ACCIDENT AND MEDICAL PRACTISE, VOCATIONALL MEDICAL INTERIM
1/B58
Effective 17 February 2010
1.0
PREAMBLE
This specification outlines the requirements for a provider to be considered for
Health Workforce New Zealand funding for training in Accident and Medical
Practice. The training programme will meet all requirements of the Accident
and Medical Practitioners’ Association (AMPA), detailed in ‘Trainee
Accreditation Handbook’.
This training leads to Fellowship of the Accident and Medical Practitioners
Association (FAMPA). The Accident and Medical training programme is based
on a four year clinical and academic curriculum.
The milestone year of training incorporates the Accident and Medical Care
Programme which prepares registrants for the Part 1 exam (AMPEX).
The Part II Exam is a University Diploma currently run as a distance learning
programme run by the University of Auckland (Goodfellow Unit). The convenor
holds a FAMPA. There are AMPA representatives on the Diploma Board of
Censors. Following successful completion of this programme, the Accident
and Medical Practitioner will qualify to apply for vocational registration in
Accident and Medical Practice. This branch of medicine is recognised by the
Medical Council.
In this specification, the term ‘trainee’ means a registrar in training as defined
in Section 3.1 Trainee Eligibility for HWNZ Funding.
2.0
DESCRIPTION OF SERVICE
Accident and Medical Practice is defined by the Medical Council as the branch
of medicine that involves the assessment and treatment, on a nonappointment basis, of patients requiring urgent attention, but does not involve
the provision of continuing care or making arrangement for such care.
Training in this branch of medicine is of four years duration. Entry into the
Accident & Medical Training Programme requires trainees to have a general
medical registration and at least two years of medical experience in a variety
of posts. Training occurs in AMPA approved clinics and emergency
departments and in supervised teaching programmes.
The overall objective of training is to develop professional medical
competence in Accident and Medical practice. Learning is facilitated through
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interactions with patients and medical and other health professionals,
supervised clinical practice, attendance at a formal teaching programme,
attendance at peer review meetings, and other continuing medical education
activities, by teaching others, by training in research practice and methodology
and by reading books and journals.
The Convenor of AMPA’s Education Committee has oversight of all trainees in
the Accident and Medical Training Programme.
This Programme Convenor works with three AMPA Committees - the Board of
Censors, the Education Committee, and the Professional Standards
Committee. These Committees, in conjunction with the AMPA executive, are
responsible for the assessment of the vocational registration status of
trainees, training programmes, quality control, examinations, disciplinary
action and competence reviews.
There are two formal examinations: AMPEX (Part 1) and the Diploma of
Community Emergency Medicine (Part 2).
A basic trainee is a trainee who has yet to complete 1000 hours of approved
clinical time with an onsite supervisor and has yet to pass AMPEX.
Completion of these criteria progresses a trainee to advanced trainee status.
2.1
LEARNING ENVIRONMENT
Part 1 – A & M Care Programme
Training is based on participation in a one year programme via distance
learning plus a 16 hour Advanced Cardiac Life Support (ACLS) weekend and
a Practical Skills weekend.
The training programme must comply with, and maintain Medical Council of
New Zealand approval.
The training programme will equip trainees with the knowledge, skills and
attitude necessary to provide accident and medical care independently in
community clinics and also in hospital Emergency Departments (EDs) with the
oversight of an emergency medicine specialist.
Where a District Health
Board-based trainee undertakes an Emergency Department rotation funded
by HWNZ, the training must comply with the requirements of vocational
training in Emergency Medicine as described in Specification 1/B4 (except
sections 1.0, 2.0, 2.1.1 (Specific Requirements), 2.1.2 (Specific
Requirements), 3.1, 6.0 and 6.1).
Training can be carried out in AMPA-approved Accident and Emergency
clinics and AMPA-approved District Health Board facilities.
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Learning takes place in a variety of settings:
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Rural and public hospital ED departments
Community Accident and Medical Clinics
Formal teaching at the Medical School and Distance Learning
Weekend workshops
Continuing education activities
Peer review Groups
Self-directed individual study.
2.1.1 Clinical Placements
(i)
General requirements
The content of training experienced in any clinical placements is in
accordance with the current AMPA approved advertised Training
Programmes, so that the trainee, over a period of four years, gains the clinical
knowledge and experience required to pass the primary and secondary
examinations.
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Learning takes place in:
AMPA-approved Level 2 Accident and Medical Clinics
AMPA-approved Emergency departments in city and rural areas
AMPA-approved District Health Board facilities
Trainees will be released from clinical duties to attend formal learning
programmes.
The focus is to:
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Ensure that the trainee can recognise, assess and provide initial management
of acute conditions to a level of competence that ensures acceptable safe
practice by a trainee when they commence independent practice in an
Accident and Medical Environment.
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Prepare each trainee to successfully complete both exams leading to full
vocational registration in Accident and Medical Practice.
(ii)
Specific requirements for trainees
Trainees spend four years in a range of approved training posts. All trainees
and their supervisors receive and agree on specific educational objectives for
each individual placement. Evaluation of the placement and assessment of
trainees’ progress are measured against these objectives. Trainees will spend
time and placement in ED departments of hospitals and community accident
and medical approved level 2 facilities.
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The breakdown of these hours is as follows:
YEAR 1
(Milestone Year)
Trainee Educational Learning Hours
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Distance learning videos (40 x 2.5 hours)
Advanced Cardiac Life Support weekend
Practical Skills weekend
Research and preparation of Clinical Case studies
Programme Material – self directed study
Peer review groups (min 5, aver. 2 hours each)
Exam preparation (self directed)
Attendance AMPEX exams
Trainee Educational hours
100 hours
16 hours
16 hours
50 hours
100 hours
10 hours
100 hours
8 hours
TOTAL = 400 hours
Trainee Clinical Working Hours
Treating patients and observing teachers and supervisors and other
vocationally registered team members.
Trainee Clinical Working hours
TOTAL = 400 hours
Supervisors Hours
Local Supervisor
 Direct supervision of trainee’s clinical work of 10 hours per week
460 hours
 Direct supervision of trainee educational time 1 hour per week
46 hours
Local Supervisor
TOTAL = 506 hours
Regional supervisor
 Direct supervision of clinical work
nil
 Direct supervision of trainee educational time of 2 hours every 3
months
8 hours
Regional Supervisor
TOTAL = 8 hours
Total Supervision time per trainee is 514 hours per annum
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YEAR 2
Trainee Educational Learning Hours
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minimum
Advanced Cardiac Life Support weekend
4 hours
Audit activity
20 hours
Peer review group / Continuing Medical Education (CME)
20 hours
Trainee Clinical Working Hours
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Clinical practice
400 hours
YEAR 3
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Trainee Educational Learning Hours
Advanced Cardiac Life Support Refresher
4 hours
Audit activity
20 hours
Peer review group / CME minimum
20 hours
PG Diploma of Community Emergency Medicine (DipCEM)
Clinical
384 hours
Attendance at specialist clinics
50 hours
Study
700 hours
Formal lectures
16 hours
Trainee Clinical Working Hours
Clinical time treating
400 hours
YEAR 4
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Trainee Educational Learning Hours
Advanced Cardiac Life Support Refresher
4 hours
Audit activity
20 hours
Peer review group / CME minimum
20 hours
PG Diploma of Community Emergency Medicine
Clinical
384 hours
Attendance at specialist clinics
112 hours
Study
500 hours
Formal lectures
16 hours
Trainee Clinical Working Hours
Clinical time treating patients
400 hours
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2.1.2 Formal Teaching Programme
(i)
General Requirements
The content of the formal teaching programme is in accordance with the
current AMPA Training programme, ‘Trainee Accreditation Handbook’.
The trainee is released from clinical duties in the milestone year to attend peer
review groups, workshops and seminars and formal teaching.
In addition trainees should undertake study and self-directed learning,
including attendance at clinical meetings and other education activities
provided by the employer for the benefit of all staff.
(ii)
Specific Requirements
In the year leading up to both the primary (AMPEX) and fellowship (DipCEM)
examinations, an additional period of approximately two hours per week of
specific examination preparation is also required.
Primary examination preparation occurs in year 1 of training. Fellowship
examination preparation occurs for examination in year 3/4 of training.
2.1.3 Access to Resources
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Resources for training include:Facilities for teaching in a clinical setting.
Facilities for meetings, case discussion and group teaching sessions.
Access to a library containing recognised texts and a relevant range of current
journals.
Audiovisual resources
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2.2
SUPERVISION
The trainee and supervisor must meet for one hour at least six times each
year. For each year the trainee and supervisor must discuss the trainee’s
personal aims and objectives, and list the particular skills to be learnt. The
supervisor will complete the AMPA assessment report.
A basic trainee must work with a supervisor at least 6 hours per week. A
supervisor must be on site while a basic trainee is undertaking clinical work.
Supervision from an offsite supervisor may be approved by AMPA.
An advanced trainee does not require supervision once they have completed
the ACLS course.
In a hospital ED department supervision will be provided by a FACEM or a
Senior Clinician, nominated by the national supervisory committee or AMPA
Education Committee, to provide clinical supervision of a trainee.
2.3
PROGRAMME CO-ORDINATION
The duties of the Education Committee in relation to the training programme
are:
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To assist with interviewing and selecting applicants.
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To provide information regarding the content of the training programme to
potential trainees.
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To assist with training of supervisors.
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To liaise with and advise supervisors regarding trainee progress and any
concerns with individual trainees.
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To provide an extra level of expertise to assist both trainees and supervisors
in addressing areas of concern.
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To advise AMPA of any changes to supervisors or serious concerns
expressed at any level about a trainee.
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To meet every 3 months and issue an annual report on the trainee together
with a recommendation on whether to pass into the next year of training.
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2.4
EXPECTED OUTCOMES
The final outcome of the training is Fellowship of the Accident and Medical
Practitioners Association (FAMPA).
The intermediary outcomes are:
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Success in the Primary Examination of AMPEX, within the first or second year
of training. This is required before progression to advanced trainee status.
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Success in the Diploma of Community Emergency Medicine examination,
taken in the third or fourth year of training.
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Four full-time equivalent (FTE) years of accredited training approved by the
AMPA Board of Censors.
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Satisfactory supervisors’ reports.
3.0
ELIGIBILITY
3.1
TRAINEE ELIGIBILITY FOR HWNZ FUNDING
To be eligible for HWNZ funding trainees must:
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Be accepted by AMPA into the training programme; and
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Be a New Zealand Citizen or hold a New Zealand residency permit
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Have been in the programme no longer than 2 FTE years beyond the
approved programme length of four years.
Medical graduates who do not meet the above criteria may be considered on a
case-by-case basis.
Entry into the training programme requires:
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3.2
Credentialing of the trainee by AMPA.
PROVIDER ELIGIBILITY
All training posts must be approved by AMPA. The Regional supervisor can
initiate an inspection of any training site at any time.
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4.0
LOCATION AND SETTING
Training takes place in AMPA Board of Censor and Education Committee-approved
level 2 facilities and AMPA-approved emergency departments.
5.0
ASSOCIATED LINKAGES
The provider has established linkages with:
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The Medical Council of New Zealand
Level 2 clinics and Hospital Emergency departments throughout New Zealand
Goodfellow Unit – Auckland University
Accident Compensation Corporation – Close liaison over 5 years developing
formal standards for Accident and Medical Clinics (NZS 8151:2001)
Schools of Medicine
Australasian College of Emergency Medicine
Other relevant advanced medical training programmes.
Other provider-based continuing education programmes.
Other providers of emergency medicine training.
6.0
PURCHASE UNIT AND REPORTING UNIT
6.1
PURCHASE UNIT
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An eligible full-time equivalent trainee, (trainees working and training for a
period of 46 weeks per annum during the milestone year of training) in AMPAapproved training facilities.
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Part-time trainees - Funding will be provided on pro rata FTE basis to a
minimum of 0.5 FTE.
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Purchase Unit:
CTM63AM A & M Practice
6.2
REPORTING UNIT
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7.0
An eligible trainee listed in Report 1 (refer to Head of Agreement).
QUALITY STANDARDS: PROGRAMME SPECIFIC
This section will be read in conjunction with Schedule 1 Part 3 of the HWNZ
Head Agreement, which specifies generic quality standards for all
programmes provided under the contract.
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7.1
LEARNING ENVIRONMENT QUALITY STANDARDS
Reports as described in Schedule 1 Part 1 of the HWNZ Head Agreement
require a summary of the programme. Schedule 1 Part 3 of the HWNZ Head
Agreement requires that providers have a quality plan in place for the ongoing
monitoring of the training provided. The summary should refer specifically to
the outcomes of this internal quality management.
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