2015 HE EoE School of EM 8 th Regional Faculty Day.

2015 HE EoE School of EM8th Regional Faculty Day

School of Emergency Medicine

UK EM Training: 20 years Evolution

• 1995 ‘Calman’ SpR, RITAs, Jnr Dr New Deal, EWTD• 2005 ‘PMETB Order’- Articles 14: CESR route• 2006 Foundation years – national introduction• 2007 MMC: abolition SHOs, RT, ACCS, ARCPs • 2008 ‘Tooke’ Enq: uncoupling Core/HST, PG Schools• 2009 National recruitment EM HST by CEM/PGD• 2010 PMETB/GMC + 2010 EM Curriculum, Trauma Networks• 2011 NHS re-organisation, National ACCS recruitment • 2012 Major recruitment and retention problems• 2013 EM Taskforce to address ‘Crisis’• 2014 RT, DRE-EM, ACCS Expansion,• 2015 Consolidation of progress, 2015 curriculum• 2016 ?? New contract??

2014-15 • Re-introduction RT training at ACCS ST1 level• Offer RT to all existing core trainees- • Expansion ACCS training:• Establish alternative pathway DRE-EM training • National recruitment ST4 + DRE-EM CT3/ST3• New 2015 EM Curriculum + Exam structure• Other national initiatives: ANP, PAs, • International recruitment –IMGs 50-70 Nov 2014



CCT EM +/- Sub-specialist – Independent specialist practitioner

Post-CCT

FY2FY1

ACCSCT2 1 year Anaesthetics + ICU 6/12 each or 9/3CT1 1 year EM + AM 6/12 each

CT3 EM PEM Paediatrics Basic MSK- MCEM level

ST4, ST5, ST6 36 months in EM

Advanced MSK

Competitive Entry: CT1 ACCS (EM) +CT3

MCEM

Article 14 -CESR route

2+3+3=8

HST 3-yrs

Sub-specialisation: PEM, ICM; Acute Med

PHEM + 1 Yr

Core Training 3 yrs

FCEM CCT route

Foundation Training

Un-coupled Emergency Medicine CCT training 2010


CCT EM +/- Sub-specialist – Independent specialist practitioner

Post-CCT

FY2FY1

ACCSST2 1 year Anaesthetics + ICU 6/12 each or 9/3ST1 1 year EM + AM 6/12 each

ST3 EM PEM Paediatrics and further EM

ST4, ST5, ST6 36 months in EM

Competitive Entry: ST1 ACCS (EM) +ST3

MCEM: Part A +B: I, II

CESR-CP=competences in NT-posts

2+3+3=8

HST 3-yrs

Sub-specialisation: PEM, PHEM + 1 Yr ICM: 2yrs An 6/12 ICM18/12

Core Training 3 yrs

FCEM: SAQ+OSCEs ST6 CCT route

Foundation Training

Run-through EM training 2014 CCT + CESR-CP Routes

CA: ST3+CTR =QIP Mg=Portfolio

OOPs: T, E, R, B


CCT EM or CESR-CPIndependent specialist practitioner

Post-CCT

FY2FY1

Anaesthetics, ICU, AM: 4-6 months each

EM + PEM

ST4, ST5, ST6

Competitive Entry: ST3/CT3 DRE-EM

MCEM: Part A (exemptions) MCEM B +C

CESR-CP Route: some work in Non- training posts

HST 3-yrs

Conversion years

FCEM: SAQ+OSCEs at ST6

CCT route

Foundation Training

BST +MRCS generic competences

DRE-EM 2014 CCT + CESR-CP ‘Alternative’ Pathway

CA: ST3+, CTR=QIP Mg=Portfolio

OOPs: T, E, R, B

24months SHO12/12EM + other ACCS competence

EM + PEM

Anaesthetics, ICU, AM: 4-6 months each

BST or other Training/Non-T posts

CESR-Article 14 pathway

4- 5 year training program like old SpRs:

SG1-SG5 3-month secondment every year out of EMAM, ICM, Anaesthetics-IAC, PEMRegular weekly teaching, WpBAs, Annual Appraisal, eportfolio, involved in teaching, mg, recruitmentATLS, ALS, US, APLS etcCollect evidence for CESR application

FCEM support: All parts Mg, CTR, CA, SAQ+OSCEs ST6

MCEM: Parts A, B, C

CESR Application approvalIndependent specialist practitioner

One year locum consultantCESR Application completion & evidence validation

ACCS CT1 EM: Outcome 1 – 32 trainees 2015-16 Outcome 3 – 1 trainee 33 44 ACCS CT2 EM: Outcome 1 – 14 trainees 14 32 ST3: Outcome 1 – 9 trainees Outcome 2 – 2 trainees Outcome 3 – 8 trainees Outcome 6 – 6 trainees 25 22 DRE-EM: Outcome 1 – 13 trainees Outcome 3 – 1 trainee 14 24 HST: Outcome 1 – 23 trainees Outcome 2 – 1 trainee Outcome 3 – 4 trainees Outcome 6 – 6 trainees Outcome 8 – 2 trainees 36 34+2PHEMTOTAL 122 160

2015 ARCP Final Outcomes:

EM Initiatives HE EoE 2014-15

• Expand ACCS 19-42 posts fully recruited• DRE-EM: 14+10 = 24• Regional monthly teaching programs:

– ACCS– ST3/DRE-EM– HST– SAS + Night Safe simulation

• Mock SAQ/OSCEs MCEM and FCEM, MCEMA course 16• ARCPs, Workshops and Faculty Days • EoE Workforce Group

– 2 Regional conferences, ACPs, PA graduate course

• School admin manager and new website

HE EoE Workforce Group 2014-15

• Task and Finish group 2012, implementation 2013• Chair by HoS and Director- Ross Collett• TPDs, Deanery, 4 Workforce partnership representatives

– Essex, Beds/Herts, N/S, Cams

• June 14 and 15 MTD Workforce Conferences • ‘Night Safe’ program funding• University-based AP program: ARU UEA

What’s New?

• 2015 curriculum + HAP 35-36 in HST

• ARCP process stringent: checklists

• ESLEs from ST3 onwards

• FEGS: Faculty Educ Governance statement

• QIP for current ST3s, MCEM/FCEM

• New Exam structure with GMC

• National recruitments: – ST3+DRE-EM, HST, ACCS

Training: Sharing Good practice

• Well staffed EDs at all Levels• Balanced Rotas, Training environment, WpBAs• Consultant 08-24, MGs 24/7, clinical supervision• Good weekly teaching programs• Attendance at regional days and SL• Regular feedback and support for progression• Faculty STRs: timely, fair, reflecting ST abilities• Support for slow learners

Middle Grade tier weakness

• Many EDs in region struggle with 24/7• ST4-6: improving, Full recruitment 2016• Recruitment from Overseas variable• IMGs/EU doctors of variable ability• ANPs and APs numbers low- infancy

• Sparce MG training programs, ad-hoc/unstructured, • Under-utilise CESR training opportunities• NO CESR established program in region

Opportunities in EoE

• PHEM, PEM, ICM

• OOPE/T/R

• Surgical Skills course: pilot Nov 15

• Simulation-ACCS/HST/NS + Lead

• Mock MCEM/FCEM +MCEM A 2d Feb16

• Formal links to SA 1-yr training

• ACP and PA programs: training

DRI CESR Model:

• Tailor-made CESR rotations

• Specifically-designed teaching programme to match FCEM curriculum

• Teaching: OSCE practice, CA, CTR, MG

• Portfolio review Consultant mentor accompanying evidence +FCEM forward GMC CESR

2015 HE EoE School of EM 8 th Regional Faculty Day.

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