Acute care common stem core training programme
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ACUTE CARE COMMON STEM CORE TRAINING PROGRAMME Curriculum and Assessment System May 2010 PrefaceThe purpose of the Acute Care Common Stem (ACCS) programme is to provide trainees with a broad range of knowledge skills and attitudes so as to be able to: assess any acutely ill patient and commence resuscitation if necessary. diagnose the most likely underlying problem. initiate appropriate investigations, commence appropriate immediate treatment and identify and liaise with the in-patient teams to ensure appropriate definitive care. Uniquely, the ACCS programme delivers the training and experience needed for this by enabling the trainee to work and learn in the four areas most closely concerned with the acutely ill patient – General Internal Medicine (GIM), Anaesthesia (AN), Intensive Care Medicine (ICM) and Emergency Medicine (EM). The knowledge base and skill set of these specialties are closely related. These specialties interface in the care of every acutely ill patient. By working in these specialties, the ACCS trainee will become familiar with the common acute and life threatening presentations, their rapid initial assessment and treatment and how to determine what definitive care will be needed and where it should best be provided. The understanding and thorough grounding in these four specialties delivered by ACCS training will enable the doctor to work effectively both individually and as part of a team in the care of the acutely ill patient and develop a firm foundation for their future chosen specialty. This document describes the curricular and assessment systems for Acute Care Common Stem core training. It is published by the College of Emergency Medicine (CEM), the Royal College of Anaesthetists (RCoA), the Federation of Royal Colleges of Physicians (FedRCP) and the Intercollegiate Board for Training in Intensive Care Medicine (IBTICM); which together form the Intercollegiate Committee for ACCS Training (ICACCST). The curriculum and assessment system has been written following consultation between CEM, the RCoA, FedRCP, IBTICM, Heads of Specialty Schools, Programme Directors, individual consultants, trainees and lay people. This feedback was reviewed and developed by the ICACCST and approved by the three Colleges and the IBTICM. The ICACCST will be pleased to receive comments on this document from both trainers and trainees. These should be addressed to ICACCST at: The Royal College of Anaesthetists Churchill House 35 Red Lion Square London WC1R 4SG
E-mail: accs@rcoa.ac.uk The document is reviewed regularly with an implementation date for any changes being not less than 6 months after the publication date. Amended pages are sent to Dean Directors, Heads of Specialty Schools, Regional Advisors and Programme Directors for the specialties concerned. An updated version of the manual is maintained on the relevant College and IBTICM websites. Occasionally, queries arise that affect the immediate interpretation or application of specific areas within this document. Answers to these will be published on the relevant College and IBTICM websites and, if necessary, earlier by e-mail to all Dean Directors, Heads of Specialty Schools, Regional Advisors and Programme Directors. ContentsPreface 1 Contents 3 Glossary of terms 5 Executive Summary 8 ACCS routes of entry and training pathways 10 1.0 Introduction 11 1.1 What is ACCS? 11 1.2 Aim of ACCS 11 1.3 Objectives of ACCS 11 1.4 ACCS & the academic trainee 12 1.5 Further advice about ACCS 12 2.0 Principles of the first two years of ACCS training 14 2.1 Introduction 14 2.2 Administration of ACCS training 14 2.3 Responsibility for training in the workplace 14 2.4 Modules and units of training 15 2.5 Appraisal and assessment 15 2.6 Supervision 16 2.7 Out of hours cover for emergency services 17 2.8 Simulators 17 3.0 Entry and progression through ACCS training 18 3.1 Entry to ACCS core training 18 3.2 Progression through the ACCS programme 18 3.3 Principles for calculating training time 20 4.0 The delivery of training and education 21 4.1 Principles of delivering training and education 21 4.2 The organisation of training and education 21 4.3 The “Lead” Educational Supervisor / “Track Lead” 22 4.4 SAS grade doctors and senior trainees as trainers 22 4.5 Workplace based learning 23 4.6 Workplace based assessment 23 4.7 Clinical knowledge 23 4.8 Formal education 24 4.9 Professional knowledge, skills, attitudes and behaviour 24 4.10 Training accommodation 26 5.0 ACCS Common Competences 27 6.0 ACCS Introduction to clinical presentations 77 6.1 ACCS Major Presentations 78 6.2 ACCS Acute Presentations 89 6.3 Anaesthetics within ACCS 145 6.4 ICM within ACCS 215 8.0 The ACCS Assessment System 233 Summary 233 Frequency of assessments 235 ACCS CT1-2 236 Appendix A 239 A.1 Specialty Specific Assessments for Emergency Medicine 239 A.1.2 Assessment tools 239 A.1.3 Overall assessment structure relating to both core and higher EM training 245 A.1.4 ACCS CT1&2 assessments 245 A.1.5 Emergency Medicine WPBA assessment tools and forms for ACCS CT1&2 248 A.2 Speciality specific assessments for Anaesthesia 276 A.3 Speciality specific assessments for Intensive Care Medicine 289 A.4 Specialty Specific assessments for Acute Medicine 295 Appendix B 309 Guidelines for Postgraduate Deans for ACCS training 309 Academic ACCS trainees 311
Glossary of termsClinical termsAAA Abdominal aortic aneurysm ALS Advanced life support APLS Advanced paediatric life support ASD Arial sepal defect BE Base excess BIS Inspectoral index BP Blood pressure BMI Body mass index BNF British National Formulary CFAM Cerebral function analysis monitor CFM Cerebral function monitor CO2 Carbon dioxide COPD Chronic obstructive pulmonary disease CPEX Cardiopulmonary exercise testing CSF Cerebrospinal fluid CT Computerised tomography CVP Central venous pressure ECG Electrocardiogram EMG Electromyogram ENT Ear, Nose and Throat GCS Glasgow Coma Score GHB Gamma hydroxybutyrate GMC General Medical Council GU Genitourinary Hb Haemoglobin IAC Initial assessment of competence IPPV Intermittent positive pressure ventilation IRMER Ionisation Radiation (Medical Exposure) Regulations IT Information technology LiDCOTM Lithium indicator dilution cardiac output MAC Minimum alveolar concentration MH Malignant hyperpyrexia MRI Magnetic resonance imaging NO Nitric oxide NSAID Non-steroidal anti-inflammatory drug PE Pulmonary embolus PFO Patent foramen ovale PONV Postoperative nausea and vomiting PSI Pounds per square inch Ref. Reference ROSC Return of spontaneous circulation RS Respiratory system SpO2 Saturation of haemoglobin with oxygen SSRI Selective serotonin receptor inhibitor SVP Saturated vapour pressure VSD Ventricular septal defect WCC White cell count
AIM Acute Internal Medicine AM Acute medicine AN Anaesthetics ASA American Society of Anesthesiologists BTS British Thoracic Society CCT Certificate of completion of training CEM College of Emergency Medicine CPD Continuing professional development CSM Committee on Safety of Medicines ED Emergency Department EM Emergency Medicine GIM General Internal Medicine GMC General Medical Council GMP Good medical Practice GIM(Acute) That part of GIM associated with the acute medical take ICACCST Inter Collegiate Committee for Acute Care Common Stem Training ICM intensive care medicine JRCPTD Joint Royal College of Physicians Training board LAT Locum appointment for training LTFT Less than full time training NCEPOD National Confidential Enquiry into Patient Outcome and Death NICE National Institute for Health and Clinical Excellence RCP Royal College of Physicians RCoA Royal college of Anaesthetists SAS Staff and associate specialist STC Specialty Training Committee
ACAT Acute Care Assessment Tool ACAT- EM Acute Care assessment tool (EM) ARCP Annual Review of Competence Progression CBD Case Based Discussion (CBD) CAP Core Acute Presentations D Direct observation of procedural skills (DOPS) E Examination FRCA Fellowship of the Royal College of Anaesthetists IAC Initial Assessment of Competence L Life support course Mi or A Mini- clinical evaluation exercise or anaesthesia clinical evaluation exercise (Mini-CEX or Anaes-CEX) M Multisource feedback MCEM Membership of the College of Emergency Medicine MRCP Membership of the Royal College of Physicians PP Practical Procedures PS Patient Survey S Simulation TO Teaching Observation WPBA Work Place Based Assessments
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