Acute care common stem core training programme
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- Appendix B
- CT3 Acute Medicine
- Academic ACCS trainees
Appendix BGuidelines for Postgraduate Deans for ACCS trainingACCS is a 3 year programme, which is overseen by the Inter-collegiate committee for ACCS training. The ICACCST is responsible for setting the standards for training, the curriculum and the assessment for ACCS training for the first 2 years. This curriculum has been approved by the GMC. ACCS has the full support of all 3 colleges (CEM, RCoA and JRCPTB) and the inter-collegiate board for ICM training. Administratively the ICBACCST is supported by the RCoA (mhumphrey@rcoa.ac.uk). Appointments to ACCS posts are currently made by the individual specialties using the HR resources of the regional deaneries. The first 2 years of ACCS training are generic and follow the same curriculum and assessment system agreed by the ICBACCST. The third year of ACCS is speciality specific and this year follows the curriculum and assessment system laid down by the parent college. Trainees are expected to nominate their intended specialty on joining the ACCS programme in order to facilitate planning of rotations and training. Those trainees that have successfully completed their first two years and wish to change to a specialty other than their original nomination can seek to do so. GMC have agreed that the competences gained in the first 2 years of training are transferable to all 3 parent specialties. However trainees will have to liaise with the local Deaneries and change will depend on availability of training posts, meeting the relevant entry requirements of that specialty for CT3 and is likely to be competitive. Information from portfolios would need to follow the trainee. A flow chart of the ACCS route of training is provided in the executive summary (page 10) It is important to note that ACCS provides the only route to HST in EM, whilst entry into AM and anaesthesia can be via other routes (CT1&2 for Anaesthesia and CMT1&2 for AM) Acute Care Common Stem (ACCS) - generic CT1&2 Most doctors entering ACCS will do so via CT1, unless they are able to enter above CT1 using the CESR CP route. Person specifications, recruitment and selection will be tailored to ensure that the most suitable candidates are appointed into generic ACCS posts. ACCS requires training and experience for one year in EM and Acute Adult Medicine (AM) and for another year in Anaesthesia and Intensive Care Medicine (ICM) during the first 2 generic training years. Trainees will then enter a third year of specialty specific training, i.e. EM, AM or Anaesthesia. The first year of ACCS training will usually include 6 months of Emergency Medicine and 6 months of Acute Medicine. In the second year of ACCS there will be a minimum of 3 months in each specialty and there is some flexibility around the amount of time spent in each post. The split within this year should ideally be 6 months and 6 months but could be 3 and 9 and this will vary according to local needs and preferences. Local solutions that work will be an important factor in implementing the acute care common stem e.g. a combined year with a rota that allows the trainee to work between an acute admitting medical assessment unit and ED might be attractive. Six months’ training in anaesthetics is likely to be required in the year split between Anaesthetics and ICM in order to gain the airway and other competences that ACCS trainee’s need. A minimum period of 3 months must be spent in each speciality in order to complete the generic 2 years. If an ACCS trainee can only spend 3/12 in anaesthesia the minimum competences required are outlined in the curriculum and must include the Initial Assessment of Competency (IAC). In this instance (i.e. 3/12 anaesthetic training) it is essential that trainees are given as much time out of their intensive care medicine training as required (which will be 9/12) to ensure they achieve these essential competencies, which are core to patient safety ACCS CT3 EM: 6/12 PEM and 6/12 EM The key objective of this year is to achieve the competences required to care for children in the ED as defined in the curriculum. The trainee should also consolidate their EM competences and be able to demonstrate the leadership skills required for entry into ST4. The preferred model for delivery of paediatric emergency medicine training would comprise 6 months experience in emergency medicine with a paediatric focus, plus additional training in acute general paediatrics/neonates. At least 3 months of this training should ideally be in a department recognised for paediatric EM sub-specialty training. The hope is that CT3 trainees could rotate into current middle grade paediatric EM posts for 3 or 6 months, or that one paediatric EM SHO post could be converted to allow 4 CT3 trainees to rotate through for 3 months each per year. Where such training opportunities are difficult to access locally the alternative would be that during the 6 months of the CT3 year with a paediatric focus, trainees work for at least 3 months in a general ED. This ED should treat around 16,000 children per year, should have recognised consultant trainer who takes the lead for paediatric issues and who can act as the educational supervisor to the trainee. There needs to be some flexibility in utilising the training opportunities available locally, so for example, where the general EM caseload plus that of a co-located acute paediatric assessment/admission unit is 16,000 per year it is likely that the clinical work will be adequate to train the doctor in an integrated programme between the two departments. Where the 6 months of the CT3 year with a paediatric focus is based solely in a general Emergency Department (ED) or in a paediatric ED, there may be a requirement to second the trainee on an individual basis to gain competence and confidence in some procedures such as paediatric airway. This might be arranged by a regular session each week, or by short attachments for focused training. The less favoured option would be for 6 months in acute in-patient paediatrics. In this case the trainee would need additional training to gain competence in the surgical and traumatic aspects of paediatric EM. This might be arranged by a regular session in an ED (that meets the requirements described above) each week, or by short block attachments for focused training there. Other sources of relevant training would be for example in paediatric fracture clinics or wards where children with head injuries are cared for. The remaining 6 months in EM should be used to consolidate the competences acquired in first two years of ACCS and develop the leadership and management skills require for progression through to ST4. CT2 Anaesthesia Satisfactory ARCPs at ACCS CT1&2 will allow the Anaesthetic trainee to enter a third year of training, which is the equivalent to CT2 Anaesthesia. During this year the trainee will be subject to the same curriculum and assessment system as trainees who have entered anaesthesia via the alternative route (see flow chart appendix C). Trainees will need to pass the part 1 of the FRCA before they are able to enter CT3 together with satisfactory ARCP outcomes. CT3 Acute MedicineACCS trainees who successfully complete ACCS CT1&2 can enter CT3 AM. The focus of this year will be to ensure further experience in acute medical specialties. This should include continued experience in the acute medical take but should also include exposure to medical patients who present with illness managed by the acute medical specialties. Although attachment to an acute medical unit for at least 4 months would be recommended during this year it is recognised that experience in the acute medical take may also be obtained during Hospital at Night experience or by rotation from a medical specialty to the acute take on a rota basis. However achieved, during this year of experience, trainees will have to acquire the competences relating to the acute medicine part of the ACCS curriculum including the defined assessments. All trainees who wish to pursue a career in a medical specialty should pass the MRCP. This will be a mandatory requirement for all entrants to ST3 posts from 2011. Until then entry to ST3 can be achieved if in possession of MRCP part 1. Subsequent progression to ST4 can only be achieved if MRCP has been achieved. Academic ACCS traineesA small number of ACCS trainees may wish to develop an academic career by applying for an NTN(A) Details are available at http://www.nccrcd.nhs.uk/intetacatrain An academic clinical fellowship would under normal circumstances require a year in addition to ACCS CT1 to CT3. The need for this additional year would be the judgement of the local ARCP panel. Academic clinical lectureship would replace ST4 to ST7, leading to appointment to a Senior Lectureship. All appointments to ACF posts are currently run though programmes in the parent specialty and progression is dependant on achieving agreed academic and clinical objectives, which will be reviewed at the ARCP. 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