health education england north west guidance for arcp

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Health Education England North West Guidance for ARCP Requirements for ACCS

Trainees in CT1/ST1 and CT2/ST2

Taken from ACCS Core Training Programme Curriculum and Assessment System, April

2012 (https://www.rcoa.ac.uk/system/files/TRG-CU-ACCS2012.pdf)

ACCS is a three year programme consisting of:

Six months Emergency Medicine

Six months Acute Medicine

One year of Anaesthetics and ICM (recommended to be six months in each

specialty)

One further year in chosen parent specialty

Most trainees in HEE NW will complete their year of EM and AM in CT1/ST1 and complete

Anaesthesia and ICM in CT2/ST2.

This document has been prepared to help the trainees and trainers plan for the ARCP at the

end of CT1/ST1 and CT2/ST2.

It is designed to distil much of the key information in the Curriculum into a format that is

easier to navigate. It should be used in conjunction with the HEE NW ACCS ARCP

Checklists which can be found in the Appendix. These checklists have some differences

from the nationally available checklists and reflect the requirements of the local ACCS

scheme.

The checklists must be completed by trainee and supervisor prior to ARCP and they

are mandatory for ARCP Panel A.

If there is any further information required, please consult the Curriculum which has much

more detail about almost all the information in this document.

The evidence of training is divided into sections:

Common Competences: provides generic competences common to all specialities

Major and Acute Presentations: clinical presentations to be covered throughout training

Practical Procedures: to be covered throughout training

Anaesthesia specific curriculum

Intensive Care specific curriculum: in addition to the above competencies

https://www.rcoa.ac.uk/system/files/TRG-CU-ACCS2012.pdf

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Common Competences

These are 25 competences that all doctors should acquire during training. The ways in which

the Curriculum suggests they can be demonstrated are in brackets.

1. History taking (E, Mi, CBD, MSF, ACAT,)

2. Clinical examination (E, Mi, CBD, ACAT)

3. Therapeutics and safe prescribing (E, Mi, CBD, ACAT)

4. Time management and decision making (E, Mi, CBD, M, ACAT)

5. Decision making and clinical reasoning (E, Mi, CBD, ACAT, AA)

6. The patient as central focus of care (E, Mi, CBD, ACAT, PS)

7. Prioritisation of patient safety in clinical practice (E, Mi, CBD, M, ACAT)

8. Team working and patient safety (Mi, CBD, MSF, ACAT)

9. Principles of quality and safety improvement (E, Mi, CBD, MSF, ACAT, AA)

10. Infection control (E, Mi, CBD, ACAT, PS, D,)

11. Managing long term conditions and promoting patient self-care (E, Mi, CBD, MSF,

ACAT, PS)

12. Relationships with patients and communication within a consultation (E, Mi, CBD,

MSF, ACAT, PS)

13. Breaking bad news (E, Mi, CBD, MSF, ACAT, PS, D)

14. Complaints and medical error (CBD, D, MSF)

15. Communication with colleagues and cooperation (Mi, CBD, MSF, ACAT)

16. Health promotion and public health (E, Mi, CBD, MSF, PS)

17. Principles of medical ethics and confidentiality (E, Mi, CBD, MSF, ACAT, PS)

18. Valid consent (E, Mi, CBD, MSF, ACAT, PS)

19. Legal framework for practice (E, Mi, CBD, MSF, ACAT)

20. Ethical research (CBD, Mi, ACAT, AA, D)

21. Evidence and guidelines (E, Mi, CBD, MSF, ACAT)

22. Audit (CBD, AA)

23. Teaching and training (CBD, MSF, TO)

24. Personal behaviour (E, Mi, CBD, MSF, ACAT, PS, D, CBD, Mini-CEX)

25. Management and NHS structure (Mi, CBD, MSF, ACAT, PS, CBD)

At least half of the competences should be at level two or higher by the end of ACCS year

two (i.e. 13/25) with all at level two by the end of year three. Within the NHS ePortfolio, the

common competences level must be completed by your supervisor. For those trainees

without access to the NHS ePortfolio (ACCS-Anaesthesia Trainees), a document that should

be used by you and your supervisor to confirm your level is in the Appendix. The descriptor

definitions of what the four levels represent can be found in the Curriculum.

Guide to assessment methods

AA Audit Assessment

ACAT Acute Care Assessment Tool

CBD Case Based Discussions

D DOPS

E Examination

Mi Mini-CEX

MSF Multisource Feedback

PS Patient Survey

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Major and Acute Presentations

These competences are focussed on the Core Major Presentations (CMPs) of patients who

need resuscitation and the Core Acute Presentations (CAPs) of patients seen in the ED,

AMU, ICU and in areas where anaesthetics are given

There must be evidence demonstrating competence in all 44 CMPs and CAPs by the end of

CT2/ST2.

At the end of CT2/ST2, trainees will have used Mini-CEX, DOPs, CBD and ACAT for the

assessment of a minimum:

All 6 Core Major Presentations

20 of 38 Core Acute Presentations

The remaining 18 Core Acute Presentations can be completed by Mini-CEX, CBD, ACAT,

eLearning, reflective entries, teaching delivered or audit assessments.

The RCEM have identified a limited number of key CMPs and CAPs that it wishes to be

assessed summatively whilst in the EM placement by an EM Consultant or equivalent. If the

summative assessments are judged unsatisfactory, the assessment can be repeated.

Core Major Presentations (CMPs)

1. Anaphylaxis

2. Cardio-respiratory arrest

3. Major trauma

4. Septic patient

5. Shocked patient

6. Unconscious patient

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Core Acute Presentations (CAPs)

1. Abdominal pain (including loin pain)

20. Limb pain and swelling (atraumatic)

2. Abdominal swelling/mass/constipation

21. Neck pain

3. Acute back pain

22. Oliguria

4. Aggressive/disturbed behaviour

23. Pain management

5. Blackout/collapse

24. Painful ear

6. Breathlessness

25. Palpitations

7. Chest pain

26. Pelvic pain

8. Confusion (acute)/delirium

27. Poisoning

9. Cough

28. Rash

10. Cyanosis

29. Red eye

11. Diarrhoea

30. Sore throat

12. Dizziness and vertigo

31. Suicidal ideation

13. Falls

32. Syncope and pre-syncope

14. Fever

33. Traumatic limb and joint injuries

15. Fits/seizure

34. Vaginal bleeding

16. Haematemesis and melaena

35. Ventilatory support

17. Headache

36. Vomiting and nausea

18. Head injury

37. Weakness and paralysis

19. Jaundice

38. Wound assessment and management

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Minimum number of assessments required at each stage of ACCS CT1/ST1 and

CT2/ST2 (and when to do them)

EM

Major Presentations (6) Acute Presentations (38) Practical Procedures (44) 2 of 6 completed summatively (mini-CEX or CBD) by EM Consultant or equivalent:

Major Trauma (if you are not placed in a Trauma Centre/Unit, this could be covered by ATLS/ETC)

Shock

Altered level of consciousness

Sepsis

Anaphylaxis (could be covered by simulation)

Cardiorespiratory arrest (could be covered by ALS or Anaes sign off)

5 of 38 completed summatively (mini-CEX or CBD) by EM consultant or equivalent:

Chest Pain

Abdominal Pain

Breathlessness Mental Health

Head Injury An additional 5 CAPs must be covered using an ACAT, mini-CEX or CBD Further 10 recommended to be completed using combination of:

ACAT

eLearning

Reflective entries

Teaching delivered Audit assessments

5 of 44 completed using DOPs RCEM suggests:

Airway

Primary Survey

Wound Care Fracture/Joint Reduction

At least one other

At the end of the EM placement, seek a summary description of the number and location of

patients seen. This is required for the Structured Training Report.

AM

Major Presentations (6) Acute Presentations (38) Practical Procedures (44)

2 of 6 completed formatively:

Major Trauma Shock

Altered level of consciousness

Sepsis

Anaphylaxis

Cardiorespiratory arrest

10 of 38 using:

Mini-CEX CBD

ACAT 8-10 remaining AP covered using combination of:

ACAT

eLearning Reflective entries

Teaching delivered

Audit assessments

5 of 44 completed using DOPs Please note that some PPs are best suited to completion during AM including:

Lumbar puncture

Pleural tap

Ascitic tap

Abdominal paracentesis

Intensive Care Medicine

Major Presentations (6) Acute Presentations (38) Practical Procedures (44)

2 of 6 completed formatively Complete any of the MPs not covered in EM or AM

Any AP seen in the ICM setting and not completed in EM or AM

13 of 44 using DOPs and other tools

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Practical Procedures (PPs)

There are 45 practical procedures that trainees are expected to complete during ACCS.

Evidence must be recorded against all 45 PPs by the end of CT2/ST2. Some of these

procedures may not be encountered directly during ACCS training. Whilst it is desirable that

all procedures should be directly observed, evidence may be provided against some of them

using other means (eLearning, simulation or in date ALS or ATLS). The PPs that could be

covered by other forms of evidence are marked by a star below. When not directly observed

during CT/ST1-2, trainees must identify means of becoming competent in each of these

procedures during training.

Procedure AM EM ICM Anaes

1. Arterial cannulation

DOPs

2. Peripheral venous cannulation

DOPs

3. Central venous cannulation

DOPs

4. Arterial blood gas sampling Mini-CEX DOPs

5. Lumbar puncture (expected as DOPs)

6. Pleural tap and drain*

7. Seldinger intercostal drain*

8. Open intercostal drain* (or could be covered by in date ATLS/ETC)

9. Ascitic tap*

10. Abdominal paracentesis*

11. Airway protection

DOPs

12. BLS/ALS DOPs

13. DC cardioversion (could be covered by in date ALS)

14.Knee Aspiration*

15. Temporary pacing (external or wire) (could be covered by in date ALS)

16. Reduction of fracture/dislocation

DOPs

17. Large joint examination (expected as DOPs)

18. Wound management

DOPs

19. Trauma primary survey

DOPs

20. Initial assessment of acutely unwell (expected as DOPS)

21. Secondary assessment of acutely unwell (expected as DOPS)

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Procedure AM EM ICM Anaes

22. Connection to mechanical ventilator

DOPs

23. Safe use of drugs to facilitate mechanical ventilation

CBD

24. Managing the patient fighting the ventilator

CBD

25. Monitoring respiratory function

CBD

26. Preoperative assessment (IAC)

Mini-CEX

27. Management of spontaneously breathing patient (IAC)

Mini-CEX

28. Administer anaesthesia for laparotomy (IAC)

Mini-CEX

29. Demonstrate RSI (IAC)

Mini-CEX

30. Recover patient from anaesthesia (IAC)

Mini-CEX

31. Demonstrate function of anaesthetic machine (IAC)

DOPs

32. Transfer patient to operating table (IAC)

DOPs

33. Technique of scrubbing up and donning gown and gloves (IAC)

DOPs

34. Basic competences for pain management (IAC)

DOPs

35. Patient identification (IAC)

CBD

36. Post-op N&V (IAC)

CBD

37. Airway Assessment (IAC)

CBD

38. Choice of muscle relaxants and induction agents (IAC)

CBD

39. Post-op analgesia (IAC)

CBD

40. Post-op oxygen therapy (IAC)

CBD

41. Emergency surgery (IAC)

CBD

42. Safe use of vasoactive drugs and electrolytes

Mini-CEX CBD

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

Mini-CEX CBD

44. Describes action required for accidental displacement of tracheal tube or tracheostomy

CBD

45. Demonstrate CPR resuscitation on a manikin

DOPs

Numbers 26 – 41 are required as part of the Anaesthetic Initial Assessment of Competence

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Anaesthetics within ACCS

The duration of time spent doing anaesthesia has varied between 3 and 9 months nationally

but all trainees are now expected to complete a minimum of six months anaesthesia in

CT1/ST1 or CT2/ST2.

Trainees must complete the Initial Assessment of Anaesthetic Competence and must also

provide evidence at ARCP demonstrating progress towards completion (at least one WPBA

in each module) of the following modules:

1. Preoperative assessment

2. Premedication

3. Induction of general anaesthesia

4. Intra-operative care

5. Post-operative and recovery room care

6. Management of respiratory and cardiac arrest

7. Control of infection

8. Introduction to anaesthesia for emergency surgery

In the ACCS Curriculum and in the NHS ePortfolio these eight modules are called the Basis

of Anaesthetic Practice. In the RCoA Curriculum and ePortfolio, they are called the

Introduction to Anaesthesia.

The further following modules are of interest to the ACCS trainee and it is suggested that the

learning outcomes may also be addressed once all the other modules are completed:

1. Airway management

2. Sedation

3. Transfer medicine

4. Critical incidents

We are aware that there is some discrepancy in some of the national ACCS guidance

regarding the fourth of these optional modules (Regional anaesthesia appears instead of

Critical incidents). We have put Critical incidents in the checklist because it is what appears

in the 2012 Curriculum. As these modules are purely optional, they will not affect Outcome at

ARCP.


Time in ICM used to sample the major and acute presentations not covered during EM or

ICM. The minimum number of assessments during ICM part of training is:

3 x Mini-CEX

6 x DOPs

4 x CBD

ICM competences to be completed

1. Demonstrates aseptic peripheral venous cannulation

2. Demonstrates aseptic arterial cannulation (+ local anaesthetic)

3. Obtains arterial blood gas sample and interprets result correctly

4. Demonstrates aseptic placement of central venous catheter

5. Connects mechanical ventilator and selects initial settings

6. Describes safe use of drugs to facilitate mechanical ventilation

7. Describes principles of monitoring respiratory function

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8. Describes assessment of patient with poor compliance during ventilator support

(fighting the ventilator)

9. Prescribes safe use of vasoactive drugs and electrolytes

10. Delivers a fluid challenge safely to an acutely unwell patient

11. Describe actions required for accidental displacement of tracheal tube or

tracheostomy

Educational Supervision

ACCS trainees will have a different Educational Supervisor in each of their four posts. Their

supervisors will need to complete a Structured Training Report (STR) at the end of each of

post. The STR is called an Educational Supervisors Structured Report (ESSR) in the RCoA

ePortfolio. For ACCS-Anaes trainees in CT1 whose supervisors do not have access to the

RCoA ePortfolio, there is a blank copy of an STR in the Appendix of this document.

Most Trusts have identified a Trust ACCS Training Lead (TATL). This is a consultant who

has overall responsibility for the ACCS trainees in their Trust. They may act as a local point

of contact for any training issues that cannot be resolved by the Educational Supervisor.

Further Requirements

MSF

These must have a minimum of twelve responses and we expect them to include a range of

professions and seniority (including consultants).

There are three MSFs required over the two years:

1. One performed whilst in AM and EM (for most people this is CT1/ST1)

2. One performed whilst in ICM

3. One performed whilst in Anaesthesia

Audit

Evidence of participation in an audit or Quality Improvement Project undertaken each year

Safeguarding Children Level 2

This can be completed locally or via eLearning. A suitable eLearning module can be found

via the e-LfH platform (http://www.e-lfh.org.uk/programmes/safeguarding-children/).

Curriculum Checklists

Please complete the curriculum checklists for your posts and year of training. They

summarise all the evidence that we need to see at ARCP. They are now mandatory for

ARCP.

Form R

Required for revalidation

GMC Survey

Evidence of GMC survey completion should be provided each year

Note for ACCS Anaesthesia Trainees

The RCoA ePortfolio does not include the forms needed to demonstrate competences of the

AM and EM elements of ACCS. The forms required can be found in Appendix A of the 2012

http://www.e-lfh.org.uk/programmes/safeguarding-children/

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ACCS Curriculum. Please use the forms for your current specialty (not parent specialty).

These forms can be uploaded to your ePortfolio but please retain the paper copies which

may be required at ARCP.

Dr Thomas Wiles

Training Programme Director ACCS (Mersey), HEE NW

March 2018

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Appendices

Contents

: CT1/ST1 Checklist (Emergency Medicine and Acute Medicine Placements)

Page 15: CT2/ST2 Checklist (Anaesthesia and Intensive Care Medicine Placements)

Page 18: ACCS-Anaes STR for completion in EM and AM Placements

Page 22: ACCS-Anaes Common Competences Record

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HEE NW ACCS ARCP Checklist ST1/CT1

Trainee: DRN/NTN:

Emergency Medicine

Summative assessments by EM Consultant (or equivalent) in at least 2 Major Presentations (CBD/Mini-CEX)

Date of assessment

Assessor’s name

CMP1 Anaphylaxis

CMP2 Cardio-respiratory arrest (or current ALS) CMP3 Major trauma

CMP4 Septic patient CMP5 Shocked patient

CMP6 Unconscious patient

Summative assessments by EM Consultant (or equivalent) in each of these 5 Acute Presentations (CBD/Mini-CEX)

Date of assessment

Assessor’s name

CAP1 Abdominal pain CAP6 Breathlessness

CAP7 Chest pain CAP18 Head injury

CAP30 Mental health

Non-summative assessment in at least 5 further Acute Presentations using ACAT(EM), CBD or mini-CEX (please insert name & number of each CAP covered)

Date of assessment

Assessor’s name

CAP CAP

CAP CAP

CAP

10 further Acute Presentations completed using teaching delivered/Audit/elearning/Reflective practice/WPBAs (please insert name & number of each CAP covered)

Date of assessment

Assessors name if applicable

CAP Teaching/Audit/elearning/Reflection/WPBA (Please circle)








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Minimum of 5 Practical Procedures (PPs) as DOPS in 4 following domains and at least one other

Date of assessment

Assessor’s name

Airway maintenance Primary survey

Wound care

Fracture/joint manipulation PP:

PP: PP:

PP: PP:

PP: PP:

14

Acute Medicine Formative assessments in 2 Major Presentations not yet covered

Date of assessment

Assessor’s name

CMP1 Anaphylaxis

CMP2 Cardio-respiratory arrest CMP3 Major trauma



Formative assessment using ACAT/mini-CEX/CBD for further 10 Acute Presentations not yet covered

Date of assessment

Assessor’s name

CAP CAP

CAP

CAP CAP

CAP CAP

CAP CAP

CAP

10 further acute presentations completed using teaching delivered/Audit/elearning/Reflective practice/WPBAs

Date of assessment

Assessors name if applicable











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Minimum of 5 different practical procedures as DOPS Date of assessment

Assessor’s name

PP:

PP: PP:

PP: PP:

PP: PP:

PP: PP:

PP:

Overview by the end of CT1/ST1

Structured Training Report for each placement

Yes/No

MSF (minimum of 12 responses, reflecting composition of MDT and including consultants)

Yes/No

Evidence of audit or quality improvement project

Yes/No

Resuscitation courses completed:


Yes/No

Satisfactory progress towards achieving level two in common competences confirmed by supervisor and trainee

Yes/No

Multi Consultant Review x 4 (ACCS-AM trainees only)

Yes/No

Exams taken/planned:

To be completed by trainee and countersigned by Educational Supervisor

Trainee Signature

Date:

ES Signature

Date:

Educational Supervisor name (please print)

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HEE NW ACCS ARCP Checklist ST2/CT2

Trainee: DRN/NTN:

Anaesthetics

Initial Assessment of Competence

Formative assessment of 5 Anaesthetic-CEX Date of assessment

Assessor’s name

IAC A01 Preoperative assessment

IAC A02 Management of spontaneously breathing patient IAC A03 Anaesthesia for laparotomy

IAC A04 Rapid Sequence Induction IAC A05 Recovery

Formative assessment of 8 specific Anaesthetic CBDs Date of assessment

Assessor’s name

IAC C01 Patient identification

IAC C02 Minimisation of post-op nausea and vomiting

IAC C03 Airway assessment

IAC C04 Choice of muscle relaxants and induction agents

IAC C05 Post-operative analgesia

IAC C06 Post-operative oxygen therapy

IAC C07 Emergency intra-abdominal surgery

IAC C08 Failed intubation

Formative assessment of Anaesthetic DOPS Date of assessment

Assessor’s name

Basic and advanced life support

IAC D01 Demonstrate functions of anaesthetic machine IAC D02 Transfer and positioning of patient on table

IAC D03 Demonstrates CPR on manikin IAC D04 Technique of scrubbing up, gown and gloves

IAC D05 Basic competencies of pain management IAC D06 Failed intubation practical drill on manikin

Basis of Anaesthetic Practice (Also known as Introduction to Anaesthesia)

Module (at least one WPBA required for each of these modules) Date of assessment

Assessor’s name

Pre-operative assessment Pre-medication

Induction of general anaesthesia Intra-operative care

Post-operative and recovery room care Introduction to anaesthesia for emergency surgery

Management of cardio-respiratory arrest Control of infection

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Optional Modules (once IAC/Basis of Anaesthetic Practice completed)

Module Date of assessment

Assessor’s name

Airway management

Sedation

Transfer medicine Critical incidents


Formative assessment of 2 Major Presentations not yet completed Date of assessment

Assessor’s name

CMP1 Anaphylaxis

CMP2 Cardio-respiratory arrest CMP3 Major trauma



Formative assessment of any Acute Presentations seen in ICM and not completed during EM/AM

Date of assessment

Assessor’s name

CAP CAP

CAP CAP

CAP CAP

CAP CAP

CAP CAP

CAP

CAP

13 practical procedures as DOPS (may be assessed as mini-CEX or CBD if indicated)

Date of assessment

Assessor’s name

Arterial cannulation Peripheral venous cannulation

Central venous cannulation Obtains and interprets ABG (DOPS/mini-CEX)

Connection to mechanical ventilator Use of drugs to facilitate mechanical ventilation (CBD)

Managing the patient fighting the ventilator (CBD) Monitoring respiratory function (CBD)

Use of vasoactive drugs/electrolytes (mini-CEX/CBD) Fluid challenge in acutely unwell patient (CBD)

Accidental displacement of ETT (CBD) Any other DOPS

Any other DOPS

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Overview by the end of CT2/ST2

All six Major Presentations completed

Yes/No

All 38 Acute Presentations completed

Yes/No

Evidence demonstrating completion of all 45 practical procedures (see guidance for how many must be completed as direct assessments and which ones can be evidenced by other means)

Yes/No

Structured Training Report for each placement

Yes/No

MSF x 2 (one in Anaesthetics and one in ICM, minimum of 12 responses in each, reflecting composition of MDT and including consultants)

Yes/No

Evidence of audit or quality improvement project

Yes/No

Resuscitation courses completed:


Yes/No

At least half of 25 common competences at level 2 or higher confirmed by supervisor and trainee

Yes/No

Multi Consultant Review x 4 (ACCS-AM trainees only)

Yes/No

Exams taken/planned:

To be completed by trainee and countersigned by Educational Supervisor

Trainee Signature

Date:

ES Signature

Date:

Educational Supervisor name (please print)

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HEE NW ACCS-Anaesthesia Structured Training Report

(to be used at the end of EM & AM placements) Trainee Name: Trainee GMC number: Training number: Supervisor name: Supervisor specialty and role: Supervisor GMC number: Specialty and dates covered by STR:

WPBAs

Please provide a list of each assessment completed including dates and which part of the ACCS curriculum covered e.g. CAP1 Abdominal Pain 8/2/17

Mini-CEX

DOPS

CBD

ACAT MSF

20

Review of other evidence in portfolio

Please review all other evidence (reflection, logs, and eLearning certificates in trainee's portfolio) and provide a brief summary

Reflective practice

Curriculum coverage

Clinical governance/Audit activity

Courses and teaching attended Teaching delivered Management activity Research activity

Mandatory courses

21

Other outcomes considered

Critical incidents Complaints Other

Summary of Trainees Assessment

Any evidence to support the following comments should be mentioned if possible

Strengths of trainee Areas in which trainee could improve

Suggested plan for development

22

Details of concerns/investigations

Are you aware if this trainee has been involved in any conduct, capability or Serious Untoward Incidents/ Significant Event Investigation or named in any complaint? Yes/No If so are you aware if it has/ these have been resolved satisfactorily with no unresolved concerns about a trainee's fitness to practise or conduct? Yes/No Comments, if any

I confirm that this is an accurate description / summary of this trainee's learning portfolio and WPBA, covering the post specified Supervisor Signature & Date

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HEE NW ACCS-Anaesthesia Common Competences

Name: DRN/NTN:

Competence Level Achieved (Sign and date)

1 2 3 4

1. 1. History taking 2.

3. 2. Clinical examination 4.

3. Therapeutics & safe prescibing

4. Time & workload

management

5. Decision making & clinical reasoning

6. The patient as central focus

of care

7. Prioritisation of patient safety in clinical practice

8. Team working & patient

safety

9. Principles of quality & safety improvement

10. Infection control

11. Managing long term conditions & promoting patient self-care

12. Relationships with patients and communication within a consultation

13. Breaking bad news

14. Complaints & 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

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21. Evidence & guidelines

22. Audit

23. Teaching & training

24. Personal behaviour

25. Management and NHS structure

Please note that the level descriptors can be found in the ACCS Curriculum

Educational Supervisor signature:

Educational Supervisor name (please print):

Trainee signature:

health education england north west guidance for arcp

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