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2015 HE EoE School of EM 8 th Regional Faculty Day

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

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2015 HE EoE School of EM 8 th Regional Faculty Day

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  1. 2015 HE EoE School of EM8th Regional Faculty Day

  2. 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?? School of Emergency Medicine

  3. 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 School of Emergency Medicine

  4. Post-CCT CCT route FCEM Article 14 -CESR route Sub-specialisation: PEM, ICM; Acute Med PHEM + 1 Yr ST4, ST5, ST6 36 months in EM Advanced MSK HST 3-yrs 2+3+3=8 CT3 EM PEM Paediatrics Basic MSK- MCEM level MCEM ACCS CT2 1 year Anaesthetics + ICU 6/12 each or 9/3 CT1 1 year EM + AM 6/12 each Core Training 3 yrs Competitive Entry: CT1 ACCS (EM) +CT3 FY2 FY1 Foundation Training Un-coupled Emergency Medicine CCT training 2010 CCT EM +/- Sub-specialist – Independent specialist practitioner School of Emergency Medicine

  5. Post-CCT FCEM: SAQ+OSCEs ST6 CCT route Sub-specialisation: PEM, PHEM + 1 Yr ICM: 2yrs An 6/12 ICM18/12 CESR-CP=competences in NT-posts ST4, ST5, ST6 36 months in EM HST 3-yrs MCEM: Part A +B: I, II ST3 EM PEM Paediatrics and further EM ACCS ST2 1 year Anaesthetics + ICU 6/12 each or 9/3 ST1 1 year EM + AM 6/12 each Core Training 3 yrs 2+3+3=8 Competitive Entry: ST1 ACCS (EM) +ST3 FY2 FY1 Foundation Training Run-through EM training 2014 CCT + CESR-CP Routes CCT EM +/- Sub-specialist – Independent specialist practitioner CA: ST3+ CTR =QIP Mg=Portfolio OOPs: T, E, R, B School of Emergency Medicine

  6. Post-CCT FCEM: SAQ+OSCEs at ST6 CCT route CESR-CP Route: some work in Non- training posts HST 3-yrs ST4, ST5, ST6 Anaesthetics, ICU, AM: 4-6 months each MCEM: Part A (exemptions) MCEM B +C Conversion years EM + PEM Competitive Entry: ST3/CT3 DRE-EM BST +MRCS generic competences FY2 FY1 Foundation Training DRE-EM 2014 CCT + CESR-CP ‘Alternative’ Pathway CCT EM or CESR-CP Independent specialist practitioner CA: ST3+, CTR=QIP Mg=Portfolio OOPs: T, E, R, B Anaesthetics, ICU, AM: 4-6 months each EM + PEM BST or other Training/Non-T posts 24months SHO 12/12EM + other ACCS competence School of Emergency Medicine

  7. CESR-Article 14 pathway CESR Application approval Independent specialist practitioner One year locum consultant CESR Application completion & evidence validation FCEM support: All parts Mg, CTR, CA, SAQ+OSCEs ST6 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 MCEM: Parts A, B, C

  8. 2015 ARCP Final Outcomes: 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+2PHEM TOTAL122 160

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

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