Principles of the first two years of ACCS training

2.3 Responsibility for training in the workplace

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  GMC is responsible for approving posts and programmes for training.
  
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  The ICACCST is responsible for:
  

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  Developing the curriculum including determining the learning objectives and competences of training; and
  

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  Advising GMC and Postgraduate Deans on the arrangements for organising and monitoring in-service training.
  

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  The Postgraduate Dean is responsible:
  

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  For selecting trainees in accordance with nationally agreed procedures
  
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  To GMC for the quality management of training
  
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  For organising the Annual Review of Competence Progression (ARCP) for each trainee
  
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  For the overall training arrangements in each hospital; the Clinical Tutor or Director of Education acts as the Dean’s officer within the hospital and is responsible for the educational environment and in some cases, aspects of generic training
  

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  The local Specialty Training Committee:
  

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  Reports to the Postgraduate Dean and is responsible for local arrangements for in-service training.
  

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  Has responsibility for deciding what evidence of progress in training will be reviewed at appraisal and evaluated at the ARCP.
  

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  Programme Directors organise the rotations to ensure that the curricula are covered and that remedial training is implemented if required.
  
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  The Clinical Directorates for each specialty within a hospital are responsible for delivering in service training in accordance with the principles adopted by GMC, the ICACCST, the Postgraduate Dean and the ACCS Training Committees.
  
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  When they are established ACCS Schools will take on responsibility for organising and monitoring the training scheme and individual trainees; in the meantime ARCP panels should include representatives from all component specialties being reviewed by the panel.
  

2.4 Modules and units of training

ACCS training is described under the headings of:

1. 
   Common Competencies
   
2. 
   Major Presentations
   
3. 
   Acute Presentations
   
4. 
   Anaesthesia in ACCS
   

Each area is described in terms of:

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  the subject area;
  
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  the required knowledge;
  
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  the required skills;
  
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  the required attitudes and behaviour;
  

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  the range of possible assessment methods that could be used
  
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  mapping to the GMP headings.
  

2.5 Appraisal and assessment

Each trainee must complete an educational agreement with their supervisor within two weeks of the start of each placement. This should clearly establish the training goals of the placement and forms part of the basis of subsequent review.

There will be regular appraisal and assessment during ACCS training. Progression is dependent on successful assessment. The timing and format of appraisal and assessment is indicated in section 8.0 and the additional specialty specific appendices.

Every trainee must have a formal appraisal at the end of the period with each specialty.
Examinations of knowledge Are one of several assessment methods used within the programme e.g. MCEM (Part A) for Emergency Medicine, the MRCP Part 1 Examination for GIM(Acute), the FRCA Primary MCQ Examination for Anaesthetics. The syllabi for these examinations of basic level knowledge are contained in the individual specialty CCT programmes.
Portfolio: Every ACCS trainee must maintain a training portfolio.
ARCP The ARCP is the process whereby all assessments of a trainee’s knowledge, skills and attitudes throughout the year come together for review at Deanery level. The STC works with the Postgraduate Deans in conducting the ARCP to provide a composite picture of the trainee’s achievements, shortcomings and consequent future training needs. ARCP panels should include representatives from all component specialties under review

2.6 Supervision

ACCS teaching and learning require that consultants and trainees work together in clinical practice. The detailed requirements of clinical supervision will vary between the four ACCS specialties and are described in the relevant CCT programmes.
Clinical supervision Every trainee must at all times be responsible to a named consultant. That consultant must be available to advise and assist the trainee as appropriate. Sometimes this will require the consultant’s immediate presence but on many occasions less direct involvement will be acceptable. All operating lists and clinical sessions involving a trainee should be under the supervision of a named consultant or SAS grade doctor. It is accepted that absences (holiday, study leave, professional leave or sickness) will occur. However, when such absences happen and a trainee undertakes clinical work, there must be an arrangement to provide appropriate direct or indirect consultant supervision for the trainee.
Supervision is a professional function of consultants and they will be able to decide what is appropriate for each circumstance in consultation with the trainee. The safety of an individual hospital’s supervision arrangements is the concern of the departmental and hospital management and it is necessary for them to agree local standards and protocols that take account of their particular circumstances. Clinical supervision for each specialty module will be in accordance with the procedures contained in the relevant CCT programme. At all times the needs of patient safety must govern the level of supervision available.
Educational supervision Every trainee must have a nominated educational supervisor to oversee individual learning.

Clinical supervision by SAS grades When clinical supervision of a trainee is being provided by a SAS grade doctor, the trainee must always have unimpeded access to a named consultant.
Clinical supervision of one trainee by another Clinical supervision of one trainee by another occurs and senior trainees must learn how to do this safely and effectively. A junior trainee may refer to a more senior trainee as the first line of advice and assistance. However, both trainees must be subject to supervision from a designated consultant.
Clinical teaching The placement of a trainee with a consultant is always a teaching opportunity even if it is primarily required for patient safety. Consultants must work with trainees both to teach them and to assess their competence on a daily basis. This experience is best described as clinical teaching to distinguish it from pairings that occur for reasons of safety (clinical supervision) though all direct clinical supervision is also clinical teaching.

2.7 Out of hours cover for emergency services

Out of hours work for trainees largely involves providing services for emergencies. Such out of hours work makes different demands upon the trainee. Whenever trainees are learning new aspects of emergency work they must have close clinical supervision.
The service requirements of hospitals, however, may necessitate trainees undertaking more out of hours emergency cover than is needed for their training. A balance therefore must be maintained between the service and training requirements of out of hours work; service must not undermine the necessity for training out of hours. This must be reviewed by evaluating the whole training scheme; out of hours emergency work must not prevent the trainee from meeting the standards of the agreed competences on schedule. Out of hours duties apply pro rata (weekdays and weekends) to flexible trainees.

Each component specialty module is distinct and there is no place for moving out of the designated specialty module to provide service work in another area.

2.8 Simulators

The ICACCST encourages the use of simulators for relevant aspects of postgraduate training in acute care especially for events of high importance but infrequent occurrence, for situations where there might be a high risk to patients and for team building and working under pressure.

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