Top Tips for ACCS EM trainee Anaesthetic Educational Supervisors for sign off of ACCS Anaesthetic competences Amanda Farrow August 2017

Educational Supervisor Any non EM Supervisor will need to register with RCEM to be added as an ES to the e-portfolio. You will need to register as an ES to be able to see the MSF etc so it is easier if the trainee has 2 ES for the posts one for Anaesthetics and the EM ES to have overall overview of the e-portfolio and the training. Please see link below for form to register http://www.rcem.ac.uk/RCEM/Exams_Training/UK_Trainees/ePortfolio/RCEM/Exams_Training/UK_Trainees/ePortfolio.aspx?hkey=3b2594d1-23cb-47ad-bc8e-449438ec41ac At the end of the Anaesthetics placement. Please ensure you have : Completed IAC ( paper forms should be uploaded by trainee to personal library in e-portfolio) or electronic IAC is available in e-portfolio ( please note in comments names of both Consultant signatures) Signed off all the required Units of Training A1- A8 ( see further details in this presentation) The trainee will be required to upload the log book to the personal library Completed an End of placement review form ( found in ES /meetings section) Created and released the MSF summary in the e-portfolio

Any queries? Questions regarding Anaesthetic competences? Please liaise with ACCS Anaesthetic Lead Rachel Walpole Questions regarding EM e-portfolio? Please liaise with ACCS EM Lead in your training site: For any other ACCS training queries please liaise with Zoe Dummett DummettZA2@cardiff.ac.uk ACCS Specialty Manager in the Wales Deanery Training Site ACCS EM Lead YGH Leesa Parkison Morriston Ranga Mothukuri Newport Tim Rogerson UHW Sue Allen NHH Owain Chandler POW Amanda Farrow PCH Tim Manfield

Anaesthetic WPBA available on RCEM e-portfolio Anaesthetic: A-CEX Anaesthetic: CBD (2015) Anaesthetic: DOPS (2015) Anaesthetic: ALMAT Anaesthetic Initial Assessment Of Competence (IAC) – please note name of second signature on form please MSF ( usual RCEM MSF can be used)

New changes to curricular requirements All ACCS trainees must complete, in addition to the IAC, the modules listed under ‘Introduction to anaesthesia’ and all the associated learning outcomes. This will require a minimum of 7 further WPBAs in addition to those used for IAC. Introduction to Anaesthesia Preoperative assessment History taking Clinical examination Specific anaesthetic evaluation Premedication Induction of general anaesthesia Intra-operative care Postoperative and recovery room care Introduction to anaesthesia for emergency surgery Management of respiratory and cardiac arrest Control of infection

A1 Preoperative assessment Learning outcomes: • Is able to perform a structured preoperative anaesthetic assessment of a patient prior to surgery and recognise when further assessment/optimisation is required • Is able to explain options and risks of routine anaesthesia to patients, in a way they understand, and obtain their consent for anaesthesia • Is able to formulate a plan for the management of common co-existing diseases, in particular the perioperative plan for the patient with diabetes IAC assessments to be included : IAC_A01 Preoperative assessment of a patient who is scheduled for a routine operating list [not urgent or emergency] [0-3 months] IAC_C03 Discuss how the airway was assessed and how difficult intubation can be predicted Unit Sign-off requires an additional 1x DOPS

A2 Premedication Learning outcome: • Is able to prescribe premedication as and when indicated, especially for the high risk population Unit Sign-off requires 1x DOPS 1x ACEX 1xCBD

A3 Induction of general anaesthesia Learning outcome: • Is able to conduct safe induction of anaesthesia in ASA grade 1-2 patients confidently • Is able to recognise and treat immediate complications of induction, including tracheal tube misplacement and adverse drug reactions • Is able to manage the effects of common complications of the induction process • Is able to conduct anaesthesia for ASA 1E and 2E patients requiring emergency surgery for common conditions (e.g. uncomplicated appendicectomy or manipulation of forearm fracture/uncomplicated open reduction and internal fixation) • Demonstrates safe practice behaviours including briefings, checklists and debriefs • Demonstrates correct pre-anaesthetic check of all equipment required ensuring its safe functioning [including the anaesthetic machine/ventilator in both the anaesthetic room and theatre if necessary] • Demonstrates safe induction of anaesthesia, using preoperative knowledge of individual patients co-morbidity to influence appropriate induction technique; shows awareness of the potential complications of process and how to identify and manage them IAC assessments to be included : IAC_D01 Demonstrate functions of the anaesthetic machine [0-3 months] IAC_C01 Discuss the steps taken to ensure correct identification of the patient, the operation and the side of operation IAC_D06 Demonstrates the routine for dealing with failed intubation on a manikin. Unit Sign-off requires an additional 1x ACEX

• Recognises the importance of working as a member of the theatre team A4 Intra-operative care Learning outcomes: • Demonstrates the ability to maintain anaesthesia for elective and emergency surgery • Demonstrates the ability to use anaesthesia monitoring systems to guide the progress of the patient and ensure safety • Considers the effects that co-existing disease and planned surgery may have on the progress of anaesthesia and plans for the management of significant co- existing diseases • Recognises the importance of working as a member of the theatre team • Safely maintains anaesthesia and shows awareness of potential complications and their management IAC assessments to be included : IAC_A02 Manage anaesthesia for a patient who is not intubated and is breathing spontaneously [0-3 months] IAC_A03 Administer anaesthesia for acute abdominal surgery [0-3 months] IAC_D02 Transfer a patient onto the operating table and position them for surgery [lateral, Lloyd Davis or lithotomy position] [0-3 months] IAC_C02 Discuss how the need to minimise postoperative nausea and vomiting influenced the conduct of the anaesthetic

A5 Postoperative and recovery room care Learning outcomes: Is able to manage the recovery of patients from general anaesthesia Is able to describe the organisation and requirements of a safe recovery room Is able to identify and manage common postoperative complications in patients with a variety of co-morbidities Is able to manage postoperative pain and nausea and vomiting Is able to manage postoperative fluid therapy Safely manages emergence from anaesthesia and extubation Shows awareness of common immediate postoperative complications and how to manage them Prescribes appropriate postoperative fluid and analgesic regimes Assesses and treats PONV IAC assessments to be included : IAC_D05 Basic Competencies for Pain Management – manages PCA including prescription and adjustment of machinery [0-3 months] IAC_A05 Recover a patient from anaesthesia [0-3 months] IAC_C05 Discuss how the trainee’s choice of post-operative analgesics was made IAC_C06 Discuss how the trainee’s choice of post-operative oxygen therapy was made

A6 Management of respiratory and cardiac arrest in adults and children Learning outcomes: • Is able to have gained a thorough understanding of the pathophysiology of respiratory and cardiac arrest and the skills required to resuscitate patients • Understands the ethics associated with resuscitation • Is able to resuscitate a patient in accordance with the latest Resuscitation Council (UK) guidelines. [Any trainee who has successfully completed a RC(UK) ALS course in the previous year, or who is an ALS Instructor/Instructor candidate, may be assumed to have achieved this outcome] IAC assessments to be included : IAC_D03 Demonstrate cardio-pulmonary resuscitation on a manikin. [0-3 months] Unit Sign-off requires either Up to date successful completion of an ALS/APLS/EPLS course or 1 DOPS ( a simulation may be used to assist in the teaching and assessment of these competencies)

A7 Control of infection Learning outcomes: • Is able to understand the need for infection control processes • Is able to understand types of infections contracted by patients in the clinical setting • Is able to understand and apply most appropriate treatment for contracted infection • Is able to understand the risks of infection and be able to apply mitigation policies and strategies • Is able to be aware of the principles of surgical antibiotic prophylaxis • Demonstrates the acquisition of good working practices in the use of aseptic techniques IAC assessments to be included : IAC_D04 Demonstrates technique of scrubbing up and donning gown and gloves. [0-3 months] Unit Sign-off requires an additional 1x ACEX and 1x CBD

A8 Introduction to anaesthesia for emergency surgery Learning outcome: • Delivers safe perioperative care to adult ASA 1E and/or 2E patients requiring uncomplicated emergency surgery IAC assessments to be included : IAC_A04 Demonstrate Rapid Sequence Induction [0-3 months] IAC_C07 Discuss the problems emergency intra-abdominal surgery causes for the anaesthetist and how the trainee dealt with these IAC_C08 Discuss the routine to be followed in the case of failed intubation. IAC_A03 Administer anaesthesia for acute abdominal surgery [0-3 months] IAC_D06 Demonstrates the routine for dealing with failed intubation on a manikin.

Click on clinical curriculum

Click on Anaesthetic competences then click on the pencil shape for the competence you wish to sign off

Click on rating – decide on level of achievement

Click on level of achievement

Then note what has been completed in the comments box, please note all requirements for the CUT for that competence, this is equivalent to CUT form so needs to be fully completed.

The level of achievement recorded and the comments will then appear in the curriculum list. This will be the overview to see what the trainee has left to complete and will aid the ease of sign off at ARCP.

End of placement review form

Thank You!