This Educational Supervisors handbook is intended as a supporting reference guide for trainers who have an Educational Supervisor role for ACCS trainees. It covers all the main aspects of training and supervision and should be the first port of call for any queries you may have along the way.
The handbook has been customised by the Severn ACCS School to include Region specific guidance on the supervision of our local ACCS trainees.
TRISH - keep as DRAFT until I have made the changes and set the contents up
Acute Care Common Stem (ACCS) Educational Supervisor Handbook
Introduction
This handbook is intended as a supporting reference guide for trainers who have an Educational Supervisor role for ACCS trainees. It covers all the main aspects of training and supervision and should be the first port of call for any queries you may have along the way.
Whilst there is a lot to digest here it is advisable to ensure familiarity with the contents at the start of the training year as this often saves a lot of time later on. For trainers who are relatively new to educational supervision this handbook covers all you need to know to get started. For more experienced supervisors, some of the content may already be familiar, however there are changes and updates every year so you are advised to check through this latest edition at the beginning of the training year.
If you require further information not contained within this handbook, or if you have any particular queries, issues, problems etc. that you cannot resolve then please contact your Training Programme Director.
Contents
1. ACCS – Definition and Structure
2. Induction
3. Supervision
4. Curriculum and Assessments
5. Teaching and Training
6. Portfolio
7. Exams
8. ARCP
9. Leave and Courses
10. ACCS Events
11. Social Media
12. Time Out of Programme (OOP)
13. Changing Specialty – Moving Region
14. Part time Working (less than full time training)
15. Trainees in difficulty
16. Contacts and Who’s Who?
17. Key Links
18. Timeline
Appendix A: ARCP Workbook
Appendix B: Educational Agreement
Appendix C: Reflective Learning Template
Appendix D: Doctors In Difficulty
ACCS: Definition and Structure
ACCS is a three year core training programme that normally follows Foundation Year 2. It is the only core training programme for trainees wishing to enter higher specialty training in Emergency Medicine. It is an alternative core training programme for trainees wishing to enter higher specialty training in General Internal Medicine (GIM), Acute Internal Medicine (AIM) or Anaesthetics. It delivers all elements of the specialty specific core training curricula, with additional augmented outcomes, i.e. competences beyond those areas covered by Core Medical Training and Anaesthetics. The first two years are spent rotating through Emergency Medicine (EM), Acute Internal Medicine, Anaesthetics and Intensive Care Medicine (ICM). The third year is spent providing training that ensures trainees meet the minimum requirements for entry into higher specialty training in their parent specialty.
Specialty Specific Objectives for ACCS training
Emergency Medicine:
ACCS constitutes the first three years of the CCT in EM in a pre-planned and structured manner. The first two years of ACCS training (EM, AIM, Anaesthetics and ICM) are followed by a further year gaining additional competences in adult EM (including musculoskeletal emergencies) and Paediatric Emergency Medicine; thus fulfilling the requirements to progress to higher training in EM.
Acute Internal Medicine:
ACCS is one of the training options available for delivering the core competencies required for a CCT in GIM, AIM or one of the JRCPTB specialties in a pre-planned and structured manner. The first two years of ACCS training (AIM, EM, Anaesthetics and ICM) are followed by a further year in acute medical specialties. This three year training programme fulfils the requirements for progression to higher training in GIM, AIM or any of the JRCPTB specialties.
Anaesthetics:
Anaesthetics offers career opportunities in a wide range of subspecialty areas, all of which can be achieved by direct entry to an Anaesthetic CCT programme. For those Anaesthetic trainees with an interest in the ‘acute’ end of the spectrum, ACCS provides a more widely-based experience than is available via the Core Anaesthesia programme. The first two years of ACCS training (AIM, EM, Anaesthetics and ICM) are followed by a year of Anaesthetic experience at CT2 level thus fulfilling the requirements for progression to higher training at ST3.
Intensive Care Medicine:
ACCS allows trainees who wish to obtain the single CCT in ICM or a dual CCT in Acute Internal Medicine & ICM, Anaesthetics & ICM or Emergency Medicine & ICM, to obtain the competences of the complementary specialties in a pre-planned and structured manner.
ACCS Severn
ACCS has its own training School within HEE Severn. This is different from many other Regions where ACCS sits as a sub-section of another Specialty School.
The ACCS School oversees the trainees first 2 years of ACCS, through the posts of Emergency Medicine, Acute Medicine, Anaesthesia and Intensive Care.
The third training year (sometimes referred to as CT2b or CT3) is overseen by the parent specialty, under the supervision of the appropriate School (e.g. EM, Anaesthesia or CMT).
Trainees are required to attend Trust/Corporate Induction at the first hospital they work at in August. They will also receive the necessary departmental/specialty induction in the first days of each post.
The ACCS School host an induction half day in August to help new trainees settle into the programme and learn about the training requirements of the ACCS programme. The date of the induction is detailed on the ACCS Severn website events.
The ACCS training programme is quite complex in its WBPAs and teaching/ training due to it being a multispecialty training programme. The induction session helps trainees get to grips with these elements as well as meet the ACCS School team and their peers. Attendance at the induction half day is compulsory and invaluable for trainees. ACCS trainers are also welcome to attend the induction day if they would like to know more about how the ACCS programme works.
3. Supervision
The supervision arrangements in ACCS are different from those in Foundation training which can sometimes cause confusion for trainees and trainers.
The trainee is allocated an Educational Supervisor for each of their 6 month blocks (or 3 month / 9 month in BRI and Weston). The Educational Supervisor should be a Consultant from the specialty the trainee is currently working in. The Educational Supervisor for each placement is who the trainees should initially contact for any training related issues. The Educational Supervisor should meet with the trainee 2 or 3 times during the 6 months.
The Educational Supervisor is responsible for completing the Structured Training Report at the end of the placement.
Within each hospital there are Clinical Tutors for each parent specialty who are able to advise trainees on specifics related to training in that specialty (e.g. exam preparation, careers advice, HST applications, etc). The details of the Clinical Tutors in each Trust are detailed on the following page and an up to date list is available on the ACCS Severn website.
The main roles of the Educational Supervisor are as follows:
- Sets up Learning Agreement
- Helps plan their training and agreed learning outcomes
- Reviews their Portfolio and WBAs
- Prepares them for ARCP
- Brings together all relevant evidence to form a summative judgement at the end of the placement
- Provides the end of placement Structured Training Report (STR) for the ARCP panel
- Offers career guidance and support (or directs to the Clinical Tutor in the trainees Parent Specialty)
- Assists with issues and problems
- Liaises with the TPD.
As an Educational Supervisor you should ensure that you remain up to date in your role. This includes being aware of how to support trainees, how to give feedback and having knowledge of their curriculum, WBAs, e-portfolio and requirements for ARCP. Educational Supervisors should work closely with the TPDs and should sit on ARCP panels regularly.
As an educational supervisor you must ensure that the trainee:
- is aware of their responsibility to initiate workplace based assessments and achieve the minimum number and type as specified in the ARCP checklists
- is supported in preparing for those assessments
- is aware of the requirement to maintain an up to date educational portfolio
- is aware of the requirements to undertake and succeed in all assessments of knowledge (usually examinations) and performance in a timely fashion based on the recommended timescale set out in the specialty curriculum
- is aware of the need to engage in processes to support revalidation
More information on these roles can be found in the Gold Guide.
Please note that Educational Supervisors require PGME/LETB recognition and GMC approval.
Severn Postgraduate Medical Education (PGME) has analysed the General Medical Council (GMC/PMETB) training requirements for educational and clinical supervisors and as a result has established seven core training requirements that all educational supervisors must meet. Details on how to become an accredited Educational Supervisor can be found on the Education and Training page on the PGME website.
Severn ACCS Educational Leads Contact Chart
4. Curriculum and Assessments
You can find the ACCS Curriculum here.
The document is self-explanatory and sets out the full list of required competencies for the component specialties within ACCS. It is vital that you familiarise yourself with this document and in particular the competences and assessment framework in order to support your trainees.
ACCS training is described under the headings of:
- Common Competencies
- Major Presentations
- Acute Presentations
- Anaesthesia in ACCS
- Practical Procedures
Some of this training must be obtained and evidenced during a particular placement, but other competencies can be achieved in any of the placements, provided that all are achieved by the end of year 2. This is all detailed in the curriculum.
In addition, to assist trainees and trainers in navigating the requirements, the ACCS School developed the ARCP Workbook which clearly sets out the evidence required from each placement and at the end of each year.
The ACRP Workbook is a crucial document for the trainees and is what should be submitted as evidence for the ARCP.
Overall, the requirements are relatively demanding and will require planning and organisation on the part of the trainee in order to achieve the required number/type. Failure to achieve this will make it difficult for you as an Educational Supervisor to ascertain whether they have satisfactorily completed their placement, which may affect the outcome of their ARCP. It is therefore vital that you work closely with your supervisee to support them in achieving the minimum requirements.
The Major and Acute presentations and most of the Common Competencies are assessed using the ACCS Workplace-based assessments (WBAs):
- Mini-Clinical Evaluation Exercise (M-CEX)
- Direct Observation of Procedural Skills (DOPS)
- Multi-Source Feedback (MSF)
- Case-Based Discussions (CBD)
- Acute Care Assessment Tool (ACAT and ACAT-EM)
- Patient Survey
- Audit Assessment
- Teaching Observation
Documentation
Trainees should use the e-portfolio of their parent specialty; WBAs for non-parent modules may be completed on e-portfolio or paper, but ACCS-EM 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 their Educational Supervisor. All ‘paperwork’, whether on e-portfolio or paper, should be summarised in the ARCP Workbook.
WBAs 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 WBA forms, as well as all the specialty-specific paperwork, can be found within the e-portfolios and on the ACCS website.
1. Common Competencies (ACCS Curriculum pages 26-73)
These are competencies that should be acquired by all doctors during their training period starting within the undergraduate career and developed throughout postgraduate training. For ACCS trainees, competence to at least level 2 descriptors will be expected prior to progression into further specialty training.
Many of these competencies 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 the required performance at each level can be found in the curriculum.
At least 50% of the common competencies must be signed off at level 2 or above by the end of the CT2 ACCS year. For a few common competencies alternative evidence should be used e.g. assessments of audit and teaching, completion of courses, management portfolio, which can be used to record management and leadership competencies.
2. Major Presentations (ACCS Curriculum pages 75-84)
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.
Two must be completed in the Emergency Medicine placement and must be summatively assessed using the Mini-CEX descriptor tool or a pass/fail CbD (see Curriculum pages 222-228). Summative tools are available for Major trauma, Shock, Altered level of consciousness and Sepsis.
Two should be assessed in the Acute Medicine placement and the other two can be done in any of the modules but it is recommended that Septic Patient should be signed off in the Intensive Care Medicine placement. The knowledge, skills and behaviours to be achieved for each presentation are listed in the curriculum.
3. Acute Presentations (ACCS Curriculum pages 85-134)
There are 38 Acute Presentations (APs) which need to be signed off by the end of the second year of ACCS. These are generally most applicable to AM and EM and whilst a minimum of 10 in AM and 10 in EM should be signed off, trainees should be strongly encouraged to complete them all during those placements. There are 5 APs that require the trainee to complete specific summative WBAs in the EM attachment. Up to 5 APs can be covered by a single ACAT in either EM or AM. The knowledge, skills and behaviours to be achieved for each presentation are listed in the curriculum.
4. Anaesthesia in ACCS
Introduction
The Anaesthesia training in ACCS is identical to the first six months of training core Anaesthesia trainees receive. During the Anaesthesia component of ACCS, trainees complete the ‘Introduction to Anaesthesia’ and achieve the Initial Assessment of Competency (IAC). All trainees must pass the IAC in their Anaesthesia placement.
All trainees should use the RCOA guide for novices.
Initial assessment of Competency (IAC)
Paper certificate and further information can be found on the RCOA website. The IAC is the first milestone in Anaesthetic training and will normally be achieved within the first 3 to 6 months of 1:1 supervised Anaesthetic training. Once trainees have achieved the IAC they may work without direct supervision and join the on call rota but they will at all times remain under the supervision of a named Consultant Anaesthetist. Anaesthetic-streamed ACCS trainees may complete the IAC directly on the RCoA e-portfolio whilst for EM and AM trainees the IAC is completed on paper and both pages of the certificate should then be uploaded to their e-portfolio. To obtain the IAC, trainees must complete a total of 19 WBAs.
Logbook
All trainees should maintain a logbook of their Anaesthetic cases, from the start of their ACCS Anaesthesia training, which needs to include a summary report by age, specialty, ASA grade and level of supervision. There is an electronic logbook available from the Royal College of Anaesthetists that is free to down load regardless of speciality and trainees are strongly advised to use this for their records, as it will generate the required reports.
Intensive Care Medicine
During Basic training in ICM, the trainee works under direct supervision for the majority of the time, being introduced to the knowledge and skills required for ICM. A broad-based outline knowledge of the wide range of problems which are seen in ICM is necessary at Basic level. Greater understanding and expertise can then be built upon this during higher stages of training should trainees wish to pursue ICM as a career.
The ICM assessment schedule includes 11 ICM-specific DOPs as well as covering a further 2 practical procedures and 2 of the Major Presentations - ideally Septic Patient plus one other.
5. Practical Procedures
There is a list of 44 Practical Procedures in the ACCS Curriculum. 39 out of 44 (ideally all) are expected to be completed by the end of the second year, and all by the end of the third year. 17 are associated with the Anaesthetic Initial Assessment of Competence, and 11 are associated with ICM training.
Multi-source Feedback (MSF)
This tool is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. "Raters" are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals.
Instructions:
- The trainee should trigger an MSF from their e-portfolio and choose a range of raters from healthcare professionals and clerical staff.
- The majority of raters should be Consultants, senior trainees and experienced nursing and allied health professional colleagues.
- A minimum of twelve assessments must be received, including at least three Consultants and both Clinical and Educational Supervisors can view the individual and collated responses within the e-portfolio.
- These results of the MSF should be discussed between the Educational Supervisor and the trainee during an appraisal meeting and the supervisor should then release the anonymised collated results to the trainee.
5. Teaching and Training
Attending teaching and training sessions is an important aspect of curriculum delivery for trainees and they should ensure they maximise their attendance at teaching.
Guidance on attendance at Regional Training days during the ACCS rotation
- All ACCS trainees (regardless of base specialty) can attend the Regional ACCS teaching during their AM and EM posts. The programme will be directed to cover the AM and EM elements of the curriculum.
- EM and AM trainees can continue to attend this training throughout their 2 years of ACCS.
- Anaesthetic trainees are invited to attend the FRCA and FICM training throughout their 2 years of ACCS training. EM and AM trainees whilst working in Anae and ICM can also attend the FRCA and FICM training if they wish.
In addition to the regional training days every department runs ‘in-house’ teaching. It is expected that the trainee immerses themselves in the specialties local teaching whilst working in that department.
‘New 2’ Introductory Days
There are four introductory modular training days that you trainees are expected to attend when they start in a new specialty: New2ICU, Novice Anaesthetist, New2AM and New2EM.
The courses are each run twice a year in Jan/Feb and again in Aug/Sept, to coincide with the rotation changes. Trainees should not apply to attend these days when they are not on the associated rotation.
All of these courses are fully funded by the School of ACCS however the trainees does need to apply for study leave to attend. Places are limited, and failure to register in good time may mean they are unable to attend.
Registering for ‘New 2’ Training Days
New2ICU. This course provides practical, hands-on experience enabling the trainee to be capable and proficient in the basic requirements of a junior doctor in the running of an intensive care unit both during the day and at night. It will also teach trainees the skills and knowledge they will require to manage emergency situations prior to the arrival of senior help.
Links to the course can be found on our Events page.
Novice Anaesthetist. This course covers management of critical incidents with a focus on airway, respiratory, and cardiovascular problems. Links to the course can be found on our Events page.
New2EM. This course provides an introduction to emergency medicine to complement local departmental induction. Links to the course can be found on our Events page.
New2AM. Links to the course can be found on our Events page.
Regional ACCS Training Days
The Regional ACCS training days are held on the second Tuesday of each month. The training days rotate through the 6 Trusts around the Region. Please see ACCS Teaching programme for more details.
An exact attendance figure is not stipulated however it is expected that trainees will attend the training days unless they are on nights, annual leave, sick leave or other approved study leave. We fully appreciate that staffing/rota crises happen and there may be occasional circumstances when trainees can’t gain study leave to attend a day but if this becomes a recurring problem this will be followed up by the ACCS School.
Attending other Regional Teaching
ACCS trainees may wish to use some of their study leave time to attend other regional teaching on offer and the ACCS School supports this. This is within the parameters of the trainees 15 days of internal study leave and 15 days of external study leave per year.
Anaesthetic Primary FRCA teaching
Anaesthetic core training days are aimed at those in CT1/2 anaesthetic training, preparing for the primary FRCA exam. ACCS-anaesthetic trainees are encouraged to attend where possible. EM and AM ACCS trainees are welcome to attend the Primary FRCA teaching but it can be quite exam focused. You should discuss which training days you would like to attend with your Educational Supervisor at your first appraisal meeting.
Please see our Events tab for a detailed list of all forthcoming primary teaching days for CT1 and 2's in Anaesthesia.
These training days take place in various hospitals around the region; the topics in the syllabus are mapped to the expertise in different locations. In order to maximise the learning opportunities attendees may be asked to complete either on-line Anaesthetic e-learning modules or specific reading tasks prior to each session, so that these act more like a workshop/tutorial and less like a lecture.
FICM teaching
ACCS trainees are invited to attend the FICM teaching days. These occur monthly and are held around the Region. ACCS trainees can attend free of charge. The details are available on the Severn ACCS website.
Core Medical Training Days
CMT training days are designed primarily for those working in medical specialties and preparing for MRCP, but ACCS-AM trainees are able to attend where possible. The content is relevant for all ACCS trainees currently working in acute medicine.
The ACCS School has ring-fenced 3 spaces at each CMT training day for ACCS trainees to use. This means you do not have to pay to attend but you do need to complete the online registration form. If more than 3 trainees would like to attend a CMT training day then please contact Trish Trim (ACCS School Support Manager) and we can arrange to increase our quota. All forthcoming CMT Training Days appear under Events where you will also find an online registration form.
6. Portfolio
Trainees should ensure they are registered with their parent specialty College and that they have access to the relevant e-portfolio which they should use throughout their training in ACCS. They should ensure they provide your details as Educational Supervisor to allow you the necessary access to their e-portfolio.
Details on enrolling for e-portfolio can be found via the relevant College websites:
Anaesthesia: http://www.rcoa.ac.uk/trainee-e-portfolio/e-portfolio-contacts
Emergency Medicine: http://www.rcem.ac.uk/Training-Exams/E-portfolio
Acute Medicine: http://www.jrcptb.org.uk/ePortfolio/Pages/Introduction.aspx
Any queries/problems that your trainee may have with this should be directed to their specialty.
In addition all ACCS trainees, regardless of parent specialty, should register for the e-Learning For Health website.
7. Exams
The trainee's parent specialty determines their exam requirements for satisfactory progression through training. The current requirement is that by the end of the 1st 2 years of ACCS trainees must have passed FRCEM Primary for Emergency Medicine or the MRCP Part 1 Examination for AIM. By the end of year 3, ACCS AIM trainees need to have passed the MRCP (including PACES) to complete the programme satisfactorily, and to be eligible for entry to higher training in a medical specialty. Anaesthetic trainees should aim to sit the FRCA Primary MCQ Examination by the end of the second year and must achieve both parts of the Primary by the end of the third year. They should ensure they discuss this with you as their Educational Supervisor and consult their College/Specialty School as necessary.
It is also vital that your trainees familiarise themselves with the exam regulations for the relevant exam, in particular when they can first sit the various parts, when to apply etc.
The FRCEM exams will be undergoing some changes over the next 1-2 years so Emergency Medicine trainees should ensure they check the RCEM website exam section regularly to clarify which exams they will need to sit.
8. Annual Review of Competency Progression (ARCP)
The ARCP is the annual review of trainees' progress.
Detailed information relating to the Annual Review of Competency Progression, (ARCP) is documented in the Gold Guide. All supervisors and trainees should make themselves familiar with this document as well as local PGME/LETB processes.
Checklists detailing the overall requirements for ARCP are found at the end of this Handbook in Appendix A.
The ARCP has two broad functions:
1) Fitness to Progress
The ACCS ARCP is the mechanism for reviewing and recording evidence and a means whereby the evidence of the outcome of assessments is recorded to provide a record of a trainee’s progress within their training post including Out Of Programme Training (OOPT). It makes judgements about the competencies acquired by a trainee and their suitability to progress to the next stage of training and provides a final statement of the trainee's attainment of the curricular competencies and thereby the completion of the stages of the training programme.
2) Fitness to Practice
The ACCS ARCP also gives advice to the PGME Revalidating Officer about revalidation of the trainee to enable a recommendation to the GMC.
ARCP Panel
The ARCP panel reviews the evidence submitted by each trainee on a set, pre-agreed date. The panel should consist of a minimum of 3 members and include representatives from each of the four ACCS posts (Anaesthetics, ICM, EM and AIM). The Chair of the panel should be trained for their role, and is usually a TPD or Postgraduate Deans representative. The panel should include Educational Supervisors, and others who are involved in medical education. A proportion of the panels will involve either a lay representative and/or an external representative from the appropriate Royal College(s). All panel members should have Equality and Diversity training.
The Evidence
It is each trainee's responsibility to submit the required evidence by a set date before the ARCP panel convenes. This should include:
- The Structured Training Reports (STR) from each Educational Supervisor
- Evidence of the competencies covered by WBAs detailed in the ARCP Workbook
- Enhanced Form R (a form giving demographic details, a description of their scope of practice and a self-declaration statement for revalidation purposes; not required in Scotland).
The panel reviews the evidence provided and awards an ARCP outcome, which is then communicated to the trainee. Only the pre-agreed documentary evidence can be considered so it is vital that the Educational Supervisor provides a full and detailed STR including details of any concerns raised by trainers, incidents etc.
Structured Training Report
As an Educational Supervisor you will write a structured report for your trainees for the ARCP panel. The STR must:
- reflect the learning agreement and objectives developed between the trainee and their Educational Supervisor
- be supported by evidence from the WBAs planned in the learning agreements
- take into account any modifications to the learning agreement or remedial action taken during the training period for whatever reason
- provide a summary comment regarding overall progress during the period of training under review, including where possible an indication of the recommended outcome supported by the views of the training faculty.
The report and any discussion which takes place following its compilation must be evidence based, timely, open and honest. The discussion and actions arising from it should be documented. The Educational Supervisor and trainee should each retain a copy of the documented discussion.
If there are concerns about a trainee’s performance, based on the available evidence, the trainee must be made aware of these prior to ARCP. Trainees are entitled to a transparent process in which they are assessed against agreed published standards, told the outcome of assessments, and given the opportunity to address any shortcomings. Trainees are responsible for listening, raising concerns or issues promptly and for taking the agreed action.
The Educational Supervisors should also support the trainees to develop an action plan to tackle any concerns and deficiencies and objectives should always be written using SMART objectives or another validated educational method.
ARCP Outcomes (From the Gold Guide)
The following outcomes can occur after an ARCP panel:
- Outcome 1: Satisfactory Progress - Achieving progress and the development of competencies at the expected rate
- Outcome 2: Development of specific competencies required - Additional training time not required. The trainee’s progress has been acceptable overall but there are some competencies which have not been fully achieved and need to be further developed. It is not expected that the rate of overall progress will be delayed or that the prospective date for completion of training will need to be extended or that a period of additional remedial training will be required.
- Outcome 3: Inadequate progress - Additional training time required. The panel has identified that a formal additional period of training is required which will extend the duration of the training programme (e.g. the anticipated CCT/CESR (CP) date). Where such an outcome is anticipated, the trainee must be informed in advance. The trainee, Educational Supervisor and employer will need to receive clear recommendations from the panel about what additional training is required and the circumstances under which it should be delivered (e.g. concerning the level of supervision).
- Outcome 4: Released from training programme - With or without specified competencies. The panel will recommend that the trainee is released from the training programme if there is still insufficient and sustained lack of progress, despite having had additional training to address concerns over progress. The trainee will be required to give up their National Training Number, but may wish to seek further advice from the Postgraduate Dean or their current employer about future career options, including pursuing a non-training but service-focused career pathway. An outcome 4 may also be recommended in some circumstances where there has not been additional training, for example for disciplinary reasons or where the trainee has exhausted all attempts at passing an exam without having received additional training time.
- Outcome 5: Incomplete evidence presented - Additional training time may be required. The panel can make no statement about progress or otherwise since the trainee has supplied either no information or incomplete information to the panel.
- Outcome 6: Gained all required competencies
For outcomes 2 - 6 the trainee is required to meet with the panel after the panel has reached their decision.
Trainees on Outcomes 2, 3 and 4 should meet with their Educational Supervisor and TPD afterwards, and a written educational plan should be agreed. The educational plan should be written using SMART objectives, and should be agreed by all parties.
9. Leave and courses
The arrangements for study leave are detailed on the PGME website.
As Educational Supervisor you should support your trainee(s) in making decisions about best use of study leave time and funding to ensure they complete all mandatory courses as well as have the opportunity to explore areas of particular individual interest.
The following list constitutes useful courses and conferences that the ACCS School Board deem appropriate for study leave.
The list is not exhaustive and other study leave courses may be approved following discussion with the Educational Supervisor. If there are any queries about the appropriateness of a course please contact SevernACCS.SW@hee.nhs.uk
Resuscitation courses
ALS
APLS
ATLS
European Trauma Course
PHTLS (Pre-Hospital Trauma Life Support)
HMIMMS (Hospital Major Incident Medical Management)
MIMMS Course (Major Incident Medical Management)
Simulation courses
UK Training in Emergency Airway Management (TEAM) Course (endorsed by RCEM, FICM, RCOA)
Transport of the Critically Ill Course (run by NBT and BMSC)
Training the Trainers course (for simulation and medical education)
Team Training for Critical Incident (run by BMSC)
Confidence with kids – Emergency Real-life scenarios (CONKERS – run by BMSC)
Acute Medical Emergencies course (run by BMSC)
Ill Medical Patients’ Acute Care & Treatment (IMPACT) course
DART Course (Difficult Airway Rescue Techniques) - http://www.airwaytraining.co.uk/dart/
Ultrasound courses
Level 1 Emergency Ultrasound course (or equivalent)
Level 2 (specialist) ultrasound if level 1 completed (e.g. Focused echo, pleural ultrasound, etc)
FICE (Focused Intensive Care Echocardiography)
CUSIC (Core Ultrasound in Intensive Care)
Conferences
ACCS National Trainees Day (hosted by RCOA)
Emergency Medicine Trainee Association (EMTA conference)
RCEM Annual Scientific Conference
RCEM Annual CPD Conference
Society for Acute Medicine (SAM) Conference
SICOWE : Society of Intensive Care for West of England Annual Scientific meeting
SODIT: Society of Devon Intensive Therapy Annual Scientific meeting
SASWR: Society of Anaesthetist of the SW Region Annual Scientific meeting
GAT: Group of Anaesthetists in Training (AAGBI) Annual Scientific meeting
ICS: Intensive Care Society Annual Scientific meeting
Study days organised and recognised by RCEM, RCP, RCOA, RSM
10. ACCS events
Information on ACCS events and the annual Trainer and Trainee Day will be posted on the ACCS website.
11. Social Media
Please see the GMC’s guidance on the use of Social Media and that of the BMA here.
12. Out of programme time (OOP)
Trainees may, subject to the approval of the PGME, spend some time out of the specialty training programme to which they were appointed. This can be for a career break or educational/training opportunities elsewhere. Whilst occasions where OOP is granted to core trainees are likely to be exceptional given the short length and the nature of their training, these opportunities are explained in detail in the Gold Guide and further information from the PGME Out of Programme page.
Global Health OOPEs
The Severn ACCS School have forged links with African Health Placements to offer ACCS trainees the opportunity to undertake a 1 year placement in rural South Africa. This Global Health Training opportunity is available to ACCS trainees at the end of their ST3 year whereby successful applicants will travel to a rural South African community for 12 months. During this placement the successful candidates will be working with African Health Placements and will receive a salary directly from the South African Government.
This opportunity is open to all ACCS trainees. For EM trainees this placement would be an ‘Out of Programme Experience’ (OOPE) and they would return to their ST4 EM post in Severn at the end of the year. For AM and Anaesthetic trainees this opportunity would be outside of the training programme and is offered at the end of the CT3 AM / CT2b anaesthetic year, however it is hoped that this opportunity would significantly enhance a trainees CV for future HST applications.
The first ACCS trainee embarked on this programme in August 2016. Two further trainees are due to go on placement in August 2017.
Further information about the Global Health Placements can be found via the African Health Placements website and the Severn Primary Care School, who offer a similar OOPE to their trainees.
If you would like any further information please contact SevernACCS.SW@hee.nhs.uk
13. Changing specialty and moving region
Changing Parent Specialty
It is not currently possible for ACCS trainees to switch from one parent specialty programme to another (e.g. Acute Internal Medicine to Anaesthesia). The ICACCST have recently had discussions with the GMC, Health Education England and the UK’s Deans to try and find some way of resolving this, but unfortunately there has been no change to the current situation.
Trainees wishing to change ACCS specialty should apply for an ACCS CT1 post within the specialty that they wish to change to. If successful, the PGME/School may approve the counting of competencies already gained towards the new specialty. Please note: this would be entirely at the PGME's discretion, and it is therefore not guaranteed that this will occur.
Inter Deanery Transfer (IDT)
The National Inter Deanery Transfer (IDT) process has been established to support trainees who have had an unforeseen and significant change in their personal circumstances since the commencement of their current training programme which requires a move to a different region. The process is managed by the National IDT team (Health Education South London) on behalf of the Conference of Postgraduate Medical Deans (COPMeD), Health Education England (HEE) and all UK regions.
In order to provide a consistent, transparent and robust process for all trainees, the National IDT team will make all decisions on eligibility and allocations in accordance with the published guidelines and criteria. You can read these guidelines and criteria as well as find out more about the process on the specialty training IDT page. You can also contact the National IDT team directly with any queries you may have.
As part of the application process, all trainees are required to submit a ‘Deanery Document’. This form can be found on the National IDT website above and should be sent to their current region’s administrative team for completion.
For details regarding the next opportunity to submit an application for the National IDT process please see the website.
HEE Severn’s guidance on IDTs.
14. Part time working (Less Than Full Time Training)
Who is Eligible for LTFT Training?
Those wishing to apply for less than full-time training must show that training on a full-time basis would not be practical for them for well-founded individual reasons:
Category 1: Doctors in training with:
- disability
- ill health (those who have health reasons will be required to attend an appointment with the LETB Occupational Health before being eligible for the scheme)
- responsibility for caring for children (men and women)
- responsibility for caring for ill/disabled partner, relative or other dependant.
Category 2: Doctors in training with:
- unique opportunities for their own personal/professional development, e.g. training for national/international sporting events, courses that contribute to the wider curriculum delivered by Health Education East Midlands
- religious commitment - involving training for a particular role which requires a specific time commitment
- non-medical professional development such as management courses, law courses, fine arts courses, etc.
LTFT training will only be offered if there are trainers and training experience available and the employing Trust agrees. There are sometimes difficulties with funding which may delay the commencement of a LTFT training post, particularly at points of re-entry into training.
Information on applying for LTFT.
15. Trainees in difficulty
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.
Supporting trainees in difficulty can be a very challenging and a very rewarding part of the role of an Educational Supervisor. The difficulties a trainee experiences may be many and varied, and may impact on their work, and patient safety. One of the roles of an Educational Supervisor or teacher is to provide ‘pastoral’ care for students and trainees. This sometimes extends outside the normal educational or clinical role and impinges on an individual’s personal life.
Sometimes trainees will find themselves in a situation where their performance falls below required standards. In most cases the individual recognises the problem and is able to solve it. However, a small number of trainees will get into difficulty which they either fail to recognise or acknowledge, or which they are unable or unwilling to seek help for.
Any issues that have the potential to impact on training progression or which may require additional evaluation/support should be alerted to the Training Programme Director at the earliest opportunity.
Notes should be kept from all relevant trainee/trainer meetings and necessary information handed over as a trainee rotates through their ACCS placements.
Please see Appendix D for detailed guidance on how to deal with the doctor in difficulty
HEE Severn has a Professional Support Unit which promotes trainee well-being and personal development. They are a very useful source of support and guidance if you have a trainee in difficult. Further details can be found here: http://severndeanery.nhs.uk/about-us/careers-support/less-than-full-time-training/
16. Contacts and Who’s Who?
The structure of the ACCS School is detailed below:
ACCS Head of School – Dr Jo Kerr
Overall ACCS Training Programme Director and EM&AM Lead – Dr Marianne Gillings
Anaesthetic Lead for ACCS Anae TPD – Judith Stedeford
ICM Lead for ACCS – Dr Dom Janssen
ACCS Severn Team - SevernACCS.SW@hee.nhs.uk
17. Key links
Royal College/Faculty websites
Royal College of Anaesthetists
Royal College of Emergency Medicine
Royal College of Physicians
Faculty of Intensive Care Medicine
Health Education England Specialty Training website
Specialtytraining.hee.nhs.uk/
RCEM Learning website
http://www.rcemlearning.co.uk/landing/
e-Portfolios
Anaesthesia
http://www.rcoa.ac.uk/trainee-e-portfolio/e-portfolio-contacts
Emergency Medicine
http://www.rcem.ac.uk/Training-Exams/E-portfolio
18. Timeline
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August changeover |
First day, local (Trust/Corporate) Induction.
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1st few days |
Departmental/clinicalInduction.
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1st 2 weeks |
Initial meeting with Educational Supervisor (trainee to arrange).
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Late October |
Midpoint meeting with Educational Supervisor (trainee to arrange); WBA review/planning.
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January |
MSF takes place (via e-Portfolio).
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January |
End of placement meeting with Educational Supervisors (trainee to arrange)
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February changeover |
First day, local (Trust/Corporate) Induction (as necessary).
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1st few days |
Departmental/clinical induction.
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1st 2 weeks |
Meeting with Educational Supervisor (trainee to arrange); MSF review.
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Late March |
Midpoint meeting with Educational Supervisor (trainee to arrange); WBA review/planning.
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Early June |
End of placement meetings with Educational Supervisor (trainee to arrange)
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Early June |
Pre-ARCP meeting with Educational Supervisor; review of WBAs and checklists, MSF and likely ARCP outcome. Educational Supervisor does STR form.
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Late June |
Trainee submits STR x 2, ARCP Workbook to Assessments Team prior to ARCP
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Late June/early July |
ARCP panel meetings
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Appendix A: ARCP Workbook
The purpose of this ARCP Workbook is to give trainees and trainers a central document where all the required competencies and clinical procedures can be recorded. It also includes all 4 modular (Educational) supervisor reports. As each trainee completes a module within the ACCS programme an end of module Educational Supervisor’s Structured Training Report should be completed by the trainee with their supervisor. This is the person that has had direct responsibility for the educational and clinical needs of the trainee during that particular module.
At the end of the year each trainee will submit this booklet having had a Structured Training Report completed for each module they have undertaken that year; there will usually be 2 of these. In addition there will also be a record of the competencies, presentations and practical procedures that they have achieved, signed off by their modular (Educational) supervisor. This booklet along with an up-to-date CV will be required for the trainees ARCP outcome to be determined for the year.
Appendix B: Learning Agreement
Download/Print Learning Agreement
Appendix C: Reflective Learning Template
Download/Print Reflective Learning Template
Appendix D: Doctors in Difficulty