The ACCS Assessment System

8.0 The ACCS Assessment System

Summary

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  Workplace based assessments are trainee driven.
  
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  The minimum number of assessments to be undertaken in each specialty and their type are indicated for the first two years in the table below.
  
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  Given the overlap between the ACCS specialties, assessment of the same presentation (major or acute) or procedure can occur in a variety of settings (ICU, Acute Medical Ward, ED, within anaesthetic training).
  
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  A small number of assessments have been identified as specialty specific and must be undertaken whilst working within that specialty. However this in no way restricts these assessments to that specialty, as assessments of the same topic in different settings is beneficial (see appendices A.1- A.4).
  
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  Trainees must have an electronic portfolio (e-portfolio) if available, which can only be arranged by registration with their parent College. Currently the RCoA does not have an e-portfolio.
  
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  All assessment forms included in this curriculum are examples only. All up to date versions can be found on college websites.
  

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  mini-Clinical Evaluation Exercise (Mi or mini-CEX, in anaesthesia A or Anaes-CEX)
  

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  Direct Observation of Procedural Skills (D or DOPS)
  
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  Multi-Source Feedback (M or MSF)
  
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  Case-Based Discussions (C or CbD)
  
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  Patient Survey (PS)
  
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  Acute Care Assessment Tool (ACAT and ACAT -EM)
  
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  Audit Assessment (AA)
  
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  Teaching Observation (TO)
  

A description of these tools is given below and further information is available in the e-portfolio trainee section. These WPBA’s should be recorded in the trainee’s e- portfolio.

It is agreed that the generic tools of the trainee’s host college can be used across all settings. This enables the majority of assessments to be performed using documentation specific to the parent college of the trainee, i.e. trainees destined for HST in EM will use EM specific tools for the majority of assessments, even when working in AM, ICM or anaesthetics.

However, all specialties have some specific documentation to be used while trainees work in that specialty, regardless of HST destination. This documentation is available on the parent college websites, the ACCSUK website and within the CEM e-portfolio.

This can provide a hard copy of the assessment which can be stored in the trainee’s portfolio so that it can be shared with the Educational Supervisor.

Generic workplace-based assessment forms for Mini-CEX, DOPS and CbD are available in appendix A.5
The workplace-based assessment methods include feedback opportunities as an integral part of the assessment process. This feedback stimulates learning and it is expected that trainees will repeat WPBA to show sustained improvement and not cram all assessments in at the end of a placement.
Some assessments within EM and anaesthesia are summative. For those presentations to be assessed by EM, clear descriptors of a trainee’s performance have been provided for successful completion. Trainees may complete a number of formative assessments before they present themselves for summative sign off.
Multi-source feedback (M or MSF)

This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collation and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters’ are individuals with whom the trainee works and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters. Feedback is given to the trainee by the Educational Supervisor.

This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available.

A DOPS is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development.

The CbD assesses the performance of a trainee in their management of a patient to provide an indication of competence in areas such as clinical reasoning, decision-making and application of knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record such as patients’ written case notes.

The ACAT is designed to assess and facilitate feedback on a doctor’s performance across a number of domains. The ACAT (GIM) is designed for use during over an Acute Medical Take. Any doctor who has been responsible for the supervision of the Acute Medical Take can be the assessor for an ACAT. The ACAT (EM) is a modified version designed for use across shifts worked in the Emergency department. The ACAT tool on any one occasion can be used to cover a number of acute presentations.

A Patient Survey identifies issues including behaviour of the doctor and effectiveness of the consultation which are important to patients. It is intended to assess the trainee’s performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation.

The Audit Assessment Tool is designed to assess a trainee’s competence in completing an audit. The Audit Assessment can be based on review of audit documentation OR on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor.

The Teaching Observation tool is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee, which has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors).  The assessment form for TO is available in the e-portfolio.  

Frequency of assessments

The suggested assessment methods relevant to each presentation are shown in the assessment methods column of this curriculum. It is not expected that all competences will be assessed and that, where they are assessed, not every method will be used. Given the overlap between the ACCS specialties assessment of the same topic can occur in a variety of settings. A small number of assessments have been identified as specialty specific and must be undertaken whilst working within that specialty. However this in no way restricts these assessments to that placement, as multiple assessments of competence in dealing with the same presentation in different settings is beneficial (see Appendix A ).
The Mini-CEX, DOPS and CBD can be used either formatively or summatively. When they should be used summatively this is clearly indicated, and clear descriptors of trainee’s performance are available in the EM and anaesthetic assessment appendices.

It is expected that trainees over the first two years will have a recorded assessment for all 6 of the ‘Major presentations’ and at least 20 of the 38 ‘Acute presentations’.
It is suggested that the minimum number of assessments in each part of the 2 year rotation is as follows:

Specialty	Mini-CEX	DOPS	CbD	ACAT
Anaesthesia	3	5	7	-
Acute Medicine	3	5	3	3
Emergency Medicine	4	5	3	1
ICM	3	6	4

Total sampling of the curriculum

Most major and acute presentations would normally be encountered and therefore assessed while working in AM, EM and ICM. The anaesthetic assessments are clearly centred on the anaesthesia part of the curriculum but opportunities to cover major and acute presentations whilst undergoing anaesthetic training should also be used.
At the beginning and end of each part of the rotation the trainee and their educational supervisor should review the outstanding assessments and plan how they will be covered as the setting of some assessment may vary based on local variations in practice.
Work place based assessments

Which assessment tool?

The number, frequency and relevant tools for assessments for anaesthesia are described in Appendix A.2.

For the remaining specialties the assessment tools of Mini-CEX (Mi), DOPs (D), CBD (C) and ACAT, which involve direct interaction with the trainer, can be used. The ACCS trainee at the end of the first two years will have used one or more of these tools for assessment of the 6 major presentations, 20 of the 38 acute presentations and 39 of the 44 practical procedures.
The trainee will need to submit themselves to assessment regularly, typically once per week, if they are to meet the minimum assessment requirements.
Most of the assessments are not summative, i.e. they are formative and are intended to provide feedback in a non judgemental way.

ACCS CT1-2

Any specialty can assess a major or acute presentation. The identification of a presentation for assessment by a specialty simply means that specialty must undertake that assessment, but this does not prevent that presentation being assessed again by another speciality. For example a trainee MUST have a miniCEX or CbD on two major presentations during the EM attachment but could repeat the assessment on those presentations during the AM attachment.

	Major Presentations (MP) 6	Acute Presentations (AP) 38	Practical Procedures (PP)44
CT1 EM	Summative 2 of the 6 MPs will be completed in EM, using a summative tool i.e. the Mini-CEX descriptor tool or a pass/fail CbD Summative tools are available for Major trauma Shock Altered level of consciousness Sepsis Note – suggested that for: Anaphylaxis in adults and children this could be covered regionally using simulation Cardio respiratory arrest could be covered either by ALS or sign off by anaesthesia	Summative 5 of the 38 APs must be completed using a summative tool i.e. the Mini-CEX descriptor tool or a pass/fail CbD The CEM suggest coverage of the following acute presentations, for which detailed descriptors are provided Chest pain Abdominal pain Breathlessness Mental health Head injury Formative An additional 5 acute presentations must be covered using x1 ACAT It is also recommended during this time that trainees also aim to cover an additional 10 acute presentations using a combination of ACATS, e learning, reflective entries, teaching and audit assessments	Formative 5 of the 44 PP must be completed using DOPs The CEM suggests coverage during EM of Airway, Primary survey wound care Fracture /joint reduction. Plus one other from the PP list not covered by another specialty
CT1 AM	Formative 2 of the 6 MPs	Formative 10 of the 38 APs using Mini-CEX, CbD or ACAT The 8-10 remaining AP can be covered using a combination of ACATS, e learning, reflective entries, teaching and audit	Formative 5 of the 44 PP Using DOPs
CT2 ICM	Formative 2 of the 6 MPs Ideally sepsis should be covered in ICM Plus any remaining MPs if not already covered.	Formative Any AP that occurs in an ICM setting and not already covered using appropriate tool.	Formative 13 of the 44 PP, Using DOPs and other tools
CT2 ANAESTHESIA	Summative Basic and advanced life support assessment Plus anaesthesia assessments		Summative 16 separate Anaesthesia related topics including initial assessment of competence

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