ACCS – 6 months in Acute medicine Philip Campbell RGH

ACCS Many consultant physicians are uncertain what ACCS means! Many consultant physicians are uncertain what ACCS means! Tend to think it is a training scheme for anaesthetics. Tend to think it is a training scheme for anaesthetics. ACCS trainees usually amongst the best doctors on the CMT rota (regardless of parent specialty). ACCS trainees usually amongst the best doctors on the CMT rota (regardless of parent specialty).

ACCS The ACCS training programme fulfils the requirements for progression to higher training in any an acute medical specialty. The ACCS training programme fulfils the requirements for progression to higher training in any an acute medical specialty. Delivers all the competences of Core Medical Training (CMT), with augmented outcomes and more broadly based experience. (3yrs vs 2). Delivers all the competences of Core Medical Training (CMT), with augmented outcomes and more broadly based experience. (3yrs vs 2).

ACCS 6 months of AM, at least 4 shifts of acute medical take per month during this period of training in medicine. (CMT1 or CMT2 level). 6 months of AM, at least 4 shifts of acute medical take per month during this period of training in medicine. (CMT1 or CMT2 level). Posts are taken from medical rotations. CT3 year returns to AM. Posts are taken from medical rotations. CT3 year returns to AM. No problems fitting in as a medical CMT. No problems fitting in as a medical CMT.

ACCS Expected to join in with grand rounds and other hospital based teaching/training/audit. Expected to join in with grand rounds and other hospital based teaching/training/audit. Are entitled to be released for parent specialty training days. Are entitled to be released for parent specialty training days. Key is to be well organised and plan ahead. Key is to be well organised and plan ahead.

ACCS WBA Mini-CEX 3 Mini-CEX 3 CbD 3 CbD 3 DOPS 5 DOPS 5 ACAT 3 ACAT 3 MSF MSF DO NOT LEAVE THESE UNTIL THE LAST MINUTE! DO NOT LEAVE THESE UNTIL THE LAST MINUTE!

2010 Curriculum Common Competencies Common Competencies Major Presentations Major Presentations Acute Presentations Acute Presentations Anaesthesia in ACCS Anaesthesia in ACCS Practical Procedures Practical Procedures

2010 Curriculum Common Competencies Common Competencies Major Presentations Major Presentations Acute Presentations Acute Presentations Anaesthesia in ACCS Anaesthesia in ACCS Practical Procedures Practical Procedures

Major Presentations Anaphylaxis Anaphylaxis Cardio/respiratory Arrest Cardio/respiratory Arrest Major Trauma (EM attachment) Major Trauma (EM attachment) The Septic Patient (recommended during ITU) The Septic Patient (recommended during ITU) The Shocked Patient The Shocked Patient The Unconscious Patient The Unconscious Patient (at least 2 out of 6)

Acute Presentations (38) 5 of these are specific to EM requiring summative WPBA during the EM module 5 of these are specific to EM requiring summative WPBA during the EM module 10 of the remainder should be signed off during the AM module (another 5 during EM). 10 of the remainder should be signed off during the AM module (another 5 during EM). A further 8-10 APs should be covered by ACAT, e- learning, reflective entries, teaching and audit. A further 8-10 APs should be covered by ACAT, e- learning, reflective entries, teaching and audit. Up to 5 APs can be covered by a single ACAT in either EM or AM Up to 5 APs can be covered by a single ACAT in either EM or AM

Practical Procedures Lumbar puncture Lumbar puncture Pleural tap & aspiration Pleural tap & aspiration Intercostal drain insertion (seldinger) Intercostal drain insertion (seldinger) Intercostal drain insertion (open) Intercostal drain insertion (open) Ascitic tap Ascitic tap Abdominal paracentesis Abdominal paracentesis DC cardioversion DC cardioversion Knee aspiration Knee aspiration Temporary pacing (external / wire) Temporary pacing (external / wire) Large joint examination. Large joint examination.

Portfolio 3 different colleges and sets of paperwork. 3 different colleges and sets of paperwork. AM and EM stream trainees have use of the e- portfolio. AM and EM stream trainees have use of the e- portfolio. AM specific documents can be printed from ACCS and RCP websites. AM specific documents can be printed from ACCS and RCP websites.

Exams Eligible for study leave for FRCA/MCEM if not AM trainee. Eligible for study leave for FRCA/MCEM if not AM trainee. If AM stream should aim to pass MRCP as soon as possible. If AM stream should aim to pass MRCP as soon as possible.

MRCP Part 1 Now eligible to sit after FP1 year. Now eligible to sit after FP1 year. Sittings in September, January, May (results within 5 weeks) Sittings in September, January, May (results within 5 weeks) Unlimited attempts (candidates who fail badly may be recommended to defer re-entry for one or more examinations). Unlimited attempts (candidates who fail badly may be recommended to defer re-entry for one or more examinations).

MRCP 1 Once passed “have 7 years to pass the second part”. Once passed “have 7 years to pass the second part”. From August 2011, possession of the full MRCP(UK) became a mandatory requirement for ST3 entry into any of the medical specialties. From August 2011, possession of the full MRCP(UK) became a mandatory requirement for ST3 entry into any of the medical specialties. Candidates can apply to sit the MRCP(UK) Part 2 Written Examination after they have been awarded a pass in the MRCP(UK) Part 1 Examination. They do not require any additional medical experience. Candidates can apply to sit the MRCP(UK) Part 2 Written Examination after they have been awarded a pass in the MRCP(UK) Part 1 Examination. They do not require any additional medical experience.

PART 2 Since 2009, PACES and PART 2 written can be taken in any order. Since 2009, PACES and PART 2 written can be taken in any order. Recommendation is to pass the written first. Recommendation is to pass the written first. Exam usually held in April, July or November.

PACES Dress and appearance are important Dress and appearance are important Infection-control policies vary from centre to centre. Infection-control policies vary from centre to centre. Usually required to wear a short-sleeved shirt or blouse, with no neck-tie, false nails, wrist-watch or wrist jewellery Usually required to wear a short-sleeved shirt or blouse, with no neck-tie, false nails, wrist-watch or wrist jewellery Candidates attending centres in the UK must come prepared to meet these criteria - failure to comply will mean that you cannot sit the exam. Candidates attending centres in the UK must come prepared to meet these criteria - failure to comply will mean that you cannot sit the exam.

MRCP AM trainees will normally be expected to have completed MRCP 1 before entering CT3 and to have passed MRCP2 & PACES by the end of CT3. AM trainees will normally be expected to have completed MRCP 1 before entering CT3 and to have passed MRCP2 & PACES by the end of CT3.

ACCS Excellent training scheme for all medical specialities. Excellent training scheme for all medical specialities. Being organised is important. Being organised is important. Don’t leave WBA till the last 2 weeks. Don’t leave WBA till the last 2 weeks.