ACCS Learning Outcomes

Specifications:

This ACCS LO is the basic building block for patient care within the ED and AMU. It outlines the development of expertise in history taking, examination, decision making and management of individual patients presenting acutely to hospital. It includes an understanding and aptitude in caring for patients with mental health problems, those with complex co-morbidities and those with frailty needs.

Key Capabilities:

At completion of ACCS a trainee will be able to:

· gather appropriate information, perform a relevant clinical examination and be able to formulate and communicate a management plan that prioritises patient’s choices and is in their best interests, knowing when to seek help

· assess and formulate a management plan for patients who present with complex medical and social needs

These capabilities will apply to patients attending with physical and psychological ill health.

Descriptors:

· Demonstrate professional behaviour with regard to patients, carers, colleagues and others

· Deliver patient centred care including shared decision making

· Take a relevant patient history including patient symptoms, concerns, priorities and preferences

· Perform accurate clinical examinations

· Show appropriate clinical reasoning by analysing physical and psychological findings

· Formulate an appropriate differential diagnosis

· Formulate an appropriate diagnostic test and management plan, taking into account patient preferences, and the urgency required

· Explain clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues

· Appropriately select, manage and interpret investigations

· Recognise need to liaise with specialty services and refers where appropriate

· Demonstrate awareness of the needs of vulnerable adults attending the acute care sector

· Demonstrate professional behaviour with regard to patients, carers, colleagues and others

Programme of learning:

· E-learning, podcasts and blogs mapped to the key capabilities and syllabus

· Local teaching also be mapped to the key capabilities and syllabus

· Supervised clinical experience

Evidence to inform decisions:

· Mini-CEX

· CbD

· ACAT

· Logbook

· E-learning module completion / self-directed learning

· MSF

· Entrustment decision

Assessment:

Experience of caring for a physiologically stable but potentially complex patient will be a key feature of the Emergency Medicine and Acute Medicine components of ACCS. In this time these key skills will be honed by experience, receiving focussed feedback, discussion, reflection and following patients through the early part of hospital admission. Development in this learning outcome is of fundamental importance.

It is therefore expected that a trainee would seek feedback on their care of such patients whenever possible.

Learners will be expected to seek feedback across the full breadth of EM and IM patients. This must include patients attending with mental health problems, frailty issues and complex co-morbidity.

Challenging case where there are barriers to history or examination or where there is uncertainty are of particular value, to chart progress in this aspect. It is expected that assessment would begin in the first week or two of each post.

Entrustment Decisions:

level 2b

At the end of ACCS a trainee will be entrusted to evaluate a physiologically stable patient by taking a history and examining the patient, formulate a differential diagnosis that includes a realistic worst case scenario and articulate a plan for investigation and management. They will also able to interpret key investigations, including ECG and plain radiography. They will be entrusted to know their limitations and when to seek help.

Specifications:

This ACCS Learning Outcome incorporates an understanding of the key steps in diagnostic reasoning, how clinicians make decisions and the factors that have a negative or positive impact on this fundamental skill. The trainee will develop an understanding of how to recognise and mitigate against cognitive errors that can cause harm and threaten patient safety. Good clinical knowledge remains key and the trainee will be able to apply the core principles of evidence based medicine to everyday clinical problems. This will extend to understanding how safe plans can be formulated, including deciding to discharge patients. It is equally important to recognise one’s limitations and know when to ask for help, which needs to be demonstrated appropriately.

Key Capabilities:

At completion of ACCS a trainee will:

· Understand how to apply clinical guidelines

· Understand how to use diagnostic tests in ruling out key pathology, and be able to describe a safe management plan, including discharge where appropriate, knowing when help is required.

· Be aware of the human factors at play in clinical decision making and their impact on patient safety

Descriptors:

· Proficient in ECG and plain film interpretation, as relevant to acute care

· Aware of the cognitive psychology of decision making

· Understand basic diagnostic test methodology

· Understand the fundamentals of decision rule design

· Aware of the strengths and limitations of using guidelines e.g. NICE

· Demonstrate capabilities in dealing with complexity and uncertainty

· Share decision making by informing patients, prioritising patient’s wishes, and respecting their beliefs, concerns and expectations

Programme of learning:

Trainees will be required to record evidence of grounding in the theoretical underpinnings of clinical reasoning.

Resources include:

· RCEM learning material

· Local and regional teaching to cover this ACCS LO

· Simulation/ human factors training on decision making

Evidence to inform decisions:

· Mini-CEX

· CbD

· ACAT

· Logbook

· FEG

· MCR

· MSF

· Patient feedback

Assessment:

ACCS trainees will have the opportunity to receive focussed feedback in this Learning Outcome with patients they review. Formative assessment should focus on trainee commitment to a decision that can be probed and opportunities to explore reasoning, or the use of diagnostic tests and guidelines. WPBA is also an opportunity to test background learning in cognitive decision making at this stage, and trainees will be expected to reflect on this following clinical encounters where decision making has been explored.

Entrustment Decisions:

level 2a

Although trainees will not need to be entrusted to answer clinical questions at the end of ACCS, they will need to be entrusted to ask questions based on sound underpinnings, ie demonstrate an understanding of key principles such as diagnostic methodology, cognitive bias, how decision rules and guidelines work and are best used.

Specifications:

This outcome is highly relevant to all 4 ACCS placements and hence is covered throughout the ACCS programme. It includes the leadership and support of resuscitation teams and communication with patients and their loved ones. It also includes knowing when not to resuscitate and when to stop. The care of those at the end of their life is also represented in this learning outcome.

Key Capabilities:

At completion of ACCS a trainee:

· will recognise and manage the initial phases of any acute life threatening presentation including cardiac arrest and peri-arrest situations

· will be able to provide definitive airway, respiratory and circulatory support to critically ill patients

· will be able to establish the most appropriate level of care for critically unwell patients – including end-of life decisions – and support their needs as well as those of their loved ones

Descriptors:

· Identify an acutely ill patient by taking account of their medical history, clinical examination, vital signs and available investigations

· Integrate clinical findings with timely and appropriate investigations to form a differential diagnosis and an initial treatment plan

· Institute definitive airway management and initiate and maintain advanced respiratory support

· Utilise intravenous fluids and inotropic drugs as clinically indicated, utilising central venous access where required and monitored by invasive monitoring techniques

· Manage life-threatening cardiac and respiratory conditions including peri-arrest and arrest situations

· Formulate and initiate ongoing treatment plan for a critically ill acute surgical or acute medical patient post resuscitation, including those with sepsis and institute timely antimicrobial therapy with an aim for ongoing stabilisation

· Communicate effectively and in a timely manner with fellow members of the multi-disciplinary team including those from other specialties and completing accurate legible and contemporaneous entries in the medical record

· Arrange escalation of care when required and provides a succinct structured handover of the relevant patient details including treatment to that point

· Recognise a patient is in danger of deterioration or who requires further treatment and provides explicit instructions regarding an ongoing treatment plan and contact details should a further review be required

· Decide when it is appropriate to end resuscitation, and is cognisant of the specific care needs of patients and their loved ones when this decision has been made

· Respect patient autonomy and understands when and how they should use advance directives and living wills

· Recognise the potential for organ donation in certain end of life situations and is aware of associated best practice guidelines and legislation relevant to the country of practice

· Demonstrate effective consultation skills in challenging circumstances

· Demonstrate compassionate professional behaviour and clinical judgement

Programme of learning:

· Simulated Practice: progressing from identification and initial treatment of critically ill patient to being a team leader of a multi-disciplinary resuscitation team

· Supervised practice: progressing from defined time in resus, being first attender to leading a resuscitation case to definite endpoint

· RCEM-learning modules: life and limb threatening conditions, resuscitation, organ donation, end-of life care, debrief

· Resuscitation courses

· Airway management skills.

Evidence to inform decisions:

· Mini-CEX

· CbD

· ACAT

· DOPS

· Logbook

· MSF

· Patient feedback

· FEGS/MCR/MTR

Assessment:

Trainees should seek feedback on their participation in and management of resuscitation situations. Initially this can be done with simulation but it is essential that all ACCS trainees develop the ability to identify and manage critically ill adult patients. This should be done with senior staff available for advice and support. Reflection on performance and use of WPBAs are important to demonstrate understanding and progress.

Entrustment Decisions:

level 2a

· Trainees at the end of ACCS training will be entrusted to identify sick patients among those they are directly providing care for, commence resuscitation and participate in multi-disciplinary resuscitation as a team member with local supervision available.

· They will also be able entrusted to formulate and initiate an ongoing treatment plan for a critically ill acute surgical or acute medical patient post initial resuscitation, including those with sepsis.

Specifications:

This ACCS Learning Outcome is specific to the EM placement.

Key Capabilities:

At completion of ACCS, a trainee will be:

· an effective member of the multidisciplinary trauma team

· able to assess, investigate and manage low energy injuries in stable patients

Descriptors:

· Able to perform primary/secondary trauma survey

· Have examination skills required to identify/diagnose injury including vascular and neurological consequences

· Appropriately use investigations including XR/CT/US/MRI to confirm presence/consequences of injury

· Provide basic management of wounds, soft tissue injuries, fractures and dislocations including local anaesthetic techniques

· Provide safe use of basic local anaesthetic techniques e.g. digital nerve block, fascia iliaca block

· Use a range of techniques for wound closure (simple dressing, suturing, skin adhesive, steri-strips).

· Know the fundamentals of management of fractures and dislocations (slings, splints, basic plastering, manipulation as appropriate)

· Able to remove foreign bodies from the eye and ear

· Provide opportunistic advice on accident prevention

· Understand the pathophysiology and management of injury (including specific populations e.g. elderly, paediatric and pregnancy

· Understand the social/economic consequences of injury upon individuals

· Estimate a timeline of healing and give general and specific safety net advice on concerning features of potential complications

· Understand the importance of considering safeguarding of vulnerable patients

· Apply CT guidelines for suspected head and cervical spine injuries

· Provide initial care for patients with fractured neck of femur

· Understand the impact of injury on patients with markers of frailty

Programme of learning:

· RCEM Learning resources

· ATLS or equivalent

· ‘Ring-fenced’ time spent in Minor injuries area for experiential learning

· participation in trauma teams where possible throughout training

Evidence to inform decisions:

· Mini-CEX

· CbD

· ACAT

· DOPS

· Logbook

· FEG

· MSF

· Patient feedback

Assessment:

· Learners will be expected to seek feedback on the care of injured patients including the frail elderly patients, and develop the fundamentals in this outcome.

· They will be expected to be part of the major trauma team and receive feedback on their role.

Entrustment Decisions:

level 2b

Trainees at the end of ACCS should be entrusted to participate in trauma resuscitations as member of trauma team directed by TTL. They should also be able to take a reliable history, elicit key examination features, construct a differential diagnosis and carry out a management plan in patients who have sustained non-life threatening injuries within the ED. Observation in the workplace and WPBAs will support a faculty entrustment statement to this effect.

Specifications:

This Learning Outcome defines the skillset required for ACCS excluding those related to anaesthetics and intensive care, which are covered in LO7 and 8 respectively.

Key Capabilities:

At completion of ACCS a trainee:

· will have the clinical knowledge to identify when key practical emergency skills are indicated

· will have the knowledge and psychomotor skills to perform the skill safely and in a timely fashion.

Descriptors:

· Pleural aspiration of air

· Chest drain: Seldinger and open technique

· Establish invasive monitoring (CVP and Art line)

· Vascular access in emergency- IO, femoral vein

· Fracture/dislocation manipulation

· External pacing

· Direct current cardioversion

· Point of care ultrasound-guided Vascular access and Fascia iliaca block

· Lumbar puncture

Programme of learning, assessment and entrustment decisions:

Pleural aspiration of air

Entrustment requirement: 2a

Programme of learning

· e-learning module

· Simulated practice or supervised practice on patient

Programme of assessment

· DOPS assessment

Chest drain: Seldinger technique

Entrustment requirement: 2a

Programme of learning

· e-learning module

· Simulated practice and/or supervised practice on patient

Programme of assessment

· DOPS assessment

Chest drain: open technique

Entrustment requirement: 1

Programme of learning

· e-learning module

· Simulated practice and/or supervised practice on patient

· National Safety Standards for Invasive Procedures (NatSSIPs) checklist

· ATLS or equivalent trauma course

Programme of assessment

· DOPS assessment OR supervised practice on patient with reflection recorded

· Simulated practice with reflection recorded OR ATLS or equivalent certificate

Establish invasive monitoring (central venous pressure and arterial line)

Entrustment requirement: 2a

Programme of learning

· Simulated practice and/or supervised practice

Programme of assessment

· DOPS assessment for central venous pressure line AND DOPS assessment for arterial line

Vascular access in emergency (intraosseous infusion and femoral vein)

Entrustment requirement: 1

Programme of learning

· Simulated practice and/or supervised practice

· ATLS or similar trauma course

Programme of assessment

· DOPS assessment on either OR supervised practice on patient with reflection recorded

· Simulated practice with reflection recorded

Fracture/dislocation manipulation

Entrustment requirement: 1

Programme of learning

· Supervised practice on patient

Programme of assessment

· DOPS assessment OR supervised practice with reflection recorded

External pacing

Entrustment requirement: 2a

Programme of learning

· e-learning module on bradyarrhythmias

· ALS course

· Simulated practice and/or supervised practice on patient

Programme of assessment

· DOPS assessment OR supervised practice on patient with reflection recorded OR simulated practice with reflection recorded

Direct current cardioversion

Entrustment requirement: 2a

Programme of learning

· e-learning module on broad and narrow complex tachycardias

· Simulated practice and/or supervised practice

· ALS course

Programme of assessment

· DOPS assessment OR supervised practice on patient with reflection recorded OR simulated practice with reflection recorded

Point of care ultrasound-guided vascular access and fascia iliaca nerve block

Entrustment requirement: 2a

Programme of learning

· Simulated practice and/or supervised practice

· Modular level 1 theory training

Programme of assessment

· DOPS assessment for vascular access AND DOPS assessment for fascia iliaca nerve block

Lumbar puncture

Entrustment requirement: 2a

Programme of learning

· e-learning module

· Simulated practice and/or supervised practice on patient

Programme of assessment

· DOPS assessment

Specifications:

This Learning Outcome is relevant to all 4 ACCS placements. The acute care setting, whether it be emergency medicine, internal medicine, intensive care or anaesthesia can be a stressful environment. Circumstances arise unpredictably which may be challenging, not only clinically but with regards to communication and professional interactions. This learning outcome is about preparing the acute care trainee to deal with them effectively.

These situations may result from patient anxiety and involve issues pertaining to consent, capacity and confidentiality with the subsequent need to communicate decisions clearly and to effectively resolve areas of disagreement or conflict. In managing these situations, the doctor needs to demonstrate empathy and understanding and operate within a specific legal and ethical framework as defined by legislation and guidance from the General Medical Council, the Royal Colleges and other significant professional bodies.

The acute care doctor needs at all times to behave in a professional manner with patient safety as a priority.

Key Capabilities:

At completion of ACCS a trainee:

· will know how to reduce the risk of harm to themselves whilst working in acute care

· will understand the personal and professional attributes of an effective acute care clinician

· will be able to effectively manage their own clinical work load

· will be able to deal with common challenging interactions in the workplace.

Descriptors:

· Know how to safely deal with violent or threatening situations

· Able to handle common but challenging situations:

► self-discharge against advice

► capacity assessment

► adult safeguarding issue

► Police/FME enquiries

· Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups

· Behave in accordance with ethical and legal requirements

· Demonstrate ability to offer apology or explanation when appropriate

· Demonstrate ability to lead the clinical team in ensuring that medical legal factors are considered openly and consistently

· Interact effectively with hospital colleagues when handing over the care of patients, in particular when this appears troublesome.

· Liaise effectively with healthcare professionals outside the hospital about patient care.

Programme of learning:

· RCEM learning/ FOAM material.

· Formal teaching in ACCS will include material mapped to the key capabilities in this ACCS LO.

· Trainees will need to record their interaction with learning material and reflection that maps to the key capabilities.

Evidence to inform decisions:

· Assessment of simulated practice

· CbD

· Mini-CEX

· MCR/MTR/FEG

· Patient feedback

Assessment:

Trainees should seek feedback on dealing with challenging situations. This might include patients who appear distressed or angry. This must be done with senior staff able to maintain patient and trainees safety. Feedback and reflection on challenging interprofessional encounters would demonstrate the practical application of approaches and concepts developed in the programme of learning.

Entrustment Decisions:

Level 2a

At the end of ACCS a trainee should be entrusted to work effectively as a member of the acute care team, with appropriate personal professional attributes.

Specifications:

This Learning outcome is specific to and only assessed during the anaesthetic placement. The requirements and expectations of this LO aligns closely with the anaesthetic curriculum such that successful completion of the IAC and the HALO for sedation required in this LO are identical to those required for stage 1 anaesthetic training.

Key Capabilities:

At completion of ACCS a trainee will be able to:

· pre-operatively assess, optimise and prepare patients for anaesthesia

· safely induce, maintain and support recovery from anaesthesia including recognition and management of complications

· provide urgent or emergency anaesthesia to ASA 1-3 patients requiring uncomplicated surgery including stabilisation and transfer

· provide safe procedural sedation for ASA 1-3 patients.

Descriptors:

· Understand the risks, aetiology, treatment and control processes of infection including the need for and ability to perform an aseptic nontouch technique

· Pre-operatively assess patients’ suitability for anaesthesia, prescribe suitable pre-medication, recognise when further investigation or optimisation is required prior to commencing surgery and adequately communicate this to the patient or their family

· Safely induce anaesthesia in ASA 1-3 patients, recognise and deal with common and important complications associated with induction

· Maintain anaesthesia for the relevant procedure, utilise appropriate monitoring and effectively interpret the information it provides to ensure the safety of the anaesthetised patient, as a member of the multidisciplinary theatre team

· Safely care for a patient recovering from anaesthesia, recognise and treat the common associated complications and manage appropriate post-operative analgesia, anti-emesis and fluid therapies

· Provide urgent or emergency anaesthesia to ASA 1-3 patients requiring uncomplicated surgery

· Plan and deliver safe sedation using appropriate agents for ASA 1-3 patients requiring procedures

Programme of learning:

· Local novice anaesthetic teaching

· E-learning

· Anaesthetic simulation teaching

· In theatre supervised learning

· Regional teaching (where appropriate)

· Reflection of clinical experiences

· Maintenance of logbook

Evidence to inform decisions:

· Mini-CEX

· CbD

· DOPS

· Logbook

· MTR

· MSF

· HALO (sedation - expected level 2a)

· IAC

Assessment:

Trainees will be expected to successfully complete both EPA 1 and 2 which make up the IAC as per the RCoA IAC workbook; a copy of the IAC workbook ca n be downloaded here: https://www.rcoa.ac.uk/media/19916

Trainees are expected to successfully complete the HALO for procedural sedation as per the RCoA Stage 1 curriculum. Click here for details of the procedual sedation domain of learning https://www.rcoa.ac.uk/documents/2021-curriculum-learning-syllabus-stage-1/procedural-sedation

This involves:

· Conducting appropriate pre-assessment of patients with respect to sedation, understanding patient related risk factors, and planning accordingly

· Choosing safe, appropriate sedative drugs to deliver conscious sedation

· Describing the particular dangers associated with the use of single or combinations of sedative drugs, particularly in the frail, elderly or critically ill patient and those requiring transfer

· Monitoring a sedated patient’s physiology appropriately

· Ensuring the provision of safe post-procedural care

· Explaining the different levels of sedation and being able to appreciate the risks associated with these

· Being able to recognise and manage the complications of sedation

Entrustment Decisions:

· IAC: Level 2b

· Sedation: Level 2a

Specifications:

This Learning outcome is specific to and only assessed during the intensive care placement. The requirements and expectations of this LO aligns closely with the anaesthetic and ICM curriculum such that successful completion the HALO for ICM required in this LO are identical to those required for stage1 anaesthetic training.

Key Capabilities:

At completion of ACCS a trainee:

· will be able to provide safe and effective care for critically ill patients across the spectrum of single or multiple organ failure

· will be able to plan and communicate effectively with patients, relatives and the wider multi-professional team when attending to the clinical and holistic needs of patients

Descriptors:

· Recognise the limitations of intensive care and employ appropriate admission criteria

· Recognise, assesses and initiate management for acutely ill adults across the spectrum of single or multiple organ failure

· Recognise and manage the patient with sepsis and employ local infection control policies

· Recognises the acutely ill child and initiates management of paediatric emergencies

· Perform safely and effectively the clinical invasive procedures to maintain cardiovascular, renal, and respiratory support.

· Undertake and evaluate laboratory and clinical imaging investigations to manage patients during their intensive care stay

· Manage the ongoing medical/surgical needs and organ support of patients during a critical illness, including the holistic care of patients and relatives

· Plan and communicate the appropriate discharge of patients from intensive care to health care professionals, patients and relatives

· Support the management of end of life care within the intensive care environment with patients, relatives and the multi-professional team

· Understand the role of transplant services when appropriate and the principles of brain-stem death testing

· Support clinical staff outside the ICU to enable the early detection of the deteriorating patient

Programme of learning:

· ICM work-based experiential learning

· ICM formal education sessions

· Regional teaching (where appropriate)

· E-learning

· Simulation

· Self-directed learning

· Reflection of clinical experiences

· Courses/conferences where appropriate

Evidence to inform decisions:

· Mini-CEX

· CbD

· DOPS

· Logbook

· MCR

· MSF

· HALO

Assessment:

Trainees are expected to successfully complete the HALO for IAC as per the RCoA Stage 1 curriculum: follow this link for details: https://www.rcoa.ac.uk/documents/2021-curriculum-learning-syllabus-stage-1/intensive-care

Entrustment Decisions:

Level 2a

Specifications:

The generic ACCS LOs are equally relevant to all ACCS placements and should be worked on throughout the 2 years of ACCS. All trainees need the opportunity to provide evidence of their activity in this LO in each year of training. All activity relating to teaching is relevant and the list of evidence that might be used is not reductive in any way. Some trainees may be inspired by the topic and seek to stretch further in this area.

Key Capabilities:

At completion of ACCS a trainee:

· will be able to set learning objectives for and deliver a teaching session

· will be able to deliver effective feedback to a junior colleague or allied health professional with an action plan.

Descriptors:

· Delivers effective teaching and training to medical students, junior doctors and other health care professionals

· Delivers effective feedback with action plan

· Able to supervise less experienced trainees in their clinical assessment and management of patients

· Able to supervise less experienced trainees in carrying out appropriate practical procedures

· Able to act as a clinical supervisor to doctors in earlier stages of training

Programme of learning:

E-LfH and parent specialty online learning platforms provide a range of resources and materials to support trainees and trainers in developing skills in teaching and supervision. Links to these are found below:

RCEM Learning: https://www.rcemlearning.co.uk/

e-Learning Anaesthesia: https://www.rcoa.ac.uk/e-learning-anaesthesia

e-Learning IM: https://www.e-lfh.org.uk/programmes/internal-medicine-training/

e-LFH (for all trainees):https://portal.e-lfh.org.uk/

· courses

· conferences

· e-learning in the field of medical education

· formal training in educational methodology

· quality improvement work in the domain of medical education

Evidence to inform decisions:

· Teaching assessment tool: We need to ensure existing Colleges’ tools are sufficiently similar and suitable for ACCS level and the list them here, else create generic ACCS one.

· EM STAT tool

· RCoA and JRCPTB equivalent to EM STAT tool

· Multi-Source Feedback (MSF)

· Reflections

· Supporting documents from the programmes of learning above

· Educational Supervisor’s report

Assessment:

· The assessment schedule has an expectation that trainees develop their teaching throughout their training and teaching should be viewed as a core part of the requirements of the ACCS trainee. A teaching assessment tool is available on each parent specialty e-Portfolio to guide trainees through such an exercise and for this to be reviewed by their clinical or educational supervisor.

· Teaching and supervision is an important domain as part of the MSF. This provides useful feedback to the trainee and can be reviewed by their clinical or educational supervisor.

· Structured feedback from external teaching opportunities; During training there may be many opportunities to teach beyond the immediate clinical placement at local, regional or national/international level. Examples could include courses (e.g. ALS, ATLS) conference workshops, university teaching, teaching of other specialties etc. Structured feedback from these sessions is valuable evidence towards the key capabilities for this LO.

Entrustment Decisions:

Below expectations

• Minimal evidence of participation in teaching and reflection on performance

• Evidence of teaching skills needing further development or unwillingness to teach (MSF, mini-CEX, trainers report)

Satisfactory/Good

• Evidence of participation in local departmental teaching, for example through development log entries

• Evidence of feedback on teaching and learning events delivered by the trainee with reflection and goal setting for development of teaching skills

Excellent

• Evidence of participation in regional or national education or training delivery

• Participation in formal teacher training programme

• Quality improvement activity in the area of education.

Specifications:

The generic ACCS LOs are equally relevant to all ACCS placements and should be worked on throughout the 2 years of ACCS. All trainees need the opportunity to provide evidence of their activity in this LO in each year of training. A key element of being a specialist in medical practice is the ability to use research evidence to drive improvement in patient care. It is a GMC requirement that all those training to UK Royal College curricula develop such skills.

Key Capabilities:

At completion of ACCS a trainee:

· will be able to search the medical literature effectively and know how to critically appraise studies.

Descriptors:

· Manages clinical information/data appropriately

· Understands principles of research and academic writing

· Demonstrates ability to carry out critical appraisal of the literature

· Understands the role of evidence in clinical practice and demonstrates shared decision making with patients

· Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry

· Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice

· Follows guidelines on ethical conduct in research and consent for research

· Understands public health epidemiology and global health patterns

· Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

Programme of learning:

· Local and regional teaching on literature searching and appraisal, evidence synthesis and coming to a conclusion

· Departmental journal clubs

· Good Clinical Practice (GCP) training

· Ideally, trainees should be involved in departmental/trust research activity during their ACCS placement

E-LfH and parent specialty online learning platforms provide a range of resources and materials to support trainees and trainers in developing skills in a wide range of educational areas including research. Links to these are found below:

RCEM Learning: https://www.rcemlearning.co.uk/

e-Learning Anaesthesia: https://www.rcoa.ac.uk/e-learning-anaesthesia

e-Learning IM: https://www.e-lfh.org.uk/programmes/internal-medicine-training/

e-LFH (for all trainees):https://portal.e-lfh.org.uk/

The parent colleges offer a range of research-themed events and most local ACCS and/or department teaching programmes can provide further support for this learning outcome.

Additional critical appraisal checklists and frameworks can be found at: https://bestpractice.bmj.com/info/toolkit/

https://www.cebm.net/2014/06/critical-appraisal/

https://www.nuhs.edu/media/25485/studyguidecriticalappraisalforresearchpapers.pdf

https://www.stemlynsblog.org/tag/critical-appraisal/

Evidence to inform decisions:

· e-Learning module completion/self-directed learning

· MSF

· MRCP(UK)

· GCP certificate or equivalent

· Evidence of literature search and critical appraisal of research

· Use of clinical guidelines

· Quality improvement and audit

· Evidence of research activity

· MCR/MTR/FEG

· End of placement reports

Assessment:

The assessment schedule has an expectation that trainees develop the ability to consider their clinical work and identify questions that they would like to seek further evidence from the medical literature to help answer. These may come from clinical encounters in the workplace, or from workplace-based assessment discussions. A CLA assessment tool is available on each parent specialty e-Portfolio to guide trainees through related exercises and for this to be reviewed by their clinical or educational supervisor.

Trainees should receive feedback on journal club presentations during training.

Entrustment Decisions:

Below expectations

• Minimal evidence of regular involvement in research-related activity (e.g. literature review, audit, critical appraisal)

• Poor use of clinical questions in e-Portfolio with no critical review of the relevant literature

Satisfactory/Good

• Evidence of regular involvement in research related activities, e.g. literature review, audit, critical appraisal; evidence may include, for example, reflection on audit projects or journal club presentations

• Good use of clinical questions in e-Portfolio, incorporating critical review of the relevant literature

Excellent

• Evidence of skills in interpretation and communication of research findings to patients, plus to the multidisciplinary team; evidence may include, for example, mini- CEX and MSF feedback

Specifications:

The generic ACCS LOs are equally relevant to all ACCS placements and should be worked on throughout the 2 years of ACCS. All trainees need the opportunity to provide evidence of their activity in this LO in each year of training. All activity relating to teaching is relevant and the list of evidence that might be used is not reductive in any way. Some trainees may be inspired by the topic and seek to stretch further in this area.

Key Capabilities:

At completion of ACCS a trainee:

· will be able to contribute effectively to a departmental quality improvement project

Descriptors:

· Makes patient safety a priority in clinical practice

· Raises and escalates concerns where there is an issue with patient safety or quality of care

· Demonstrates commitment to learning from patient safety investigations and complaints

· Shares good practice appropriately

· Contributes to and delivers quality improvement

· Understands basic Human Factors principles and practice at individual, team, organisational and system levels

· Understands the importance of non-technical skills and crisis resource management

· Recognises and works within limit of personal competence

· Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

Programme of learning:

E-LfH and parent specialty online learning platforms provide a range of resources and materials to support trainees and trainers in developing skills in a wide range of educational areas including quality improvement. Links to these are found below:

RCEM Learning: https://www.rcemlearning.co.uk/

e-Learning Anaesthesia: https://www.rcoa.ac.uk/e-learning-anaesthesia

e-Learning IM: https://www.e-lfh.org.uk/programmes/internal-medicine-training/

e-LFH (for all trainees):https://portal.e-lfh.org.uk/

In addition the parent colleges offer a range of QI-themed events and most local ACCS and/or department teaching programmes can provide further support for this learning outcome.

Evidence to inform decisions:

· QIPAT

· e-Learning module completion/self-directed learning

· MSF

· ES annual report

· End of placement reports

Assessment:

The assessment schedule has an expectation that trainees develop their QI skills throughout their training. A QI assessment tool is available on each parent specialty e-Portfolio to guide trainees through related exercises and for this to be reviewed by their clinical or educational supervisor.

Entrustment Decisions:

Below expectations

• Minimal evidence of activity in quality improvement activity

Satisfactory/Good

• Evidence of engagement in quality improvement processes within the NHS Trust

• For each year of training, evidence of involvement in an audit or other process related to quality improvement (service evaluation, audit, re-audit, quality improvement, guideline development, etc.)

• Presentation at local QI meeting

Excellent

• Presentation of the findings and actions from more than one project or in more than one setting

• Demonstrates translation of findings and learning from one audit into another area of practice or another hospital.