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ACCS-Wales

Workbook

&

ARCP Record BookFor CT1 and 2 ACCS Trainees in the Welsh School

ACCS – Wales

Version 2.7 June 2014

1

Contents

Introduction 3

Who’s Who & Contact Information 4

Trainee Representatives 5

Social Media 5

ACCS Curriculum 5

Educational Supervisors 6

Looking After Yourself (Your Health) 7

Protecting Your Patients (The Francis Report) 7

ARCP Checklist 8

Personal Details 13

Common Competences 14

Major Presentations 16

Acute Presentations 17

Advice for ACCS-EM Trainees 19

Anaesthesia for ACCS 20

Practical Procedures 22

Acute Medicine Paperwork 25

Emergency Medicine Paperwork 45

Anaesthesia Paperwork 72

Intensive Care Medicine Paperwork 92

A Career in Intensive Care Medicine? 112

2

Introduction

Since the introduction of the new ACCS curriculum in May 2010 ACCS training is described under the headings of:

1. Common Competencies

2. Major Presentations

3. Acute Presentations

4. Anaesthesia in ACCS

5. Practical Procedures

Some of this training must be obtained in a particular module, but other competencies can be achieved in any of the modules, provided that all are achieved by the end of year 2. This system can make it difficult for trainees and trainers to keep track of what competencies remain outstanding, and the ACCS workbook is designed to make this process easier.

The workbook gives trainees and trainers a central document where all the required competencies and clinical procedures can be recorded, and correct paperwork identified.

Trainees should use the e-portfolio for their parent specialty; non-parent modules may be completed on e-portfolio or paper, but ACCS-EM and ACCS-Medicine trainees are encouraged to use the e-portfolio for all modules. The Anaesthesia e-portfolio only contains anaesthesia-specific forms, so anaesthetists must use paper forms for other modules. Each time the trainee completes a module within the ACCS programme a Structured Training Report (StR) should be completed by the Module Supervisor. All “paperwork” whether on e-portfolio or paper, should be summarised on the paper checklists in this workbook. Supervisors’ signatures in the workbook are not necessary – “see e-portfolio” etc is acceptable.

WPBAs including MSFs differ slightly between specialties, and should be completed using the paperwork specific to the specialty being assessed, NOT the parent specialty. Specialty-specific MSF and other WPBA forms, as well as all the specialty-specific paperwork, can be found in this workbook.

At the ARCP the trainee should submit this workbook summarising the acquired competencies, along with the paper or e-portfolio evidence. A detailed ARCP Checklist can be found on pages 8-12.

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Rachel Walpole: Training Programme Director, ACCS Wales

Who’s Who and Contact Information

Training Programme Director / Lead for ACCS Wales:

Rachel Walpole, Consultant Anaesthetist, Newport

Email: [email protected]

Specialty Leads

ACCS Lead for Anaesthesia: Rachel Walpole, Consultant Anaesthetist, Newport


ACCS Lead for Acute Medicine: Llifon Edwards, Consultant Physician, Newport


ACCS Lead for Intensive Care Medicine: Alison Ingham, Consultant Anaesthetist & Intensivist, Bangor


ACCS Lead for Emergency Medicine: Robin Roop, Consultant Emergency Medicine, Wrexham


Hospital Leads

University Hospital of Wales, Cardiff: Melvyn Jenkins-Welch, Consultant Anaesthetist


Morriston Hospital, Swansea: Dinendra Gill, Consultant Emergency Physician


Royal Gwent Hospital, Newport: Rachel Walpole, Consultant Anaesthetist


Ysbyty Gwynedd, Bangor: Alison Ingham, Consultant Anaesthetist & Intensivist, Bangor


Wrexham Maelor Hospital: Ben Thomas, Consultant Physician

4

mailto:[email protected]










Specialty Training Manager, Deanery

Ms Lisa Bassett


Trainee Representatives

There are 2 elected trainee representatives, one from CT1 and one from CT2. They represent trainees’ views at Specialist Training Committee meetings. Please contact one of them if there are issues you wish to bring to the attention of the STC.

CT2: Jonathan Lloyd-Evans (Cardiff)


CT1: will be elected in September 2014

Educational Supervision

Each department has an identified Educational Supervisor who takes responsibility for ACCS trainees (see page 6). You should contact this person before you begin the placement or as soon as possible afterwards, and arrange for an initial meeting within 2 weeks of starting in post. If you are unsure who is supervising you please email Lisa Bassett, address above.

Social Media

There is an ACCS Wales Facebook Group and Twitter account. On Facebook, please search for ACCS Wales and join the group, it is open to everyone. You are welcome to use it to share information or to put questions to other members of the group. For Twitter: follow @ACCSWales to receive information, reminders and updates.

ACCS Curriculum

The ACCS Curriculum can be found on the ACCS pages of the Welsh Deanery Website:

http://www.walesdeanery.org/index.php/en/trainees-in-training.html

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http://www.walesdeanery.org/index.php/en/trainees-in-training.html




Educational SupervisorsWrexham Lead: Ben Thomas

Anaesthesia: Venkataravan Madhavan

ITU: Mahmoud Wagih

AM: Ben Thomas

EM: Robin Roop

Swansea Lead: Dinendra Gill

Anaesthesia: Tracey Wall

ITU: Vijay Kumar

AM: Praveen Eadala

EM: Dinendra Gill

Cardiff Lead: Melvyn Jenkins-Welch

Anaesthesia: Melvyn Jenkins-Welch

ITU: Sabine Grundler

AM: Simon Barry & Andrew Freedman

EM: Susan Allen

Newport Lead: Rachel Walpole (Anaesthesia)

Anaesthesia: Helen Jewitt

ITU: Babu Muthuswamy

Acute Med: Llifon Edwards ; Cardiology: Philip Campbell; Respiratory Med: Sara Fairbairn

EM: Tim Rogerson

Nevill Hall Lead: Ed Curtis

Anaesthesia & ITU: Ed Curtis

EM: Ella Harrison-Hansley

Bangor Lead: Alison Ingham

Anaesthesia & ITU: Alison Ingham

AM: Mahdi Jibani

EM: Leesa Parkinson

6

Looking after Yourself

Medicine is a stressful profession, and Core Training can be particularly difficult because of frequent changes of post, a steep learning curve, and exam pressures.

The GMC makes clear that a good doctor looks after their own health and well-being as well as that of their patients.

If you find yourself struggling then either your Educational Supervisor or any Consultant that you feel able to talk to should be your first source of support. However if you feel unable to confide in a senior colleague, you may wish to make use of the BMA helpline; it is not necessary to be a BMA member to use it:

BMA Counselling & Doctor Adviser Service: 0845 9200169

Alternatively, Health for Health Professionals Wales offers free Psychotherapy referral to any doctor in Wales. It is a confidential service funded by the Welsh Government.

http://www.hhpwales.co.uk

Tel 0800 0582738 between 9am and 5pm Mon-Fri, calls free from a landline.

Protecting your Patients & The Francis Report

The Francis Report stressed that junior doctors have a duty to “blow the whistle” if they feel that they have witnessed poor standards of patient care. Concerns about standards should ideally be discussed with your Educational Supervisor, the College Tutor or Clinical Director. If you do not feel able to speak to any of these people, you can contact a member of the ACCS STC who works outside of your own hospital (contact details on p.4). Alternatively, the Intranet should have details of your Health Board’s Whistleblowing Policy. (It may be “Whistleblowing”, or “Raising Concerns” etc).

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http://www.hhpwales.co.uk/

ACCS ARCP ChecklistTrainees should attend with their portfolio, ACCS Workbook and the following:

Enhanced Form R: should be completed and returned at least 2 weeks in advance of the ARCP.

Absence Monitoring Declaration: this is a self-declaration of any unplanned absences since your last ARCP. You should record any absences other than Annual Leave and Study Leave. Examples of unplanned absences are Sick Leave, Maternity or Paternity Leave, Compassionate Leave, etc.

Study Leave Record: This can be printed out from Intrepid.

GMC Survey: Evidence of completion.

The portfolio requirements for ACCS ARCPs are in 2 parts:

1. Competencies that can be achieved at any point during CT1 and 2 but must be achieved by the end of CT2.

2. Competencies and evidence of satisfactory performance in each of the modules (usually 2) undertaken since the last ARCP.

CT2 trainees should present all paperwork relating to the entire 2 years of ACCS training, even if it has previously been presented at the CT1 ARCP.

Please note that an ARCP Structured Report must be presented for each module of training, even if the module is incomplete (usually a June / July ARCP for a module that ends in July).

ACCS ARCP Checklist8

Major & Acute Presentations, Practical Procedures

The following competencies must be achieved by the end of CT2.

Trainees for CT1 ARCP should have evidence that progress is being made towards achieving these competencies.

Common Competencies

At least 50% achieved to level 2 descriptors

Ref: Workbook p13

Definitions of descriptors can be found at: http://www.accs.severndeanery.nhs.uk/assets/Accs/Curriculum/CommonCompetenciesforACCSleveldescriptorscurriculumpage.docx

All 6 Major Presentations

Ref: Workbook p15; at least 2 during EM and 2 during AM.

28 Acute Presentations:

At least 20 of the 38 by WPBA: 10 during EM, 10 during AM.

8 further Acute Presentations covered by WPBAs including ACAT, or by e-learning, reflective entries, teaching and audit.

Ref: Workbook p16

39 Practical Procedures:

At least 39 of the 44. Ref: Workbook p20

ALS-Provider

Mandatory for all ACCS trainees by the end of CT2. This is in addition to a WPBA for Cardiorespiratory Arrest (see Major Presentations).

EM Trainees must be APLS and ATLS-Providers (or equivalent) by the end of CT3.

ACCS ARCP Checklist9

http://www.accs.severndeanery.nhs.uk/assets/Accs/Curriculum/CommonCompetenciesforACCSleveldescriptorscurriculumpage.docx


Individual Module RequirementsAnaesthesia

o ARCP Structured Report

o Initial Assessment of Competency Certificate (IACC)o All required WPBAs are incorporated into the IACC

o A Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)o Copy of Logbooko Educational Agreement

Intensive Care Medicineo Educational Supervisor’s Report

o Logbook

o 6 x Directly Observed Procedural Skills (DOPS)

o 4 x Case Based Discussions (CBD)

o 3 x Clinical Evaluation Exercises (CEX)

o Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)

WPBAs Should Include:

o 2 of the 6 Major Presentations: CBD or CEX (formative)

o Sepsis is suggested

ACCS ARCP Checklist

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Acute Medicine

o Educational Supervisor’s Report

o Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF) o Educational Agreement

WPBAs:

o 3 x Acute Care Assessment Tools (ACAT)

o 3 x Case Based Discussions (CBD)

o 3 x Clinical Evaluation Exercises (CEX)

o 5 x Directly Observed Procedural Skills (DOPS)o A different 5 from those assessed in EM


o 2 of the 6 Major Presentations: CBD or CEX (formative)

o 10 of the 38 Acute Presentations: CBD, CEX or ACAT (formative)

Please note that Multiple Consultant Reports (MCRs) are not required for ACCS, though ACCS-Medicine trainees may choose to do them.

ACCS ARCP ChecklistEmergency Medicine

11

o Structured Training Report

o Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)o Training Agreemento Logbook

WPBAs:

o 1 x Acute Care Assessment Tools (ACAT)o 3 x Case Based Discussions (CBD)o 4 x Clinical Evaluation Exercises (CEX)o 5 Directly Observed Procedural Skills (DOPS) using specific forms; these

5 are suggested: Airway maintenance Primary Survey in Trauma Wound Management Fracture or Joint Manipulation 1 other of the 44 listed practical procedures not covered

elsewhere (list below)


o 2 of the 6 Major Presentations: summative* CBD or CEX; must be Consultant assessment.

o 5 of the 38 Acute Presentations, summative* CBD or CEX; must be Consultant assessment, these 5 are suggested:

Abdominal Pain Breathlessness Chest Pain Head Injury Mental Health

o 5 further Acute Presentations, ACAT (formative*)

*A summative assessment has a pass/fail outcome and must be assessed by a Consultant. A formative assessment is not a pass or fail assessment and can be performed by any appropriate person.

Personal Details

Trainee’s Name

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GMC Number

ACCS Parent Specialty

College Training Number

Base Hospital(s)

Parent Specialty Supervisor*

Module 1 Specialty / Dates

Module 1 Clinical Supervisor**


Module 2 Clinical Supervisor**

Year 1 ARCP Date Outcome


Module 3 Supervisor**


Module 4 Supervisor**

Year 2 ARCP Date Outcome

*Parent Specialty Supervisor is a Consultant in the base hospital from the trainee’s parent specialty. This person provides continuity of support over the 3-year programme, and is a source of careers advice, exam support etc.

**Module supervisor (Also known as Clinical Supervisor) is the person responsible for the trainee during that module and will be the person completing the Structured Training Report at the end of that specific module with the trainee.

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COMMON COMPETENCES

Many of these competences are an integral part of clinical practice and as such will be assessed concurrently with the clinical presentations and procedures assessments. Trainees should use these assessments to provide evidence that they have achieved the appropriate level. Descriptors of required performance at each level can be found at:


For a small number of common competences alternative evidence should be used, e.g. assessments of audit and teaching, completion of courses, management portfolio. At least 50% of Common Competences should be signed off by the end of the CT2 ACCS year.

Competency Level achieved (Sign and date)1 2 3 4

1) History taking

2) Clinical examination

3) Therapeutics and safe prescribing

4) Time management and decision making

5) Decision making and clinical reasoning

6) The patient as central focus of care

7) Prioritisation of patient safety in clinical practice

8) Team working and patient safety

9) Principles of quality and safety improvement

10) Infection control

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Competency Level achieved (Sign and date)1 2 3 4

11) Managing long term conditions and promoting patient self-care

12) Relationships with patients and communication within a consultation

13) Breaking bad news

14) Complaints and medical error

15) Communication with colleagues and cooperation

16) Health promotion and public health

17) Principles of medical ethics and confidentiality

18) Valid consent

19) Legal framework for practice

20) Ethical research

21) Evidence and guidelines

22) Audit

23) Teaching and training

24) Personal behaviour

25) Management and NHS structure

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MAJOR PRESENTATIONS

These are seen as the cornerstone of the clinical skills of ACCS trainees and they should all be signed off by the end of the second year. 2 must be completed during the Emergency Medicine module and must be assessed by a Summative Assessment by a Consultant using either a CbD or mini-CEX specifically designed for Summative Assessment (Curriculum pages 221 & 225). 2 will be assessed in the Acute Medicine module and the other 2 can be done in any of the modules, but it is recommended that the Septic Patient should be signed off in the Intensive Care Medicine module.

Anapylaxis and Cardiorespiratory Arrest may be simulated – BUT an ALS Course is not a substitute for either of these. The knowledge, skills and behaviours to be achieved for each presentation are listed in the curriculum pp 75– 84.

Presentation ACCS Module AM/EM/ICM/An

Date Modular (Clinical) supervisor

1) Anaphylaxis

2) Cardiorespiratory Arrest

3) Major Trauma

4) Septic Patient

5) Shocked Patient

6) Unconscious Patient

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ACUTE PRESENTATIONS

There are 38 Acute Presentations (APs). 10 should be signed off during the AM module, and 10 during the EM module. At least 8 further APs should be covered by ACAT, e-learning, reflective entries, teaching and audit. There are 5 APs that require the trainee to complete specific summative WPBA during the EM module (see table). Up to 5 APs can be covered by a single ACAT in either EM or AM. The knowledge, skills and behaviours required for each presentation are listed in the curriculum pp86-140.

Presentation ACCS Module AM/EM/ICM/

An


1) Abdominal Pain including loin pain

EM

2) Abdominal Swelling, Mass & Constipation

3) Acute Back Pain

4) Aggressive/disturbed behaviour

5) Blackout/Collapse

6) Breathlessness EM

7) Chest Pain EM

8) Confusion: Acute/Delirium

9) Cough

10) Cyanosis

11) Diarrhoea

12) Dizziness and Vertigo

13) Falls

14) Fever

15) Fits / Seizure

16) Haematemesis & Melaena

17) Headache

18) Head Injury EM

19) Jaundice 17

20) Limb Pain & Swelling – Atraumatic

21) Neck pain

22) Oliguric patient

23) Pain Management

24) Painful ear

25) Palpitations

26) Pelvic pain

27) Poisoning

28) Rash

29) Red eye

30) Suicidal ideation / Mental health

EM

31) Sore throat

32) Syncope and pre-syncope

33) Traumatic limb and joint injuries

34) Vaginal bleeding

35) Ventilatory Support

36) Vomiting & Nausea

37) Weakness & Paralysis

38) Wound assessment and management

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Advice for ACCS-EM Trainees: Prepare now for your CT3 ARCP!

The ACCS Curriculum covers CT1-2 but it is worth anticipating the requirements for CT3 as it is much easier to get the competencies signed off as you see them rather than trying to “chase” then later.

By the end of CT3 you will need the following:

All 6 Major Presentations by Summative WPBA assessed by a Consultant:

Anaphylaxis and Cardiorespiratory Arrest may be assessed by simulation ALS-Provider status is not a substitute for this assessment

All 38 Acute Presentations:

20 of these to be covered by WPBA during CT1-2 as detailed on p17 of this Workbook.

The remaining 18 to be covered by WPBA or by e-learning, reflection, teaching etc o 8 by the end of CT2o And all 18 by the end of CT3

NB: The e-learning modules are designed to help you pass MCEM; another reason not to leave them for CT3.

All 45 DOPS:

39 by the end of CT2 as detailed on p21 of this Workbook. All 45 by the end of CT3.

o Pacing and Cardioversion made by assessed by simulation.

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ANAESTHESIA FOR ACCS

Within the ACCS anaesthesia module the trainee must achieve the Initial Assessment of Competence (IAC).

The 17 WPBAs that make up the IAC are listed under Practical Procedures (see next section).

Date Signature and name of supervisor

Initial Test of competency passed

20

PRACTICAL PROCEDURES

There is a list of 44 Practical procedures in the ACCS Curriculum; 39 should be completed by the end of the second year. Some procedures and their assessment are specific to certain elements of the ACCS programme and a specific type of WPBA has been recommended: these have been indicated in brackets using the key below. These include the 17 that are associated with the Anaesthetic Initial Assessment of Competence.

Mi, A = Mini-CEX(Anaesthetic), D = DOPs, C = CBD

Practical procedures ACCS Module

WBA type


1. Arterial cannulation ICM (D)

2. Peripheral venous cannulation

ICM (D)

3. Central venous cannulation

ICM (D)

4. Arterial blood gas sampling

ICM (Mi,D)

5. Lumbar puncture

6. Pleural tap and aspiration

7. Intercostal drain: Seldinger

8. Intercostal drain: Open

9. Ascitic tap

10. Abdominal paracentesis

11. Airway protection EM (D)

12. Basic and advanced life support

Anaes (D)

13. DC Cardioversion

22

14. Knee aspiration

15. Temporary pacing (external/ wire)

16. Reduction of dislocation/ fracture

EM (D)

17. Large joint examination

18. Wound management EM (D)

19. Trauma primary survey EM (D)

20. Initial assessment of the acutely unwell

21. Secondary assessment of the acutely unwell

22. Connection to a mechanical ventilator

ICM (D)

23. Safe use of drugs to facilitate mechanical ventilation

ICM (C)

24. Managing the patient fighting the ventilator

ICM (C)

25. Monitoring Respiratory function

ICM (C)

Anaesthesia Initial Assessment of Competence (IAC) - as listed below from Preoperative assessment to Emergency surgery

26. Preoperative assessment Anaes (A)

27. Management of spontaneously breathing patient

Anaes (A)

28. Administer anaesthesia for laparotomy

Anaes (A)

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29. Demonstrate RSI Anaes (A)

30. Recover patient from anaesthesia

Anaes (A)

31. Demonstrate function of anaesthetic machine

Anaes (D)

32. Transfer of patient to operating table

Anaes (D)

33. Technique of scrubbing up and donning gown and gloves

Anaes (D)

34. Basic competences for pain management

Anaes (D)

35. Patient Identification Anaes (C)

36. Post op N&V Anaes (C)

37. Airway assessment Anaes (C)

38. Choice of muscle relaxants and induction agents

Anaes (C)

39. Postoperative analgesia Anaes (C)

40. Postoperative oxygen therapy

Anaes (C)

41. Emergency surgery Anaes (C)

42. Safe use of vasoactive drugs and electrolytes

ICM (Mi,C)

43. Deliver a fluid challenge safely to an acutely unwell patient

ICM (C)

44. Describe actions required for accidental displacement of tracheal tube or tracheostomy

ICM (C)

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Acute Medicine Paperwork

Contents of this section:

Structured Training Report form (to be completed at the end of the module)

Induction Appraisal Form (to be completed at the start of the module) ACAT Form DOPS form MiniCEX form CbD form MSF Guidelines MSF form MSF Results Summary

Please note that Multiple Consultant Reports (MCRs) are not required for ACCS, though ACCS-Medicine trainees may choose to do them.

Recommended Reading / Useful Websites:

The Oxford Handbook of Acute Medicine

And / or

The Oxford Handbook of Clinical Medicine

Each £25-£30 available on Amazon

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Structured Training Report for Acute Medicine Module

The clinical/modular supervisor must complete this STR, having reviewed the trainee’s learning portfolio and WPBAs. Alternatively please substitute a print out of the STR from the Medicine e Portfolio.

Current Placement

Base Hospital/Department

Dates

Clinical supervisor

WPBA in Current Placements

Assessment Number Comments

Mini-CEX

(min 3 in 6 months)

DOPs

(min 5 in 6 months)

List procedures included in DOPs and ensure they are signed off in Practical procedures

CBD

(min 3 in 6 months)

ACAT

(min 3 in 6 months)

MSF

Experiential outcomes (please review evidence in learning portfolio)

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Comments

Major Presentations (at least 2 out of 6)

Acute Presentations: WPBAs (at least 10 of the 38)

Acute Presentations: ACAT, e-learning, Reflective Entries, Teaching, Audit (at least 8 of the 38)

Log book

Clinical Governance/Audit

Exams / Other Educational Achievements

Life Support Courses

Other Courses

27

Other Achievements

Other outcomes to be considered that may not be in the learning portfolio. (e.g. Critical Incidents, Complaints)

Summary of Trainees Assessment

Supervisor to complete. Please attach evidence if available to support opinions or give examples of behaviours.

Pen Picture of Trainee:

Clinical

Professionalism

Communication

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Strengths of Trainee

Academic Endeavour/Learning

I confirm that this is an accurate description/summary of this trainee’s learning

Portfolio and WPBA, covering the period from ………………..to ……………….

Supervisor Name and Signature Trainee Signature

Date: Date:

Induction Appraisal Form (ACCS Acute Medicine Attachment)

Trainee:

Meeting Date:

Timetable of regular weekly fixed commitments eg ward rounds, clinics, etc

DAY AM PM Teaching etcMonday:

Tuesday:

Wednesday:

Thursday:

Friday:

Out of hours work:

29

Suggestions for improvement

Arrangements for senior review of admissions:

Are there any other induction considerations to be taken into account? e.g. duties of the placement(s); arrangements for clinical supervision; academic and welfare support:

What are the objectives for the trainee, for the ACCS curriculum? What evidence will be used to ensure these objectives have been met?

Main Curriculum Objectives and Evidence of Achievement:

These are documented fully in the ACCS handbook, but by the end of the attachment the trainee must be able to provide a minimum of:-

3 x Acute Care Assessment Tools (ACAT)

3 x Case Based Discussions (CBD)

3 x Clinical Evaluation Exercises (CEX)

5 x Directly Observed Procedures (DOPS)

A Multi-Source Feedback: 360o Team Assessment of Behaviour (MSF)

Completed Workplace Assessments

In addition:-

- Assessments must include Acute Coronary Syndrome.

- Should aim to see as many of the “top 20 presentations” as possible.

Top 20 Acute Presentations:

Abdominal Pain*

Acute Back Pain

Blackout / Collapse

Vomiting / nausea

Weakness / paralysis

Breathlessness*

Chest Pain* Confusion Cough Diarrhoea

30

Falls Fever Headache Rash Palpitations

Fits/ Seizure Poisoning Limb Pain/swelling

Jaundice Haematemesis / Melaena

* These presentations are required to be assessed during the EM module and so cannot count towards the 10 required for AM.

Generic Competencies: These are as documented in the ACCS handbook.

What learning methods will be used to meet these objectives? Is any study leave planned?

Are there any training concerns at this stage?

Supervisor's Signature Trainee’s Signature

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Acute Care Assessment Tool (ACAT) InstructionsACAT Instructions:

A different observer for each assessment

Observers can be any doctor from SpR grade and above, who was responsible for the supervision of the take you are being assessed on

The process is trainee led (choosing the take period)

An ACAT should take no longer than 15 minutes, and this includes the feedback given over the different sections of the ACAT assessment forms

The completed ACAT forms should be entered onto the trainee’s ‘e’ portfolio.

Clinical assessmentQuality of History and Examination to arrive at appropriate differential diagnoses

Medical record keepingQuality of recording of patient encounters on the take, and including drug and fluid prescriptions

Investigations and referrals

Quality of a trainee’s choice of investigations, and referrals over a take period

Management of critically ill patient

Quality of treatment given to critically ill patients encountered on the take (assessment, investigations, urgent treatment administered, involvement of appropriate colleagues including senior)

Time management

Prioritisation of cases and issues within the take, ensuring sickest patients seen first and the patient’s most pressing issues are dealt with initially.

Recognition of the quality of a colleague’s initial clerking to inform how much further detail is needed. A full repeat clerking is not always needed by a more senior doctor.

Management of Take / Team working

Appropriate relationship with and involvement of other health professionals

Clinical leadership Appropriate delegation and supervision of junior staff.

Handover

Quality of the handover of care of patients from the take to the relieving team. If patients have been transferred to a different area of care then this applies to the quality of the handover to the new team.

OVERALL CLINICAL JUDGEMENT

Quality of the trainee’s integrated thinking based on clinical assessment, investigations and referrals resulting in the patients’ management plan

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RCP Guidelines for completing a MSF assessment

Dear Colleague, Name of ‘Rater’: Please write name of ‘rater’ he r e

The Royal Colleges of Physicians (UK) are now using multisource feedback (MSF),otherwise known as 3600 assessment, to assess doctors in training. MSF assessment is a method of assessing generic skills such as communication, leadership, team working, teaching, punctuality and reliability. This allows objective systematic collection and feedback of performance data on an individual, which is derived from a number of stakeholders in theirperformance. This assessment method has been shown, in a UK pilot study, to provide areliable rating of an individual doctor. ‘Raters’ are people with whom the doctor being assessed works and this includes nurses, other doctors, secretaries and other clerical staff and other allied health professionals. The data from 20 ‘raters’ forms is put together to provide the doctor with structured feedback about their performance.

You have been asked to assess: Please write name of doctor to be assessed here

What is required of you?

1. You have been selected by the trainee or their educational supervisor to assess the trainee.

2. We would be grateful if you would complete the accompanying form about the trainee. MSF is used to assess the behaviour, team working and communication skills of trainees. It is NOT an assessment of knowledge or practical skills.

3. Ordinarily the trainee will not be able to identify you and will not see your individual responses. The trainee’s educational supervisor will collate the information from all of the MSF assessments onto a single summary form, which will be used to give the trainee feedback. Trainees will not normally see any individual responses/forms or scores. In the event of a legal challenge the Data Protection Act may allow the information to be released, but should not be released until the legal process has run its course.

4. Please score the trainee from 1 (extremely poor) to 9 (extremely good). A score of 1-3 would be considered unsatisfactory, 4-6 satisfactory and 7-9 would be considered above that expected, for a trainee at the same stage of training and level of experience. You must justify each score of 1-3 with at least one explanation/example in the comments box, failure to do so will invalidate the assessment. If you feel unable to comment on an aspect you may mark the ‘Don’t know’ box.

5. If you feel, for whatever reason, that the trainee doctor falls below what you believe to be a minimum standard for a qualified doctor who is training to be a consultant it is important for you to make this clear on the form.

6. If you have had insufficient contact with the trainee to assess certain aspects then please fill in the ‘Don’t know’ box.

7. Please make written comments to supplement or explain your scoring if you think this may be helpful, you must do this for all scores of 1-3. Please write clearly.

8. When you have FULLY completed the form please return it in the envelope providedto the trainee’s educational supervisor, NOT the . This process will be conducted sensitively and carefully so you should feel free to give honest answers to questions,as this is fundamental to the success of the process.

© 2008 Royal Colleges of Physicians - modified for use in Wales39

Ho w to co mple te the form

Your completed form will be scanned to enable a quick and accurate analysis of results, to aid this process please keep the following in mind:

1. Try not to fold your form2. Only use pens with black or dark blue ink & print firmly3 Only write in allocated areas on the form - if you have any additional comments please

use a separate sheet of paper4. For optimum accuracy print in capital letters / numbers (where applicable) and avoid

contact with the edge of the box. For example:

A B C D E F G H I J K L M N O P 1 2 3 4 5 6 7 8 9

5. Shade circles like this:

Mark any mistakes made like

Please det a ch the completed MSF assessment form and put it in the envelope provided, seal it, and either hand it to the educational supervisor or put it in the internal post to them. Do NOT give the completed form directly to the trainee .

Thank you for your help.

© 2008 Royal Colleges of Physicians - modified for use in Wales

RCP MSF feedback and summary form of trainee’s scoresThis form is to be completed by the educational supervisor at the end of the 6 month

module

Name of trainee: Trainee’s GMC number:

Educational supervisor’s name:

Medicine Attachment:

Form to be completed by the educational supervisor before meeting with the trainee:

Items Number of “raters” who scored item

Range of “raters” scores

Mean “raters”

score

Self score Any score of 1-3 or “Yes”for item 6?

Attitude to staff

Attitude to patients

Reliability and Punctuality

Communication skills: patients

Communication skills: colleagues

42

Honesty and integrity, do you have any concerns?

Team player skills

Leadership skills

Overall professional Competence

Grade of “raters”

Comments from “raters”

43

Future recommendations for training:

Signature: Date:

Trainee

Educational Supervisor

44

Emergency Medicine Paperwork



Training Agreement Personal Development Plan MSF Form DOPS form Formative CbD form Summative CbD form Formative MiniCEX form Summative MiniCEX form ACAT-EM form


The Oxford Handbook of Emergency Medicine

£25-£30, available on Amazon and elsewhere

45

College of Emergency MedicineStructured Training Report for ACCS EM CT1

The Educational Supervisor must complete this STR, having reviewed the trainee’s e-portfolio

Trainees Name and GMC Number

Educational Supervisor name

and GMC Number

Deanery / School Wales

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates

ARCP decision tool for EM CT1

Assessments and number required Number completed

Outcome Comments

Common Competences CC 1-25

At least 50% to level 2 in CT1&2

Please see section below

Core Major Presentations Adult (CMP1-6)

2/6 summative in EM CT1

Core Acute Presentations CAP Adults 1-38

5/38 summative in CT1, in specified topics

X1 ACAT-EM covering 5/38 APs

Additional 10/38 using ACAT, e-learning etc

Adult Practical Procedures = 45

5 EM DOPs required (4 specified + additional)

Min assessments in EM CT1 = 13

2 MPs, 5 APs, 1 ACAT, 5 DOPs

Management and leadership

46

Examinations = MCEM A (not mandatory)

Safeguarding Children Level 1&2 (not mandatory)

ALS-Provider

Experience 800 patient in 6/12 EM

Please review trainees log book or equivalent*

MSF

Other outcomes to be considered

Activity Date Outcome Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence from the post, include sick leave

Out of programme time, but not annual leave

* trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas, e.g. resus, majors, paeds or minors

47

Common Competencies progression

Completion of the EM WPBA tools on the e-portfolio will automatically populate the trainee’s common competences framework. Using this framework and knowledge of the trainees competence against the common competency curriculum the following table should describe the level at which the trainee is working at present i.e. level 1-4.

DomainCompetence

level 1-4Comments (if any)

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical practice

Team working and patient safety

Principles of quality and safety improvement

Infection control

Managing long term conditions and promoting patient self-care

Relationships with patients and communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and cooperation

48

Health promotion and public health

Principles of medical ethics and confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure

Strengths of trainee

Weaknesses of trainee

Suggestions for development

Issues not covered elsewhere

Does the ES recommendation to ARCP panel for this trainee to progress to next stage of training Yes No

If no, reasons why and specific areas that need to be addressed

ES Name and Signature Trainee Signature

Date: Date:

49

Training Agreement for ACCS EM and Non-EM Trainees

This is a training agreement between the CT1/2 trainees and their educational supervisors in

the emergency department.

Training agreement declaration

As a trainee

I understand and agree that I shall attend/complete the following training requirements during

my placement in the ED:

Develop a personal educational plan with my educational supervisor at the start of my

placement.

Read the curriculum produced by the College of Emergency Medicine (CEM)

Complete the required Workplace based assessments: Summative assessments should

only be completed by Consultants or Associate Specialists. Formative assessments may

be completed by registrars as well as consultants.

1. 2 Summative Assessments (Mini-CEX OR CBD) by a Consultant on 2 of the Major

Presentations using the specific summative Mini-CEX or generic summative CBD

forms.

2. 5 Summative Assessments on the following 5 Acute Presentations (Chest Pain,

Abdominal Pain, Mental Health, Head Injury, Breathlessness) using the specific

summative Mini-CEX or generic summative CBD forms and completed by

Consultants.

3. The above assessments will consist of a minimum of 4 Mini-CEX and 3 CBDs.

4. 1 x ACAT-EM which may cover up to 5 additional Acute Presentations (not including

the 5 specified in point 2)

50

5. 5x DOPS (using specific DOPs forms to include Airway, Wound management,

Primary Survey in trauma, Joint or fracture manipulation + one other from ACCS list

of practical procedures)

6. 10 additional assessments of acute presentations using a combination or

■ e-learning■ reflective entries■ teaching and audit assessments

additional ACAT-EMs7. 1 x MSF (minimum of 10 to include 3 Consultants)

Participate fully in the educational programme of the ED and be prepared to spend some

of my own time on educational activities, including audit

Complete promptly all training and assessment documentation, including my Portfolio of

evidence and log book; and participate as required in assessment meetings, i.e. ARCP

I understand that it is my responsibility to:

Familiarise myself with the training programme

Ensure that I request study time in good time and complete the relevant trust leave

form/online request so that suitable arrangements can be made within the ED

Arrange my 3 meetings and sign off (Structured Training Form) with my educational

supervisor

As a trainer I understand and agree that:

The trainee is working with a ACCS focus in the ED with appropriate supervision

I will do my best to see that the trainee receives all the support which will enable them to

train successfully

I will develop a personal educational plan with my trainee at the start of his/her

placement. This plan will take into account their current training needs and the time and

resources available

I will meet with the trainee on at least 3 separate occasions, at the beginning, mid point

and end of their placement for appraisal

I will complete a structured training report prior to the trainee's ARCP

51

Trainee's name and signature:

Trainer's name and signature:

Date:

52

Personal Development Plan

Trainee name: Training number:

What development needs and goals do I have?

Explain the need and goal

How will I address them?

Explain the action you intend to take & what resources you

will need

Date by which I plan to achieve the goal Date agreed for

achieving the goal

The outcome

How will you show that you have achieved the goal?

Completed Completion agreed by

Your supervisor

(date & sign)

COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)

This form is completely anonymous.

Trainee name:

Grade of assessor: Date / /

UNKNOWN 1 2 3 4 5

Not Observed

Performance

Does Not Meet Expectations

Performance Partially Meets

Expectations

Performance

Meets

Expectations

Performance Exceeds Expectations

Performance Consistently Exceeds

Expectations

Good Clinical Care 1-5 or UK Comments

1 Medical knowledge and clinical skills

2 Problem-solving skills

3 Note-keeping – clarity; legibility and completeness

4 Emergency Care skills

Comments on this doctors clinical care

Relationships with Patients 1-5 or UK

1 Empathy and sensitivity

2 Communicates well with all patient groups

3 Treats patients and relatives with respect

4 Appreciates the pyscho-social aspects of patient care

5 Offers explanations

Comments on this doctors relationships with patients

Relationships with Colleagues 1-5 or UK

1 Is a team-player

2 Asks for others’ point of view and advice

3 Encourages discussion Empathy and sensitivity

4 Is clear and precise with instructions

5 Treats colleagues with respect

6 Communicates well (incl. non-verbal communication)

7 Is reliable

8 Can lead a team well

9 Takes responsibility

10 “I like working with this doctor”

Comments on this doctors relationships with colleagues

Teaching and Training 1-5 or UK

1 Teaching is structured

2 Is enthusiastic about teaching

3 This doctor’s teaching sessions are beneficial

4 Teaching is presented well

5 Uses varied teaching skills

Comments on this doctors teaching and training skills

Global ratings and concerns 1-5 or UK

1 Overall how do you rate this Dr compared to other ST1 Drs

2 How would you rate this trainees performance at this stage of training

3 Do you have any concerns over this Drs probity or health?

General comments

55

COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)

Trainee name:

Summary of Responses Date / /

UNKNOWN 1 2 3 4 5

Not Observed

Performance

Does Not Meet Expectations

Performance Partially Meets

Expectations

Performance

Meets

Expectations

Performance Exceeds Expectations

Performance Consistently Exceeds

Expectations

Good Clinical Care 1 2 3 4 5 UK Comments

1 Medical knowledge and clinical skills

2 Problem-solving skills

3 Note-keeping – clarity; legibility and completeness

4 Emergency Care skills

Comments on this doctors clinical care

Relationships with Patients 1 2 3 4 5 UK Comments

1 Empathy and sensitivity

2 Communicates well with all patient groups

3 Treats patients and relatives with respect

4 Appreciates the pyscho-social aspects of patient care

5 Offers explanations

Comments on this doctors relationships with patients

56

Relationships with Colleagues 1 2 3 4 5 UK Comments

1 Is a team-player

2 Asks for others’ point of view and advice

3 Encourages discussion Empathy and sensitivity

4 Is clear and precise with instructions

5 Treats colleagues with respect

6 Communicates well (incl. non-verbal communication)

7 Is reliable

8 Can lead a team well

9 Takes responsibility

10 “I like working with this doctor”

Comments on this doctors relationships with colleagues

Teaching and Training 1 2 3 4 5 UK

1 Teaching is structured

2 Is enthusiastic about teaching

3 This doctor’s teaching sessions are beneficial

4 Teaching is presented well

5 Uses varied teaching skills

Comments on this doctors teaching and training skills

Global ratings and concerns 1 2 3 4 5 UK

1 Overall how do you rate this Dr compared to other ST1 Drs

2 How would you rate this trainees performance at this stage of training

3 Do you have any concerns over this Drs probity or health?

General comments

57

Summarised by: ………………………………………………………………………. Educational Supervisor

College of Emergency MedicineDirect Observation of procedural Skills – DOPs

Trainee name:

Assessor: Assessor GMC No:

Grade of assessor: Date / /Procedure observed (including indications)

Please TICK to indicate the standard

of the trainee’s performance in each

area

Not observ

ed

Further core

learning needed

Demonstrates good practice

Demonstrates excellent practice

Must address learning points

highlighted below

Should address learning points

highlighted below

Indication for procedure discussed with assessor

Obtaining informed consent

Appropriate preparation including monitoring, analgesia and sedationTechnical skills and aseptic technique

58

Situation awareness and clinical judgement

Safety, including prevention and management of complications

Care /investigations immediately post procedure

Professionalism, communication and consideration for patient, relatives and staff

Documentation in the notes

Completed task appropriatelyThings done particularly well

Learning points

Action points

Assessor Signature: Trainee Signature:

59

College of Emergency Medicine

Formative Case Based Discussion CbD Trainee name:

Assessor:GMC assessor No:


Case discussed (brief description) Presentation – please see curriculum for number

Please TICK to indicate the standard of the

trainee’s performance in each area

Not observed

Further core

learning needed


Demonstrates excellent practice


highlighted below


highlighted below

Record keeping

Review of investigations

Diagnosis

Treatment

Planning for subsequent care (in patient or discharged patients)

Clinical reasoning

Patient safety issues

Overall clinical care

60

Things done particularly well

Learning points

Action points



61

Summative Case Based Discussion CbD Trainee name:

Assessor:GMC assessor No:


Case discussed (brief description) Presentation – please see curriculum for number

Expected behaviours

Succ

essf

ul

Unsu

cces

sful No

t ob

serv

ed

Record keeping Records should be legible and signed. Should be structured and include provisional and differential diagnoses and initial investigation & management plan. Should record results and treatments given.

Review of investigations Undertook appropriate investigations. Results are recorded and correctly interpreted. Any Imaging should be reviewed in the light of the trainees interpretation

Diagnosis The correct diagnosis was achieved with an appropriate differential diagnosis. Were any important conditions omitted?

Treatment Emergency treatment was correct and response recorded. Subsequent treatments appropriate and comprehensive

62

Planning for subsequent care (in patient or discharged patients)

Clear plan demonstrating expected clinical course, recognition of and planning for possible complications and instructions to patient (if appropriate)

Clinical reasoning Able to integrate the history, examination and investigative data to arrive at a logical diagnosis and appropriate treatment plan taking into account the patients co morbidities and social circumstances

Patient safety issues Able to recognise effects of systems, process, environment and staffing on patient safety issues

Overall clinical care The case records and the trainees discussion should demonstrate that this episode of clinical care was conducted in accordance with good clinical practice and to a good overall standard

Overall Successful

Unsuccessful

If more than two “not observed” then unsuccessful


63

Learning points

Action points


College of Emergency MedicineFormative Mini-Clinical Evaluation Exercise - Mini-CEX

Trainee name:

Assessor: Assessor GMC no.

Grade of assessor: Date / /Case discussed (brief description) Presentation – please see curriculum

for number

64

Please TICK to indicate the standard

of the trainee’s performance in each

area

Not observed

Further core

learning needed


Demonstrates

excellent practice


highlighted below


highlighted below

Initial approach

History and information gathering

Examination

Investigation

Clinical decision making and judgment

Communication with patient, relatives, staffOverall plan

Professionalism

65


Learning points

Action points


66

College of Emergency MedicineSummative Mini-Clinical Evaluation Exercise - Mini-CEX

Trainee name:


Grade of assessor: Date / /Case discussed (brief description) Presentation – please see curriculum for

number

Descriptors of poor performance Successful

unsuccessful

Initial approach

History and information gathering

History taking was not focused Did not recognise the critical symptoms, symptom

patterns Failed to gather all the important information from

the patient, missing important points Did not engage with the patient Was unable to elicit the history in difficult

circumstances- busy, noisy, multiple demandsExamination Failed to detect /elicit and interpret important

physical signs Did not maintain dignity and privacy

Investigation Was not discriminatory in the use of diagnostic tests

Clinical decision making and Did not identify the most likely diagnosis in a given

67

judgment situation Did not construct a comprehensive and likely

differential diagnosis Did not correctly identify those who need admission

and those who can be safely discharged. Did not recognise atypical presentation Did not recognise the urgency of the case Did not select the most effective treatments Did not make decisions in a timely fashion Decisions did not reflect clear understanding of

underlying principles Did not reassess the patient Did not anticipate interventions and slow to respond Did not review effect of interventions

Communication with patient,

relatives, staff

Communication skills with colleagues Did not listen to other views Did not discuss issues with the team Failed to follow the lead of others when appropriate Rude to colleagues Did not give clear and timely instructions Inconsiderate of the rest of the team Was not clear in referral process- was it for opinion,

advice, or admissionCommunication with patients Did not elicit the concerns of the patient, their

understanding of their illness and what they expect Did not inform and educate patients/carers Did not encourage patient involvement/ partnership

in decision making Did not respect confidentiality Did not protect the patients dignity Insensitive to patients opinions/hopes/fears Did not explain plan and risks in a way the patient

68

could understandOverall plan Was slow to progress the case

Professionalism Did not ensure patient was in a safe monitored

environment Did not anticipate or recognise complications Did not focus sufficiently on safe practice Did not follow published standards guidelines or

protocols Did not follow infection control measures Did not safely prescribe

Overall Successful

Unsuccessful (this outcome if any one criteria unsuccessful


Learning points

Action points



69

The Acute Care Assessment Tool (ACAT-EM) form

Trainee name:



Setting, Acute presentations covered (5 max for EM)

Timing, duration and level of responsibility

Please TICK to indicate the

standard of the trainee’s

performance in each area

Not observed

Further core

learning needed


Demonstrates excellent

practiceMust

address learning points

highlighted below


highlighted below

Clinical Assessment

Medical record keeping

Investigation and treatment of the critically ill patient

Time management

Management of the team

Clinical leadership

70

Patient safety

Handover

Overall Clinical Judgement

Which aspects were done well Learning points

Unsatisfactory acute presentation? – which

Plan for further AP assessment, specify WPBA tool and review date

Trainees Comments Action points


ACAT –EM

Assessment Description

71

Domains

Clinical assessment and clinical topics covered

Quality of history and examination to arrive at appropriate diagnosis- made by direct observation in different areas especially in the resuscitation room.No more than 5 AP should be covered in each ACAT and this should involve a review of the notes and management plan of the patient.

Medical record keeping

Quality of recording of patient encounters including drug and fluid prescriptions

Investigations and referrals

Quality of trainees choice of investigations and referrals

Management of patients

Quality of treatment given (assessment, investigation, urgent treatment given involvement of seniors)

Time management

Prioritisation of cases , doesn’t spend too much time with any one patient

Management of take/team working

Appropriate relationship with and involvement of other health professionals

Clinical leadership

Appropriate delegation and supervision of junior staff

Handover Quality of handover of care of patients between EM and in patient teams and in house handover including obs/CDU ward

Patient safety Able to recognise effects of systems, process, environment and staffing on patient safety issues

Overall clinical judgement

Quality of trainees integrated thinking based on clinical assessment, investigations and referrals. safe and appropriate management, use of resources sensibly

72

Anaesthesia Paperwork



Learning Agreement ACCS Trainee Appraisal Record MSF Instructions MSF form MSF Summary form


The Oxford Handbook of Anaesthesiao Approx £30, available on Amazon and elsewhere.

Junior Anaesthetists of Wales (JAW) – on Facebook and Twitter Welsh School of Anaesthesia

o www.welshschool.co.uk

73

http://www.welshschool.co.uk/

Structured Training Report for Anaesthesia Module

Current Placement


Dates

Clinical supervisor

1. Basic Level Training

BASIS of Anaesthetic Practice – Please tick all completed units of training to date

Preoperative Assessment

Premedication

Induction of general anaesthesia

Intra-operative Care

Post-operative and recovery room care

Introduction to anaesthesia for emergency surgery

Management of Cardiac & Respiratory Arrest

Control of Infection

Initial Assessment of Competence signed Date:

Primary FRCA Status Date passed No. of attempts

MCQ

SOE

OSCE

Other Specialty Examinations Achieved and Dates:

74

2. Workplace based assessments tools (WPBAs) completed:

Assessment Number Summary of Comments

Anaes –CEX

DOPs

CBD

MSF Please include MSFSummary Sheet as an appendix to this report

3. Experiential Outcomes

Activity Date/s Outcomes Comment

1 Log-Book Total Cases in 6 month module:

Expected activity achieved / not achieved.

2 Audits Completed / not completed / presented

3 Research projects work in progress/completed

4 Publications

5 Teaching

6 Management

75

Development

7 Presentations

8 Courses attended

Other qualifications gained (e.g. ATLS, APLS, PGCE)

4.Other outcomes

Date/s Outcome Comment

1 Reported adverse incidents

(The PG Dean in Wales

has instructed that all

critical incidents involving

a named trainee must be

reported at their ARCP)

Resolved/pending

No case to find/

accountable

2 Complaints /

disciplinary issues/

litigation

Resolved/pending

No case to find/

accountable

3 Other

76

No. of days sick leave taken in the 6 months………………….. (Please verify with department secretary / manager)

Sections 5-8 will usually be completed by the College Tutor. The College Tutor should be guided by the results of MSF and/or other sources which will endeavour to ensure that, as far as possible, ratings are recorded objectively.

If a trainee’s performance is deemed below average or un-acceptable in the following sections, please outline how this conclusion was reached and provide supporting documentation where possible.

5. Clinical Skills - Based on MSF and other sources

Good:

Performing to expected standard

* Below average:

sometimes performance is inadequate

* Un-acceptable:

often performance is inadequate

History taking

Physical examination

Investigation & Diagnosis

Judgement & Patient Management

Practical Skills

Communications Skills

6. Knowledge (please tick the appropriate boxes)

77

Good:


* Below average:


* Un-acceptable:


Basic Science

Clinical

7. Attitudes (please tick the appropriate boxes)

Good:


* Below average:


* Un-acceptable:


Reliability

Initiative

Administration

Time Keeping

8.Relationships (please tick the appropriate boxes)78

Good:


* Below average:


* Un-acceptable:


Patients

Colleagues

Other Staff

Would you expect a satisfactory outcome for the ARCP? Y / N

If you feel the ARCP is not going to be satisfactory the Programme Director must be contacted well in advance of the ARCP interview.

Strengths of Trainee:

79

Suggestions for improvement:

Comments:

Signed by: _________________________ (Educational Supervisor) Date ________________

Signed by: _________________________ (College Tutor) Date ________________

Signed by: _________________________ (Trainee) Date ________________

80

Welsh School of Anaesthesia

LEARNING AGREEMENT

Our goal is to provide an ideal working and learning environment. Postgraduate medical education takes time and effort by the teachers and learners.

We aim to provide:

A named educational supervisor: Dr ……………………………… A comprehensive Induction Program Regular teaching in protected time Supervised operating theatre lists Appropriate clinical supervision at all times Opportunities to attend and present at journal club An adequate library, computers with internet access and other learning resources Regular constructive feedback An appraisal system Annual assessments

For your part we expect you to:

Familiarize yourself and adhere to the duties and responsibilities of a doctor registered with the General Medical Council and outlined in the Council’s document “Good Medical Practice”.

Download and familiarise yourself with the CCT in Anaesthesia document (and ACCS Core Training document if appropriate)

Download and familiarise yourself with the contents of the Gold Guide to specialty training

Familiarize yourself with the anaesthetic departments’ guidelines and protocols. Participate fully in your clinical and educational programme Be prepared to spend some of your own time on educational activities Develop and maintain a learning portfolio Book appointments for regular appraisals Be receptive to feedback and develop your personal learning plan with your

appraiser. Complete promptly all training and assessment documentation required by your

educational supervisor Seek help from your appraiser or educational supervisor if you have any problems Maintain standards of punctuality, cleanliness and appearance expected of a

healthcare professional Be responsible and considerate when booking leave

81

Trainee name:___________________________ Signature: ____________________

Date: ________________

Educational Supervisor Name:__________________Signature: _____________________

Date : ________________

Please keep the completed original form in your portfolio and give a photocopy to your Educational Supervisor.

82

WELSH SCHOOL OF ANAESTHESIA

ACCS TRAINEE APPRAISAL RECORD

Name: ………………………………………………. Parent Specialty: ……………………………………

Rotation Details:

Aug 20… – Jan 20… : ……………………………… CT1

Feb – July 20… : ……………………………… CT1

Aug 20… – Jan 20… : ……………………………… CT2

Feb – July 20… : ………………………………. CT2

Aug 20… – July 20… : ………………………………. CT Parent Specialty

Pre-ACCS experience: Dates:

………………………………………………………………… ………………

Exams passed and dates:

…………………………………. ……………..

Exam planned and date:

…………………………………. ………………

Resuscitation Training:

ALS (required for all ACCS Trainees before CT2 ARCP) Provider Instructor No Booked

APLS* (obligatory for EM only, before CT3 ARCP) Provider Instructor No Booked

ATLS* (obligatory for EM only, before CT3 ARCP) Provider Instructor No Booked

Registered with parent college Yes No Advised to

Registered with RCoA (for e-learning) Yes No Advised to

Portfolio Yes No Advised to

*or equivalent

83

Section 2: 3 month appraisal

1) Progress towards Initial Competencies:

2) Logbook review:

3) Progress towards other objectives:

3) Feedback from trainers:

4) Has attendance at teaching sessions been satisfactory?

5) Study Leave

Additional Comments:

Signed: ………………………………………. Print: ……………………..Date: ……………………

(Trainer)

Signed: ……………………………………….. Print: ……………………Date: …………………….

(Trainee)84

Section 3: 6 month appraisal1) Certificate of Initial Competencies Achieved:

2) Logbook review:

3) Results of Multi-Source Feedback:

4) Completed Assessment Tools:

DOPS (6)

AnaesCEX (2)

CbD (2)

5) Other achievements in this post:

6) Study Leave

7) Trainee Feedback

Additional Comments:

Signed: ………………………………………. Print: ……………………..Date: ……………………

(Trainer)

Signed: ……………………………………….. Print: ……………………Date: …………………….

(Trainee)

85

Welsh School of Anaesthesia

Multi Source Feedback

Instructions for Use

Assessment subject

1. Select 12 people to complete an assessment form.2. … assessors must be consultant anaesthetists, … must be anaesthetic support staff, recovery

or ITU nurses, … must be other trainee anaesthetists and one secretary.3. Ensure that each assessor is given an assessment form, an addressed reply envelope and an

instruction sheet.4. All assessment forms should be all distributed 2 weeks prior to your appraisal date.

Assessor

1. Thank you for completing this form2. Your comments will be fed back anonymously3. Please be honest and include good and bad points as necessary4. Please keep the assessment form confidential5. Please return the completed form in the attached envelope to Dr ………………………..,

Educational Supervisor, Dept. of Anaesthesia.

86

The Royal College of Anaesthetists

Multi Source Feedback (MSF) Assessment Form

Please complete the question using a cross (x). Please use black ink and CAPITAL LETTERS

Trainee’s surnameTrainee’s forename(s)GMC number GMC NUMBER MUST BE COMPLETED

Observed by RoleSignatureGMC/NMC/HPC number GMC/NMC/HPC NUMBER MUST BE COMPLETED

Date

Which clinical setting have you primarily observed the doctor in?

Theatre ICU A&E Delivery Suite Pain Clinic Other

How do you rate this doctor in their:

Good SatisfactoryNeeds to improve

UnacceptableUnable to comment

Knowledge, skills, performance

1. Ability to diagnose patient problems

2. Ability to plan patient care

3. Awareness of their own limitations

4. Ability to keep up to date with knowledge and skills

5. Responds to pain and distress in patients appropriately

6. Technical skills [appropriate to grade]

87

7. Ability to multitask and work effectively in a complex environment

8. Ability to manage time effectively / prioritise

9. Able to cope under stress

10. Willingness and effectiveness when teaching / training colleagues

11. Ability to take leadership role when circumstances required

12. Keeps clear, accurate, legible records contemporaneously

Safety and quality

13. Contributes constructively to audit, appraisal and clinical governance

14. Safeguards and protects patients wellbeing

15. Responds promptly to risks posed by patients

Communication, partnership and teamwork

16. Communication with patients

17. Communication with carers and/or family

18. Verbal communication with colleagues

19. Written communication with colleagues

20. Ability to recognise and value the contribution of others

21. Accessibility / reliability

Maintaining trust

22. Respect for patients privacy, right for confidentiality

88

23. Polite, considerate and honest to patients

24. Treats patients fairly and without discrimination

25. Treats colleagues fairly and without discrimination

26. Honest and objective when appraising and assessing colleagues

Are there any concerns about this doctor’s probity or health? Yes No

If yes, please provide details

Please add any additional comments

If any boxes were marked with minor or major concerns, please explain why

Signature Date

89

The Royal College of Anaesthetists

Multi Source Feedback (MSF) Summary Form

Clinical settings of observation: (Enter number of raters)

Theatre ICU A&E Delivery Suite Pain Clinic Other

Summary of raters’ responses:

How the doctor was rated in their:



Knowledge, skills, performance

1. Ability to diagnose patient problems

2. Ability to plan patient care

3. Awareness of their own limitations

4. Ability to keep up to date with knowledge and skills

5. Responds to pain and distress in patients appropriately

6. Technical skills [appropriate to grade]

7. Ability to multitask and work effectively in a complex environment

8. Ability to manage time effectively / prioritise

9. Able to cope under stress

10. Willingness and effectiveness when teaching / training colleagues

11. Ability to take leadership role when circumstances

90





required12. Keeps clear, accurate,

legible records contemporaneously

Safety and quality

13. Contributes constructively to audit, appraisal and clinical governance

14. Safeguards and protects patients wellbeing

15. Responds promptly to risks posed by patients

Communication, partnership and teamwork

16. Communication with patients

17. Communication with carers and/or family

18. Verbal communication with colleagues

19. Written communication with colleagues

20. Ability to recognise and value the contribution of others

21. Accessibility / reliability

Maintaining trust

22. Respect for patients privacy, right for confidentiality

23. Polite, considerate and honest to patients

24. Treats patients fairly and without discrimination

25. Treats colleagues fairly and without discrimination

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26. Honest and objective when appraising and assessing colleagues

Yes

No

Were there any concerns about this doctor’s probity or health?

Summary of details from those with concerns:

Summary of raters’ general comments:

Summary of raters’ explanations of minor or major concerns:

Signature DateTrainee

Educational Supervisor

92

Trainee’s surnameTrainee’s forename(s)

Intensive Care Medicine Paperwork



MSF / TAB form Logbook Summary DOPS form CEX form CbD form

Information for Educational Supervisors:

Competency Level Descriptors (for Ed Sup information) Training Progression Grid


The Oxford Handbook of Critical Care

£25-£30, available on Amazon and elsewhere

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Structured Training Report for Intensive Care Medicine Module

The educational/modular supervisor must complete this STR, having reviewed the trainee’s learning portfolio and WPBAs.

Current Placement


Dates

Clinical supervisor

WPBA in Current Placement

Assessment Number Comments

Mini-CEX

(min 3 in 6 months)

DOPs

(min 6 in 6 months)

List procedures included in DOPs and ensure they are signed off in Practical procedures

CBD

(min 4 in 6 months)

MSF

(1 per placement)

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Experiential outcomes (please review evidence in learning portfolio)Practical Procedure WBA Date Outcome CommentsDemonstrates aseptic peripheral venous cannulation

DOPS

Demonstrates aseptic arterial cannulation (+ local anaesthetic)

DOPS

Obtains an arterial blood gas sample safely, interprets results correctly

DOPS or M CEX

Demonstrates aseptic placement of central venous catheter

DOPS

Connects mechanical ventilator and selects initial settings

DOPS

Describes Safe Use of Drugs to Facilitate Mechanical Ventilation

CBD

Describes Principles of Monitoring Respiratory Function

CBD

Describes the Assessment of the patient with poor compliance during Ventilatory Support (‘fighting the ventilator’)

CBD

Prescribes safe use of vasoactive drugs and electrolytes

M CEX or CBD

Delivers a fluid challenge safely to an acutely unwell patient

CBD

Describes actions required for accidental displacement of ETT or tracheostomy

CBD

COMPETENCY DOMAINS SUCCESSFULLY ACHIEVED Competency Domain (at a level appropriate for ACCS) Signature

1. Resuscitation and initial management of the acutely ill patient

2. Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation

3. Disease Management

4. Therapeutic interventions / Organ system support in single or multiple organ failure

5. Practical procedures

6. Perioperative care

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7. Comfort and recovery

8. End of life care

9. Transport

10. Patient safety and health systems management

11. Professionalism

Summary of Trainee Assessment

Supervisor to complete. Please attach evidence if available to support opinions or give examples of behaviours.

I

confirm that this is an accurate description/summary of this trainee’s learning

portfolio and WPBA, covering the period from ………………..to ……………….

Supervisor Name and Signature Trainee Signature

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Strengths of Trainee

Weaknesses of Trainee

Suggestions for improvement

Date: Date:

ICM Multi Source Feedback (MSF)Team Assessment of Behaviour (TAB)

Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink.

Trainee’s surnameTrainee’s forename(s)GMC Number GMC NUMBER MUST BE COMPLETED

Observed bySignatureDate

Domain

No

Conc

erns

Min

or C

once

rns

Maj

or o

r Ser

ious

Con

cern

s

Comments

Please provide feedback on professional behaviour including areas of excellence and areas for improvement

NB: Any concerns must be commented on to allow constructive feedback and planning for improvement

1. Maintaining trust/ professional relationships with patients

Listens Is polite and caring Shows respect for

patients’ opinions, privacy, dignity and is unprejudiced

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2. Verbal communication skills

Gives clear, understandable information

Speaks good English at an appropriate level for patient or relative

3. Team working/ working with colleagues

Respects others’ roles Works constructively

within team Effective handover Delegates appropriately Supportive of

colleagues

4. Accessibility

Accessible to all staff Does not shirk duty Responds when called Arranges cover for

planned absence, notifies of unplanned absence

Do you have any concerns about this doctor’s probity or health?

If yes please explain on additional sheetYes No

Additional comments on doctor’s professional behaviour:

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ICM logbook summaryPlease use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink.

Trainee’s surnameTrainee’s forename(s)GMC Number GMC NUMBER MUST BE COMPLETED

Hospital placement:Duration of placement:Total beds: Level 2: Level 3: Mixed 2/3:Level of training: Core Step 1 Step 2 Step 3 Speciality: General Cardiac Neuro Paeds

Total unit admissions during placement: Data can be obtained from ICNARC database

ICM logbook summary

Procedure Local supervision Distant supervision

Teaching

Airw

ay &

Lun

gs

Emergency intubation

Percutaneous tracheostomy

Bronchoscopy

99

Chest drain – seldinger

Chest drain – blunt dissection

Lung ultrasound

Card

iova

scul

ar

Arterial cannulation

Central venous access – IJ

Central venous access – SC

Central venous access – Femoral

Pulmonary artery catheter

Non-invasive CO monitoring

Echocardiogram

Abdo

men

Ascitic drain/tap

Sengstaken tube placement

Abdominal ultrasound/FAST

CNS

Lumbar puncture

Brainstem death testing

Procedures performed should be appropriate to level of training; Experience of the all the above procedures is desirable but NOT essential

FICM DOPS Assessment Form

Trainee’s SurnameTrainee’s Forename(s)GMC Number GMC NUMBER MUST BE COMPLETED

Procedure

Code Number

100

Observed byGMC Number GMC NUMBER MUST BE COMPLETED

DateSignature of observing doctor

Assessment:

Practice was satisfactory Tick one

Assessor’s signaturePractice was unsatisfactory Tick

oneAssessor’s signature

Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory score given.Example of good practice were:

Areas of practice requiring improvement were:

Further learning and experience should focus on:

Performance YES NO Comments

Understands indications and contraindications for the procedure

Tick Tick Comments

Explained procedure to patient Tick Tick Comments

Understands relevant anatomy Tick Tick Comments

Satisfactory preparation for procedure Tick Tick Comments

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Communicated appropriately with patient and staff Tick Tick Comments

Full aseptic technique Tick Tick Comments

Satisfactory technical performance of procedure Tick Tick Comments

Adapted to unexpected problems during procedure Tick Tick Comments

Demonstrated adequate skill and practical fluency Tick Tick Comments

Maintained Safe practice Tick Tick Comments

Completed procedure Tick Tick Comments

Satisfactory documentation of procedure Tick Tick Comments

Issued clear post-procedure instructions to patient and staff

Tick Tick Comments

Maintained professional demeanour throughout procedure

Tick Tick Comments

FICM CEX Assessment FormPlease complete this form in BLOCK CAPITALS and BLACK ink


Observation

Code Number


102

DateSignature of supervising doctor

Clinical Setting:

ICU HDU ED Ward Transfer Other

Assessment:

Practice was satisfactory Tick one Assessor’s signature

Practice was unsatisfactory Tick one Assessor’s signature

Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory score given.

Examples of good practice were:



Please grade the following areas:(Please see Domain Descriptors)

S

atisf

acto

ry

U

nsati

sfac

tory

1. History taking and information gathering Tick Tick

103

2. Assessment and differential diagnosis Tick Tick

3. Immediate management and stabilisation Tick Tick

4. Further management and clinical judgement Tick Tick

5. Identification of potential problems and difficulties Tick Tick

6. Maintain safe practice for patient, trainee & staff Tick Tick

7. Communication with patient, staff and colleagues Tick Tick

8. Record keeping Tick Tick

9. Overall clinical care Tick Tick

FICM CbD Assessment FormPlease complete this form in BLOCK CAPITALS and BLACK ink


Observation

Code Number

104


DateSignature of supervising doctor

Clinical Setting:

ICU HDU ED Ward Transfer Other

Assessment:

Practice was satisfactory Tick one Assessor’s signature

Practice was unsatisfactory Tick one Assessor’s signature

Expand on areas of good practice. You MUST expand on areas for improvement for each unsatisfactory score given.

Examples of good practice were:



Special Focus of Discussion:

Please grade the following areas:(Please see Domain Descriptors)

Satis

fact

ory

Uns

atisf

acto

ry

1. History taking and information gathering Tick Tick

105

2. Assessment and differential diagnosis Tick Tick

3. Immediate management and stabilisation Tick Tick

4. Further management and clinical judgement Tick Tick

5. Identification of potential problems and difficulties Tick Tick

6. Communication with patient, staff and colleagues Tick Tick

7. Record keeping Tick Tick

8. Overall clinical care Tick Tick

9.Understanding of the issues surrounding the clinical focus chosen by the assessor

Tick Tick

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A Career in Intensive Care MedicineDr Alison Ingham - ICM lead for ACCS

Intensive Care Medicine (ICM) is an exciting and dynamic career choice (I’m biased of course!). Hopefully you will enjoy your ACCS ICM placement so much, you will be thinking about further training in ICM. If so, here is how you go about it.

You can apply to enter ICM higher specialist training following ACCS or core anaesthesia (CAT) or core medical training (CMT). You can, of course, dual with a second specialty, but more about that later.

The training is divided into 3 stages:

Stage 1 training:

Stage 1 training is 4 years. This includes ACCS (or CAT / CMT) core training and years ST3 and ST4 of higher training. By the end of ST4 you will need to have completed the following:

1 year of Anaesthesia

1 year of Medicine (including Emergency Medicine)

1 year of ICM

For example, a trainee coming from CMT, would probably need 1 year of ICM and 1 year of Anaesthesia in their ST3 and ST4 years. If you have done 3 years of ACCS Anaesthesia, you are likely to need 6 months in ICM and the other 6 months could be in any of the specialties. You get the idea.

Stage 2 training:

Stage 2 training is 2 years, ST5 and ST6.

ST5 consists of specialist rotations, with 3 months in neuro ICU, 3 months in paediatric (PICU) and 3 months in cardiac ICU. The remaining 3 month block in that year may be flexible. Trainees dualling with anaesthesia will gain most of their neuro, paediatric and cardiac competencies in theatres during this year, as it is also counted towards their anaesthetic training. Trainees dualling with Medicine or Emergency Medicine will be based on the specialist ICUs.

ST6 is a “special skills” year and is only undertaken by ICM single CCT trainees. Dual trainees will spend this year in their partner specialty. The special skills year could include research, teaching and training or further time in a specialist ICU.

During stage 2 training, you will also have to pass the FFICM exam.

Stage 3 training:

This is one year and is similar to the old “advanced ICM training year”. You will start working in a more senior role and learning the skills needed to become a consultant.

Dual Training:

You can dual train with the following specialties:

Acute Medicine

Emergency Medicine

Anaesthesia

Renal Medicine

Respiratory Medicine

Luckily, getting a dual CCT does not double your training time. Instead it increases it from 7 to 8.5 years. Parts of your training will count towards both specialities and your training programme will be tailored by the appropriate Training Programme Directors. Application is stepped. This means that although you can apply for both specialties at the same time, you can only hold one offer, so application for the second specialty will be needed the following year. It does not matter which specialty you accept first, but both must be in the same Deanery.

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Unfortunately you will have to keep two portfolios, one for each specialty. You may also have to get used to being at different stages of training in your two specialties – for example you might have finished stage one training in ICM (ST4) but still be finishing your ST3 year in your partner specialty.

So why chose Wales? Words from Dr Chris Thorpe – Regional Advisor for ICM

Wales is a diverse country that will give you a great life style as you build your future career. Wales offers something for everyone, from cosmopolitan towns and cities to stunning coastal locations. With affordable housing and welcoming communities it is an ideal place to achieve a work-life balance. It even has its own language, although it is not necessary to learn it to pursue training, employment or to live here. Wales is covered by a single Deanery which puts high quality training at the heart of medical careers. The Wales Deanery also holds an award for being the “most family-friendly”.

The ICM specialist training scheme in Wales is funded directly by the Deanery which allows us to choose posts which will best benefit the trainee. This enables us to provide excellent posts in Anaesthesia and Medicine as well as ICM.

Currently hospitals training at ST3-4 level are in Swansea, Newport, Bangor and Wrexham, with the ST5 year based in Cardiff. Other hospitals also provide training and placements may take in other units depending on the trainee’s needs. The ST6 year will be tailored according to whether the trainee is dual or single accrediting and the ST7 year is likely to be mainly in South Wales.

The Specialist Training Committee and Deanery make support of the trainee central to their business and you can look forward to a carefully developed scheme that allows you to grow in experience and confidence as the years go by. You will experience a variety of Intensive Care Units and will emerge from the scheme a rounded and mature professional with the ability to take on a consultant role in both large and small hospitals.

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Further Information

For further information on ICM training and dual training in particular, please also see Dr Thorpe’s article on page 31 of the summer 2013 edition of the FICM newsletter, “Critical Eye”.

http://www.ficm.ac.uk/sites/default/files/Critical%20Eye%204%20-%20website%20version.pdf

If you would like to talk to someone in more detail about ICM training, please contact either Dr Thorpe or myself. There will also be an ICM Faculty Tutor at each hospital within Wales who provide ACCS training, who will be able to help you.

Dr Alison Ingham [email protected]

Dr Chris Thorpe [email protected]

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