PAPER 13/PC/08
Report on Emergency Care, Clinical and Resuscitation Skills Theme 12-13
Theme Head: Dr Janet Skinner
Deputy Theme Head: Dr Ellis Simon, Mrs Val Mcdowall
Theme Description:
Emergency Care, Clinical and Resuscitation Skills (ECCARS) are vital skills that are required to
function competently as a junior doctor and in subsequent medical practice. Most of these skills are
taught as part of a structured programme over the five years in the Clinical Skills Centre where the
simulated environment allows them to be practised in a safe way, without risking harm to patients.
The theme builds up from simple skills, such as checking a blood pressure in the early years, to more
complex skills, such as functioning as part of an emergency team in the later years. Transferring
skills from the simulated environment into clinical practice is extremely important and students benefit
hugely from the clinical skills ‘apprenticeship’ that they experience in the rich clinical environments of
the programme.
Learning Outcomes
The Edinburgh medical graduate will be able to recognise and systematically assess acutely unwell
patients and institute immediate management, including first aid and resuscitation, and perform a
range of clinical skills and procedures safely and effectively.
• Recognise an acutely unwell patient and perform a structured initial assessment
• Diagnose and provide initial management to a range of emergency patients
• Provide basic and advanced life support as part of cardiac arrest management
• Perform a range of diagnostic and therapeutic procedures safely and effectively in clinical practice
• Provide an explanation, give advice and gain consent for these procedures
• Demonstrate appropriate infection control measures when performing clinical procedures
ECCARS teaching
Year 1
Year 2
Year 3
Year 4
Year 5
Vital signs
Venepuncture
IV cannulation
Arterial blood gases
IV/SC/IM therapies
Hand washing
Blood glucose testing
IV fluids
Ophthalmoscopy
Suturing & wound care
PR examination
Otoscopy
Immediate Life Support
Respiratory Function
Cervical smear & pelvic Patient safety
Cleanliness
Champions
BLS/ first aid
and administration of
insulin
Nutritional assessment
Urinalysis
Cleanliness
Champions
Moving & Handling
Cleanliness
Champions
MBChB Programme Committee November 2013
examination
Urethral catheterisation
IAR (initial assessment
simulation (Scottish
Simulation Centre)
Paediatric BLS and
emergency care
Breast examination
BLS/ Airway
IAR (initial
assessment &
recognition)
and resuscitation)
Simulated ward rounds
Acute care simulation
Development of Clinical Skills and Simulation Centre in Chancellor’s Building
Most of these ECCARS teaching sessions are delivered by the clinical skills team in the recently
redeveloped clinical skills and simulation centre in Chancellor’s building. After undertaking a joint
funding initiative with NHS Education Scotland, University of Edinburgh and NHS Lothian we now
have now installed a high fidelity simulator (SIM MAN), associated AV (SMOTS) technology
throughout the centre and built a large 4-bedded simulated ward area. These and other developments
have ensured that the centre is now state of the art with excellent, flexible facilities that can be used
for a wide variety of teaching purposes and can house small-medium sized OSCEs. In a bid to
maximise efficiency and consolidate resources all skills teaching now takes place in Chancellor’s
Buildings and the rooms at the Western General Hospital are no longer used for skills teaching.
Recent Changes to ECCARS teaching
Changes to ECCARS teaching in the last few years includes
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
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Movement of respiratory function teaching from year 1 to year 3 so it is aligned with the
respiratory module
Introduction of comprehensive vital signs teaching into year 1 to replace blood pressure
sessions
Year 1 recording an ECG sessions were lost when the cardiac physiologist retired
Removal of blood culture sessions from year 2 (to take place in later years)
Introduction of pregnancy testing to year 2 urinalysis sessions
Implementation of the ‘Cleanliness Champions Programme that students complete over years
1-3 finishing with a reflective essay on infection control
Continual evolution of resuscitation teaching from management of cardiac arrest to the initial
assessment and management of an acutely unwell patient (structured programme over years
3-5)
Development of simulation sessions with an acute care session in year 4 and a simulated
ward round in year 5
Many of these changes have taken place because of continual review of ECCARS teaching in line
with feedback from students, evolving best evidence-based practice, recommendations from the GMC
(Appendix 1) and other external factors such as patient safety initiatives. The team have moved
towards trying more effective ways of delivering teaching such as the use of ‘flipped’ teaching, traffic
lights and pre-programmed scenarios aligned to learning outcomes.
Challenges
Delivering excellent skills and resuscitation teaching in the clinical skills centre is only one aspect of
the ECCARS theme. Once of the major challenges across all aspects of the theme is encouraging
students to transfer skills into practice. While simulation can help students with this transfer it is still no
substitute for carrying out procedures in the clinical area and seeing ‘real’ sick patients. Good success
has been achieved through the use of ward-base skills facilitators (Fife), near peer teaching (NHS
Lothian) and the use of log books with cumulative sum charts.
Assessment
MBChB Programme Committee November 2013
All aspects of ECCARS are assessed in the years 2,3 and 4 OSCEs, the year 2 and 3 OSCA and the
year 5 SIPP paper. There is a proposal for an acute care simulated scenario to replace prescribing in
finals which will be a real step forward in that ECCARS will be formally assessed in clinical finals. In
terms of the year 3 OSCE the team consistently meet quality standards including: examiner training,
standard setting and providing timely feedback to students.
The GMC mandates that students should have achieved competency in all of 32 procedures by
graduation (appendix 1). For most of these skills an element of assessment in the workplace is
required for competence to be assessed. However, for 32 skills this is a huge undertaking with
significant resource implications. Also there are concerns that certain of the skills with patient safety
issues, such as use of infusion devices and blood transfusion, should not be performed by students
independently. We conducted a recent survey asking 500 clinical skills experts how competent
students should be at each of these skills on graduation. Results are shown in Appendix 1.
Future plans
Once agreement has been reached over levels of competence a programme of workplace
assessment of key skills needs to be implemented. This can be managed through the log book using
a ‘ticketed’ system similar to nhsDOTS. Consideration needs to be given to mandatory progression
issues, for example, could a student be stopped from graduating if they did not have their key skills
signed off? And logistically how would we manage this process?
We also need to focus on the best use of simulation within ECCARS teaching while still paying equal
if not more attention to issues around skills transferral and preparation for practice.
Evidence from students, junior doctors and educational supervisors consistently suggests that
students need more clinical skills and acute care teaching. We are also not able to meet the
requirements of the GMC due to lack of teaching time in the curriculum and teacher resource. We
need to seek out additional time and resources whilst also looking at new more efficient ways to
deliver teaching and maximising best use of our current resources.
Janet Skinner
01/11/2013
MBChB Programme Committee November 2013
Appendix 1 – GMC Procedures from Tomorrow’s Doctors
Measuring body temperature
Measuring pulse rate and blood pressure
Transcutaneous monitoring of oxygen saturation
Venepuncture
Managing blood samples correctly
Taking blood cultures
Measuring blood glucose
Managing an electrocardiograph (ECG) monitor
Performing and interpreting a 12-lead electrocardiograph
Basic respiratory function tests
Urine multi dipstick test
Advising patients on how to collect a mid-stream urine specimen
Taking nose, throat and skin swabs
Nutritional assessment
Pregnancy testing
Administering oxygen
Establishing peripheral intravenous access and setting up an infusion; use of infusion devices
Making up drugs for parenteral administration
Dosage and administration of insulin and use of sliding scales
Subcutaneous and intramuscular injections
Blood transfusion
Male and female urinary catheterisation
Instructing patients in the use of devices for inhaled medication
Use of local anaesthetics
Skin suturing
Wound care and basic wound dressing
Correct techniques for 'moving and handling', including patients
Giving information about the procedure, obtaining and recording consent
Hand washing
Use of personal protective equipment (gloves, gowns, masks)
Infection control in relation to procedures
Safe disposal of clinical waste, needles and other ‘sharps’
MBChB Programme Committee November 2013
Taught
Proposed
Competence level
yes
yes
yes
yes
yes
no
yes
yes
no
yes
yes
yes
yes
unsupervised
unsupervised
unsupervised
unsupervised
unsupervised
unsupervised
unsupervised
unsupervised
unsupervised
with supervision
unsupervised
with supervision
with minimal
supervision
with supervision
with minimal
supervision
unsupervised
with supervision
with supervision
with supervision
With minimal
supervision
with supervision
with supervision
with supervision
with supervision
with supervision
with supervision
with minimal
supervision
with supervision
unsupervised
unsupervised
unsupervised
unsupervised
yes
yes
yes
yes /no
yes
yes
yes
yes
yes / no
yes
partly
yes
no
yes
yes
yes
yes
yes
yes
Proposed
workplace
assessment
yes
yes
yes
yes
yes
yes
yes
yes / no