Acute care common stem core training programme

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Curriculum and Assessment System

May 2010


The 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



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.


Preface 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 terms

Clinical terms

AAA 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

DVT Deep vein thrombosis

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

RSI Rapid sequence induction

SpO2 Saturation of haemoglobin with oxygen

SSRI Selective serotonin receptor inhibitor

SVP Saturated vapour pressure

VSD Ventricular septal defect

WCC White cell count

Educational and organisational terms

ACCS Acute Care Common Stem

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

Curriculum sections and Assessment Method Glossary

AA Audit Assessment

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

CMP Core Major 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

GMP domain headings

GMP 1 Knowledge, skills and performance

GMP 2 Safety and quality

GMP 3 Communication, partnership and teamwork

GMP 4 Maintaining trust

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