HE EoE ACCS Training HE EoE ACCS Training Programme Programme

An OverviewChris Maimaris

ObjectivesObjectives• Outline of ACCS• Structure and supervision• WPBAs• Annual Appraisals-ARCP• Revalidation• Who to ask for advice• Regional Days

FY2FY1

ACUTE CARE COMMON STEM ACCS CT1 and CT26/12 Emergency Medicine 6/12 Acute Medicine 6/12 Anaesthetics 6/12 Intensive Care Medicine

MCEM A/B/C MRCP I/II FRCA, ICM Exams

CT3 12 monthsEM Paediatric EM

ST4, ST5, ST6 in EMTraditional SpR posts

MCEM Part B&C

FCEM Exit Exam

CCT in EM +/- sub-specialty

CCT Pathway, 2015 curriculum

Competitive Entry to ST1 ACCS from FY2/ equivalent by Interviews and streaming to specialty

CT2 12 monthsAnaesthetics

FRCA Part I

ST3, ST4, ST5 ST6 ST7 MG posts

ST3, ST4, ST5, ST6 AM and speciallties

CT3 12 monthsMedical specialties

MRCP +Paces

CCT Anaesthesia +/- sub-specialty

CCT in AM or specialisms

FRCA Exam

School of Emergency Medicine

CCT EM +/- Sub-specialist – Independent specialist practitioner

Post-CCT

FY2FY1

ACCSST2 1 year Anaesthetics + ICU 6/12 each or 9/3ST1 1 year EM + AM 6/12 each

ST3 EM PEM Paediatrics and further EM

ST4, ST5, ST6 36 months in EM

Competitive Entry: ST1 ACCS (EM) +ST3

MCEM: Part A +B: I, II

CESR-CP combine competences in HST+ Non-Train posts

2+3+3=8

HST 3-yrs

Sub-specialisation: PEM, PHEM + 1 Yr ICM: 2yrs An 6/12 ICM18/12

Core Training 3 yrs

FCEM: SAQ+OSCEs ST6 CCT route

Foundation Training

Run-through EM training 2015 CCT

CA: ST3+CTR =QIP Mg=Portfolio

OOPs: T, E, R, B

1 Dana Shor AM Addenb EM Addenb AM WSH ICU WSH Anaes

2 Nicola Humphrys EM Addenb AM Addenb EM WSH ICU WSH Anaes

3 Frances Paine EM Addenb EM AddenAM-ED WSH ICU WSH Anaes

4 Corrina Lea EM Adden AM-ED Addenb EM WSH ICU WSH Anaes

5 Donna Cummins EM Addenb EM Addenb AM Addenb ICU Addenb Anaes

6 Brendan Fletcher EM Addenb AM Addenb EM Addenb Anaes Addenb ICU

           

7 Yeng Yap ANAES WSH EM WSH AM WSH ICU WSH Anaes

8 Nathan Po-Hang Chu ANAES WSH AM WSH EM WSH ICU WSH Anaes

             

9 Rachel Phillips ANAES PDH EM PDH AM PDH anaes PDH ICU

10 Edward Davis ANAES PDH AM PDH EM PDH ICU PDH anaes

11 Nicola Koo AM PDH EM PDH AM PDH anaes PDH ICU

12 Neil Cattell EM PDH AM PDH EM PDH ICU PDH anaes

             

13 Sebastian Clark EM BH EM BH AM Bedford Anaes Bedford ICU

14 Chris Beng EM BH AM BH EM Bedford ICU Bedford anaes

         

15 Georgia Ellis ANAES L+D EM L+D AM L+D Anaes L+D ICU

16 Umair Qureshi EM L+D AM L+D EM L+D ICU L+D Anaes

             17 Sadia Choudhury ANAES Ipswich EM Ipswich AM Ipswich Anaes Ipswich ICU

18 Egidija Bielskute AM Ipswich AM Ipswich EM Ipswich ICU Ipswich Anaes

             

19 Michael Murphy AM Norwich EM Norwich AM Norwich ICU Norwich Anaes

20 Hannah Cox ANAES Norwich AM Norwich EM Norwich Anaes Norwich ICU

21 David Sparksman AM Norwich EM Norwich AM Norwich Anaes Norwich ICU

22 Christopher Christou ANAES Norwich AM Norwich EM Norwich ICU Norwich Anaes

             

23 Rhiannon Jones ANAES KingsLynn EM Norwich AM KingsLyn Anaes Kings Lyn ICU

24 Megan Murray-Robertson AM Norwich AM KingsLynEM KingsLyn ICU KingsLyn anaes

25 Mehul Vadher ANAES KingsLynn EM King's Lynn AM KingsLyn Anaes KingsLyn ICU

26

Katie McCann

EM King'sLynn AM KingsLynEM KingsLyn ICU KingsLynanaes

             

27 Jack Carmichael ANAES J Paget EM J Paget AM J Paget Anaes J Paget ICU

28 Andrew Linder EM J Paget AM J Paget EM J Paget ICU J Paget Anaes

             

29 Muhammad Asaria EM Lister EM Lister AM Lister Anes Lister ICM

30 Omar Elsaka EM Lister AM Lister EM Lister ICM Lister Anes

31 Gisela Pereira EM Lister EM Lister AM Lister Anes Lister ICM

32 Kathleen Lin AM Lister AM Lister EM Lister ICM Lister Anes

           

33 Iryna Boubriak AM Chelmsfo EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU

34 Stephen Norris AM Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes

35 Dominic Espitalier-Noel EM Chelmsfo EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU

36 Frencesca Saddington ANAES Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes

             

37 Neil Studd EM Colchest EM Colchest AM Colchest Anaes Colchest ICU

38 Robert Derrick ANAES Colchest AM Colchest EM Colchest ICU Colchest AnAnaes

             

39 Harriet Scott ANAES Southend EM Southend AM Southend An Southend ICU

40 Fiona Mendes EM Southend AM Southend EM Southend ICU Southend An

             

41 Samuel Davis EM Harlow EM Harlow AM Harlow Anaes Harlow ICU

42 Orlanda Allen EM Harlow AM Harlow EM Harlow ICU Harlow Anaes

ACCS: EM/AM, Anaesthetics/ITUACCS: EM/AM, Anaesthetics/ITURotations • Norfolk/Suffolk 4 hosp

• Cambridgeshire 4 • Beds/Herts 4• Essex 5

EoE ACCS Training Programme 2014-16 Cohort of trainees DRAFT 4ACCS ST1   ACCS ST2  

Post Sector -Hospital Rotation STREAM Aug-14 Feb-15 Aug-15 Feb-16

  Norfolk/Suffolk

P1 JP An- ACCS ANAES J Paget EM J Paget AM J Paget Anaes J Paget ICU

P2 JP EM-ACCS1 JP EM1 J Paget AM J Paget EM J Paget ICU J Paget Anaes

P3 JP EM-ACCS2 -New New ACCS 1 J Paget EM J Paget AM J Paget Anaes J Paget ICU

P4 JP EM-ACCS3 -New New ACCS 2 J Paget AM J Paget EM J Paget ICU J Paget Anaes

 

P5 KL An- ACCS 1 ANAES KingsLynn EM King'sLynn AM KingsLyn Anaes Kings Lyn ICU

P6 KL An- ACCS 2 ANAES King'sLynn AM KingsLynn EM KingsLyn Anaes KingsLyn ICU

P7KL EM-ACCS

EM KingsLynEM King'sLynn AM KingsLyn ICU KingsLynanaes

P8 KL AM-ACCS AM King'sLynn AM KingsLynEM KingsLyn ICU KingsLyn anaes

 

P9 N+N AM-ACCS 1 AM Norwich AM Norwich EM Norwich Anaes Norwich ICU

P10 N+N AM-ACCS 2 AM Norwich EM Norwich AM Norwich ICU Norwich Anaes

P11 N+N An-ACCS 1 ANAES Norwich EM Norwich AM Norwich Anaes Norwich ICU

P12 N+N An-ACCS 2 ANAES Norwich AM Norwich EM Norwich ICU Norwich Anaes

P13 N+N EM-ACCS1 -New New ACCS 3 Norwich EM Norwich AM Norwich ICU Norwich Anaes

P14 N+N EM-ACCS2 -New New ACCS 4 Norwich AM Norwich EM Norwich Anaes Norwich ICU

             

P15 Ipswich An-ACCS ANAES Ipswich EM Ipswich AM Ipswich Anaes Ipswich ICU

P16 Ipswich AM-ACCS AM Ipswich AM Ipswich EM Ipswich ICU Ipswich Anaes

P17 Ipswich EM-ACCS1 -New New ACCS 5 Ipswich EM Ipswich AM Ipswich ICU Ipswich Anaes

P18 Ipswich EM-ACCS2 -New New ACCS 6 Ipswich AM Ipswich EM Ipswich Anaes Ipswich ICU

             

Cambs/WSH Cambs/WSH

P19 AH AM-ACCS AM Addenb EM Addenb AM WSH ICU WSH Anaes

P20 AH EM-ACCS 1 EM Addenb AM Addenb EM WSH ICU WSH Anaes

P21 AH EM-ACCS 2 EM Addenb EM AddenAM-ED WSH ICU WSH Anaes

P22 AH EM-ACCS 3 EM Adden AM-ED Addenb EM WSH ICU WSH Anaes

P23 AH EM-ACCS 4 EM Addenb EM Addenb AM Addenb ICU Addenb Anaes

P24 AH EM-ACCS 5 EM Addenb AM Addenb EM Addenb Anaes Addenb ICU

P25 AH EM-ACCS 6 -New New ACCS 7 Addenb EM AddenAM-ED Addenb NCCU Addenb Anaes

P26 AH EM-ACCS 7 -New New ACCS 8 AddenAM-ED Addenb EM Addenb Anaes Addenb NCCU

 

P27 WSH An-ACCS 1 WSH An-ACCS 1 WSH EM WSH AM WSH ICU WSH Anaes

P28 WSH An-ACCS 2 WSH An-ACCS 2 WSH AM WSH EM WSH ICU WSH Anaes

 

P29 PDH An-ACCS 1 PDH An-ACCS 1 PDH EM PDH AM PDH anaes PDH ICU

P30

Ranjith Kandavelu LAS-EM

PDH An-ACCS 2 PDH AM PDH EM PDH ICU PDH anaes

P31 PDH AM-ACCS PDH AM-ACCS PDH EM PDH AM PDH anaes PDH ICU

P32 PDH EM-ACCS 1 EM PDH AM PDH EM PDH ICU PDH anaes

P33 PDH EM-ACCS 2 -New New ACCS 9 PDH AM PDH EM PDH ICU PDH anaes

P34 PDH EM-ACCS 3 -New New ACCS 10 PDH EM PDH AM PDH anaes PDH ICU

           

  BEDS/HERTS BEDS/HERTS

P35 Bedf EM-ACCS 1 EM BH EM BH AM Bedford Anaes Bedford ICU

P36 Bedf EM-ACCS 2 EM BH AM BH EM Bedford ICU Bedford anaes

           

P37 Lister EM-ACCS 1 EM Lister EM Lister AM Lister Anes Lister ICM

P38 Lister EM-ACCS 2 EM Lister AM Lister EM Lister ICM Lister Anes

P39 Lister EM-ACCS 3 EM Lister EM Lister AM Lister Anes Lister ICM

P40 Lister AM-ACCS AM Lister AM Lister EM Lister ICM Lister Anes

 

P41 L+D AN-ACCS ANAES L+D EM L+D AM L+D Anaes L+D ICU

P42 L+D EM-ACCS EM L+D AM L+D EM L+D ICU L+D Anaes

 

ESSEX

P43 Chelmsf AM-ACCS 1 AM Chelmsfo EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU

P44 Chelmsf AM-ACCS 2 AM Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes

P45 Chelmsf EM-ACCS EM Chelmsfo EM Chelmsfo AM Chelmsfo Anaes Chelmsfo ITU

P46 Chelmsf An-ACCS ANAES Chelmsfo AM Chelmsfo EM Chelmsfo ITU Chelms anaes

           

P47 Cholchester EM-ACCS EM Colchest EM Colchest AM Colchest Anaes Colchest ICU

P48 Cholchester An-ACCS ANAES Colchest AM Colchest EM Colchest ICU Colchest Ans

           

P49 Southend An-ACCS ANAES Southend EM Southend AM Southend An Southend ICU

P50 Southend EM-ACCS EM Southend AM Southend EM Southend ICU Southend An

P51 Harlow EM-ACCS 1 EM Harlow EM Harlow AM Harlow Anaes Harlow ICU

P52 Harlow EM-ACCS 2 EM Harlow AM Harlow EM Harlow ICU Harlow Anaes

           

P53 Basildon EM-ACCS 1 -New New ACCS 11 Basildon EM Basildon AM Basildon ICM Basildon An

P54 Basildon EM-ACCS 2 -New New ACCS 12 Basildon AM Basildon EM Basildon An Basildon ICM

ACCS CT1 year: ACCS CT1 year: ExpectationsExpectations

• Emergency Medicine -- 6 months• Acute Medicine – 6 months (9/3 set up at AH)• Curriculum: induction pack what to cover• Simulation course: X3 AH• Life Support courses and teaching -GIC• Audits and presentations• Exams• MSF

The College of Emergency Medicine

What you’ll see in A&E….What you’ll see in A&E….• Acute medicine -lots• Paediatrics• Fractures• Minor injury• Primary care• Major trauma• O&G• Acute psychiatric• Acute surgery

Acute MedicineAcute Medicine

e-portfoliose-portfolios• EM and AM support

both years of ACCS• RCoA only ACCS CT2• CS and ES Report forms• WPBAs must do CT1• ARCP Form

SupervisionSupervision• Educational Supervisor for whole year• Usually from stream specialty• Initial meeting, mid-point end of year• ES structured report

• Clinical Supervisor: each post 6/12• Initial meeting, mid-point, end of 6/12• CS report

EM WPBAs: 2015 curriculum EM WPBAs: 2015 curriculum

Total 27Total 27

• CMP1 - Anaphylaxis • CMP2 – Cardio-respiratory arrest • CMP3 - Major Trauma • CMP4 - Septic patient • CMP5 - Shocked patient • CMP6 - Unconscious patient• CAP7 - Chest pain • CAP1 - Abdominal pain • CAP6 - Breathlessness • CAP30 - Mental health

AM: AM: Minimum number of Minimum number of

assessments per 6 monthsassessments per 6 months

• 3 Mini-CEX• 5 DOPs• 3 Cbds• 3 ACATs plus 1 MSF

AM DOPs: AM DOPs:

• Lumbar puncture• Pleural tap & aspiration• Intercostal drain insertion (seldinger)• Intercostal drain insertion open• Ascitic tap• Abdominal paracentesis• DC cardioversion• Knee aspiration• Temporary pacing (external/wire)• Large joint examination

ACCS CT2 yearACCS CT2 year• Anaesthetics –6/12• Intensive Care Medicine –6/12• Initial Assessment of Competence 3/12• WPBAs• Log-Book• As per CT1: LSCs, Audit, MSF, Exams,

After ACCS: 3rd yearAfter ACCS: 3rd year• Anaesthetics –12/12 Total of 2 yrs before HST-

ST3• EM: The CT3 year: EM+PEM• AM: Additional year of Medicine: Ologies• Intensive Care Medicine –12/12

The ARCP The ARCP Annual Review of competency and Annual Review of competency and

progressionprogression

Annual Appraisal +RevalidationAnnual Appraisal +Revalidation

An Overview

Purpose of the ARCPPurpose of the ARCPNormally at least annually•A review and record of the trainee’s progress•Allows judgement to be made about the competences acquired by a trainee and their suitability to progress to the next stage of training•Provides final statement of trainee’s successful attainment of the competences and thereby completion of the training programme

ARCPs Applicable To: ARCPs Applicable To: • All specialty trainees and core trainees• Academic trainees• Trainees OOP• LTFT trainees• FTSTAs• LATs

Basic RequirementsBasic Requirements• ES Structured report +CS reports• WpBAS• Curriculum covered• MSF: minimum 10 people of different

grades/groups• Audit• Complaints/compliments/critical incidents• Enhanced Form R

• All these organised through out the year

ARCP Checklist:ARCP Checklist:• Up-to-date Curriculum Vitae • Completed and updated enhanced Form R • Structured Educational Supervisor • Clinical Supervisor report for each post – one

form to be completed for each placement• Registration with the relevant College • WPBAs: See separate document for ARCP

requirements for each post in ACCS programme • DOPS, CEX, CbDs, ACAT or ECAT• ALS ATLS EPLS APLS prn

ARCP Checklist:ARCP Checklist:• Multi-Source Feedback: minimum 10 mix grades• Evidence of internal teaching attendance • Evidence of external courses and attendance• Evidence of audit or change management projects • Evidence of research and publications undertaken • List of sick, carer, paternal or maternity leave taken • Level two child protection training certificate • Evidence of compliments and thanks • Personal complaints received + any reflective notes  • Personal concerns including Incidents reported, SUIs,

any reflective notes

Meet the ARCP Panel?Meet the ARCP Panel?

The Invitation to the The Invitation to the TraineeTrainee

• Must be sent at least 6 weeks before the ARCP• Reminds them that they need to get an

educational supervisors report• Reminds them to update their CV• Reminds them about the relevant JRCPTB

Decision Aid(s) and sends them the link(s)

Reminder to TraineesReminder to Trainees• A reminder about the ARCP is sent if they do not

reply within 10 days• The Deanery does not check the eportfolios for

Educational Supervisors reports or send reminders about these (not recommended in the Gold Guide)

The Day of the ARCPsThe Day of the ARCPsThe panel convene 15-30 minutes before ARCP agree:•Who will chair the panel•Who will complete the electronic and the handwritten records•Who will feedback to the trainee, including their training needs

ARCPs – The ARCPs – The ProcedureProcedure

The eportfolio should be reviewed before inviting the trainee into the room: •Previous ARCP(s)•The educational supervisors report•The specialty curriculum, the GIM curriculum if appropriate (‘plenty of yellow, green and brown’)•Assessments, especially MSF.

AssessmentsAssessments• Generally formative• Try to ensure that they are done by appropriate

people• The MSF can be valuable

ARCPs – The Procedure ARCPs – The Procedure (3)(3)

The trainee is then invited into the room•Welcomed, panel members introduced•Purpose of ARCP explained•Outcome discussed (aim to be positive, supportive)•CCT date reviewed and if appropriate, Period of Grace discussed (entered in comments section on ARCP proforma in eportfolio)•Training to date and training needs discussed

Outcome 1Outcome 1Satisfactory progressFulfils all of the criteria of curriculum requirements

Outcome 2Outcome 2Development of specific competences required – additional training time not required•Acceptable progress •Some competences not achieved •Not expected that overall progress (and therefore the CCT date) will be delayed•The trainee can ask for this outcome to be reviewed but cannot appeal

Outcome 3Outcome 3Inadequate progress by the trainee – additional training time required•The panel considers that a period of additional training is required which will extend the duration of training •If this outcome is likely the trainee must be present. •The panel gives recommendations about the additional training. The Deanery decides the details, based on the panel’s recommendations •Usual maximum 1 year•The trainee can appeal

Outcome 4Outcome 4Released from training programme with or without specified competences•Insufficient and sustained lack of progress, despite additional training•Panel should ensure that competences that have been achieved are documented•Trainee required to give up their NTN•The trainee can appeal

Outcome 5Outcome 5Incomplete evidence presented – additional training time may be required•Examples include absent educational supervisor’s report, insufficient assessments, insufficient competences signed off•The trainee should submit a written explanation to the panel within 5 working days•The panel can require trainee to submit the necessary documentation by a designated date•Once documentation received, the panel can issue an assessment outcome (they don’t have to meet)

Outcome 6Outcome 6Gained all required competences – will be recommended as having completed the training programme and for award of a CCT (or CESR)

Outcome 7Outcome 7FTSTAs or LATs•The panel should give this outcome to FTSTAs and LATs, documenting the competences achieved

Outcome 8Outcome 8Out of programme for research, approved clinical training or a career break•If the trainee is on a clinical placement, which has been prospectively approved by the GMC/PMETB, the usual documents for a clinical placement should be reviewed•If the trainee is in research the panel should receive a research supervisors report

Outcome 9Outcome 9Doctors undertaking top-up training in a training post•Applies to doctors applying for a CESR where the GMC has recommended top-up training and they have been appointed competitively to a gap in a training programme.•The panel consider evidence including assessments to decide whether the objectives set by the GMC have been met

Trainees with an Trainees with an Adverse Outcome Adverse Outcome

(2,3,4)(2,3,4)Supplementary documentation should be completed by the ARCP panel and made available to: •The trainee •TPD•Educational supervisor •Medical director and Trust HR department•JRCPTB

Enhanced Form R: Enhanced Form R: and Revalidationand Revalidation

• Scope of practice: current jobs, • Other work: locums, volunteer work, formal teach• Revalidation officer: Prof Simon Gregory• Revalidation Date from GMC• Complaints/complements• Incidents, Adverse Events• Reflection on these• Probity: nothing to declare?• Concerns for revalidation• Any concerns from ARCP reported to PG Dean

Out of Programme - Out of Programme - ResearchResearch

Documentation required:•OOPR return•Report from research supervisor

This should indicate whether appropriate progress has been made with the research and ‘that the planned date of completion.. has not changed’

Out of Programme - Out of Programme - ResearchResearch

Duration of research:•Should not normally exceed 3 years•A request to exceed 3 years must be made by the research supervisor to the Dean at least a year in advanceOutcome:•The panel should issue an OOP outcome, recommending continuation of the OOPR or it’s termination, with a date

Less Than Full Time Less Than Full Time TrainingTraining

• LTFT trainees should still have ARCPs annually• Important to review CCT date carefully taking into

account LTFT training

Outcome 6Outcome 6

SimulationSimulationAddenbrooke’s Hospital

•X 3 a year•X10 each course•Get in touch with PGC AH: Sue East

Regional daysRegional days

The College of Emergency Medicine

Emergency Medicine: Brief Emergency Medicine: Brief

history Casualty - A&E - EMhistory Casualty - A&E - EM• 45 years old hospital specialty• CSA1968 part of BMA• 1980- Registrar Training• 1993 Faculty -FAEM exit exam• 2005 College Emergency Medicine

• 2008 Royal assent -- RCEM • 1100+ Consultants• Trainees: 440 ACCS+600 STs• 220 Acute A&E hospitals• 21 million attendances•

Emergency Emergency

MedicineMedicine

The College of Emergency Medicine

FY2FY1

ACUTE CARE COMMON STEM ACCS CT1 and CT26/12 Emergency Medicine 6/12 Acute Medicine 6/12 Anaesthetics 6/12 Intensive Care Medicine

MCEM Part A

CT3 12 monthsEM + MSK T&O EM + Paediatric EM

ST4, ST5, ST6 in Emergency MedicineTraditional SpR posts

MCEM Part B&C

FCEM Exit Exam Sub-specialty training: dual accreditation PEM, ICM; Acute Medicine PHEM

CCT in Emergency Medicine +/- sub-specialty/certification

Emergency Medicine Training programme for 2010

Competitive Entry to ST1 ACCS (EM) from FY2/ equivalent by Interview and structured references

Core Training - 3 yrs

HST 3-yrs

Question TimeQuestion Time