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

2. 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
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

3. 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 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. • 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

10. 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

11. 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)

12. 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

13. 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.

14. Click on clinical curriculum

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

16. Click on rating – decide on level of achievement

17. Click on level of achievement

18. 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.

19. 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.

20. End of placement review form

21. Thank You!