2015 HE EoE School of EM 8 th 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 2006Foundation years – national introduction 2007 MMC: abolition SHOs, RT, ACCS, ARCPs 2008‘Tooke’ Enq: uncoupling Core/HST, PG Schools 2009National recruitment EM HST by CEM/PGD 2010 PMETB/GMC EM Curriculum, Trauma Networks 2011NHS re-organisation, National ACCS recruitment 2012Major recruitment and retention problems 2013EM Taskforce to address ‘Crisis’ 2014RT, DRE-EM, ACCS Expansion, 2015Consolidation of progress, 2015 curriculum 2016?? New contract??

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 Nov 2014 School of Emergency Medicine

CCT EM +/- Sub-specialist – Independent specialist practitioner Post-CCT FY2 FY1 ACCS CT2 1 year Anaesthetics + ICU 6/12 each or 9/3 CT1 1 year EM + AM 6/12 each CT3 EM PE M 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

School of Emergency Medicine CCT EM +/- Sub-specialist – Independent specialist practitioner Post-CCT FY2 FY1 ACCS ST2 1 year Anaesthetics + ICU 6/12 each or 9/3 ST1 1 year EM + AM 6/12 each ST3 EM PE M 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

School of Emergency Medicine CCT EM or CESR-CP Independent specialist practitioner Post-CCT FY2 FY1 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 SHO 12/12EM + 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 EM AM, ICM, Anaesthetics-IAC, PEM Regular weekly teaching, WpBAs, Annual Appraisal, eportfolio, involved in teaching, mg, recruitment ATLS, ALS, US, APLS etc Collect evidence for CESR application FCEM support: All parts Mg, CTR, CA, SAQ+OSCEs ST6 MCEM: Parts A, B, C CESR Application approval Independent specialist practitioner One year locum consultant CESR Application completion & evidence validation

ACCS CT1 EM: Outcome 1 – 32 trainees Outcome 3 – 1 trainee3344 ACCS CT2 EM: Outcome 1 – 14 trainees1432 ST3: Outcome 1 – 9 trainees Outcome 2 – 2 trainees Outcome 3 – 8 trainees Outcome 6 – 6 trainees2522 DRE-EM: Outcome 1 – 13 trainees Outcome 3 – 1 trainee 1424 HST: Outcome 1 – 23 trainees Outcome 2 – 1 trainee Outcome 3 – 4 trainees Outcome 6 – 6 trainees Outcome 8 – 2 trainees3634+2PHEM TOTAL ARCP Final Outcomes:

EM Initiatives HE EoE Expand ACCS posts fully recruited DRE-EM: = 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 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 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