (in patient or
discharged patients)
Clinical reasoning
Patient safety issues
Overall clinical care
59
Things done particularly well
Learning points
Action points
Assessor Signature:
Trainee Signature:
60
College of Emergency Medicine
Summative Case Based Discussion CbD
Trainee name:
Assessor:
GMC
assessor No:
Grade of assessor:
Date
/
Record keeping
Records should be legible and signed.
Should be structured and include
provisional and differential diagnoses
and initial investigation &
management plan. Should record
results and treatments given.
Review of investigations
Undertook appropriate investigations.
Results are recorded and correctly
interpreted. Any Imaging should be
reviewed in the light of the trainees
interpretation
Diagnosis
The correct diagnosis was achieved
with an appropriate differential
diagnosis. Were any important
conditions omitted?
Not
observed
Expected behaviours
Unsuccessful
Presentation – please see curriculum for
number
Successful
Case discussed (brief description)
/
61
Treatment
Emergency treatment was correct
and response recorded. Subsequent
treatments appropriate and
comprehensive
Planning for subsequent
care (in patient or
discharged patients)
Clear plan demonstrating expected
clinical course, recognition of and
planning for possible complications
and instructions to patient (if
appropriate)
Clinical reasoning
Able to integrate the history,
examination and investigative data to
arrive at a logical diagnosis and
appropriate treatment plan taking
into account the patients co
morbidities and social circumstances
Patient safety issues
Able to recognise effects of systems,
process, environment and staffing on
patient safety issues
Overall clinical care
The case records and the trainees
discussion should demonstrate that
this episode of clinical care was
conducted in accordance with good
clinical practice and to a good
overall standard
Overall
Successful
Unsuccessful
If more than two “not observed” then
unsuccessful
62
Things done particularly well
Learning points
Action points
Assessor Signature:
Trainee Signature:
63
College of Emergency Medicine
Formative Mini-Clinical Evaluation Exercise - Mini-CEX
Trainee name:
Assessor:
Assessor
GMC no.
Grade of assessor:
Date
Case discussed (brief description)
Please TICK to indicate the
standard of the trainee’s
performance in each area
Not
observed
/
/
Presentation – please see curriculum for
number
Further
core
learning
needed
Demonstrates good
practice
Must
address
learning
points
highlighted
below
Should
address
learning
points
highlighted
below
Demonstrat
es excellent
practice
Initial approach
History and information
gathering
Examination
Investigation
Clinical decision making
and judgment
Communication with
patient, relatives, staff
64
Overall plan
Professionalism
Things done particularly well
Learning points
Action points
Assessor Signature:
Trainee Signature:
65
College of Emergency Medicine
Summative Mini-Clinical Evaluation Exercise - Mini-CEX
Trainee name:
Assessor:
Assessor
GMC no.
Grade of assessor:
Date
Case discussed (brief description)
/
/
Presentation – please see curriculum for
number
Descriptors of poor performance
Successf
ul
unsucce
ssful
Initial approach
History and
information
gathering

History taking was not focused

Did not recognise the critical symptoms, symptom
patterns

Failed to gather all the important information from the
patient, missing important points

Did not engage with the patient

Was unable to elicit the history in difficult
circumstances- busy, noisy, multiple demands
Examination
Investigation


Failed to detect /elicit and interpret important
physical signs

Did not maintain dignity and privacy
Was not discriminatory in the use of diagnostic tests
66
Clinical decision
making and
judgment
Communication
with patient,
relatives, staff

Did not identify the most likely diagnosis in a given
situation

Did not construct a comprehensive and likely
differential diagnosis

Did not correctly identify those who need admission
and those who can be safely discharged.

Did not recognise atypical presentation

Did not recognise the urgency of the case

Did not select the most effective treatments

Did not make decisions in a timely fashion

Decisions did not reflect clear understanding of
underlying principles

Did not reassess the patient

Did not anticipate interventions and slow to respond

Did not review effect of interventions
Communication skills with colleagues

Did not listen to other views

Did not discuss issues with the team

Failed to follow the lead of others when appropriate

Rude to colleagues

Did not give clear and timely instructions

Inconsiderate of the rest of the team

Was not clear in referral process- was it for opinion,
advice, or admission
Communication with patients

Did not elicit the concerns of the patient, their
understanding of their illness and what they expect

Did not inform and educate patients/carers

Did not encourage patient involvement/ partnership in
decision making

Did not respect confidentiality

Did not protect the patients dignity
67
Overall plan

Insensitive to patients opinions/hopes/fears

Did not explain plan and risks in a way the patient
could understand
Was slow to progress the case

Did not ensure patient was in a safe monitored
environment

Did not anticipate or recognise complications

Did not focus sufficiently on safe practice

Did not follow published standards guidelines or
protocols

Did not follow infection control measures

Did not safely prescribe
Professionalism
Overall
Successful
Unsuccessful (this outcome if any one criteria unsuccessful
Things done particularly well
Learning points
Action points
Assessor Signature:
Trainee Signature:
68
College of Emergency Medicine
The Acute Care Assessment Tool (ACAT-EM) form
Trainee name:
Assessor:
Assessor GMC
no.
Grade of assessor:
Date
Setting,
Acute
presentations
covered (5 max
for EM)
/
/
Timing, duration and level
of responsibility
Please TICK to
indicate the
standard of the
trainee’s
performance in
each area
Not
observed
Further
core
learning
needed
Demonstrates good
practice
Must
Should
address
address
learning
learning
points
points
highlighted
highlighted
below
below
Demonstrates
excellent
practice
Clinical Assessment
Medical record
keeping
Investigation and
treatment of the
critically ill patient
Time management
Management of
the team
69
Clinical leadership
Patient safety
Handover
Overall Clinical
Judgement
Which aspects were done well
Learning points
Unsatisfactory acute presentation? –
which
Plan for further AP assessment, specify WPBA
tool and review date
Trainees Comments
Action points
Assessor Signature:
Trainee Signature:
70
ACAT –EM
Assessment
Domains
Description
Clinical
assessment and
clinical topics
covered
Quality of history and examination to arrive at
appropriate diagnosis- made by direct observation in
different areas especially in the resuscitation room.
Medical record
keeping
Quality of recording of patient encounters including drug
and fluid prescriptions
No more than 5 AP should be covered in each ACAT and
this should involve a review of the notes and
management plan of the patient.
Investigations and Quality of trainees choice of investigations and referrals
referrals
Management of
patients
Quality of treatment given (assessment, investigation,
urgent treatment given involvement of seniors)
Time
management
Prioritisation of cases , doesn’t spend too much time with
any one patient
Management of
take/team
working
Appropriate relationship with and involvement of other
health professionals
Clinical
leadership
Appropriate delegation and supervision of junior staff
Handover
Quality of handover of care of patients between EM and
in patient teams and in house handover including
obs/CDU ward
Patient safety
Able to recognise effects of systems, process,
environment and staffing on patient safety issues
Overall clinical
judgement
Quality of trainees integrated thinking based on clinical
assessment, investigations and referrals. safe and
appropriate management, use of resources sensibly
71
Anaesthesia Paperwork
Contents of this section:
 Structured Training Report form (to be completed at the end of the
module)
 Learning Agreement
 ACCS Trainee Appraisal Record
 MSF Instructions
 MSF form
 MSF Summary form
Recommended Reading / Useful Websites:
 The Oxford Handbook of Anaesthesia
o Approx £30, available on Amazon and elsewhere.
 Junior Anaesthetists of Wales (JAW) – on Facebook and Twitter
 Welsh School of Anaesthesia
o www.welshschool.co.uk
72
Structured Training Report for Anaesthesia Module
Current Placement
Base Hospital/Department
Dates
Clinical supervisor
1. Basic Level Training
BASIS of Anaesthetic Practice – Please tick all completed units of training to date
Preoperative Assessment
Premedication
Induction of general anaesthesia
Intra-operative Care
Post-operative and recovery room care
Introduction to anaesthesia for emergency surgery
Management of Cardiac & Respiratory Arrest
Control of Infection
Initial Assessment of Competence signed
Primary FRCA Status
Date:
Date passed
No. of attempts
MCQ
SOE
OSCE
Other Specialty Examinations Achieved and Dates:
73
2. Workplace based assessments tools (WPBAs) completed:
Assessment
Number
Summary of Comments
Anaes –CEX
DOPs
CBD
MSF
Please include MSFSummary Sheet as an appendix to this report
3. Experiential Outcomes
Activity
1
Log-Book
Date/s
Outcomes
Comment
Total Cases in 6 month module:
Expected activity achieved / not achieved.
2
Audits
Completed / not completed / presented
3
Research projects
work in progress/completed
4
Publications
5
Teaching
74
6
Management
Development
7
Presentations
8
Courses attended
Other qualifications gained (e.g. ATLS, APLS, PGCE)
4.Other outcomes
Date/s
1
Reported adverse incidents
Outcome
Comment
Resolved/pending
(The PG Dean in Wales
has instructed that all
No case to find/
critical incidents involving
accountable
a named trainee must be
reported at their ARCP)
2
3
Complaints /
Resolved/pending
disciplinary issues/
No case to find/
litigation
accountable
Other
A
75
No. of days sick leave taken in the 6 months………………….. (Please verify with department secretary / manager)
Sections 5-8 will usually be completed by the College Tutor. The College Tutor should be guided by the results of MSF and/or
other sources which will endeavour to ensure that, as far as possible, ratings are recorded objectively.
If a trainee’s performance is deemed below average or un-acceptable in the following sections, please outline how
this conclusion was reached and provide supporting documentation where possible.
5. Clinical Skills - Based on MSF and other sources
Good:
* Below average:
* Un-acceptable:
Performing to expected
standard
sometimes performance is
inadequate
often performance is
inadequate
History taking
Physical examination
Investigation & Diagnosis
Judgement & Patient
Management
Practical Skills
Communications Skills
76
6. Knowledge (please tick the appropriate boxes)
Good:
* Below average:
* Un-acceptable:
Performing to
expected standard
sometimes performance is
inadequate
often performance is
inadequate
Basic Science
Clinical
7. Attitudes (please tick the appropriate boxes)
Good:
* Below average:
* Un-acceptable:
Performing to
expected standard
sometimes performance is
inadequate
often performance is
inadequate
Reliability
Initiative
Administration
Time Keeping
77
8.Relationships (please tick the appropriate boxes)
Good:
* Below average:
* Un-acceptable:
Performing to
expected standard
sometimes performance is
inadequate
often performance is
inadequate
Patients
Colleagues
Other Staff
Would you expect a satisfactory outcome for the ARCP? Y / N
If you feel the ARCP is not going to be satisfactory the Programme Director must be contacted well in advance of
the ARCP interview.
78
Strengths of Trainee:
Suggestions for improvement:
Comments:
Signed by: _________________________
(Educational Supervisor)
Date ________________
Signed by: _________________________
(College Tutor)
Date ________________
Signed by: _________________________
(Trainee)
Date ________________
79
Welsh School of Anaesthesia
LEARNING AGREEMENT
Our goal is to provide an ideal working and learning environment. Postgraduate medical education takes
time and effort by the teachers and learners.
We aim to provide:










A named educational supervisor: Dr ………………………………
A comprehensive Induction Program
Regular teaching in protected time
Supervised operating theatre lists
Appropriate clinical supervision at all times
Opportunities to attend and present at journal club
An adequate library, computers with internet access and other learning resources
Regular constructive feedback
An appraisal system
Annual assessments
For your part we expect you to:













Familiarize yourself and adhere to the duties and responsibilities of a doctor
registered with the General Medical Council and outlined in the Council’s document
“Good Medical Practice”.
Download and familiarise yourself with the CCT in Anaesthesia document (and ACCS
Core Training document if appropriate)
Download and familiarise yourself with the contents of the Gold Guide to specialty
training
Familiarize yourself with the anaesthetic departments’ guidelines and protocols.
Participate fully in your clinical and educational programme
Be prepared to spend some of your own time on educational activities
Develop and maintain a learning portfolio
Book appointments for regular appraisals
Be receptive to feedback and develop your personal learning plan with your
appraiser.
Complete promptly all training and assessment documentation required by your
educational supervisor
Seek help from your appraiser or educational supervisor if you have any problems
Maintain standards of punctuality, cleanliness and appearance expected of a
healthcare professional
Be responsible and considerate when booking leave
80
Trainee name:___________________________ Signature: ____________________
Date: ________________
Educational Supervisor Name:__________________Signature: _____________________
Date : ________________
Please keep the completed original form in your portfolio and give a photocopy to your Educational
Supervisor.
81
WELSH SCHOOL OF ANAESTHESIA
ACCS TRAINEE APPRAISAL RECORD
Name: ……………………………………………….
Parent Specialty: ……………………………………
Rotation Details:
Aug 20… – Jan 20… : ……………………………… CT1
Feb – July 20… : ……………………………… CT1
Aug 20… – Jan 20… : ……………………………… CT2
Feb – July 20… : ………………………………. CT2
Aug 20… – July 20… : ………………………………. CT Parent Specialty
Pre-ACCS experience:
Dates:
…………………………………………………………………
………………
Exams passed and dates:
………………………………….
……………..
Exam planned and date:
………………………………….
………………
Resuscitation Training:
ALS (required for all ACCS Trainees before CT2 ARCP)
Provider
Instructor
No
Booked
APLS* (obligatory for EM only, before CT3 ARCP)
Provider
Instructor
No
Booked
ATLS* (obligatory for EM only, before CT3 ARCP)
Provider
Instructor
No
Booked
Registered with parent college
Yes
No
Advised to
Registered with RCoA (for e-learning)
Yes
No
Advised to
Portfolio
Yes
No
Advised to
*or equivalent
82
Section 2: 3 month appraisal
1) Progress towards Initial Competencies:
2) Logbook review:
3) Progress towards other objectives:
3) Feedback from trainers:
4) Has attendance at teaching sessions been satisfactory?
5) Study Leave
Additional Comments:
Signed: ………………………………………. Print: ……………………..Date: ……………………
(Trainer)
Signed: ……………………………………….. Print: ……………………Date: …………………….
(Trainee)
83
Section 3: 6 month appraisal
1) Certificate of Initial Competencies Achieved:
2) Logbook review:
3) Results of Multi-Source Feedback:
4) Completed Assessment Tools:
DOPS (6)
AnaesCEX (2)
CbD (2)
5) Other achievements in this post:
6) Study Leave
7) Trainee Feedback
Additional Comments:
Signed: ………………………………………. Print: ……………………..Date: ……………………
(Trainer)
Signed: ……………………………………….. Print: ……………………Date: …………………….
(Trainee)
84
Welsh School of Anaesthesia
Multi Source Feedback
Instructions for Use
Assessment subject
1. Select 12 people to complete an assessment form.
2. … assessors must be consultant anaesthetists, … must be anaesthetic support staff,
recovery or ITU nurses, … must be other trainee anaesthetists and one secretary.
3. Ensure that each assessor is given an assessment form, an addressed reply envelope and an
instruction sheet.
4. All assessment forms should be all distributed 2 weeks prior to your appraisal date.
Assessor
1.
2.
3.
4.
5.
Thank you for completing this form
Your comments will be fed back anonymously
Please be honest and include good and bad points as necessary
Please keep the assessment form confidential
Please return the completed form in the attached envelope to Dr ………………………..,
Educational Supervisor, Dept. of Anaesthesia.
85
The Royal College of Anaesthetists
Multi Source Feedback (MSF) Assessment Form
Please complete the question using a cross (x). Please use black ink and CAPITAL LETTERS
Trainee’s surname
Trainee’s forename(s)
GMC number
GMC NUMBER MUST BE COMPLETED
Observed by
Signature
GMC/NMC/HPC number
Date
Role
GMC/NMC/HPC NUMBER MUST BE COMPLETED
Which clinical setting have you primarily observed the doctor in?
Theatre
ICU
A&E
How do you rate this
doctor in their:
Delivery Suite
Good
Pain Clinic
Satisfactory
Other
Needs to
improve
Unacceptable
Unable to
comment
Knowledge, skills, performance
1. Ability to diagnose
patient problems
2. Ability to plan patient
care
3. Awareness of their
own limitations
4. Ability to keep up to
date with knowledge
and skills
5. Responds to pain and
distress in patients
appropriately
6. Technical skills
[appropriate to grade]
7. Ability to multitask and
work effectively in a
complex environment
86
8. Ability to manage time
effectively / prioritise
9. Able to cope under
stress
10. Willingness and
effectiveness when
teaching / training
colleagues
11. Ability to take
leadership role when
circumstances
required
12. Keeps clear, accurate,
legible records
contemporaneously
Safety and quality
13. Contributes
constructively to audit,
appraisal and clinical
governance
14. Safeguards and
protects patients
wellbeing
15. Responds promptly to
risks posed by patients
Communication, partnership and teamwork
16. Communication with
patients
17. Communication with
carers and/or family
18. Verbal communication
with colleagues
19. Written
communication with
colleagues
20. Ability to recognise
and value the
contribution of others
21. Accessibility /
reliability
Maintaining trust
22. Respect for patients
privacy, right for
confidentiality
23. Polite, considerate and
honest to patients
87
24. Treats patients fairly
and without
discrimination
25. Treats colleagues fairly
and without
discrimination
26. Honest and objective
when appraising and
assessing colleagues
Are there any concerns about this doctor’s probity or health? Yes
No
If yes, please provide details
Please add any additional comments
If any boxes were marked with minor or major concerns, please explain why
Signature
Date
88
The Royal College of Anaesthetists
Multi Source Feedback (MSF) Summary Form
Clinical settings of observation: (Enter number of raters)
Theatre
ICU
A&E
Delivery Suite
Pain Clinic
Other
Summary of raters’ responses:
How the doctor was
rated in their:
Good
Satisfactory
Needs to
improve
Unacceptable
Unable to
comment
Knowledge, skills, performance
1.
Ability to
diagnose patient
problems
2. Ability to plan patient
care
3. Awareness of their
own limitations
4. Ability to keep up to
date with knowledge
and skills
5. Responds to pain and
distress in patients
appropriately
6. Technical skills
[appropriate to grade]
7. Ability to multitask and
work effectively in a
complex environment
8. Ability to manage time
effectively / prioritise
9. Able to cope under
stress
10. Willingness and
effectiveness when
teaching / training
colleagues
11. Ability to take
leadership role when
circumstances
required
89
Summary of raters’ responses:
How the doctor was
rated in their:
Good
Satisfactory
Needs to
improve
Unacceptable
Unable to
comment
12. Keeps clear, accurate,
legible records
contemporaneously
Safety and quality
13. Contributes
constructively to audit,
appraisal and clinical
governance
14. Safeguards and
protects patients
wellbeing
15. Responds promptly to
risks posed by patients
Communication, partnership and teamwork
16. Communication with
patients
17. Communication with
carers and/or family
18. Verbal communication
with colleagues
19. Written
communication with
colleagues
20. Ability to recognise
and value the
contribution of others
21. Accessibility /
reliability
Maintaining trust
22. Respect for patients
privacy, right for
confidentiality
23. Polite, considerate and
honest to patients
24. Treats patients fairly
and without
discrimination
25. Treats colleagues fairly
and without
discrimination
90
Summary of raters’ responses:
How the doctor was
rated in their:
Good
Satisfactory
Needs to
improve
Unacceptable
Unable to
comment
26. Honest and objective
when appraising and
assessing colleagues
Were there any concerns about this doctor’s probity or health?
Yes No
Summary of details from those with concerns:
Summary of raters’ general comments:
Summary of raters’ explanations of minor or major concerns:
Signature
Date
Trainee
Educational
Supervisor
Trainee’s surname
Trainee’s forename(s)
91
Intensive Care Medicine Paperwork
Contents of this section:
 Structured Training Report form (to be completed at the end of the
module)
 MSF / TAB form
 Logbook Summary
 DOPS form
 CEX form
 CbD form
Information for Educational Supervisors:
 Competency Level Descriptors (for Ed Sup information)
 Training Progression Grid
Recommended Reading / Useful Websites:
 The Oxford Handbook of Critical Care
£25-£30, available on Amazon and elsewhere
92
Structured Training Report for Intensive Care Medicine Module
The educational/modular supervisor must complete this STR, having reviewed the trainee’s learning
portfolio and WPBAs.
Current Placement
Base Hospital/Department
Dates
Clinical supervisor
WPBA in Current Placement
Assessment
Number
Comments
Mini-CEX
(min 3 in 6 months)
DOPs
(min 6 in 6 months)
List procedures included in DOPs and ensure they are
signed off in Practical procedures
CBD
(min 4 in 6 months)
MSF
(1 per placement)
93
Experiential outcomes (please review evidence in learning portfolio)
Practical Procedure
WBA
Date
Outcome
Demonstrates aseptic peripheral
DOPS
venous cannulation
Demonstrates aseptic arterial
DOPS
cannulation (+ local anaesthetic)
Obtains an arterial blood gas sample DOPS or
safely, interprets results correctly
M CEX
Demonstrates aseptic placement of DOPS
central venous catheter
Connects mechanical ventilator and DOPS
selects initial settings
Describes Safe Use of Drugs to
CBD
Facilitate Mechanical Ventilation
Describes Principles of Monitoring
CBD
Respiratory Function
Describes the Assessment of the
CBD
patient with poor compliance during
Ventilatory Support (‘fighting the
ventilator’)
Prescribes safe use of vasoactive
M CEX
drugs and electrolytes
or CBD
Delivers a fluid challenge safely to
CBD
an acutely unwell patient
Describes actions required for
CBD
accidental displacement of ETT or
tracheostomy
Comments
COMPETENCY DOMAINS SUCCESSFULLY ACHIEVED
Competency Domain (at a level appropriate for ACCS)
Signature
1. Resuscitation and initial management of the acutely ill patient
2. Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
3. Disease Management
4. Therapeutic interventions / Organ system support in single or multiple organ
failure
5. Practical procedures
6. Perioperative care
94
7. Comfort and recovery
8. End of life care
9. Transport
10. Patient safety and health systems management
11. Professionalism
Summary of Trainee Assessment
Supervisor to complete. Please attach evidence if available to support opinions or give examples of
behaviours.
Strengths of Trainee
I confirm that this is an accurate description/summary of this trainee’s learning
portfolio and WPBA, covering the period from ………………..to ……………….
Supervisor Name and Signature
Trainee Signature
95
Suggestions
improvement
Weaknesses for
of Trainee
Date:
Date:
ICM Multi Source Feedback (MSF)
Team Assessment of Behaviour (TAB)
Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink.
Trainee’s surname
Trainee’s forename(s)
GMC Number
GMC NUMBER MUST BE COMPLETED
Observed by
Signature
Date
96
Major or Serious Concerns
Minor Concerns
Comments
No Concerns
Domain
Please provide feedback on professional behaviour including
areas of excellence and areas for improvement
NB: Any concerns must be commented on to allow
constructive feedback and planning for improvement
1. Maintaining trust/
professional relationships
with patients
 Listens
 Is polite and caring
 Shows respect for
patients’ opinions,
privacy, dignity and is
unprejudiced
2. Verbal communication
skills
 Gives clear,
understandable
information
 Speaks good English at
an appropriate level
for patient or relative
3. Team working/
working with colleagues
 Respects others’ roles
 Works constructively
within team
 Effective handover
 Delegates appropriately
 Supportive of
colleagues
97
4. Accessibility




Accessible to all staff
Does not shirk duty
Responds when called
Arranges cover for
planned absence,
notifies of unplanned
absence
Do you have any concerns about this doctor’s probity or health?
Yes
No
If yes please explain on additional sheet
Additional comments on doctor’s professional behaviour:
ICM logbook summary
Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink.
Trainee’s surname
Trainee’s forename(s)
GMC Number
GMC NUMBER MUST BE COMPLETED
Hospital placement:
Duration of placement:
98
Total beds:
Level of training:
Speciality:
Level 2:
Core
General
Level 3:
Mixed 2/3:
Step 1
Step 2
Step 3
Cardiac
Neuro
Paeds
Total unit admissions during placement:
Data can be obtained from ICNARC database
Event
Local supervision
Distant supervision
Teaching
Ward review
Admission
Lead ward round
Cardiac arrest
Trauma team
Intra-hospital transfer
Inter-hospital transfer
Discussion with relatives
End of life care/donation
ICM logbook summary
Airway & Lungs
Procedure
Local supervision
Distant
supervision
Teaching
Emergency intubation
Percutaneous tracheostomy
Bronchoscopy
99
Chest drain – seldinger
Chest drain – blunt dissection
Lung ultrasound
Arterial cannulation
Cardiovascular
Central venous access – IJ
Central venous access – SC
Central venous access – Femoral
Pulmonary artery catheter
Non-invasive CO monitoring
Echocardiogram
Abdomen
Ascitic drain/tap
Sengstaken tube placement
Abdominal ultrasound/FAST
CNS
Lumbar puncture
Brainstem death testing
Procedures performed should be appropriate to level of training;
Experience of the all the above procedures is desirable but NOT essential
FICM DOPS Assessment Form
Trainee’s Surname
Trainee’s Forename(s)
GMC Number
GMC NUMBER MUST BE COMPLETED
Procedure
Code Number
Observed by
100
GMC NUMBER MUST BE COMPLETED
GMC Number
Date
Signature of observing
doctor
Assessment:
Practice was satisfactory
Practice was unsatisfactory
Tick
one
Tick
Assessor’s signature
Assessor’s signature
one
Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory
score
given.
Example
of good practice were:
Areas of practice requiring improvement were:
Further learning and experience should focus on:
FICM CEX Assessment FormPlease complete this form in BLOCK CAPITALS and BLACK ink
Trainee’s Surname
Trainee’s Forename(s)
GMC Number
GMC NUMBER MUST BE COMPLETED
Observation
Code Number
Observed by
GMC Number
Date
GMC NUMBER MUST BE COMPLETED
101
Performance
YES
NO
Comments
Understands indications and contraindications for
the procedure
Tick
Tick
Comments
Explained procedure to patient
Tick
Tick
Comments
Understands relevant anatomy
Tick
Tick
Comments
Satisfactory preparation for procedure
Tick
Tick
Comments
Communicated appropriately with patient and staff
Tick
Tick
Comments
Full aseptic technique
Tick
Tick
Comments
Satisfactory technical performance of procedure
Tick
Tick
Comments
Adapted to unexpected problems during procedure
Tick
Tick
Comments
Demonstrated adequate skill and practical fluency
Tick
Tick
Comments
Maintained Safe practice
Tick
Tick
Comments
Completed procedure
Tick
Tick
Comments
Satisfactory documentation of procedure
Tick
Tick
Comments
Issued clear post-procedure instructions to patient
and staff
Tick
Tick
Comments
Maintained professional demeanour throughout
procedure
Tick
Tick
Comments
Signature of supervising
doctor
102
Clinical Setting:
ICU
HDU
ED
Ward
Transfer
Other
Assessment:
Practice was satisfactory
Tick one
Assessor’s signature
Practice was unsatisfactory
Tick one
Assessor’s signature
Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory score
given.
Examples of good practice were:
Areas of practice requiring improvement were:
Satisfactory
Unsatisfactory
Further learning and experience should focus on:
1.
History taking and information gathering
Tick
Tick
2.
Assessment and differential diagnosis
Tick
Tick
Please grade the following areas:
(Please see Domain Descriptors)
103
3.
Immediate management and stabilisation
Tick
Tick
4.
Further management and clinical judgement
Tick
Tick
5.
Identification of potential problems and difficulties
Tick
Tick
6.
Maintain safe practice for patient, trainee & staff
Tick
Tick
7.
Communication with patient, staff and colleagues
Tick
Tick
8.
Record keeping
Tick
Tick
9.
Overall clinical care
Tick
Tick
FICM CbD Assessment FormPlease complete this form in BLOCK CAPITALS and BLACK ink
Trainee’s Surname
Trainee’s Forename(s)
GMC Number
GMC NUMBER MUST BE COMPLETED
Observation
Code Number
Observed by
GMC Number
Date
GMC NUMBER MUST BE COMPLETED
104
Signature of supervising
doctor
Clinical Setting:
ICU
HDU
ED
Ward
Transfer
Other
Assessment:
Practice was satisfactory
Tick one
Assessor’s signature
Practice was unsatisfactory
Tick one
Assessor’s signature
Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory score
given.
Examples of good practice were:
Areas of practice requiring improvement were:
Further learning and experience should focus on:
Satisfactory
Unsatisfactory
Special Focus of Discussion:
1.
History taking and information gathering
Tick
Tick
2.
Assessment and differential diagnosis
Tick
Tick
Please grade the following areas:
(Please see Domain Descriptors)
105
3.
Immediate management and stabilisation
Tick
Tick
4.
Further management and clinical judgement
Tick
Tick
5.
Identification of potential problems and difficulties
Tick
Tick
6.
Communication with patient, staff and colleagues
Tick
Tick
7.
Record keeping
Tick
Tick
8.
Overall clinical care
Tick
Tick
Tick
Tick
9.
Understanding of the issues surrounding the clinical focus chosen by
the assessor
106
107
A Career in Intensive Care Medicine
Dr Alison Ingham - ICM lead for ACCS
Intensive Care Medicine (ICM) is an exciting and dynamic career choice (I’m biased of
course!). Hopefully you will enjoy your ACCS ICM placement so much, you will be thinking
about further training in ICM. If so, here is how you go about it.
You can apply to enter ICM higher specialist training following ACCS or core anaesthesia
(CAT) or core medical training (CMT). You can, of course, dual with a second specialty,
but more about that later.
The training is divided into 3 stages:
Stage 1 training:
Stage 1 training is 4 years. This includes ACCS (or CAT / CMT) core training and years
ST3 and ST4 of higher training. By the end of ST4 you will need to have completed the
following:
1 year of Anaesthesia
1 year of Medicine (including Emergency Medicine)
1 year of ICM
For example, a trainee coming from CMT, would probably need 1 year of ICM and 1 year
of Anaesthesia in their ST3 and ST4 years. If you have done 3 years of ACCS
Anaesthesia, you are likely to need 6 months in ICM and the other 6 months could be in
any of the specialties. You get the idea.
Stage 2 training:
Stage 2 training is 2 years, ST5 and ST6.
ST5 consists of specialist rotations, with 3 months in neuro ICU, 3 months in paediatric
(PICU) and 3 months in cardiac ICU. The remaining 3 month block in that year may be
flexible. Trainees dualling with anaesthesia will gain most of their neuro, paediatric and
cardiac competencies in theatres during this year, as it is also counted towards their
anaesthetic training. Trainees dualling with Medicine or Emergency Medicine will be
based on the specialist ICUs.
ST6 is a “special skills” year and is only undertaken by ICM single CCT trainees. Dual
trainees will spend this year in their partner specialty. The special skills year could include
research, teaching and training or further time in a specialist ICU.
During stage 2 training, you will also have to pass the FFICM exam.
Stage 3 training:
This is one year and is similar to the old “advanced ICM training year”. You will start
working in a more senior role and learning the skills needed to become a consultant.
Dual Training:
You can dual train with the following specialties:
Acute Medicine
Emergency Medicine
Anaesthesia
Renal Medicine
Respiratory Medicine
Luckily, getting a dual CCT does not double your training time. Instead it increases it from
7 to 8.5 years. Parts of your training will count towards both specialities and your training
programme will be tailored by the appropriate Training Programme Directors. Application
is stepped. This means that although you can apply for both specialties at the same time,
you can only hold one offer, so application for the second specialty will be needed the
following year. It does not matter which specialty you accept first, but both must be in the
same Deanery.
113
Unfortunately you will have to keep two portfolios, one for each specialty. You may also
have to get used to being at different stages of training in your two specialties – for
example you might have finished stage one training in ICM (ST4) but still be finishing your
ST3 year in your partner specialty.
So why chose Wales? Words from Dr Chris Thorpe – Regional Advisor for ICM
Wales is a diverse country that will give you a great life style as you build your future
career. Wales offers something for everyone, from cosmopolitan towns and cities to
stunning coastal locations. With affordable housing and welcoming communities it is an
ideal place to achieve a work-life balance. It even has its own language, although it is not
necessary to learn it to pursue training, employment or to live here. Wales is covered by
a single Deanery which puts high quality training at the heart of medical careers. The
Wales Deanery also holds an award for being the “most family-friendly”.
The ICM specialist training scheme in Wales is funded directly by the Deanery which
allows us to choose posts which will best benefit the trainee. This enables us to provide
excellent posts in Anaesthesia and Medicine as well as ICM.
Currently hospitals training at ST3-4 level are in Swansea, Newport, Bangor and
Wrexham, with the ST5 year based in Cardiff. Other hospitals also provide training and
placements may take in other units depending on the trainee’s needs. The ST6 year will
be tailored according to whether the trainee is dual or single accrediting and the ST7 year
is likely to be mainly in South Wales.
The Specialist Training Committee and Deanery make support of the trainee central to
their business and you can look forward to a carefully developed scheme that allows you
to grow in experience and confidence as the years go by. You will experience a variety of
Intensive Care Units and will emerge from the scheme a rounded and mature professional
with the ability to take on a consultant role in both large and small hospitals.
114
Further Information
For further information on ICM training and dual training in particular, please also see Dr
Thorpe’s article on page 31 of the summer 2013 edition of the FICM newsletter, “Critical
Eye”.
http://www.ficm.ac.uk/sites/default/files/Critical%20Eye%204%20%20website%20version.pdf
If you would like to talk to someone in more detail about ICM training, please contact
either Dr Thorpe or myself. There will also be an ICM Faculty Tutor at each hospital within
Wales who provide ACCS training, who will be able to help you.
Dr Alison Ingham
Alison.ingham@wales.nhs.uk
Dr Chris Thorpe
Chris.Thorpe@wales.nhs.uk
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