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© The Faculty of Intensive Care Medicine.

.sourceThe Faculty appreciates citation as to the may be reproduced for training purposes. This guidance

The Faculty of edicine

Care M

Intensive

2015 1Edition

Practitioners

Advanced Critical Care Curriculum for Training for

Preface This is the first edition of the curriculum for a Postgraduate Diploma/Masters level qualification in Advanced Critical Care Practice. It has been informed by and aligned to the National Education and Competence Framework for Advanced Critical Care Practitioners (Department of Health, March 2008) and The Advanced Practice Toolkit for Scotland (Scottish Government, June 2008). This curriculum is applicable for trainees entering training from August 2015.

Abbreviations A list of commonly used abbreviations is provided in Appendix 1.

Practitioner registration All ACCP trainees must register with the Faculty as soon as possible after starting their ACCP training, via submission of an ACCP Trainee Registration Form to the Faculty. There is no fee for registration but it is considered vital that ACCP trainees register to inform future training and workforce planning.

Advice For information concerning ACCP training or career planning please see the FICM website: www.ficm.ac.uk. For further advice, practitioners should approach their ACCP Local Clinical Lead [LCL], the National Lead for ACCPs and their local Higher Education Institution.

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Handbook

Advanced Critical Care Practitioners for Curriculum for Training

The Faculty of Care MedicineIntensive

Part I

Contents Preface………………………….. .......................................................................................................................... ii 1. Introduction .............................................................................................................................. 4

1.1 Aim ................................................................................................................................................. 4

1.2 Definition of Intensive Care Medicine .......................................................................................... 4

1.3 Definition of Advanced Practitioners ........................................................................................... 4

1.4 The scope of Intensive Care practice ............................................................................................ 6

1.5 Curriculum development process ................................................................................................ 7

1.5.1 Development group, consultation and feedback ............................................................ 7

1.6 Ongoing curriculum review .......................................................................................................... 7

1.7 Structure of the curriculum manual ............................................................................................. 8

2. Entry requirements and training pathways ................................................................................. 9 2.1 ACCP entry ....................................................................................................................................

9 2.2 Registration with Faculty ..............................................................................................................

9 2.3 Local course delivery ....................................................................................................................

9 2.4 Clinical Teaching and training .......................................................................................................

9 3. Content of learning .................................................................................................................. 10

3.1 Underlying principles .................................................................................................................. 10

3.1.1 The combined and parallel clinical and academic nature of the ACCP training programme .............................................................................................. 10

3.1.2 ‘Spiral’ learning ............................................................................................................... 10

3.2 Non-Medical Prescribing ............................................................................................................ 11

3.2.1 Standards for prescribing practice.................................................................................. 11

3.3 General structure of the ACCP programme ............................................................................... 11

3.3.1 Duration of training ........................................................................................................ 11

3.3.2 Less Than Full Time [LTFT] Training ................................................................................ 11

3.4 Functions of the Advanced Critical Care Practitioner ................................................................ 12

3.5 Local decisions about exact composition of programme ........................................................... 13

3.6 Enrolment with the Faculty and FICM Associate Membership .................................................. 13

3.6.1 Existing ACCPs and Advanced Nurse Practitioners ......................................................... 14

3.7 Professional Registration for ACCPs ........................................................................................... 14

4. Learning and Teaching ............................................................................................................. 15 4.1 Educational strategies .................................................................................................................

15 4.2 Teaching and Learning Methods .................................................................................................

15 4.2.1 Learning from experience and practice .......................................................................... 15 4.2.2 Learning from feedback .................................................................................................. 16

4.2.3 Learning with peers ........................................................................................................ 16 4.2.4 Learning in formal situations .......................................................................................... 16 4.2.5 Personal Study ................................................................................................................ 16 4.2.6 Independent learning ..................................................................................................... 16 4.2.7 Specific trainer input ...................................................................................................... 16

4.3 Out of hours commitments ......................................................................................................... 16 4.4 Less than full-time [LTFT] trainees .............................................................................................. 17

4.5 Maternity leave and sick leave .................................................................................................... 17 4.6 Training environments ................................................................................................................ 17 4.7 Accommodation for training and trainees .................................................................................. 17

5. Assessment ............................................................................................................................. 19 5.1 Workplace-based assessments of progress................................................................................

19 5.1.1 Choosing appropriate Assessment Instruments .............................................................

19 5.1.2 The Available Assessment Methodologies .....................................................................

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5.1.3 How many workplace-based assessments? ................................................................... 20

5.2 Observational Assessments ........................................................................................................ 21

5.2.1 Scoring observational assessments ................................................................................ 21

5.2.2 Case-based Discussion [CBD] .......................................................................................... 22

5.2.3 The ICM Mini Clinical Evaluation Exercise [I-CEX] .......................................................... 22

5.2.4 Directly Observed Procedural Skills [DOPS].................................................................... 22

5.2.5 Multi-Source Feedback [MSF] ........................................................................................ 22

5.2.6 Acute Care Assessment Tool [ACAT] .............................................................................. 22

5.3 Formative and Summative Assessments .................................................................................... 22

5.4 Logbook and Portfolio ................................................................................................................ 23

5.4.1 Logbook .......................................................................................................................... 23

5.4.2 Training Portfolio ............................................................................................................ 24

5.5 Oral assessment .......................................................................................................................... 25

5.5.1 Advantages of Oral Assessment ..................................................................................... 25

5.6 Expanded Case Summaries ......................................................................................................... 26

5.7 Future ACCP Examination ........................................................................................................... 26

5.8 HEI Assessments ......................................................................................................................... 27

6. Training Progression and Review .............................................................................................. 28 6.1 The Educational Supervisor’s Report .......................................................................................... 28 6.2 Educational Agreement .............................................................................................................. 28 6.3 Quarterly Meetings with ACCP Local Clinical Lead ..................................................................... 28 6.4 Annual Review of Competency Progression [ARCP] ................................................................... 29

6.1.1 The ARCP panel ............................................................................................................... 29

6.1.2 The ARCP process ........................................................................................................... 29

6.4 Independent Appraisal ................................................................................................................ 30

6.5 Trainees in difficulty .................................................................................................................... 30

7. Supervision and Feedback ........................................................................................................ 31 7.1 Role of the Educational and Clinical Supervisors .......................................................................

31

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7.1.1 ACCP trainees as trainers ................................................................................................ 31

7.2 Criteria for appointment as a trainer .......................................................................................... 32

7.3 Supervision .................................................................................................................................. 32

7.3.1 Clinical supervision ......................................................................................................... 33

7.3.2 Educational supervision .................................................................................................. 33

8. Managing Curriculum Implementation ..................................................................................... 34 8.1 Roles and Responsibilities ...........................................................................................................

34 8.2 Quality Assurance ........................................................................................................................

34 9. Equality and Diversity .............................................................................................................. 35

9.1 Protected characteristics ............................................................................................................. 35

Appendix 1: Abbreviations .......................................................................................................... 37 Appendix 2: Curriculum development group ................................................................................ 38

1. Introduction 1.1 Aim

This curriculum identifies the aims and objectives, content, experiences, outcomes and processes of postgraduate specialist training leading to a Postgraduate Diploma/Masters qualification in Advanced Critical Care Practice or equivalent. It defines the structure and expected methods of learning, teaching, feedback and supervision. It sets out what knowledge, skills, attitudes and behaviours the ACCP trainee will achieve. A system of assessments is used to monitor the ACCP trainee’s progress through the stages of training. The objective of the programme is to produce high quality patient-centred practitioners with appropriate knowledge, skills and attitudes to enable them to practice in Intensive Care Medicine.

1.2 Definition of Intensive Care Medicine

Intensive Care Medicine [ICM], also referred to as critical care medicine, is that body of specialist knowledge and practice concerned with the treatment of patients, with, at risk of, or recovering from potentially life-threatening failure of one or more of the body’s organ systems. It includes the provision of organ system support, the investigation, diagnosis, and treatment of acute illness, systems management and patient safety, ethics, end-of-life care, and the support of families.

1.3 Definition of Advanced Practitioners

The Career Framework for Health developed by Skills for Health in 2006 provided a structured career

ladder that can be characterised as level 'benchmarks' to support consistency. This framework places the 'Advanced Practitioner' at Level 7, defining advanced practitioners as:

“Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload.”

– Skills for Health, 2007 The intention of the Career Framework for Health definition of advanced-level practice is to relate to a wide range of professional roles and can be used as an over-arching definition of 'advanced practice' crossing professional groups and practice contexts. It is likely that entrants into this advanced role will be from established roles in healthcare, such as nursing and Allied Health Professions. ACCPs can be from a nursing or physiotherapy background however the majority of trainee ACCPs at present have nursing as their primary profession. The Nursing & Midwifery Council [NMC] definition of Advanced Nurse Practitioner [ANP] is:

“Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed.”

This applies to advanced practice in all domains including primary care.

I - 4 Fig 1: Skills for Health career framework

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Advanced nurse practitioners are described as highly skilled nurses who can:

• Take a comprehensive patient history; • Undertake clinical examination; • Use their expert knowledge and clinical judgement to identify the potential diagnosis; • Refer patients for investigations where appropriate; • Make a provisional differential diagnosis; • Decide on and carry out treatment, including the prescribing of medicines, or refer patients to

an appropriate specialist; • Plan and provide skilled and competent care to meet patients’ health and social care needs,

involving other members of the health care team as appropriate; • Ensure the provision of continuity of care including follow-up visits; • Assess and evaluate, with patients, the effectiveness of the treatment and care provided and

make changes as needed; • Work independently, under consultant supervision as part of the intensive care team; • Provide leadership; and • Make sure that each patient’s treatment and care is based on best practice.

Scottish Advanced Practice Toolkit (2008) describes Advanced Practice as a level of practice rather than a specific role or title encompassing:

• Advanced clinical practice • Facilitating learning • Leadership/management • Research

“These themes are underpinned by autonomous practice, critical thinking, high levels of decision

making and problem solving, values-based care and improving practice” www.advancedpractice.scot.nhs.uk

ACCP training conforms to this skills set and as such would meet the competence criteria of the NMC and the Scottish Advanced Practice Toolkit. This ACCP Curriculum builds on this and the requirements of the National Advanced Critical Care Practitioner Competency Framework [2008] providing clear levels of knowledge skill and competence with defined supervision. It should be noted that whilst this curriculum reflects the Skills for Health Career Framework, the levels within this framework do not automatically equate to NHS Agenda for Change pay Bands, which are beyond the purview of this document. The ACCP curriculum and ACCP Advisory Group deal with the training of ACCPs, not contractual employment arrangements.

1.4 The scope of Intensive Care practice

Intensive Care Medicine involves the combination of the ability to correct abnormal pathophysiology (support) whilst simultaneously making sure that the definitive diagnosis is accurately made and therefore that disease modifying therapy (definitive treatment/medicine) is applied, both components of the patient’s overall care.

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ICM comprises a constellation of knowledge and practice – almost all of which is well represented in a variety of other specialties. The ICM specialist transcends the traditional borders of medical specialities bringing all of these competences together in one specialist and in so doing develops a unique approach to critical illness. Intensive Care Medicine specialists are therefore medical experts in:

• Resuscitation • Advanced physiological monitoring • Provision of advanced organ support (often multiple) • Diagnosis and disease management in the context of the most gravely ill patients in the hospital • Provision of symptom control • Management and support of the family of the critically ill patient • End of life care • Collaboratively leading the intensive care team • Coordination of specialist and multi-specialty input to complicated clinical cases in the unique

context of intensive care. These specialists are based in Intensive Care Units [ICUs] which are hospital areas in which increased concentration of specially trained staff and monitoring equipment allow more detailed and more frequent monitoring and interventions for a seriously ill patient. Whilst practitioners may be based in Intensive Care and High Dependency Units their range of referral practice includes most of the acute hospital. Within a single day, ACCPs may find themselves involved in the care of patients ranging from the young adult to the very old; encompassing locations such as the Emergency Department and Acute Admissions Units.

1.5 Curriculum development process This curriculum has been based on the FICM Curriculum for Training in Intensive Care Medicine (2011), the National Competency Framework for Advanced Critical Care Practitioners (2008) and curricula from the established ACCP programmes from around the UK. This curriculum documents takes into account guidance from the NHS Litigation Authority [NHSLA], a Special Health Authority responsible for handling negligence claims made against NHS bodies in England1. The NHSLA has published standards expected of Trusts. For training these emphasise the need for appropriate supervision and assessment, and the documentation of competencies.

1.5.1 Development group, consultation and feedback This curriculum which is based on the FICM curriculum has been developed by a curriculum development group of the RCoA and FICM, all of whom are actively involved clinically in intensive care teaching and training, in conjunction with lay representatives and in consultation with representatives of Higher Education Institutions. This curriculum has been made available for consultation by the wider,

1 The Welsh Risk Pool and the Scottish Clinical Negligence and Other Risks (Non-Clinical) Indemnity Scheme [CNORIS] fulfil similar roles to the NHSLA. In Northern Ireland each Trust has its own risk assessment and negligence scheme.

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multidisciplinary ICM community. Feedback from all these groups was then used in the production of this final version.

1.6 Ongoing curriculum review

The ACCP curriculum is a new programme of training and will clearly need a series of modifications and changes following initial implementation. The FICM, through the ACCP Advisory Group, will initially review this curriculum on a yearly basis in consultation with HEIs and LCLs, with an implementation date for any changes being not less than 12 months after their publication date. As the ACCP profession matures the review period may be lengthened. Minor changes will be inserted in the online manuals immediately. Major changes will be submitted to the FICM Board for approval as and when necessary and will be inserted into the curriculum when approval has been granted. Summaries of changes will be listed on the ACCP training pages of the FICM website as they occur. Occasionally the Faculty has to take decisions that may affect the immediate interpretation or application of specific items in this manual. These will be published on the website and circulated to ACCP Local Clinical Leads.

1.7 Structure of the curriculum manual This curriculum document has three parts:

• Part I is the Handbook, an overview of competency-based training in Advanced Critical Care Practice. It includes background information, current criteria and standards for training and assessment methods.

• Part II is the Assessment System, which provides the outcome paperwork for trainees to demonstrate their development as they progress through the ACCP training programme.

• Part III is the Syllabus, which details the ACCP Competencies including core science, common competencies derived from the Academy Common Competency Framework and specialist competencies taken from the National Education and Competency Framework document (DoH, March 2008) along with relevant assessment tools.

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2. Entry requirements and training pathways 2.1 ACCP entry

Entry into ACCP training is possible providing the following criteria are met.

• Be registered as a healthcare professional, with recent experience of working within critical care and be able to demonstrate evidence of appropriate continuing professional development.

• Have a bachelor-level degree or be able to demonstrate academic ability at degree level . • Be in a substantive recognised trainee Advanced Critical Care Practitioner post, having

successfully met individual trust selection procedure in terms of skills and relevant experience. • Be employed as an ACCP trainee in a unit recognised for Medical Intensive Care training by FICM

and with the capacity and ability to offer ACCP training. • Be entered into a programme leading to an appropriate Postgraduate Diploma/Masters degree

with a Higher Education Institution, including Non-Medical Prescribing.

2.2 Registration with Faculty

ACCP trainees must register with the FICM upon commencing the training programme.

2.3 Local course delivery The Higher Education Institution (HEI) granting the Postgraduate Diploma is responsible for delivering this curriculum and ensuring the competence of the ACCPs it produces. This training must be done in collaboration with training units in partner hospitals. Teaching within hospitals should be overseen by an ACCP Local Clinical Lead who will be a consultant in intensive care medicine and should hold an honorary appointment with the HEI and be responsible to the HEI for the delivery of the clinical components of training. The LCL will be the point of liaison with the FICM. The partner hospitals must satisfy themselves that the HEI can deliver the ACCP programme to the appropriate level, and the HEI must ensure that hospitals can deliver both competent and excellent clinical training and supervision in the workplace. Trainee ACCPs must be entirely supernumerary during their training; it is not possible for them to fill in staffing gaps on units.

2.4 Clinical Teaching and training

Teaching and supervision in clinical practice by Intensive Care Medicine consultants should espouse the principles and values on which good practice is founded which derive from the GMC’s Good Medical Practice (2013) standards.

Both ACCP trainees and trainers must be familiar with this guidance as they are key to the delivery of the ACCP curriculum.

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3. Content of learning 3.1 Underlying principles

The principles of the UK Advanced Critical Care Practitioner training programme are that it:

• Is outcome based • Is planned and managed • Promotes safe practice • Is delivered by appropriately trained and appointed trainers • Allows time for study • Includes those core professional aspects of clinical practice that are essential in the training of all

ACCPs • Meets the service needs of the NHS • Respects the rights and needs of patients • Is prepared with input from the representatives of patients • Accommodates the specific career needs of the individual ACCP trainee • Is evaluated • Is subject to review and revision

3.1.1 The combined and parallel clinical and academic nature of the ACCP training programme Existing ACCP training across the UK combines robust clinical education and assessment with a Higher Education Institution-based academic programme which can be taken to Postgraduate Diploma or Masters level. The clinical component is mainly delivered by clinically active subject matter experts in intensive care. The academic component is integral to the successful completion of the training programme particularly in basic sciences including physiology, pathophysiology and pharmacology and the development of critical thinking and disciplined noticing both in clinical practice and in appraisal of the literature. ACCP trainees must acquire 60 academic credits per year via the completion of HEI modules; generally two per year, though the exact format may vary for each HEI. The acquisition of the ability to undertake Non-Medical Prescribing [NMP] is pivotal to the success of the individual ACCP in practice and their full integration into the critical care team; the NMP module is nationally set and counts for 40 academic credits. ACCP trainees will usually undertake the NMP module in year 2 of their training programme; the exact timing of the module within the PgDIP will be determined by the respective HEI.

3.1.2 ‘Spiral’ learning The training programme is based on this concept which ensures that the basic principles learnt and understood are repeated, expanded and further elucidated as time in training progresses; this also applies to the acquisition of skills, attitudes and behaviours. The outcome is such that mastery of the specialty to the level required to commence autonomous practice in a specific post is achieved by the end of training as knowledge, skills, attitudes and behaviours metaphorically spiral upwards. Following qualification, the continuing professional development of the ACCP will follow the same model.

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3.2 Non-Medical Prescribing

All non-medical prescribing is underpinned by legislation and regulatory standards. Accordingly, all nonmedical prescribers must record their qualification with their professional regulator and have a responsibility to remain up to date with the knowledge and skills that enable them to prescribe competently and safely2. Following a successful consultation process physiotherapists have now been added to the list of practitioners eligible to become independent prescribers. Whilst the full details of implementation of this change are not yet available we anticipate these will be in place imminently. 3.2.1 Standards for prescribing practice The full set of standards for professional practice and behaviour set for nurse and midwife prescribers can be found in the code and in Standards of proficiency for nurse and midwife prescribers. Prescribers must be:

• properly qualified • recorded on the register as holding a prescribing qualification • professionally accountable and working within their area of expertise

Prescribers can only prescribe when:

• there is a genuine need for treatment • a thorough assessment of the patient/client has been made • other healthcare professionals caring for the patient/client are aware of and have proper access

to accurate, up to date records about the prescription3

3.3 General structure of the ACCP programme

3.3.1 Duration of training

The minimum indicative duration of training is two years and should be full time. Training times are indicative and assume an average rate of gain of competency and may be extended for less than full time trainees or those experiencing difficulties. The PgD/MSc is awarded by the HEI but the full assumption of the role of ACCP requires successful completion of assessment of clinical competence in the workplace by consultant trainers in ICM. ACCPs who have satisfactorily completed training to a minimum of PgD level can apply to become an Associate Member of the Faculty. 3.3.2 Less Than Full Time [LTFT] Training

The provision of less than full time training is the responsibility of the HEI and LCL in conjunction with employers (see 4.4).

2 National Prescribing Centre, 2012 http://www.npc.nhs.uk/

3

NMC Standards, guidance, advice and additional resources from nurse and midwife prescribers – NMC, 2010

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Fig 2: ACCP pathway

3.4 Functions of the Advanced Critical Care Practitioner 2

• Undertake comprehensive clinical assessment of a patient’s condition • Request and perform diagnostic tests • Initiate and manage a clinical treatment plan • Provide accurate and effective clinical handovers • Undertake invasive interventions within the scope of practice • Provide professional leadership and support within a multi-professional team

2 National Competency Framework for Advanced Critical Care Practitioners, 2008 I - 12

• Work autonomously in recognised situations • Demonstrate comprehensive knowledge across a range of subject areas relevant to the field of

critical care • Critically analyse, evaluate and synthesise different sources of information for the purpose of

assessing and managing the care of a critically ill patient • Apply the principles of diagnosis and clinical reasoning that underlie clinical judgement and

decision making • Apply theory to practice through a clinical decision-making model • Apply the principles of therapeutics and safe prescribing • Understand the professional accountability and legal frameworks for advanced practice • Function at an advanced level of practice as part of the multidisciplinary team as determined by

the competency framework • Apply the principles of evidence-based practice to the management of the critically ill patient • Understand and perform clinical audit

These competencies are included in the CoBaTrICE competency framework, albeit under a different domain structure. In order to ensure consistency with other core training programmes we include these competencies and their assessment framework in Part IV.

3.5 Local decisions about exact composition of programme

The exact nature of each training programme will be decided locally following discussion between Local Education and Training Boards, the ACCP, Local Clinical Lead, the HEI and the local trainers. However the overall programme must conform to the specifications outlined and deliver the training outcomes defined in this curriculum. The overarching responsibility rests with the HEI awarding the Diploma who must ensure the standards set are commensurate with independent practice and facilitate the production of a high quality transferable qualification recognised nationally by the Faculty of Intensive Care Medicine. The curriculum for ACCP provides a core set of competencies required of all ACCPs. It is recognised that individual trusts in addition to this core skills set may wish to train their ACCPs to perform additional tasks or procedures dependent on the clinical case mix and requirements for their own units. The LCL and local trainers hold responsibility for ensuring appropriate governance structures are in place.

3.6 Enrolment with the Faculty and FICM Associate Membership

All ACCP trainees must register with the Faculty as soon as possible after starting their ACCP training, via submission of an ACCP Trainee Registration Form to the Faculty. There is no fee for registration but it is considered important that ACCP trainees register to inform future training and workforce planning. Registration also enables ACCP Trainees to establish contact with the Faculty and remain abreast of developments in the field and ACCP related or relevant Faculty events and initiatives. Upon completion of their training programme, ACCPs may apply for FICM Associate Membership status. It should be noted that submission of an ACCP Trainee Registration Form does not mean that the trainee will automatically be awarded FICM Associate Membership at the end of their training; this will be contingent on the content of their Associate Membership application and the location/content of their ACCP programme.

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3.6.1 Existing ACCPs and Advanced Nurse Practitioners ACCPs and ANPs who are already trained and in post can also apply for FICM Associate Membership. The application form is available via the ACCP pages of the FICM website. The key issues to consider when applying are that:

• The applicant is either in a training or substantive ACCP post. • The applicant can meet the competencies and training requirements of the curriculum, including: o MSc

o Non-Medical Prescribing

• The applicant has support from their unit ACCP Local Clinical Lead.

Applicants who find they are deficient in any area of their application, or lack the requisite evidence, should liaise with their HEIs to arrange the addition of any further training modules required, or the APEL recognition of modules which have already been completed.

3.7 Professional Registration for ACCPs

There is currently no specifically designated regulator for Advanced Practitioners. It is expected that ACCPs remain registered with their primary professional body, such as the NMC [Nursing & Midwifery Council] and the HPC [Health and Care Professions Council].

4. Learning and Teaching 4.1 Educational strategies

The curriculum describes educational strategies that are suited to work-based experiential learning and to appropriate academic education. The manner in which the training programme is organised to deliver such training will vary depending on local facilities. However, a vitally important element of training is appropriately supervised direct participation in the care of patients with a wide range of conditions. Training should therefore be structured to allow the trainee to be involved in the care of patients with the full range of critical illness and related problems. During the training programme the trainee must demonstrate increasing responsibility and capability across the full range of practice expected of an independent qualified ACCP.

4.2 Teaching and Learning Methods

The curriculum will be delivered through a variety of learning experiences. Trainees will learn from practice clinical skills appropriate to their level of training and to their attachment within the department. An appropriate balance needs to be struck between work-based experiential learning, appropriate off-the-job education and independent self-directed learning. ICM is a specialty that encompasses a huge range of clinical conditions and a significant number of practical skills, such that a significant proportion of learning should be work-based experience supported by a robust Structured Training Programme [STP]. The curriculum indicates where particular learning methods/experiences are especially recommended. It is for the HEI and LCL to tailor the exact balance of methods to the particular regional environment in the most suitable blended manner. Trainees should have supervised responsibility for the care of patients. A guiding principle should be that the degree of responsibility taken by the trainee will increase as competency increases. This means that the degree of clinical supervision will vary as training progresses, with increasing clinical independence and responsibility as learning outcomes and competences are achieved. All trainees are adult learners and take responsibility for their own education. It is the responsibility of the trainers to ensure adequate and appropriate educational opportunities are made available to the trainee. In turn the trainee should be enthusiastic and pro-active in identifying their own gaps in knowledge, skills, attitudes and behaviour. Trainees need to take advantage of all the formal and informal learning opportunities that go on in departments. The following identifies the types of situations in which trainees learn, and draws from the AoMRC Medical Leadership Curriculum. 4.2.1 Learning from experience and practice Trainees spend a large proportion of time on workplace-based experiential learning during supervised clinical practice in hospital settings. Learning involves closely supervised clinical practice until competence is achieved. The learning environment includes wards, clinics, laboratories, simulated activities and meetings. These more informal settings are valuable situations in which to develop leadership abilities, alongside

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colleagues from other professions and fields of work. With increasing responsibilities and independence, the trainee will take the lead for an area of work.

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4.2.2 Learning from feedback Trainees learn from experience and this can be enhanced by reflecting on feedback from colleagues and other staff, carers, and the public, as well as structured formative feedback from consultant trainers. 4.2.3 Learning with peers There are many opportunities for trainees to learn with their peers. Local and regional postgraduate teaching opportunities allow trainees at different phases of training to come together for group learning. 4.2.4 Learning in formal situations A robust and thorough programme of formal lectures must be in place to deliver the scientific component of the curriculum, ideally this will be based in and taught by the HEI but with suitable scrutiny by the HEI this can be delivered in the workplace. The HEI is responsible for the standards of this formal programme. In addition there are many other opportunities including attending regional and national courses and conferences to meet educational needs. 4.2.5 Personal Study Time should be provided during training for personal study for self-directed learning to support educational objectives or to attend formal courses in support of the stage of training, specialist interests and career aims. 4.2.6 Independent learning This may include new learning technologies such as ‘e-learning’, which may be helpful in conveying the knowledge components of the curriculum. 4.2.7 Specific trainer input It is important to recognise and capitalise on the experience and expertise within each department. Different members of the team can act as role models at different stages, including those from other professions or spheres of work.

4.3 Out of hours commitments

Most ICM work is unscheduled and at least 50% of admissions to ICUs occur ‘out of hours’. In view of this it is essential for ACCP trainees to gain experience outside routine working hours with the appropriate supervision. This provides:

• An opportunity to experience and develop clinical decision making, with the inevitable reduction in out-of-hours facilities.

• An opportunity to learn when to seek advice and appreciating that, when learning new aspects of emergency work as trainees, they require close clinical supervision.

• A reflection of professional ICU practice, as in most hospitals patients are admitted 24 hours a day, seven days a week, so requiring dedicated out-of-hours emergency facilities.

ACCP involvement in out of hours working will depend on local circumstances.

4.4 Less than full-time [LTFT] trainees

The provision of less than full time training is the responsibility of the HEI and LCL in conjunction with employers.

4.5 Maternity leave and sick leave

Local negotiation around maternity and sick leave will be managed by the trainees employing line manager in conjunction with the ACCP Local Clinical Lead. The duration of the programme will require to be extended. Maximum allowance is 2 weeks per year; greater duration of absence will necessitate prolongation of training time.

4.6 Training environments

There is no central FICM process for formal endorsement of ACCP training; the training of ACCPs will occur in existing UK training centres approved for, at a minimum, Stage 1 and 2 ICM level training. The FICM considers that units who do not train this level of ICM CCT trainee would be unable to deliver the level of training required by the ACCP curriculum; as such the Faculty would not consider it appropriate for FICM Associate Fellowship to be awarded to any ACCPs trained in units who do not receive this level of ICM CCT trainee. Whilst non-training units may be able to partner with a HEI and offer ACCP training to interested nurse and AHP colleagues, those trainees would not be eligible for any official Faculty recognition of that training, nor to apply for FICM Associate Fellowship upon completion of their ACCP training programme. Any non-ICM training approved unit seeking to run ACCP training must make this prospectively clear to any applicants for their programme. The training environment should provide appropriate training and supervision with an adequate exposure to a wide spectrum of critical illness. If necessary, rotations to other hospitals should be arranged. Departments in which training occurs must comply with the regulations and recommendations of the relevant national Departments of Health, the GMC, NMC, HPC and the FICM. Programmes which meet the requirements of this ACCP curriculum, as set out by the ACCP Advisory Group, will be listed on the ACCP pages of the FICM website. FICM will not formally assess individual courses for formal endorsement. However those courses meeting the training requirements set in this curriculum will produce ACCPs eligible for FICM recognition.

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4.7 Accommodation for training and trainees

Any hospital with trainees must have appropriate accommodation to support training and education; this may be in the department or elsewhere in the hospital e.g. the Postgraduate Teaching Centre. The Faculty’s guidelines are that this accommodation should include:

• A focal point for the ICU staff to meet so that effective service and training can be co-ordinated and optimal opportunities provided for gaining experience and teaching.

• Adequate accommodation for trainers and teachers in which to prepare their work. • A private area where confidential activities such as assessment, appraisal, counselling and

mentoring can occur. • A secure storage facility for confidential training records. • A reference library where trainees have ready access to bench books (or an electronic

equivalent) and where they can access information at any time.

I - 17 • Access for trainees to IT equipment such that they can carry out basic tasks on a computer,

including the preparation of audio-visual presentations; access to the internet is recognised as an essential adjunct to learning.

• A suitably equipped teaching area and a private study area. • An appropriate rest area whilst on shift.

5. Assessment Note: This section must be read in conjunction with and implemented via the outcome paperwork provided in Part II: Assessment System of this curriculum manual.

Assessment is through a mixture of formal tests of knowledge based in the HEI and workplace based assessments undertaken in the clinical area. Assessment has a number of purposes. It is designed to provide reassurance to trainees, trainers, employers and the general public that training is progressing at a satisfactory rate. It may also identify areas of weakness where ACCP trainees will need further work to achieve learning outcomes. Assessments are also opportunities for trainees to demonstrate excellence in their field. The trainee is expected to undertake formal examinations of knowledge at least at the end of Year 1 (where success is necessary for progress to Year 2) and at the end of training where it will be a compulsory component of the successful completion of training. It is essential that, on appointment to a training programme, ACCP trainees have information about the assessments that they are required to undertake and their timing. The ACCP Local Clinical Lead and Educational Supervisor should ensure that the ACCP trainee is aware of their responsibilities in terms of workplace-based assessments [WPBAs]3 and that they maintain their training portfolio. The FICM has developed an integrated set of WPBAs which are to be used throughout the entire postgraduate training programme. A key component of the use of WPBAs is the provision of detailed and constructive feedback enabling the trainee to improve their practice; this feedback should cover analysis of the level at which the trainee is functioning mapped against the competencies. Each competency in the curriculum has been blueprinted against the suitable WPBA assessment tools and the requirements of the GMC’s Good Medical Practice4. The assessments presented here have been validated for medical training in the UK. WPBAs must only be undertaken by those who are appropriately trained; if they are performed by others than consultants in intensive care, a consultant must take ultimate responsibility for the assessment outcome.

5.1 Workplace-based assessments of progress 5.1.1 Choosing appropriate Assessment Instruments The curriculum was reviewed and the cognitive, psychomotor and behavioural learning outcomes have been allocated to appropriate instruments for WPBA. During the ACCP training programme the ACCP trainee will progressively build a portfolio of evidence to demonstrate that he or she has mastered the competencies as defined in Part III. Every ACCP trainee should have an Educational Supervisor [ES] who will follow them throughout their training period and assist in monitoring and defining the trainee’s educational requirements. In addition for each clinical attachment the trainee should have a Clinical Supervisor [CS] responsible for monitoring and guiding their progress in each clinical area. The ES will provide an end of placement assessment

3 Workplace Based Assessment: A Guide for Implementation. GMC, April 2010.

4 Good Medical Practice. GMC, 2009.

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based on WPBAs and Multi-Source feedback [MSF] from members of the multi-disciplinary team. It may be appropriate for the ES and CS roles to be undertaken by the same person.

One major goal of the initial meeting between ACCP trainee and ES at the beginning of each training module is to agree on the areas to be covered. The ACCP trainee and supervisor should meet every two months at minimum in order to monitor adequate training progression. The trainee and assessor should agree on the competences that will be covered by a WPBA prior to or immediately following the assessment. This should be an ACCP trainee driven process. Following a WPBA the trainee should fill in their Annual Training Record as appropriate with the type of WPBA, competencies covered and level of practice. A print out of the Record should be available at the quarterly meetings and Annual Review of Competence Progression (RCP) to inform decision making. 5.1.2 The Available Assessment Methodologies A pragmatic approach to the choice of assessment methods has been adopted. Assessment by the direct observation of work is based on the belief that an expert is able to make a judgment about the quality of an expert process by watching its progress. This is the methodology of the motor vehicle driving test and there is a long history of the use of observational assessment in the accreditation of practice. WPBAs provide instantaneous, structured formative feedback to the trainee. WPBAs used are the ICM Mini-CEX [I-CEX], Directly Observed Procedural Skills [DOPS], Case-based Discussion [CBD] and Acute Care Clinical Assessment Tool [ACAT]. These methodologies have a practical utility attested to by experience in their use and at least some objective evidence that correctly applied they have validity and reliability. Multi-Source Feedback [MSF] is another well-validated assessment tool for global performance, particularly in more complex areas such as team working. It is important that focused, formative verbal and written feedback is provided for each WPBA. Assessment forms are available for download from the FICM website and are not included within this manual. 5.1.3 How many workplace-based assessments? The purpose of WPBAs is not to tick off each individual competence but through a process of supervised apprenticeship to provide a series of snapshots of work, from the general features of which it can be inferred whether the trainee is making the necessary progress, not only in the specific work observed, but in related areas of the application of knowledge and skill. Given the inherent 2 year time restriction within the training programme, a minimum number of WPBAs has been specified, but these numbers should be viewed as an absolute minimum. The actual number of observations of work required will depend on the individual ACCP trainee’s progress and guidance from their supervisors; trainees should be encouraged to undertake as many WPBAs as they feel is needed to support their acquisition of competence. The Faculty’s aim is always to maintain training standards and quality without developing undue ‘assessment burden’ for trainers and trainees. As a minimum standard, trainees must have at least one piece of satisfactory assessment evidence for every competency required for sign-off, though it is expected that trainees will ultimately have multiple assessment mapping to multiple competencies. For some sections of the curriculum (i.e. Practical Procedures) it is expected that more than one assessment will be required, at the discretion of local trainers. Where an ACCP trainee performs unsatisfactorily more assessments will be needed. It is the responsibility of the trainee to provide sufficient evidence of satisfactory performance and satisfactory

progress in their annual review. They will need evidence of performance in each block of training or section of the curriculum they have undertaken. It is the Educational Supervisor’s responsibility to help the trainee to understand what that evidence will be in their specific circumstances. The ACCP Local Clinical Lead in conjunction with other team members must complete a structured summary of the learner’s performance via their consultant feedback; the HEI Tutor will likewise summarise the

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trainee’s performance using the HEI End of Attachment Assessment. These forms should all be submitted, along with the Educational Supervisor’s Report, at the trainee’s Annual Review; templates for each can be found in Part II. Once again it must be stressed that there is no single, valid, reliable test of competence and the Annual Review of Competency Progression [ARCP] will review all the evidence, triangulating performance measured by different instruments, before drawing conclusions about a trainee’s progress (see Part I, section 6). The following represents the minimum number of clinical assessments to be included in the trainee’s portfolio for submission at the end of each academic year. Fig 3: Minimum assessments

Minimum Assessments per ACCP Academic Year

Assessment Minimum No. Direct Observation of Procedural Skills [DOPS] 8

Acute Care Assessment Tool [ACAT] 4

Case-based Discussion [CBD] 2

ICM Mini-Clinical Evaluation Exercise [I-CEX] 2

Multi-Source Feedback [MSF] (including self-assessment exercise within specified domains)

1

Expanded Case Summary – 2000 words max. (to standard of case presentation in departmental meeting)

1

Logbook Summary – demonstrating activities, patient involvement, practical procedures and critical incidents. Note: No patient identifiable material should be stored or presented.

1

Records of reflective practice – 500 words max. 2

Summary of all formal teaching sessions and courses attended 1

Trainees should refer to the guidance notes on each assessment tool available from the FICM website 5. Help should also be sought from their Educational supervisor.

5.2 Observational Assessments

Assessment by the direct observation of work is based on the belief that an expert is able to make a judgement about the quality of an expert process by watching its progress. This is the methodology of the motor vehicle driving test and there is a long history of the use of observational assessment in the accreditation of practice. Workplace-based assessments provide instantaneous feedback to the trainee. Assessment forms are available for download from the FICM website.

5.2.1 Scoring observational assessments

5 http://www.ficm.ac.uk/curriculum-and-assessment/assessments-and-logbook

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The primary focus of an FICM assessment is to provide formative feedback however it is also of value to the trainee to know whether the observer considers their performance is at the appropriate level or not. The decision is based on the observer’s judgment, as an expert in the field. Whether the assessor believes the performance to be satisfactory or not they must offer formative feedback; both positive and negative. If the observer considers elements of performance to be unsatisfactory a grid is provided, which tabulates specific areas for concern, This will enable the trainee to reflect on and improve their practice. 5.2.2 Case-based Discussion [CBD] CBD can be used for a variety of training and assessment purposes as indicated in the curriculum section of this document. It will often focus on patient management. CBD is also used for assessing both generic, and clinical, knowledge and skills needed for effective practice, e.g. evidence-based practice, maintaining safety, teamwork, clinical research methodologies. 5.2.3 The ICM Mini Clinical Evaluation Exercise [I-CEX] This is used to assess an ACCP trainee’s skill in real clinical encounters with patients. It involves the assessor directly observing a trainee in a real clinical situation such as the initial assessment and treatment of a patient with sepsis in the admissions unit. It is designed to assess a variety of skills such as history taking, examination, communication skills and clinical judgement. Suitable areas for mini-CEX assessment are detailed in the syllabus. 5.2.4 Directly Observed Procedural Skills [DOPS] This is an assessment of practical skills and ability. The assessor directly observes the ACCP undertaking a practical procedure and assesses their performance and gives feedback. 5.2.5 Multi-Source Feedback [MSF] MSF is an objective, systematic collection of feedback of performance data, using a structured questionnaire, on an individual ACCP trainee. This is derived from a number of stakeholders in their performance and will typically include a mixture of health care professionals and possibly others. 5.2.6 Acute Care Assessment Tool [ACAT] The ACAT is designed to assess the ACCP trainee’s ability to manage a body of work over a more extended period of time. In the ICM environment this will usually be over a shift period and the assessment may focus on a variety of areas including record keeping, time management, team working, hand-over quality and team leadership.

5.3 Formative and Summative Assessments

Assessment of the trainee ACCP is a continual process throughout the two year training period. It is achieved through a mixture of formal tests of knowledge based in the HEI and/or the training unit (including end of year summative assessments and intra-module assessments) together with formative clinical assessments (OSCEs, long case and portfolio vivas, clinical simulations) and workplace-based

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assessments undertaken in the clinical area. Appropriate scheduling, resources and marking formats must be applied to these assessments. The Higher Education Institute will oversee the administration of the requisite summative assessments as determined within the HEI course structure document. This will include both intra-module summative assessments e.g. during the Non-Medical Prescribing module, and also the end of academic year triggered assessments. 5.4 Logbook and Portfolio 5.4.1 Logbook ACCP Trainees are required to keep a record of the cases that they manage. The FICM does not have a single specified logbook which ACCP trainees must use; rather it provides an ACCP Logbook Summary (see Part II) which details the information required. Trainees may use their own preferred method to collect this information, providing it can output the necessary data. Whatever the format, the logbook must be able to record the information required by the Logbook Summary and allow for the recording of any problems encountered during or after the relevant procedure. A completed Logbook Summary must be presented by the ACCP Trainee at each quarterly meeting with their ACCP Local Clinical Lead. The logbook is a formal record of the various practical procedures that the trainee ACCP will undertake. The aim is for the trainee to eventually become proficient in each technique. Initially the majority of procedures will be closely supervised, but as the trainee’s technical ability develops, supervision will become less immediate and ultimately the ACCP should be able to perform these techniques independently. The ACCP trainee must have had a significant input into the care and management of the patient and this input should be mapped onto the major domains of the curriculum. Brief diagnostic information should also be included, for example using the ICNARC diagnostic criteria, along with an opportunity to place reflective comments in the case record. The case logbook will be part of the portfolio of evidence that the ACCP trainee will collect to demonstrate their experience and competence. In the event that assessments indicate underperformance in an area of practice the first response is to check from the logbook that the learner has had sufficient exposure to it. Lack of competence in the face of what is usually sufficient exposure is a cause for concern. For certain procedures details of the site and specific technique used will also be recorded. The Logbook Summary contains a list of mandatory procedures in which the trainee must become proficient and a list of desirable procedures. Please note that the ‘desirable’ list is not exhaustive and can be added to for specific unit clinical need (e.g. cardiac). Fig 4: ACCP Logbook Procedures

ACCP Logbook Procedures

Essential Desirable (list not exhaustive) Peripheral venous cannulation

Arterial cannulation Pulmonary artery flotation catheter insertion

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Central venous cannulation Endotracheal intubation

Nasogastric tube insertion Insertion of TOE probe

Urinary catheterisation Bronchoscopy

Defibrillation in cardiac arrest Cardioversion/Defibrillation

Laryngeal mask airway insertion Intra-aortic balloon pump removal

Dialysis catheter insertion Thromboelastography/ROTEM analysis The logbook must also record the level of supervision under which the ACCP Trainee carried out the respective procedures. The logbook should record the level of supervision using the levels of supervision (Direct Supervision (DS) – Indirect Supervision (IS) – Independent Practice (IP) – Demonstrates Knowledge (DK)) described in section 7.3 (Fig.5) of this curriculum manual.

5.4.2 Training Portfolio The trainee ACCP must maintain a contemporaneous record of all their activities in sections of the portfolio as outlined below. The portfolio must contain a record of:

• Common and specialist competencies as matched against curriculum • DOPS assessments and guidance notes • CBD assessments and guidance notes • Mini-CEX assessments and guidance notes • ACAT assessments and guidance notes • Case Summaries • Records of Reflective practice • Multi-Source Feedback and guidance notes • Logbook of Practical procedures • Record of Summation of quarterly Consultant assessments with dialogue sheets • Record of external and internal courses attended • Record of course teaching days attended (minimum 80% attendance) • University module credits • Record of audit activity • Record of teaching activity • Record of research activity (if any) • Record of critical incident reporting • Record of patient and relative feedback • Completed an Assessment of Training Document

5.4.3 Evidence of participation in and attendance at training events Until recently evidence of attendance at a learning session was taken to be the standard for accumulation of credits in continuing education. Attendance does not assure that learning has occurred but it does signify compliance with an appropriate learning plan. There are a number of aspects of training which support clinical practice but are situated more peripherally such as Research Methods, Management, Teaching and Assessment. At present there is little focused assessment in these areas

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and significant practical difficulties lie in the way of introducing assessment. The FICM requires that evidence of participation in learning is presented to the ARCP. These include attendance at specific courses, and local morbidity and mortality meetings (clinical review process) evidence of presentation at local audit and research meetings and records, and feedback from teaching the ACCP trainee has delivered. 5.4.4 Data Protection The Data Protection Act 1998 governs the collection, retention, and transmission of information held about living individuals and the rights of those individuals to see information concerning them. The Act also requires the use of appropriate security measures for the protection of personal data. Special treatment is required for the processing of 'sensitive data' (e.g. religion, race, health etc). All doctors must be aware of the implications of this legislation for their work. The legislation is not limited specifically to data held electronically; it applies to any personal information, which is recorded in a system that allows the information to be readily accessible (e.g. a training logbook). 5.4.5 Use of patient ID in logbooks Patients must not be individually identifiable from the patient ID used. The GMC Confidentiality Guidance (glossary) defines anonymised data as:

“Data from which the patient cannot be identified by the recipient of the information. The name, address and full postcode must be removed together with any other information which, in conjunction with other data held by or disclosed to the recipient, could identify the patient”’6

The FICM recommends that ACCP trainees only record the age (not date of birth) and sex of patients and that any other unique numbers retained (such as the patient’s unit or CAI or CHI number) must be done so in complete compliance with data protection law.

5.5 Oral assessment

The ACCP assessment system makes extensive use of oral assessment:

• Face to face assessment • Elements of the I-CEX and CBD • Simulation

5.5.1 Advantages of Oral Assessment Oral assessment:

•Is ‘Authentic’. Case-based Discussion; OSCE and some viva voce discussions across the examination table are conducted in ways that resemble the clinical use of material. During

6 http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp

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work, colleagues require an intensivist to explain and justify a clinical decision, and an oral format for questioning allows a more realistic context for assessment.

•Explores decision-making. Candidates can explain the reasons for things very clearly. This applies equally to scientific understandings and to the choice between clinical alternatives. Not only can they explain their reasoning but also they can argue in favour of their choices. Written tests require that the candidate has the same understanding of the question as the examiner from a limited scenario whereas in discussion the examiner can correct any misunderstandings so that the trainee gets a fair chance to explain and defend their proposed actions. This replicates the exchanges in clinical teams.

•Is Engaging. Just as learners have preferred learning styles, so they have preferred assessment styles. Some candidates engage better with assessment by discussion than with written tests. Use of a variety of assessment methods allows all candidates to have some assessment in their preferred style.

•

Promotes learning. Proper preparation for oral examinations is a powerful instructional tool. It promotes clarity of thinking and clear communication.

•Promotes Examination Security. Impersonation and plagiarism are hard to counter but face to face examining can be associated with good security. It would be very audacious, to appear for a highstakes oral examination on behalf of another. If the candidate was impersonated at the written exams this could be revealed by a discrepancy between the oral, workplace and written marks.

•Allows ‘Triangulation’. The use of a variety of assessment systems enables judgement to be made about capability by more than one method. This can confirm that a problem is real or allow the interpretation to be made that a candidate has a difficulty with the style of an assessment system – for which allowance can then be made.

Oral exams are most suitable for assessment of:

•Communication skills;

•Understanding – students can explain their knowledge and understanding;

•Problem solving, critical-thinking, clinical-reasoning and the application of knowledge – a problem can be thought through and each stage described;

• Prioritisation – learners can identify what is important and minimise less important knowledge. This is invaluable, as the trainee who knows all the answers but thinks first of rarities is well known

to clinicians, and is less effective in the workplace than the learner who sees clearly;

• Interpersonal skills. Scenarios with simulations or in real clinical situations give an opportunity for candidates to show their real interpersonal skills;

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• Professional demeanour – clinical cases, whether real or simulated allow the professional persona or ‘bedside manner’ to be observed; and

• Personal characteristics – some oral formats enable the observer to judge manner, calmness under pressure etc.

5.6 Expanded Case Summaries

Commensurate with the planned spiral of learning in the curriculum all ACCP Trainees will be expected to write selected case summaries during their training. To successfully complete each ARCP trainees will have had to submit one acceptable case summary each year, which will be evaluated locally by the trainee’s Educational Supervisor before progressing to the ARCP panel. It is envisaged that the standard of these case summaries will reflect the standard of a case presentation at a departmental meeting. This might perhaps include case series which illustrate differences in management options. Cases are expected to contain references to back up the written statements. Examples of Expanded Case Summaries and their marking scheme can be found at www.ficm.ac.uk. The purpose of the case summaries is to allow the candidate to demonstrate critical thinking, knowledge of recent literature in the field of Intensive Care Medicine, critical appraisal and a sound approach to evidence-based medicine.

5.7 Future ACCP Examination

It is the aspiration of the ACCP Advisory Group to produce a national exam as a bench mark of ACCP standards across the countries; this will likely take the form of an OSCE. It is not currently possible to deliver a national ACCP examination but the Group intends to work towards this in future years. The development of this exam will take some time and will be a responsibility of the ACCP Advisory Group. Ideally this OSCE will over time become integrated into each HEIs formal programme of assessment and become a joint exam success in which is necessary for both the granting of the Postgraduate Diploma and Associate Membership of the Faculty.

5.8 HEI Assessments

ACCP trainees must acquire 60 academic credits per year via the completion of HEI modules; generally two per year, though the exact format may vary for each HEI. Trainees should record their HEI assessment progress via the HEI End of Attachment Assessment form which can be found in Part II. The acquisition of the ability to undertake Non-Medical Prescribing [NMP] is pivotal to the success of the individual ACCP in practice and their full integration into the critical care team; the NMP module is nationally set and counts for 40 academic credits. ACCP trainees will usually undertake the NMP module in year 2 of their training programme.

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6. Training Progression and Review Note: This section must be read in conjunction with and implemented via the outcome paperwork provided in Part II: Assessment System of this curriculum manual. Both trainees and trainers need to ensure that training is both comprehensive and that progression of training is occurring at a satisfactory rate. The ACCP trainee will undertake a number of meetings and assessments throughout the academic year with their Educational Supervisor and ACCP Local Clinical Lead or nominated deputy. These meetings form part of a structured assessment programme that allows the establishment and regular review of educational objectives and overall competency progression. The structure of these educational meetings and assessment programme is detailed below. The documentation templates required for each of these learning events can be found in Part II: Assessment System of this curriculum manual.

6.1 The Educational Supervisor’s Report

The Educational Supervisor’s structured report is a vital and essential piece of information which informs the ARCP meeting. An ES report template is available in Part II of this curriculum. The content of the report must reflect the learning agreement and objectives established at the initial appraisal. There must be appropriate supporting evidence available to the ES and this must be clearly documented in the report. If there has been any modification to the initial learning agreement during the relevant period of training the reasons for this must be included. It is important to include other evidence to encourage and promote excellence. Logbooks, audit reports, research and publications are assessments of experience and are valid records of progress. The availability of a checklist may assist when assessing the portfolio so that any deficiencies are easily identified they should also be able to suggest an appropriate outcome having reviewed and checked the documentation. The report must be discussed with the trainee prior to submission so that they are aware of any concerns regarding their training progress, and trainees will receive feedback as part of the ARCP process.

6.2 Educational Agreement

Trainees will meet with their Educational Supervisor at the start of each training attachment and create an Educational Agreement (see template in Part II).

6.3 Quarterly Meetings with ACCP Local Clinical Lead

Each ACCP Trainee should meet with the ACCP Local Clinical Lead (or nominated deputy) on a quarterly basis in order to undergo a formal review of progress and approval of the forthcoming targeted learning plan, which the trainee should already have in place via their Educational Supervisor. These meetings should occur at months 4, 8, 16 & 20 during the 2 year training period and are in addition to the end of year appraisal meetings (which take place in months 12 and 24).

These meetings allow the ACCP Local Clinical Lead to maintain an overarching view of each trainee’s progress and correlate an individual’s performance against an expected common standard. Feedback forms will be issued to every consultant within the teaching unit who has had direct contact with the trainee (see Part II for forms). These forms will be collated by the ACCP Local Clinical Lead and the results fed beck to the trainee during the meeting. On the basis of this feedback an abbreviated

I - 28 SWOT analysis should be conducted in order to allow the trainee to address any potential areas of concern.

6.4 Annual Review of Competency Progression [ARCP]

At the end of each year the trainee ACCP will undergo a formal Annual Review of Competency Progression [ARCP] in order to examine their overall performance and progress. The ARCP is an assessment of the documentary evidence submitted by the ACCP trainee. This should include, as a minimum, a review of the ACCP trainee’s Training Record and portfolio and a structured report from the Educational or Clinical Supervisor. Assessment of the trainee usually occurs in the workplace and academically by the HEI. The outcome of these assessments should be contained in the portfolio. Appraisal and annual planning are separate processes but can be combined with the ARCP as long as the outcome of the panel is decided prior to seeing the ACCP trainee. The data and documentation that will be required to inform this process are detailed below and constitute the ACCP’s Professional Development Portfolio. This must be kept up-to-date throughout the training, and must be available for inspection by the ACCP Local Clinical Lead /deputy at any time. The trainee ACCP must maintain a contemporaneous record of all their activities in sections as outlined below. These elements will be assessed at their annual review meeting:

• Record of official competencies as matched against syllabus/curriculum • Record of DOPS assessments • Record of CBD assessments • Record of Mini-CEX assessments • Record of ACAT assessments • Case Summaries • Records of Reflective practice • Multi-Source Feedback • Logbook of Practical procedures • Record of Summation of quarterly Consultant assessments, with dialogue sheets • Record of external and internal courses attended • Record of course teaching days attended (minimum 80% attendance) • University modules • Record of audit activity • Record of teaching activity • Record of research activity • Record of critical incident reporting

• Record of patient feedback 6.4.1 The ARCP panel

There must be a minimum of two panel members, one of whom must be the ACCP Local Clinical Lead or their deputy and the other from the HEI. Where there is an unfavourable outcome, an external trainer should be consulted. All assessors must be appropriately trained.

6.4.2 The ARCP process

The trainee should be given at least 6 weeks’ notice of the panel meeting date so that they have adequate time to gather together their documentation and the ES report. Given the team nature of

I - 29 ACCP work it is recommended that this report draws on the views of the multi-disciplinary team during the trainee’s placement. The panel will review the evidence provided and decide on an outcome (this may have been recommended by the ES). Where there is an unsatisfactory outcome of the meeting agreement needs to be reached on objectives that need to be met in order to produce a satisfactory outcome and also to define the timescale. The provisional date of completion of training should be reviewed and any possible change documented.

6.4 Independent Appraisal

Evidence to inform the ARCP must include a recent appraisal.

6.5 Trainees in difficulty

ACCPs in training can encounter either personal or professional problems which may affect their performance. The use of personal development plans, appraisal, regular workplace and academic assessment, and educational supervision trainees who struggle to achieve their goals within the expected timescale can be more easily identified and may require support during their career. Whatever the reason for difficulty it should be identified as early as possible. Depending on the level of risk the Educational Supervisor will require a variable degree of support. It is highly recommended that all those involved in the education and clinical supervision of trainees are aware of their local strategy to ensure appropriate support can be provided to the trainee and that patient safety is maintained. HEIs and ACCP training centres must develop a clear strategy for dealing with such situations encompassing the spectrum of performance difficulties. HEIs often work in 3 month academic cycles

and this should be kept in mind when supportive or remedial action is required. It is the responsibility of the ACCP Local Clinical Lead (or nominated deputy) to liaise with the HEI regarding trainees in difficulty. Attempts to re-sit HEI assessments will be governed by the regulations of the specific HEI; the awarding institute’s policies and procedures should be followed in such cases. It is the decision of local trusts or boards whether employment in an ACCP training post is a seconded or a new appointment. Dependent on this, decisions over leaving the programme and subsequent employment rest with the employing organisation.

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7. Supervision and Feedback 7.1 Role of the Educational and Clinical Supervisors

It is recognised that competence in practice is achieved by supported exposure to practical learning experiences, and that reflective dialogue will help ensure that theoretical concepts are used to support advanced decision-making. The contribution of the Clinical Supervisor in relation to providing supervision, support and opportunities to develop mastery and competence in a specialist area of advanced practice is crucial. As a Supervisor you need to:

• Attend an initial meeting to facilitate your induction to the role, introduce the practice modules and the methods that will be used by the local University to support you in this new role. The workshop will also introduce the mastery element of the module and the skills and knowledge required to support ACCP trainees to achieve this level of practice.

• Attend formative progress meetings every three months with the ACCP Local Clinical Lead and trainee ACCP.

• Liaise with the ACCP Local Clinical Lead regarding the ACCP trainee’s progress and highlight any areas of concern.

• Agree with your ACCP trainee how work-based teaching, supervision and assessment will be conducted.

• Help to institute the competency framework for the advanced practice role that the ACCP trainee will undertake.

• Use all the tools in the Portfolio as directed by the competency evidence log and engage with the triggered assessments at six-monthly intervals. Maintain the quality of the work-based competency assessment process commensurate with mastery.

• Ensure that all Practice Mentors working with the student are aware of the guidelines relating to trainee ACCP practice and are experienced professionally qualified practitioners.

• Facilitate learning in the clinical area. • Encourage reflective activity and enquiry. • Use all the tools in the Portfolio as directed by the competency evidence log and engage with

the triggered assessments at six-monthly intervals. Students will initially work under your direct supervision, however this level of supervision will decrease to indirect and then proximal as they progress through the programme, demonstrating competence and confidence and becoming more autonomous within their role. Initially students will be working weekdays when maximum supervision and support is available, however, as they achieve their Portfolio benchmarks you, in conjunction with the Local Clinical Leads, will decide when it is appropriate for them to progress from direct to indirect to proximal supervision and to out-of-hours working. It is anticipated that students will progress to proximal supervision by the end of Year 2. 7.1.1 ACCP trainees as trainers

By the time they complete their training programme, trainees must have learnt to assume responsibility for the support of more junior trainees. As part of their CPD senior ACCPs should have the opportunity to contribute to the organisation and delivery of formal training under the supervision of the LCL or other designated trainers as identified in this curriculum.

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7.2 Criteria for appointment as a trainer Essential criteria:

• The trainer’s employing institution must be integrated into the local Schools of ICM, Anaesthesia, Medicine, Emergency Medicine and Surgery.

• Willingness to teach and commitment to deliver ‘hands on’ teaching and training including preoperative and postoperative care.

• Regular clinical commitment (e.g. in operating theatres, Intensive Care Units). • Robust evidence of recent continued CPD normally based on the previous two years. • Being up-to-date and supported in a post with protected time for further CPD. • Familiarity with the assessment procedures and documentation of the knowledge, skills,

attitudes and behaviour components of competency based training. • Willingness to continuously assess the trainee throughout the appointment and to complete

trainees’ assessment forms on a regular basis as necessary. • Participation in audit. • Ability to detect the failing trainee • Successful completion of a ‘Training the Trainers’ course or equivalent • Ability to use educational technology

• Familiarity with teaching evidence-based medicine • Ability to provide remedial support to the trainee in difficulty • Willingness to guide and stimulate trainees to carry out audit and, if appropriate, clinical

research • Willingness to ensure that the volume and content of clinical training encounters and other

sessions reflect the additional time required for training • Willingness to mentor individual trainees

7.3 Supervision

The critical nature of ICU work necessitates very close supervision of ACCP trainees. However, this must be balanced against the need for ACCP trainees to develop towards independent, expert practitioners. As always patient safety is the most important priority and must override any other apparent training needs. Overall supervision (direct or indirect) will be provided by a consultant in intensive care medicine but elements of supervision could be provided by other senior medical practitioners where deemed appropriate by the LCL. Where the supervising consultant in Intensive Care Medicine is not physically present they must always be readily available for consultation and it is identified that ultimate responsibility for standards of patient care lies with the consultant in Intensive Care Medicine. Core competencies based on the National Competency Framework for Advanced Critical Care Practitioners [2008] specifies practice and supervision levels as defined below:

I - 32 Fig 5: ACCP levels of supervision

Direct Supervision (DS) Is able to perform under full direct supervision (Direct = consultant physically present and overseeing procedure)

Indirect Supervision (IS) Is able to perform under indirect supervision (Indirect = supervising consultant is not physically present but is available to trainee within 5 to 30 minutes)

Independent Practice (IP) Is able to perform fully independently without any consultant input or monitoring.

Demonstrates Knowledge (DK) Is able to demonstrate knowledge of the relevant procedure.

Supervising consultants in Intensive Care Medicine will be accountable overall for the work of the Advanced Critical Care Practitioner, in a similar manner to their responsibilities for trainee doctors. Advanced Critical Care Practitioners will still be accountable for their own practice, within the boundaries of supervision and defined scope of practice. The General Medical Council’s Good Medical Practice Guide (May 2001, 3rd edition) states that: Delegation involves asking a nurse, doctor, medical student or other health care worker to provide treatment or care on your behalf. When you delegate care or treatment you must be sure that the person to whom you delegate is competent to carry out the procedure or provide the therapy involved. You must always pass on enough information about the patient and the treatment needed. You will still be responsible for the overall management of the patient. The Advanced Critical Care Practitioner will work in association with and under the supervision of the consultant as an integral part of the critical care team. 7.3.1 Clinical supervision Every trainee must, at all times, be responsible to a nominated consultant. The consultant must be available to advise and assist the ACCP trainee as appropriate. Sometimes this will require the consultant’s immediate presence but on many occasions less direct involvement will be needed. Supervision is a professional function of consultants and they must be able to decide what is appropriate for each circumstance in consultation with the ACCP trainee. The safety of an individual hospital’s supervision arrangements is the concern of the local department in conjunction with the hospital management; it is necessary for them to agree local standards and protocols that take account of their particular circumstances. 7.3.2 Educational supervision Every ACCP trainee must have a nominated Educational Supervisor to oversee their individual learning.

I - 33

8. Managing Curriculum Implementation 8.1 Roles and Responsibilities

Competency based training relies on assessments made during clinical service. The responsibility for the organisation, monitoring and efficacy of this training and assessment is shared by a variety of authorities:

The FICM is responsible for: • advising the competencies/learning outcomes in ACCP training • advising HEE, LETBs, Health Boards, HEIs and partner hospital on programmes of training. • Evaluating the training of individual trainees who seek Associate Membership of FICM

The HEI is responsible for

• producing and delivery a suitable academic programme • assessment of academic competence • ensuring clinical and educational supervisors are competent to supervise and assess clinical skills

acquisition and assessment of clinical competence The employer is responsible for

• ensuring appropriate terms of employment and facilitating supernumerary training • providing suitable training facilities • clinical governance • providing HR support

The ACCP Local Clinical Lead is responsible:

• To the HEI for the quality management of the training programme • For the overall training arrangements in each Trust through the education and training

structures in place locally. • For ensuring that the ARCP process is organised correctly

8.2 Quality Assurance

This is defined as the arrangements (procedures, organisation) within local education providers (Health Board, NHS Trusts, Independent Sector) that ensure ACCP trainees receive education and training that achieves local, national and professional standards. The organisations responsible for this are local education providers (Health Boards, NHS Trusts, and the Independent Sector) and any other service provider that hosts and supports trainees. These organisations will have a Board level officer accountable for this function. Structures may vary regionally, but each organisation must take responsibility to ensure that standards and requirements are being achieved.

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9. Equality and Diversity

Equality of opportunity is fundamental to the selection, training and assessment of intensivists. It seeks to recruit trainees regardless of race, religion, ethnic origin, disability, age, gender or sexual orientation. Patients, trainees and trainers and all others amongst whom interactions occur in the practice of ACCP have a right to be treated with fairness and transparency in all circumstances and at all times. Equality characterises a society in which everyone has the opportunity to fulfil his or her potential. Diversity addresses the recognition and valuation of the differences between and amongst individuals. Promoting equality and valuing diversity are central to the ACCP curriculum. Discrimination, harassment or victimisation of any of these groups of people may be related to: ability, age, bodily appearance and decoration, class, creed, caste, culture, gender, health status, relationship status, mental health, offending background, place of origin, political beliefs, race, and responsibility for dependants, religion and sexual orientation.

The importance of Equality and Diversity in the NHS has been addressed by the Department of Health in England in ‘The Vital Connection’7, in Scotland in ‘Our National Health: A Plan for Action, A Plan for Change’8 and in Wales by the establishment of the NHS Wales Equality Unit. These themes must therefore be considered an integral part of the NHS commitment to patients and employees alike. The theme was developed in the particular instance of the medical workforce in Sharing the Challenge, Sharing the Benefits – Equality and Diversity in the Medical Workforce9. Furthermore, Equality and Diversity are enshrined in legislation enacted in both the United Kingdom and the European Union. Prominent among the relevant items of legislation are:

• Equality Act 2010 (which replaces many previous, disparate pieces of legislation) (the Act)

• Human Rights Act 1998

• Gender Recognition Act 2004

• Civil Partnership Act 2004

• Welsh Language Act 1993 (where applicable)

It is therefore considered essential that all persons involved in the management and delivery of training are themselves trained and well versed in the tenets of Equality and Diversity.

9.1 Protected characteristics

The Equality Act 2010 identifies the following protected characteristics:

• Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion or belief

7 The Vital Connection: An Equalities Framework for the NHS: DH, April 2000.

8 Our National Health: A Plan for Action, A Plan for Change: Scottish Executive, undated.

9 Sharing the Challenge, Sharing the Benefits – Equality and Diversity in the Medical Workforce: DH Workforce Directorate,

June 2004. I - 35

• Sex • Sexual orientation

Practitioners must be aware of these protected characteristics and must treat patients with respect whatever their life choices and beliefs. They must not unfairly discriminate against patients by allowing their personal views (including any views about a patient’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status) to affect adversely their professional relationship with them or the treatment they provide or arrange. The Faculty has considered these protected characteristics in the production of this curriculum manual and does not believe there is any negative impact on the protected groups arising from the precepts of the ACCP training programme. Equality and Diversity information is collected by the Faculty from trainees as part of the trainee registration process, on a voluntary basis.

As part of their professional development trainees will be expected to receive appropriate training in Equality and Diversity and to apply those principles to every aspect of all their relationships. The delivery of this training is the responsibility of the employing Trust. A record of completion of this training must be held in the ACCP trainee’s portfolio. The benefits of this training are:

• To educate the trainee in the issues in relation to patients, carers and colleagues and others whom they may meet in a professional context;

• To inform the trainee of his or her reasonable expectations from the training programme; and • To advise what redress may be available if the principles of the legislation are breached.

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Appendix 1: Abbreviations The below is a list of abbreviations commonly used throughout this curriculum document:

Abbreviation Term

ACCP Advanced Critical Care Practitioner

APEL Accreditation of Prior Experiential Learning

ANP Advanced Nurse Practitioner

CoBaTrICE Competency Based Training programme in Intensive Care Medicine for Europe

LCL Local Clinical Lead

FICM Faculty of Intensive Care Medicine

GMC General Medical Council

HDU High Dependency Unit

HEI Higher Education Institution

HPC Health and Care Professions Council

ICM Intensive Care Medicine

ICU Intensive Care Unit

NMC Nursing & Midwifery Council for England and Wales

OSCE Objective Structured Clinical Examination

RCoA-ARPC Royal College of Anaesthetists’ Anaesthesia-Related Professionals Committee

ARCP Annual Review of Competency Progression

SOE Structured Oral Examination

TPD Training Programme Director

WPBA Workplace-based assessment

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Appendix 2: Curriculum development group The FICM wishes to gratefully acknowledge the efforts of the following contributors in the creation of this curriculum:

Dr Anna Batchelor RCoA-ARPC Chair and former ICM curriculum lead

Carole Boulanger National ACCP training representative/Consultant ACCP

Dr Simon Gardner National Clinical Lead for ACCPs

James Goodwin Faculty Supervisor, FICM

Jane McNulty Lead ANP Lothian

Dr Graham R. Nimmo National Clinical Lead for ACCPs

Annette Richardson Nurse Consultant

Daniel Waeland Head of Faculty, FICM

I - 38

Advanced Critical Care Practitioners Curriculum for Training for

System

Assessment

The Faculty of Care MedicineIntensive

Part II

Contents

Contents

1. Assessment Materials .............................................................................................................. 3

1.1 Red/Amber/Green [RAG] assessment status ............................................................................. 3

1.2 How many workplace-based assessments?................................................................................ 4

1.3 Recording levels of supervision .................................................................................................. 5

ACCP Training Record ..............................................................................................................................

6 ACCP Logbook

Summary .......................................................................................................................... 9 ACCP

Educational Agreement ................................................................................................................ 10

ACCP Trainee – Consultant Feedback Form ..........................................................................................

11 ACCP Quarterly Summation of Consultant

Assessments ...................................................................... 13 Higher Education Institution [HEI] End of

Attachment Assessment ...................................................... 15

Educational Supervisor’s Report ............................................................................................................ 16

ACCP Annual Review of Competency Progression [ARCP] .................................................................... 18

Supplementary documentation for ARCP Outcome Form ............................................................... 19

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1. Assessment MaterialsNote: This Assessment System and paperwork must be read in tandem with and implemented as per the precepts and processes described in Part I (sections 5, 6 and 7) of this curriculum manual. Whilst some material from these sections appears here for ease of reference, the bulk of explanatory detail is included in Part I to avoid excessive repetition.

Assessment is through a mixture of formal tests of knowledge based in the HEI and workplace based assessments undertaken in the clinical area. Assessment has a number of purposes. It is designed to provide reassurance to trainees, trainers, employers and the general public that training is progressing at a satisfactory rate. It may also identify areas of weakness where ACCP trainees will need further work to achieve learning outcomes. Assessments are also opportunities for trainees to demonstrate excellence in their field. This part of the curriculum provides the paperwork for these assessments.

The trainee is expected to undertake formal reviews of knowledge, skills and attributes at least at the end of Year 1 (where success is necessary for progress to Year 2) and at the end of training where it will be a compulsory component of the successful completion of training.

It is essential that, on appointment to a training programme, ACCP trainees have information about the assessments that they are required to undertake and their timing. The ACCP Local Clinical Lead and Educational Supervisor should ensure that the ACCP trainee is aware of their responsibilities in terms of workplace-based assessments [WPBAs]10 and that they maintain their training portfolio. The programme of assessments should be established at the start of the training year as per the pattern described in Part I of this curriculum.

The FICM has developed an integrated set of WPBAs which are to be used throughout the entire postgraduate training programme. Each competency in the curriculum has been blueprinted against the suitable WPBA assessment tools and the requirements of the GMC’s Good Medical Practice11. These assessments have been validated for medical training in the UK. WPBAs must only be undertaken by those who are appropriately trained; if they are performed by others than consultants in intensive care, a consultant must take ultimate responsibility for the assessment outcome.

1.1 Red/Amber/Green [RAG] assessment status

This manual contains a Training Record template for use by ACCP trainees. This is designed to provide outcome paperwork enabling trainees to demonstrate their acquisition of competencies required by the ACCP curriculum. Competency acquisition is measured via a R(ed) A(mber) G(reen) ‘traffic light’ system:

RED Not achieved at stage appropriate for training – detail plans for review

AMBER Partially achieved / currently under development

GREEN Fully achieved / standard met

This measuring system is commonly used in nurse training and should be familiar to many ACCPs.

1.2 How many workplace-based assessments?

Please see Part I, section 5 for more information on WPBAs and their use.

10 Workplace Based Assessment: A Guide for Implementation. GMC, April 2010.11 Good Medical Practice. GMC, 2009.

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The purpose of WPBAs is not to tick off each individual competence but through a process of supervised apprenticeship to provide a series of snapshots of work, from the general features of which it can be inferred whether the trainee is making the necessary progress, not only in the specific work observed, but in related areas of the application of knowledge and skill. Given the inherent 2 year time restriction within the training programme, a minimum number of WPBAs has been specified, but these numbers should be viewed as an absolute minimum. The actual number of observations of work required will depend on the individual ACCP trainee’s progress and guidance from their supervisors; trainees should be encouraged to undertake as many WPBAs as they feel is needed to support their acquisition of competence. The Faculty’s aim is always to maintain training standards and quality without developing undue ‘assessment burden’ for trainers and trainees. As a minimum standard, trainees must have at least one piece of satisfactory assessment evidence for every competency required for sign-off, though it is expected that trainees will ultimately have multiple assessment mapping to multiple competencies. For some sections of the curriculum (i.e. Practical Procedures) it is expected that more than one assessment will be required, at the discretion of local trainers. Once again it must be stressed that there is no single, valid, reliable test of competence and the Annual Review of Competency Progression [ARCP] will review all the evidence, triangulating performance measured by different instruments, before drawing conclusions about a trainee’s progress (see Part I, section 6). The following represents the minimum number of clinical assessments to be included in the trainee’s portfolio for submission at the end of each academic year.

Fig 1: Minimum assessments

Minimum Assessments per ACCP Academic Year

Assessment Minimum No.

Direct Observation of Procedural Skills [DOPS] 8

Acute Care Assessment Tool [ACAT] 4

Case-based Discussion [CBD] 2

ICM Mini-Clinical Evaluation Exercise [I-CEX] 2

Multi-Source Feedback [MSF] (including self-assessment exercise within specified domains)

1

Expanded Case Summary – 2000 words max. (to standard of case presentation in departmental meeting)

1

Logbook Summary – demonstrating activities, patient involvement, practical procedures and critical incidents. Note: No patient identifiable material should be stored or presented.

1

Records of reflective practice – 500 words max. 2

Summary of all formal teaching sessions and courses attended 1

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1.3 Recording levels of supervision

Please see Part I, section 7 for more information on Supervision. The critical nature of ICU work necessitates very close supervision of ACCP trainees. However, this must be balanced against the need for ACCP trainees to develop towards independent, expert practitioners. As always patient safety is the most important priority and must override any other apparent training needs. Overall supervision (direct or indirect) will be provided by a consultant in Intensive Care Medicine but elements of supervision could be provided by other senior medical practitioners where deemed appropriate by the Local Clinical Lead. Where the supervising consultant in Intensive Care Medicine is not physically present they must always be readily available for consultation and it is identified that ultimate responsibility for standards of patient care lies with the consultant in Intensive Care Medicine. Core competencies based on the National Competency Framework for Advanced Critical Care Practitioners [2008] specifies practice and supervision levels as defined below: Fig 2: ACCP levels of supervision

Direct Supervision [DS] Is able to perform under full direct supervision (Direct = consultant physically present and overseeing procedure)

Indirect Supervision [IS] Is able to perform under indirect supervision (Indirect = supervising consultant is not physically present but is available to trainee within 5 to 30 minutes)

Independent Practice [IP] Is able to perform fully independently without any consultant input or monitoring.

Demonstrates Knowledge [DK] Is able to demonstrate knowledge of the relevant procedure.

Supervising consultants in Intensive Care Medicine will be accountable overall for the work of the Advanced Critical Care Practitioner, in a similar manner to their responsibilities for trainee doctors. Advanced Critical Care Practitioners will still be accountable for their own practice, within the boundaries of supervision and defined scope of practice. The Advanced Critical Care Practitioner will work in association with and under the supervision of the consultant as an integral part of the critical care team.

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ACCP Training Record Year 1 Name of ACCP

Hospital(s): NMC/HPC Number:

Trainee: Training period from:

(DD/MM/YYYY)

Note: Trainees should maintain a Training Record (with required sign-offs) as part of the training portfolio developed throughout their ACCP training programme.

RAG Assessment Key

RED Not achieved at stage appropriate for training – detail plans for review

AMBER Partially achieved / currently under development GREEN Fully achieved / standard met

To: (DD/MM/YYYY)

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3.4 Time management and personal organisation

3.5 Decision making and clinical reasoning

3.6 The patient as a central focus of care

3.7 Prioritisation of patient safety in clinical practice

3.8 Team working and patient safety

3.9 Principles of quality and safety management

3.10 Infection control

3.11 Managing long term conditions and promoting patient self-care

3.12 Relationships with patients and communication within a consultation

3.13 Breaking bad news

3.14 Communication with colleagues and cooperation

3.15 Complaints and medical error

3.16 Principles of medical ethics and confidentiality

3.17 Valid consent

3.18 Legal framework for practice

3.19 Ethical research

3.20 Evidence and guidelines

3.21 Audit

3.22 Personal behaviour

3.23 Management and NHS structure

3.24 Teaching and training

Specialist Intensive Care Medicine Competencies

4.1 Resuscitation and first stage management of the critically ill patient

4.2 Interpretation of clinical data and investigations in the assessment and management of critical care patients

4.3 Diagnosis and disease management within the scope of critical care

4.4 Therapeutic interventions/organ system support

II - 7

4.5 Practical procedures

4.6 Perioperative care

4.7 Patient comfort and psychological care

4.8 Discharge planning and rehabilitation

4.9 End of life care

4.10 Transport

4.11 Patient safety and health systems management

4.12 Professionalism

4.13 Professional relationships with members of the healthcare team

4.14 Development of clinical practice

Please add further rows to table as required.

Trainer Comments Trainer Signature Date (DD/MM/YYYY)

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ACCP Logbook Summary Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS

ACCP Trainee Name:

NMC/HPC Number: MUST BE PROVIDED

Training period from: (DD/MM/YYYY)

Hospital placement: Total beds: Level 2: Level 3: Mixed 2/3:

Year within ACCP training: Year 1 Year 2

Speciality: General Cardiac Neuro

Total unit admissions during placement:

Please Note: ‘Desirable’ list is not exhaustive; additional lines and procedures may be added to table for specific unit clinical need.

Procedure Direct Supervision [DS]

Indirect Supervision [IS]

Independent Practice [IP]

Demonstrates Knowledge [DK]

Peripheral venous cannulation

Arterial cannulation

Central venous cannulation

Nasogastric tube insertion

Urinary catheterisation

Defibrillation in cardiac arrest

Dialysis catheter insertion

Pulmonary artery flotation catheter insertion

Endotracheal intubation

Laryngeal mask airway insertion

Insertion of TOE probe

Bronchoscopy

Cardioversion

Intra-aortic balloon pump removal

Thromboelastography/ROTEM analysis

ESSE

NTI

AL DE

SIRA

BLE

To:(DD/MM/YYYY)

ACCP Educational Agreement

ACCP TRAINEE:


EDUCATIONAL SUPERVISOR:

Hospital and ICU:

HEI TUTOR:

Higher Education Institution:

Objectives: (Please add further lines to table as required)

Clinical management:

Practical procedures:

ICU management:

Audit, research, presentations:

Teaching:

II - 11

NMC/HPC Number:

To:

(DD/MM/YYYY) Year within ACCP Training: (e.g. 1, 2)

Ed Supervisor

GMC Number:

Date for next review of progress in achieving educational goals: (DD/MM/YYYY)

ACCP TRAINEE Date: Signature: (DD/MM/YYYY)

I agree to complete and keep up to date the appropriate training documents relevant to this training attachment and that the result of any assessment of this attachment can be passed on to my next Educational Supervisor.

EDUCATIONAL Date: SUPERVISOR (DD/MM/YYYY)

Signature:

HEI TUTOR Date: Signature: (DD/MM/YYYY)

II - 10

ACCP Trainee – Consultant Feedback Form

Name of ACCP TRAINEE: NMC/HPC Number:


Name of CONSULTANT: GMC Number:

I am this ACCP Trainee’s supervising consultant (tick as appropriate): Yes

I have worked with this ACCP Trainee: Frequently Never

Please Note: if you tick ‘Unacceptable’ or ‘Cause for Concern’ for any area then you must provide explanatory comments.

Appropriate to Grade

Cause for Concern

Unacceptable Unable to comment

Clinical Skills

Knowledge Adequate and up to date. Tick Occasional gaps in knowledge.

Tick Lacks essentials. Poor ability to apply knowledge.

Tick Tick

Judgement

Normally good application of knowledge. Appropriately seeks advice.

Tick

Poor application of knowledge. May fail to ask for help when necessary.

Tick

Unreliable. Fails to grasp significance of situations. Fails to recognise limitations and seek advice appropriately.

Tick Tick

Practical skills Normally good. Tick Difficulty with some procedures.

Tick Poor skills for stage of training

Tick Tick

To:(DD/MM/YYYY)

No

A few times

Only 1-2 times

Personal characteristics

Initiative

Normally shows initiative, takes responsibility appropriately.

Tick

Needs pushing and may fail to show initiative. Slow to take responsibility.

Tick No initiative. Does not take responsibility.

Tick Tick

Manner Good sense of team. Good working relationships.

Tick

May be careless of others. May have difficulty team working. May make rather than solve problems.

Tick

May be rude or arrogant. Careless of others. Poor sense of team. Causes rather than solves problems.

Tick Tick

Organisational ability

Normally well prepared and organised. Deals competently with admin tasks. Adapts to local policies.

Tick

May be unprepared and poorly organised. Muddles some admin tasks. Slow to adapt to local policies.

Tick

Poorly prepared and disorganised. Unreliable with admin tasks. Fails to adapt to local policies.

Tick Tick

Communication skills

Good communicator. Establishes rapport. Listens well.

Tick

Sometimes has communication difficulties with staff, patients or relatives.

Tick

Often has communication difficulties with staff, patients or relatives. Tick Tick

Time keeping & reliability

Punctual and reliable. Warns department of problems.

Tick Sometimes late or unreliable. Has failed to warn of problems.

Tick Often late or unreliable. Usually does not warn of problems.

Tick Tick

Involvement in department

Participates in departmental activities. Tick

Participation below that expected. Tick

Rarely participates in any departmental activity. Tick Tick

Confidence Appropriate confidence. Tick Occasional over/under confidence (must specify in comments).

Tick Consistent over or under confidence (must specify in comments).

Tick Tick

Please provide comments and signature overleaf >>

Individual comments on trainee’s performance: (must be provided for any areas marked ‘Cause for Concern’ or ‘Unacceptable’)

CONSULTANT Date: Signature: (DD/MM/YYYY)

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ACCP Quarterly Summation of Consultant Assessments

ACCP TRAINEE:



Please Note: Frequency of marks in each box represents forms returned by Consultants

Appropriate to Grade

Cause for Concern Unacceptable

Unable to comment

Clinical Skills

Knowledge

NMC/HPC Number:

To:


GMC Number:

Judgement

Practical skills

Personal characteristics

Initiative

Manner

Organisational ability

Communication skills

Time keeping & reliability

Involvement in department

Confidence

Verbatim copy of comments by individual Consultants:

Please provide comments and signatures overleaf >> Record of Dialogue – Educational Supervisor comments:

Trainee comments:

Clinical Lead comments:

II - 15

SWOT analysis & 4 month learning plan:

Strengths

Weaknesses

Opportunities

Threats

EDUCATIONAL Date: SUPERVISOR (DD/MM/YYYY) Signature:

I hereby certify that this is a true copy of the comments written by Consultants about this ACCP Trainee.

This Summation has been discussed by me with the ACCP Local Clinical Lead Yes


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Higher Education Institution [HEI] End of Attachment Assessment

ACCP TRAINEE:


Tick No Tick

NMC/HPC Number:

To:


HEI TUTOR:

Higher Education Institutition:

Modules completed during attachment: (Please add further lines to table as required)

Name of Module Level Achieved (Tick) Credits

Awarded FAIL RESUBMIT PASS DISTINCTION

Total

Credits: /60

Has the trainee achieved 120 credits at M level? Yes No

If Yes, please enter Date of Exam Board: (DD/MM/YYYY)

Has the trainee achieved award of PG Diploma in

Yes No Advanced Critical Care Practice?

Has the trainee progressed to MSc 3rd year? Yes No

MSc 3rd year to be completed by: (DD/MM/YYYY)

ACCP TRAINEE Date: Signature:

(DD/MM/YYYY)

HEI TUTOR Date:

(DD/MM/YYYY) Signature:


Signature:

II - 17

Tick Tick N/A at this stage of training Tick



Educational Supervisors’ Report

ACCP TRAINEE:



Hospital and ICU:

HEI TUTOR:

Higher Education Institution:

Has the trainee completed the following as appropriate to their level of ACCP training?

All required clinical competencies to the appropriate level Yes

All required HEI modules to the appropriate level Yes

ACCP Logbook Summary Yes

ACCP Training Record completed to appropriate level Yes

ACCP Consultant feedback appropriate to their grade Yes

Undertaken all training in supernumerary capacity? Yes

If the answer to any of the above is ‘No’, you must provide comments:

Additional Evidence: (e.g. Logbook, audit reports, research, publications – please add further lines to table as required) Evidence Comments

II - 18

NMC/HPC Number:

To:


Ed Supervisor

GMC Number:

Tick No Tick

Tick No Tick

Tick No Tick

Tick No Tick

Tick No Tick

Tick No Tick

Please provide comments and signatures overleaf >>

Objectives: (Please add further lines to table as required)

Clinical management:

Objective Objective Achieved? (Tick)

Comments NO PARTIALLY YES

Practical procedures:



ICU management:



Audit, research, presentations:



Teaching:



EDUCATIONAL SUPERVISOR comments:

ACCP TRAINEE comments:

II - 19

ACCP TRAINEE Date: Signature:

(DD/MM/YYYY)


Signature:

HEI TUTOR Date: Signature: (DD/MM/YYYY)

ACCP Annual Review of Competency Progression [ARCP]

Name of ACCP TRAINEE:

Date of Review:

Period covered from: (DD/MM/YYYY)

Programme End Date: (prior to review)

Names of ARCP Panel and appointment: (ACCP Local Clinical Lead, etc)

Please tick to denote all required evidence has been submitted

Documentation taken into account and known to the trainee

Record of official competencies as matched against syllabus/curriculum

Tick Quarterly Summation of Consultant assessments

Tick

Record of DOPS assessments Tick Logbook of Practical procedures Tick

Record of CBD assessments Tick University modules Tick

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NMC/HPC Number:

Year within ACCP

training: (e.g.1, 2)

To:(DD/MM/YYYY)

Record of Mini-CEX assessments Tick Record of audit activity Tick

Record of ACAT assessments Tick Record of teaching activity Tick

Expanded Case Summary Tick Record of research activity Tick

Records of Reflective practice Tick Record of critical incident reporting Tick

Multi-Source Feedback Tick Record of patient feedback Tick

Record of course teaching days attended and/or undertaken (minimum 80% attendance)

Tick

Has the trainee satisfactorily completed all HE-mandated assessments? Yes

Recommended Outcomes from Review Panel

Satisfactory Progress

1. Achieving progress and competencies at the expected rate

Unsatisfactory Evidence Details must be provided overleaf

2. Development of specific competencies required – additional training time not required

3. Inadequate progress by the trainee – additional training time required

4. Released from training programme with or without specified competencies

Insufficient Evidence Details must be provided overleaf

5. Incomplete evidence presented – additional training time may be required

Recommendation for completion of training programme (Year 2 only)

6. Gained all required competencies for the programme Please provide comments and signatures overleaf >>

Supplementary documentation for ARCP Outcome Form

Name of ACCP TRAINEE:

Outcome Recommended:

Detailed Reasons for Recommended Outcome:

1.

2.

3.

Discussion with Trainee: Mitigating circumstances

Competencies which need to be developed

II - 21

Tick No Tick

NMC/HPC Number:

Recommended actions

Recommended additional training time (if required)

Date of next review:

ARCP PANEL CHAIR Date: Signature: (DD/MM/YYYY)


LOCAL CLINICAL LEAD Date:

Signature: (DD/MM/YYYY)

II - 22

Recommended programme End Date: (if changed from front page of RCP assessment)

Syllabus

dvanced Critical Care PractitionersA for Curriculum for Training

Faculty ofThe Care MedicineIntensive

IIIrt aP

Contents

1. Introduction .............................................................................................................................. 4

1.1 Aim…………… ..................................................................................................................................4 1.2 Alignment to Good Medical Practice ............................................................................................4

2. Core knowledge including Basic Science ..................................................................................... 5 2.2 History taking and examination .............................................................................................5 2.3 Radiology ................................................................................................................................5 2.4 Principles of microbiology ......................................................................................................6 2.5 Principles of laboratory medicine ..........................................................................................6 2.6 Principles of pharmacology and prescribing ..........................................................................6 2.7 Technology in critical care ......................................................................................................7 2.8 Discharge planning and rehabilitation ...................................................................................8 2.9 End of life care ........................................................................................................................8 2.10 Organ/tissue donation ...........................................................................................................8 2.11 Surgical procedures ................................................................................................................8

3. Common Competencies ............................................................................................................. 9 3.1 History Taking ...................................................................................................................... 10 3.2 Clinical Examination ............................................................................................................

11 3.3 Therapeutics and safe prescribing ...................................................................................... 12

Integrated clinical practice and patient safety ................................................................................... 13 3.4 Time management and Personal organisation ................................................................... 13 3.5 Decision making and clinical reasoning ............................................................................... 14 3.6 The patient as central focus of care .................................................................................... 15 3.7 Prioritisation of patient safety in clinical practice ............................................................... 15 3.8 Team working and patient safety ........................................................................................ 17 3.9 Infection Control ................................................................................................................. 17 3.10 Managing long term conditions and promoting patient self-care ...................................... 18

Communication ................................................................................................................................... 19 3.11 Relationships with patients and communication within a consultation ............................. 19 3.12 Breaking bad news .............................................................................................................. 20 3.13 Communication with colleagues and cooperation ............................................................. 21 3.14 Complaints and medical error ............................................................................................. 22

Legal and ethical aspects of care ........................................................................................................ 23 3.15 Principles of medical ethics and confidentiality .................................................................. 23 3.16 Valid consent ....................................................................................................................... 24 3.17 Legal framework for practice .............................................................................................. 25 3.18 Ethical research ................................................................................................................... 25

Standards of care and education ........................................................................................................ 26 3.19 Evidence and guidelines ...................................................................................................... 26 3.20 Audit .................................................................................................................................... 27

Personal attitudes and behaviours ..................................................................................................... 28 3.21 Personal behaviour .............................................................................................................. 28

Management and leadership .............................................................................................................. 29

3.22 Management and NHS structure ......................................................................................... 29 Teaching and supervising competencies ............................................................................................ 30

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3.23 Teaching and training .......................................................................................................... 30 4. Specialist Intensive Care Medicine Competencies ...................................................................... 32

Clinical competencies .......................................................................................................................... 33 4.1 Resuscitation and first stage management of the critically ill patient ................................ 34 4.2 Interpretation of clinical data and investigations in the assessment and

management of critical care patients ................................................................................. 35

4.3 Diagnosis and disease management within the scope of critical care ................................ 36 4.4 Therapeutic interventions/organ system support .............................................................. 37 4.5 Practical procedures ............................................................................................................ 38 4.6 Perioperative care ............................................................................................................... 39 4.7 Patient comfort and psychological care .............................................................................. 39 4.8 Discharge planning and rehabilitation ................................................................................ 40 4.9 End of life care ..................................................................................................................... 40 4.10 Transport ............................................................................................................................. 41

Professional competencies .................................................................................................................. 414.11 Patient safety and health systems management ................................................................ 41 4.12 Professionalism ................................................................................................................... 42

Leadership competencies .................................................................................................................... 434.13 Professional relationships with members of the healthcare team ..................................... 43 4.14 Development of clinical practice ......................................................................................... 44

1. Introduction

1.1 Aim

The aims of this Advanced Critical Care Practitioner (ACCP) competency framework are to:

• Enable ACCP training to a nationally agreed standard. • To describe the theoretical knowledge, practical skills and professional judgment required of an ACCP. • Facilitate incremental development and demonstration of competence to practice as an ACCP. • Promote the necessary attitudes and behaviours required to care for patients as part of a

multidisciplinary team.

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The competences identify knowledge, common and specialist elements, which are deemed essential to the role, while allowing for flexibility within local settings to meet service needs. Each individual practitioner will take professional responsibility for their autonomous practice including acknowledgement of their limitations and when to ‘refer the patient on’ to medical colleagues or other appropriate professionals. The Advanced Critical Care Practitioner competences have components common to medical trainees in Intensive Care Medicine and critical care nurses. The competences have been developed in consultation with medical training schemes and other National Practitioner Programme projects. The ACCP trainee competencies align to the National Competency Framework for Critical Care Nurses and have the potential to dovetail into Level three of the Critical Care National Network Nurse Leads Forum (CC3N) competency framework. The main sources of the ACCP competencies are the Competency-Based Training in Intensive Care Europe (CoBaTrICE) syllabus, a European Society of Intensive Care Medicine [ESICM] project12. and the core competencies common to all medical training schemes. Where appropriate these have been modified to recognise the difference between an ACCP and a medically qualified practitioner.

1.2 Alignment to Good Medical Practice

A trained ACCP will be working within a medical model of care delivery; therefore the competences for the trainee ACCP are aligned to the four domains of Good Medical Practice.

Domains of Good Medical Practice

Domain Descriptor

1 Knowledge, skills and performance

2 Safety and quality

3 Communication, partnership and teamwork

4 Maintaining trust

2. Core knowledge including Basic Science The ACCP trainee must be taught and be able to demonstrate their knowledge of the theoretical underpinning necessary for the role. The timing, organisation and delivery of these components will not necessarily be the same in all training centres. Each training centre must ensure it is delivering the following to a level commensurate with post-graduate study to Masters level and with sufficient depth that ACCPs are able to fulfill the clinical competencies expected of them.

12 www.cobatrice.org/02-competencies

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2.1. Anatomy, physiology and pathophysiology

This theoretical component will be taught and assessed by the HEI

Competence Assessment

Methods GMP

Knowledge

Cellular physiology HEI 1 Homeostasis HEI 1 Systems anatomy, physiology and pathophysiology: • Respiratory • Cardiovascular • Neurological • Gastrointestinal and hepatic • Renal • Musculoskeletal • Endocrine • Immune • Blood and coagulation

HEI 1

2.2 History taking and examination

This will be taught and assessed by the HEI and in clinical practice by the LCL/ES


Methods GMP

Knowledge

Admission, history taking and assessment, and daily review HEI, C 1,2,3 Physical assessment of the critically ill patient HEI, C 1,3 Effective note writing and ward round case presentation technique HEI, C 1,2,3 Medico-legal requirements in the context of written notes HEI, C 1,2,3

2.3 Radiology



Methods GMP

Knowledge

Indications for chest x-ray and chest x-ray interpretation HEI, C 1,2 Indications for CT and MRI scanning and basic head, chest and abdominal CT/MRI interpretation

HEI, C 1,2

Indications for thoracic and abdominal ultrasound HEI, C 1,2 Ultrasound of major vessels for line insertion HEI, C 1,2 Echocardiography: indications for and basic interpretation HEI, C 1,2,3

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Radiation and radiation governance requirements including Ionising Radiation (Medical Exposure) Regulations (IRMER)

HEI, C 1,2

2.4 Principles of microbiology



Methods GMP

Knowledge

Principles of microbiological sampling including blood culture and bronchoalveolar lavage

HEI, C 1,2

Infection diagnosis and management HEI, C 1,2,3 Appropriate antibiotic selection, prescribing, administration and monitoring HEI, C 1,2,3 Antimicrobial approach to management of invasive devices HEI, C 1,2,3 Principles of infection control HEI, C 1,2,3

2.5 Principles of laboratory medicine



Methods GMP

Knowledge

Biochemistry as it relates to critical care HEI, C 1 Laboratory and near patient testing including principles of Quality Assurance HEI, C 1 Haematology as it relates to critical care HEI, C 1 Haematology testing and blood cross matching HEI, C 1 Authorisation of blood products HEI, C 1

2.6 Principles of pharmacology and prescribing It is expected that the competencies relating to pharmacology and prescribing will be met by the knowledge skills and assessment process of the Non-Medical Prescribing module whose academic component will be provided by the HEI and the clinical aspects in the designated critical care units. The Local Clinical Leads should ensure the Designated Medical Practitioner [DMP] essential for NMP, focuses on specifics of critical care prescribing. Additional clinical teaching will be necessary to ensure this.


Methods GMP

Knowledge

To include: • Mechanism of drug action • Pharmacokinetics and pharmacodynamics • Side effects and their management including anaphylaxis management •

Administration • Monitoring • Therapeutic ranges • Metabolism and excretion

HEI, C 1,2

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• Overdose For each of these groups of drugs: • Sedatives • Analgesics • Cardiovascular drugs – including antiarrhythmics and vasoactive drugs • Drugs acting on the respiratory system • Drugs acting on the kidney • Anticonvulsants • Muscle relaxants • Therapeutic use of hormones, including insulin, steroids, thyroxine • Drugs acting on the gastrointestinal tract • Management of patients following accidental or deliberate drug overdose,

knowledge of common toxidromes and where to seek toxicology advice and support

• Knowledge of where to find information about medication patient may be receiving before admission e.g. Emergency Care Summary

HEI, C 1,2

2.7 Technology in critical care



Methods GMP

Knowledge

Principles of use and function of equipment used to support patients in critical care to include: • Safety • Equipment set up • Relevant physics • Use of alarms • Cleaning and infection control • Troubleshooting • Limitations to their use • Optimising their use

HEI, C 1,2

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For the following types of equipment: • Oxygen delivery systems • Humidification systems • Ventilators • Non-invasive ventilators • Oxygen saturation monitoring • End-tidal CO2 monitoring • Blood gas analysers • Chest drainage systems • The range of tracheostomy products • Cardiac monitoring • Invasive and non-invasive blood pressure measurement • Cardiac output monitoring • Defibrillators • Internal pacemakers • External pacemakers • Intracranial pressure monitoring • Cerebral function monitoring • Peripheral nerve stimulators • Renal support modalities • Specialised critical care beds • Ultrasound scanner • The range of wound care products and devices

HEI, C 1,2

• Specific equipment for patient transport • Knowledge of computerised patient charting and information systems including

prescribing.

2.8 Discharge planning and rehabilitation



Methods GMP

Knowledge

Optimising post-ICU survival: immediate follow up HEI, C 1,3 Critical care outreach HEI, C 1,2,3 Physical and psychological sequelae of critical illness HEI, C 1,2,3,4 Longer term follow-up: clinics HEI, C 1,2,3,4

2.9 End of life care The Advanced Critical Care Practitioner will not be responsible for making treatment limitation decisions but will contribute to decision making discussions as a member of the critical care multi-professional team. The Advanced Critical Care Practitioner will not be responsible for the diagnosis of brain-stem death. This domain will be taught and assessed by the HEI and in clinical practice by the LCL/ES


Methods GMP

Knowledge

Approaches to supporting the patient and family/friends of terminally ill patients HEI, C 1,3,4,

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Bereavement support HEI, C 1,3,4 Understanding how diagnosis of brain-stem death is made HEI, C 1,3,4 Management of the patient diagnosed brain-stem dead HEI, C 1,3,4

2.10 Organ/tissue donation



Methods GMP

Knowledge

Management of organ donors: following brain stem death or donation after cardiac death

HEI, C 1,2,3,4

Transplant co-ordination HEI, C 1,3, Discussing donation with families HEI, C 1,3,4

2.11 Surgical procedures



Methods GMP

Knowledge

Understand the nature of specific surgical procedures in order to provide optimum post-operative management and recognise complications, e.g.

• Major abdominal surgery • Cardiac surgical procedures • Major neurological surgical procedures.

HEI, C 1,2

3. Common Competencies These competencies required of ACCPs are also common to all medical trainees and form the basis of ACCP practice. They underpin the specialist competencies and are included to provide more detail to support the specialist competencies.

Basic clinical competencies

• History Taking • Clinical Examination • Therapeutics and safe prescribing

Integrated clinical practice and patient safety

• Time management and personal organisation • Decision making and clinical reasoning • The patient as the central focus of care • Prioritisation of patient safety in clinical practice

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• Team working and patient safety • Principles of quality and safety improvement • Infection control • Environmental protection and emergency planning • Managing long term conditions and promoting patient self-care

Communication

• Relationships with patients and communication within a consultation • Breaking bad news • Complaints and medical error • Communication with colleagues and cooperation • Health promotion and health improvement

Legal and ethical aspects of care

• Principles of medical ethics and confidentiality • Valid consent • Legal framework for practice • Ethical research

Standards of care and education

• Evidence and guidelines • Audit • Teaching and training

Personal attitudes and behaviours

• Personal behaviour

Management and leadership

• Management and NHS structure

Each competence is accompanied by a suite of level descriptors reflecting maturation throughout training. Recommended assessment processes

Assessment tools for both common and specialist competencies are the same as those in familiar use in the assessment of medical trainees. Each competence is mapped to the relevant assessment tools as follows. Each competence is also mapped to the four domains of Good Medical Practice:

Assessment Tools

Code Full name

D Direct Observation of Procedural Skills [DOPS] I ICM Mini- Clinical Evaluation Exercise [ICM-CEX]

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C Case Based Discussion [CBD] M Multisource Feedback [MSF] T Acute Care Assessment Tool [ACAT] S Simulation O Observation of clinical practice

IPC Independent Prescribing Course HEI Higher Education Institution exam PS Patient Survey

Audit Audit Basic clinical competencies 3.1 History Taking Objectives: • To elicit a relevant focused history from patients with increasingly complex issues and in increasingly challenging

circumstances • To record the history accurately and synthesise this with relevant clinical examination, establish a problem list based on

pattern recognition including differential diagnosis(es) and formulate a management plan that takes account of likely clinical evolution.


Methods GMP

Knowledge Recognises the importance of different elements of history I 1 Recognises that patients do not present history in structured fashion T, I 1, 3 Knows likely causes and risk factors for conditions relevant to mode of presentation I 1 Recognises that history should inform examination, investigation and management I 1 Recognises that the patients’ wishes and beliefs and their history should inform examination, investigation and management

I 1

Skills Identifies and overcomes possible barriers to effective communication I 1, 3 Supplements history with standardised instruments or questionnaires when relevant T, I 1 Manages alternative and conflicting views from family, carers, friends and members of the multidisciplinary team T, I 1, 3

Assimilates history from the available information from patient and other sources T, I 1, 3 Recognises and interpret the use of non-verbal communication from patients and carers I 1, 3 Focuses on relevant aspects of history T, I 1, 3 Behaviours Shows respect and behave in accordance with Good Medical Practice T, I 3, 4

Scope of Practice

Is able to perform independently

•

• •

•

•

Records information in most informative fashion. Writes legibly dating and signing entries. Records regular follow up notes Is able to write a summary of the case. Produces written notes which are always comprehensive, focused and informative. Is able to accurately summarise the details of patient notes. Demonstrates an awareness that effective history taking needs to take due account of patients beliefs and understanding. Demonstrates ability to rapidly obtain relevant history in context of severely ill patients.

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• Demonstrates ability to obtain history in difficult circumstances e.g. from angry or distressed patient / relatives.

• Demonstrates ability to keep interview focussed on most important clinical issues.

• Writes timely, comprehensive and informative letters to patients and to GPs.

3.2 Clinical Examination Objectives: • To perform focused, relevant and accurate clinical examination in patients with increasingly complex issues and in

increasingly challenging circumstances • To relate physical findings to history in order to establish diagnosis(es) and formulate a management plan.


Methods GMP

Knowledge Understands the need for a targeted and relevant clinical examination C, I 1 Understands the basis for clinical signs and the relevance of positive and negative physical signs T, C, I 1 Recognises constraints to performing physical examination and strategies that may be used to overcome them

C, I 1

Recognises when the offer/use of a chaperone is appropriate or required. T, C, I 1 Skills Performs valid, targeted and time efficient an examination relevant to the presentation and risk factors

T, C, I 1

Recognises the possibility of deliberate harm (both by self and others) in vulnerable patients and report to appropriate agencies

T, C, I 1, 2

Interprets findings from the history, physical examination and mental state examination, appreciating the importance of clinical, psychological, religious, social and cultural factors

I, C 1

Actively elicits important clinical findings C, M 1 Performs relevant adjunctive examinations C, M 1 Behaviours Show respect and behaves in accordance with Good Medical Practice T, C, I, M 1, 4 Considers social, cultural and religious boundaries to clinical examination, appropriately communicates with the patient and makes alternative arrangements where necessary

C, I, M 1, 4

Scope of Practice


• Elicits most important physical signs. • Uses and interprets findings adjuncts to basic examination e.g. internal examination, blood

pressure measurement, pulse oximetry, peak flow. • Performs focused clinical examination directed to presenting complaint e.g. cardiorespiratory

symptoms, abdominal pain. • Actively seeks and elicits relevant positive and negative signs. • Uses and interprets findings of adjuncts to basic examination e.g. electrocardiography, spirometry,

ankle brachial pressure index. • Rapidly and accurately performs and interprets focussed clinical examination in challenging

circumstances e.g. acute medical or surgical emergency Many of the competencies listed below will be acquired during the Independent Prescribing Course [IPC]. 3.3 Therapeutics and safe prescribing

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Objective: • To prescribe, review and monitor appropriate therapeutic and preventive interventions relevant to clinical

practice including those which are non-medication based .


Methods GMP

Knowledge Recalls indications, contraindications, side effects, drug interactions and dosage of commonly used drugs

T, C, I, IPC 1

Recalls range of adverse drug reactions to commonly used drugs, including complementary medicines

T, C, I, IPC 1

Recalls drugs requiring therapeutic drug monitoring and interpret results T, C, I, IPC 1 Outlines tools to promote patient safety and prescribing, including IT systems T, C, I 1, 2 Defines the effects of age, body size, organ dysfunction and concurrent illness on drug distribution and metabolism relevant to the trainees practice

T, C, I, IPC 1, 2

Understands the roles of regulatory agencies involved in drug use, monitoring and licensing (e.g. Committee on Safety of Medicines, National Institute for Clinical Excellence/ Scottish Medicines Consortium, regional and hospital formulary committees).

T, C, I, IPC 1, 2

Skills Reviews the continuing need for effect of and adverse effects of long term medications relevant to the ACCPs clinical practice

T, C, I, IPC 1, 2

Anticipates and avoid defined drug interactions, including complementary medicines T, C, I, IPC 1 Advises patients (and carers) about important interactions and adverse drug effects T, C, I, IPC 1, 3 Makes appropriate dose adjustments following therapeutic drug monitoring, or physiological change (e.g. deteriorating renal function)

T, C, I, IPC 1

Uses IT prescribing tools where available to improve safety T, C, I 1, 2 Employ svalidated methods to improve patient concordance with prescribed medication T, C 1, 3 Provides comprehensible explanations to the patient, and carers when relevant, for the use of medicines

T, C, I 1, 3

Recognises the importance of resources when prescribing, including the role of a Drug Formulary e.g. British National Formulary and electronic prescribing systems

C, M 1, 2

Behaviours

Minimises the number of medications taken by a patient to a level compatible with best care T, C, I, IPC 1

Appreciates the role of non-medical prescribers T, C, I, IPC 1, 3 Remains open to advice from other health professionals on medication issues T, C, I, IPC 1, 3 Participates in adverse drug event reporting mechanisms T, C, IPC 1, 2 Ensures prescribing information is shared promptly and accurately between a patient’s health providers, including between primary and secondary care

T, C 1, 3

Remains up to date with therapeutic alerts, and respond appropriately T, C 1 Complies with individual Trust or Health Board NMP governance procedures M, Audit 1,2

Scope of Practice


• Understands the importance of patient compliance with prescribed medication. • Outlines the adverse effects of commonly prescribed medicines. • Uses reference works to ensure accurate, precise prescribing. • Seeks advice on the most appropriate medicine in all but the most common situations. • Makes sure an accurate record of prescribed medication is transmitted promptly to relevant others

involved in a patient’s care.

• Knows indications for commonly used drugs that require monitoring to avoid adverse effects. • Modifies patient’s prescriptions to ensure the most appropriate medicines are used for any specific

condition.• Is aware of the precise indications, dosages, adverse effects and modes of administration of the

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drugs used commonly within their specialty. • Uses databases and other reference works to ensure knowledge of new therapies and adverse

effects is up to date. • Knows how to report adverse effects and take part in this mechanism

• Is aware of the regulatory bodies relevant to prescribed medicines both locally and nationally.

• Ensures that resources are used in the most effective way for patient benefit.

Integrated clinical practice and patient safety

This part of the generic competencies relates to direct clinical practice; the importance of patient needs at the centre of care and of promotion of patient safety, team working, and high quality infection control. Furthermore, the prevalence of long term conditions in patients presenting to Critical Care means that specific competencies have been defined that are mandated in the management of this group of patients. 3.4 Time management and Personal organisation

Objectives: • To become increasingly able to prioritise and organise clinical and clerical duties in order to optimise patient care. • To become increasingly able to make appropriate clinical and clerical decisions in order to optimise the effectiveness

of the clinical team resource.


Methods GMP

Knowledge Understands that organisation is key to time management T, C 1 Understands that some tasks are more urgent or more important than others T, C 1 Understands the need to prioritise work according to urgency and importance T, C 1 Understands that some tasks may have to wait or be delegated to others T, C 1 Outlines techniques for improving time management T, C 1 Understands the importance of prompt investigation, diagnosis and treatment in disease management

T, C, I 1, 2

Skills Maintains focus on individual patient needs whilst balancing multiple competing pressures T, C 1 Identifies clinical and clerical tasks requiring attention or which are predicted to arise T, C, I 1, 2 Estimates the time likely to be required for essential tasks and plans accordingly T, C, I 1 Groups together tasks when this will be the most effective way of working T, C, I 1 Recognises the most urgent / important tasks and ensures that they are managed expediently T, C, I 1 Regularly reviews and re-prioritises personal and team work load T, C, I 1 Organises and manages workload effectively T, C, I 1 Makes appropriate use of other healthcare professionals and support workers T, C, I 1 Behaviours Demonstrates ability to work flexibly and deal with tasks in an effective fashion T, C, I 3 Recognises when you or others are falling behind and takes steps to rectify the situation T, C, I 3 Communicates changes in priority to others T, C, I 1 Remains calm in stressful or high pressure situations and adopts a timely, rational approach T, C, I 1 Appropriately recognises and handles uncertainty within the consultation T, M 3

Scope of Practice

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• Comprehends the need to identify work and compiles a list of tasks. • Understands the importance of completing tasks and checks progress with more senior members

of the MDT. • Understands importance of communicating progress with other team members. • Is able to say when finding workload too much. • Always consults more senior member of team when unsure. • Organises work appropriately and is able to prioritise. • Discusses work on a daily basis with more senior member of team. • Completes work within an acceptable amount of time. • Organises own work efficiently and effectively and supervises work of others. • Acts professionally and works within reasonable timescales. • Manages to balance competing tasks.

• Recognises the most important tasks and responds appropriately.

• Anticipates when priorities should be changed.

• Demonstrates starting to lead and direct the clinical team in effective fashion.

• Supports others who are falling behind.

• Requires minimal organisational supervision.

• Shows calm leadership in stressful situations

3.5 Decision making and clinical reasoning

Objectives: • To develop the ability to formulate a diagnostic and therapeutic plan for a patient according to the clinical

information available

• To develop the ability to prioritise the diagnostic and therapeutic plan

• To be able to communicate a diagnostic and therapeutic plan appropriately. Competence

Assessment Methods

GMP

Knowledge

Defines the steps of diagnostic reasoning: T, C, I 1 Understands the psychological component of disease and illness presentation T, C, I 1 Conceptualises clinical problem in a clinical and social context T, C, I 1 Recognises how to use expert advice, clinical guidelines and algorithms T, C, I 1 Recognises and appropriately respond to sources of information accessed by patients T, C, I 1, 2 Defines the concepts of disease natural history and assessment of risk T, C, I 1 Outlines methods and associated problems of quantifying risk e.g. cohort studies T, C 1 Outlines the concepts and drawbacks of quantitative assessment of risk or benefit e.g. numbers needed to treat

T, C 1

Describes commonly used statistical methodology C, I 1

Knows how relative and absolute risks are derived and the meaning of the terms predictive value, sensitivity and specificity in relation to diagnostic tests

C, I 1

Skills

Interprets clinical features, their reliability and relevance to clinical scenarios including recognition of the breadth of presentation of common disorders

T, C, I 1

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Incorporates an understanding of the psychological and social elements of clinical situations into decision making through a robust process of clinical reasoning

T, C, I 1,2,3

Interprets history and clinical signs T, C, I 1,2 Recognises critical illness and responds with due urgency T, C, I 1 Generates hypothesis within context of clinical likelihood T, C, I 1 Tests, refines and verifies hypothesis T, C, I 1,2 Constructs a concise and applicable problem list using available information T, C, I 1 Comprehends the need to determine the best value and most effective treatment for the individual patient and for a patient cohort

T, C, I 1

Constructs concise and applicable hypothesis(es) following patient assessment T, C, I 1 Applies quantitative data of risks and benefits of therapeutic intervention to an individual patient T, C, I 1

Searchs and comprehends medical literature to guide reasoning T, C 1 Behaviours

Recognises the difficulties in predicting occurrence of future events T, C, I 1 Is willing to discuss intelligibly with a patient the notion and difficulties of prediction of future events, and benefit/risk balance of therapeutic intervention

T, C, I 3

Is willing to adapt and adjust approaches according to the beliefs and preferences of the patient and/or carers

T,C,I 3,4

Is willing to facilitate patient choice T, C, I 3 Is willing to search for evidence to support clinical decision making T, C, I 1.4 Demonstrates ability to identify one’s own biases and inconsistencies in clinical reasoning T, C, I 1.3

Scope of Practice


• • • •

Develops a provisional diagnosis and a differential diagnosis on the basis of the clinical evidence. Institutes an appropriate investigative plan. Institutes an appropriate therapeutic plan. Seeks appropriate support from others.

• Takes account of the patient’s wishes

3.6 The patient as central focus of care Objective:

• Prioritise the patient’s wishes encompassing their beliefs, concerns expectations and needs. Competence

Assessment Methods

GMP

Knowledge Outlines health needs of particular populations e.g. ethnic minorities and recognises the impact of culture and ethnicity in presentations of physical and psychological conditions

T, C 1

Skills Gives adequate time for patients to express ideas, concerns and expectations T, I 1, 3, 4 Encourages the health care team to respect the philosophy of patient-focused care T, C, I, M 3 Develops a self-management plan with the patient T, C, I 1, 3 Supports patients, parents and carers where relevant to comply with management plans T, C, I 3 Encourages patients to voice their preferences and personal choices about their care T, I 3 Behaviours Supports patient self-management T, C, I 3 Recognises the duty of the medical professional to act as patient advocate T, C, I, M 3, 4

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Scope of Practice


• Responds honestly and promptly to patient questions but knows when to refer for senior help • Comprehends the need for disparate approaches to individual patients • Is always respectful to patients • Introduces self clearly to patients and indicates own place in team • Always checks that patients are comfortable and willing to be seen. Asks about and explains all

elements of examination before undertaking straight forward procedures e.g. taking a pulse • Always warns patient of any procedure and is aware of the notion of implicit consent • Only undertakes consent for a procedure that he/she is competent to do • Always seeks senior help when does not know answer patients queries • Always asks patients if there is anything else they need to know or ask • Recognises more complex situations of communication, accommodates disparate needs and

develops strategies to cope • Is sensitive to patients cultural values and beliefs • Is able to explain diagnoses and clinical procedures in ways that enable patients understanding and

supports their decision making about their healthcare 3.7 Prioritisation of patient safety in clinical practice

Objectives: • To understand that patient safety depends on: o the effective and efficient organisation of

care o healthcare professionals working well together

o safe systems, not just individual competency and safe practice

• To ensure that all staff are aware of risks and work together to minimise risk

• To ensure actions always promote patient safety


Methods GMP

Knowledge

Outlines the features of a safe working environment T, C, I 1 Outlines the hazards of medical equipment in common use T, C 1 Recalls side effects and contraindications of medications prescribed T, C, I, IPC 1 Recalls principles of risk assessment and management C 1 Recalls the components of safe working practice in the personal, clinical and organisational settings

T, C 1

Outlines human factors theory and understand its impact on safety C 1 Understands root cause analysis C 1 Understands significant event analysis C 1 Outlines local procedures for optimal practice e.g. GI bleed protocol, safe prescribing T, C, I 1 Understands the investigation of significant events and serious untoward incidents and near misses

T, C, I 1

Skills Recognises limits of own professional and only practices within these T, C, I 1 Recognises when a patient is not responding to treatment, reassesses the situation, and encourages others to do so

T, C, I 1

Ensures the correct and safe use of medical equipment, ensuring faulty equipment is reported appropriately

T, C, I, IPC 1

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Improves patients’ and colleagues’ understanding of the side effects and contraindications of therapeutic intervention

T, C, I 1, 3

Sensitively counsels a colleague following a significant event, or near incident, to encourage improvement in practice of individual and unit

T, C 3

Recognises and responds to the manifestations of a patient’s deterioration (symptoms, signs, observations, and laboratory results) and supports other members of the team to act similarly

T, C, I, M 1

Behaviours Maintains a high level of safety awareness and consciousness at all times T, C, I 2 Encourages feedback from all members of the team on safety issues T, C, I, M 3 Reports serious untoward incidents and near misses and co-operate with the investigation of the same

T, C, I, M 3

Shows willingness to take action when concerns are raised about performance of members of the healthcare team, and acts appropriately when these concerns are voiced to you by others

T, C, I, M 3

Continues to be aware of one’s own limitations, and operate within them competently T, C, I 1 Scope of Practice


• Respects and follows ward protocols and guidelines • Takes direction from the nursing staff as well as medical team on matters related to patient safety • Discusses risks of treatments with patients and is able to help patients make decisions about their

treatment • Always ensures the safe use of equipment • Follows guidelines unless there is a clear reason for doing otherwise • Acts promptly when a patient’s condition deteriorates • Always escalates concerns promptly

• Demonstrates ability to lead team discussion on risk assessment and risk management and to work with the team to make organisational changes that will reduce risk and improve safety

• Understands the relationship between good team working and patient safety • Is able to work with and when appropriate lead the whole clinical team • Promotes patients safety to more junior colleagues • Comprehends untoward or significant events and always reports these • Leads discussion of causes of clinical incidents with staff and enables them to reflect on the causes

Is able to undertake a root cause analysis

3.8 Team working and patient safety Objectives: • To work well in a variety of different teams and team settings – for example the ward team, the laboratory team, the

infection control team, the theatre team – and to contribute to discussion on the team’s role in patient safety • To display the leadership skills necessary to lead teams so that they are more effective and better able to deliver safer

care Competence

Assessment Methods

GMP

Knowledge Outlines the components of effective collaboration and team working T, C 1

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Describes the roles and responsibilities of members of the healthcare team T, C 1 Outlines factors adversely affecting a practitioner’s performance and methods to rectify these C 1 Skills Provides good continuity of care T, C, I 1, 3, 4 Performs accurate attributable note-keeping including electronic clinical record systems T, C, I 1, 3 Prepares patient lists with clarification of problems and ongoing care plan T, C, I, M 1 Gives detailed handover between shifts and areas of care T, C, I, M 1, 3 Demonstrates leadership and management in the following areas:

• Education and training

• Deteriorating performance of colleagues (e.g. stress, fatigue)

• High quality care

• Effective handover of care between shifts and teams

T, C, I 1, 2, 3

Participates in multidisciplinary team meetings T, C, I 3 Provides appropriate supervision to less experienced colleagues T, C, M 3 Behaviours Encourages an open environment to foster concerns and issues about the functioning and safety of team working

T, C, M 3

Recognises limits of own professional competence and only practices within these T, C, M 2 Recognises and respects the request for a second opinion T, C, M 3 Recognises the importance of induction for new members of a team T, C, M 3 Recognises the importance of prompt and accurate information sharing with Primary Care team at and following hospital discharge

T, C, I, M 3

Scope of Practice


• Works well within the multidisciplinary team and recognises when assistance is required from the relevant team member.

• Demonstrates awareness of own contribution to patient safety within a team and is able to outline the roles of other team members.

• Keeps records up-to-date and legible and relevant to the safe progress of the patient. • Hands over care in a precise, timely and effective manner • Demonstrates ability to discuss problems within a team to senior colleagues • Provides an analysis and plan for change • Demonstrates ability to work with the virtual team to develop the ability to work well in a variety

of different teams – for example the ward team and the infection control team - and to contribute to discussion on the team’s role in patient safety.

• Developing the leadership skills necessary to deliver more effective and safer care

3.9 Infection Control Objective: • To manage and control infection in patients. Including controlling the risk of cross-infection, appropriately managing

infection in individual patients, and working appropriately within the wider community to manage the risk posed by communicable diseases.


Methods GMP

Knowledge Understands the principles of infection control T, C, I 1 Understands the principles of preventing infection in high risk groups (e.g. managing antibiotic use to prevent Clostridium difficile) including understanding the local antibiotic prescribing policy

T, C, I, IPC

1

III - 19

Understands the role of Notification within the UK and identify the principle notifiable diseases for UK and international purposes

T, C, I 1

Understands the role of the Health Protection Agency, Consultants in Health Protection (previously Consultants in Communicable Disease Control – CCDC) and SICSAG-Healthcare Associated Infections (Scotland).

T, C 1

Skills Recognises the potential for infection within patients being cared for T, C 1, 2 Counsels patients on matters of infection risk, transmission and control T, C, I 2, 3 Recognises potential for cross-infection in clinical settings T, C, I. M 1, 2 Practices aseptic technique whenever relevant D 1 Behaviours Actively engages in local infection control procedures T, C 1 Actively engages in local infection control monitoring and reporting processes T, C 1, 2 Complies with bare below the elbows dress code T, C 1 Complies with and encourages others to comply with the use of hand decontamination before and after every patient contact

T, C, M 1

Prescribes antibiotics according to local antibiotic guidelines T, C, M, IPC 1 Encourages all staff, patients and relatives to observe infection control principles T, C, M 1, 3

Scope of Practice


• Always follows local infection control protocols. Including washing hands before and after seeing every patient

• Demonstrates ability to perform basic hand hygiene • Is able to explain infection control protocols to students and to patients and their relatives. • Is aware of infections of concern – including MRSA and C difficile • Is aware of the risks of nosocomial infections • Understands the links between antibiotic prescription and the development of nosocomial

infections • Always discusses antibiotic use with a more senior colleague • Communicates effectively to the patient the need for treatment and any prevention measures to

prevent re-infection or spread • Demonstrates an ability to perform more complex clinical procedures whilst maintaining aseptic

technique throughout • Identifies potential for infection amongst high risk patients obtaining appropriate investigations • Works effectively with diagnostic departments in relation to identifying appropriate investigations

and monitoring therapy

3.10 Managing long term conditions and promoting patient self-care Objective: • Work with patients and use their expertise to manage their condition collaboratively and in partnership, with mutual benefit


Methods GMP

Knowledge Describes the natural history of diseases that run a chronic course T, C, I 1 Defines role of rehabilitation services and the multi-disciplinary team to facilitate long-term care T, C, I 1 Outlines the concept of quality of life and how this can be measured understanding the limitation of such measures for individual patients

C 1

Outlines the concept of patient self-care and the role of the expert patient C 1

III - 20

Knows, understands and is able to compare medical and social models of disability C 1 Knows about the key provisions of disability discrimination legislation C 1, 4 Understands the relationship between local health, educational and social service provision including the voluntary sector

C 1

Skills Develops and agrees a management plan with the patient (and carers), ensuring awareness of alternatives to maximise self-care within patients care pathway

T, C, I 1, 3

Develops and sustains supportive relationships with patients with whom care will be prolonged C, I 1, 4 Provides relevant evidence based information and where appropriate effective patient/carer education, with support of the multi-disciplinary team

T, C, I 1, 3, 4

Provides relevant and evidence based information in an appropriate medium to enable sufficient choice, when possible

C 1, 3

Behaviours Shows willingness and support for the patient in their own advocacy, within the constraints of available resources and taking into account the best interests of the wider community

T, C, I 3, 4

Promotes and encourages involvement of patients in appropriate support networks, both to receive support and to give support to others

C 1, 3

Recognises the impact of long term conditions on the patient, family and friends T, C, I 1 Ensures equipment and devices relevant to the patient’s care are discussed T, C, I 1 Puts patients in touch with the relevant agency including the voluntary sector from where they can procure the items and support as appropriate

T, C, I 1, 3

Provides the relevant tools and devices when possible T, C, I 1, 2 Shows willingness to facilitate access to the appropriate training and skills in order to develop the patient's confidence and competence to self-care

T, C, I, IPC 1, 3, 4

Shows willingness to maintain a close working relationship with other members of the multidisciplinary team and primary and community care

T, C, I 3

Shows willingness to engage with expert patients and representatives of charities or networks that focus on diseases and comprehends their role in supporting patients and their families and carers (where relevant)

C 1, 3, 4

Recognises and respects the role of family, friends and carers in the management of the patient with a long term condition

T, C, I 1,3

Scope of Practice


• Describes relevant long term conditions after critical care • Understands that quality of life is an important goal and that this has different meanings for each

patient • Shows awareness of the need for promotion of patient self-care and independence • Helps the patient with an understanding of their condition and how they can promote

selfmanagement • Demonstrates awareness of management of relevant long term conditions • Is aware of the tools and devices that can be used in long term conditions

Communication Issues of communication both with patients and carers and within the healthcare team are often causes of complaint and inadequate communication can lead to poorer standards of patient care. Specific issues are highlighted within this section to promote better communication generally and within certain situations.

3.11 Relationships with patients and communication within a consultation Objective: • To recognise the need, and develop the abilities, to communicate effectively and sensitively with patients, relatives and

carers (where relevant)

III - 21


Methods GMP

Knowledge Structures a consultation appropriately T, C, I 1 Understands the importance of the patient's background, culture, education and preconceptions (ideas, concerns, expectations) to the process

T, C, I 1

Skills Establishes a rapport with the patient and any relevant others (e.g. carers) T, C, I 1, 3 Utilises open and closed questioning appropriately T, I 1, 3 Listens actively and question sensitively to guide the patient and to clarify information T, I 1, 3 Identifies and manages communication barriers, tailoring language to the individual patient and using interpreters/translators when indicated

T, C, I 1, 3

Delivers information compassionately, being alert to and managing their and personal emotional response (anxiety, antipathy etc)

T, C, I 1, 3, 4

Uses, and refers patients to, appropriate written and other evidence-based information sources T, C, I 1, 3 Checks the patient's/carer's understanding, ensuring that all their concerns/questions have been covered

T, C, I 1, 3

Indicates when the interview is nearing its end and concludes with a summary and appropriate action plan; asks the patient to summarise back to check their understanding

T, C, I 1, 3

Makes accurate contemporaneous records of the discussion T, C, I 1, 3 Manages follow-up effectively T, C, I 1, 3 Ensures that the appropriate referral and communications with other healthcare professionals resulting from the consultation are made accurately and timely

C 3

Behaviours Approaches the situation with courtesy, empathy, compassion and professionalism, especially by appropriate body language acting as an equal not a superior

T, C, I, M 1, 3, 4

Ensures appropriate personal language and behaviour T, I, E 1, 3 Ensures that the approach is inclusive person and patient centred and respects the diversity of values in patients, carers and colleagues

T, C, I, M 1, 3

Is willing to provide patients with a second opinion T, C, I, M 1, 3 Use different methods of ethical reasoning to come to a balanced decision where complex and conflicting issues are involved

T, C, I, M 1, 3

Be appropriately confident and positive in one’s own values T, C, I, M 1, 3 Scope of Practice


• Conducts interviews on complex concepts with due empathy and sensitivity, confirming that accurate two-way communication has occurred, and writes accurate records thereof.

3.12 Breaking bad news Objectives: • To recognise the fundamental importance of breaking bad news.

• To use strategies for skilled delivery of bad news according to the needs of individual patients and their relatives / carers.


Methods GMP

Knowledge Is aware that the way in which bad news is delivered to a patient can affect them for the rest of their lives in terms of emotions, perception of the condition and their ability to cope. It also irretrievably affects the subsequent relationship with the patient

T, C, I, M 1

III - 22

Is aware that every patient may desire different levels of explanation and have different responses to bad news

T, C, I 1, 4

Is aware that bad news is confidential but the patient may wish to be accompanied T, C, I, M 1 Is aware that once the news is given, patients are unlikely to take anything subsequent in, so a further meeting should be arranged for soon afterwards

C, I 1

Is aware that breaking bad news can be extremely stressful for the practitioner or professional involved

T, C, I 1, 3

Understands that the interaction may be an educational opportunity T, C, I 1 Knows the importance of adequate preparation for breaking bad news T, C, I 1

Knows that “bad news” may be expected or unexpected T, C, I 1 Recognises that sensitive communication of bad news is an essential part of professional practice T, C, I 1

Understands that “bad news” has different connotations depending on the context, individual, social and cultural circumstances

T, C, I 1

Understands that a post mortem examination may be required and understand what this involves T, C, I 1 Understands the local organ donation referral and retrieval process T, C, I 1 Skills Demonstrates to others good practice in breaking bad news C, D, M 1, 3 Involves patients and carers in decisions regarding their future management; comprehends the impact of the bad news on the patient, carer (where relevant), supporters, staff members and self

C, D, M 1, 3, 4

Encourages questioning and ensures comprehension C, D, M 1, 3 Responds appropriately to verbal and visual cues from patients and relatives C, D, M 1, 3 Acts with empathy, honesty and sensitivity avoiding undue optimism or pessimism C, D, M 1, 3 Prepares to break bad news by

• Setting aside sufficient uninterrupted time • Choosing an appropriate private environment • Having sufficient information regarding prognosis and treatment • Structuring the interview • Being honest, factual, realistic and empathic • Being aware of relevant guidance documents

T, C, I 1, 2, 4

Structures the interview e.g. • Sets the scene • Establishes understanding • Discusses: diagnosis, implications, treatment, prognosis and subsequent care

C, D, M 1, 3

Behaviours

Takes leadership in breaking bad news where appropriate C, D, M 1 Respects the different ways people react to bad news C, D, M 1 Ensures appropriate recognition and management that the impact of breaking bad news has on the clinician delivering it

C, D, M 1

Scope of Practice


• Is able to break bad news in planned settings • Prepares well for interview • Prepares patient to receive bad news • Establishes what patient wants to know and ensures understanding • Is responsive to patient reactions

3.13 Communication with colleagues and cooperation

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Objectives: • To recognise and accept the responsibilities and role of the ACCP in relation to other healthcare professionals

• To communicate succinctly and effectively with other professionals as appropriate Competence

Assessment Methods

GMP

Knowledge Understands the section in "Good Medical Practice" on Working with Colleagues, in particular: C, M 1 The roles played by all members of a multi-disciplinary team C, M 1 The features of good team dynamics C, M 1 The principles of effective inter-professional collaboration to optimise patient, or population, care C, M 1 Understands the principles of confidentiality that provide boundaries to communicate C 1 Knows techniques to manage anger and aggression in self and colleagues C 1 Knows responsibility of the practitioner in the management of physical and/or mental ill health in self and colleagues

C 1

Skills Communicates accurately, clearly, promptly and comprehensively with relevant colleagues by means appropriate to the urgency of a situation (telephone, email, letter etc), especially where responsibility for a patient's care is transferred

T, C, I 1, 3

Utilises the expertise of the whole multi-disciplinary team as appropriate, ensuring when delegating responsibility that appropriate supervision is maintained

T, C, I, M 1, 3

Participates in, and co-ordinates, an effective outreach team when relevant T, C, I, M 1 Communicates effectively with administrative bodies and support organisations C, I, M 1, 3 Employs behavioural management skills with colleagues to prevent and resolve conflict T, C, I, M 1, 3 Behaviours Shows awareness of the importance of, and takes part in, multi-disciplinary work, including adoption of a leadership role when appropriate but also recognising when others are better equipped to lead

T, C, I, M 3

Fosters a supportive and respectful environment where there is open and transparent communication between all team members

T, C, I, M 1, 3

Ensures appropriate confidentiality is maintained during communication with any member of the team

T, C, I, M 1, 3

Recognises the need for a healthy work/life balance for the whole team, including yourself, but take any leave yourself only after giving appropriate notice to ensure that cover is in place

C, I, M 1

Is prepared to accept additional duties in situations of unavoidable and unpredictable absence of colleagues

C, M 1

Scope of Practice


• Accepts his/her role in the healthcare team and communicates appropriately with all relevant members thereof

3.14 Complaints and medical error

Objectives: • To recognise the causes of error and to learn from them

• To realise the importance of honesty and effective apology

• To take a leadership role in the handling of complaints Competence Assessment GMP

III - 24

Methods

Knowledge

Basic consultation techniques and skills described for UK Foundation programme and to include:

• Defining the local complaints procedure • Recognising factors likely to lead to complaints (poor communication, dishonesty etc)

C, D, M 1

Outlines the principles of an effective apology C, D, M 1 Identifies sources of help and support when a complaint is made about yourself or a colleague C, D, M 1 Skills

Contributes to processes whereby complaints are reviewed and learned from C, D, M 1 Explains comprehensibly to the patient the events leading up to a medical error C, D, M 1, 3 Recognises when something has gone wrong and identifies appropriate staff to communicate this with

C, D, M 1

Delivers an appropriate apology and explanation (either of an error or for a process of investigation of a potential error, and reporting of the same)

C, D, M 1, 3, 4

Distinguishes between system and individual errors C, D, M 1 Shows an ability to learn from previous error C, D, M 1 Behaviours

Takes leadership over relevant complaint issues C, D, M 1 Adopts behaviour likely to prevent complaints C, D, M 1, 3 Deals appropriately with dissatisfied patients or relatives C, D, M 1 Acts with honesty and sensitivity in a non-confrontational manner C, D, M 1 Recognises the impact of complaints and medical error on staff, patients, and the National Health Service

C, D, M 1, 3

Contributes to a fair and transparent culture around complaints and errors C, D, M 1 Recognises the rights of patients, family members and carers to make a complaint C, D, M 1, 4 Recognisess the impact of a complaint upon self and seeks appropriate help and support C 1

Scope of Practice


• Defines the local complaints procedure. • Recognises need for honesty in management of complaints. • Responds promptly to concerns that have been raised. • Understands the importance of an effective apology. • Learns from errors • Manages conflict without confrontation. • Recognises and responds to the difference between system failure and individual error • Recognises and manages the effects of any complaint within members of the team • Provides timely accurate written responses to complaints when required.

Legal and ethical aspects of care The legal and ethical framework associated with healthcare must be a vital part of the practitioner’s competencies if safe practice is to be sustained. Within this the ethical aspects of research must be considered. The competencies associated with these areas of practice are defined in the following section.

3.15 Principles of medical ethics and confidentiality Objective: • To know, understand and apply appropriately the principles, guidance and laws regarding medical ethics and confidentiality

III - 25


Methods GMP

Knowledge

Demonstrates knowledge of the principles of medical ethics T, C, I, HEI,

E 1

Outlines and follows the guidance on confidentiality T, C, I 1 Defines the provisions of the Data Protection Act and Freedom of Information Act T, C, I 1 Defines the principles of information governance C, I 1 Defines the role of the Caldicott Guardian within an institution, and outlines the process of attaining Caldicott approval for audit or research

T, C, I 1, 4

Outlines situations where patient consent, while desirable, is not required for disclosure e.g. communicable diseases, public interest

T, C, I 1, 4

Outlines the procedures for seeking a patient’s consent for disclosure of identifiable information T, C, I 1 Recalls the obligations for confidentiality following a patient’s death T, C, I 1, 4 Defines the standards of practice defined by the GMC when deciding to withhold or withdraw life-prolonging treatment

T, C, I 1

Knows the role and legal standing of advance directives T, C, I 1 Outline the principles of the Mental Capacity Act and the Adults with Incapacity Act T, C, I 1 Skills Uses and shares information with the highest regard for confidentiality, and encourages such behaviour in other members of the team

T, C, I, M 1, 2,3

Recognises the problems posed by disclosure in the public interest, without patient’s consent T, C, I 1, 4 Recognises the factors influencing ethical decision making: religion, moral beliefs, cultural practices

T, C, I 1

Uses and promotes strategies to ensure confidentiality is maintained e.g. anonymisation C 1 Counsels patients on the need for information distribution within members of the immediate healthcare team

T, C, M 1, 3

Counsels patients, family, carers and advocates tactfully and effectively when making decisions about resuscitation status, and withholding or withdrawing treatment

T, C, M 1, 3

Behaviours Encourages ethical reflection in others T, C, M 1 Shows willingness to seek advice of peers, legal bodies, and their regulator in the event of ethical dilemmas over disclosure and confidentiality

T, C, I, M 1

Respects patient’s requests for information not to be shared, unless this puts the patient, or others, at risk of harm

T, C, I 1, 4

Shows willingness to share information about their care with patients, unless they have expressed a wish not to receive such information

T, C, I 1, 3

Shows willingness to seek the opinion of others when making decisions about resuscitation status, and withholding or withdrawing treatment

T, C, I, M 1, 3

Scope of Practice


• •

• •

• • •

Respects patients’ confidentiality and their autonomy Demonstrates the need for the highest regard for confidentiality adhering to the Data Protection Act with respect to information about patients Keeps in mind, when writing or storing data, the importance of the Freedom of Information Act Knowledge of the guidance given by the GMC in respect of the Data Protection Act and the Freedom of Information Act Does not hurry patients into decisions Demonstrates understanding that the information in patient’s notes is the patients Only shares information outside the clinical team and the patient after discussion with senior colleagues

• Demonstrates familiarity with the principles of the Mental Capacity Act

III - 26

• Discusses with a senior colleague if in doubt about a patient’s competence and ability to consent even to the most simple of acts e.g. history taking or examination

• Participates in decisions about resuscitation status and withholding or withdrawing treatment.

• Counsels patients on the need for information distribution within members of the immediate healthcare team and seek patients’ consent for disclosure of identifiable information

• Discusses with the patient with whom they would like information about their health to be shared.

3.16 Valid consent Objective: • To understand the necessity of obtaining valid consent from the patient, know how to obtain it and obtain when indicated


Methods GMP

Knowledge Outlines the guidance on consent, in particular: • Understand that consent is a process that may culminate in, but is not limited to, the

completion of a consent form • Understand the particular importance of considering the patient's level of understanding and

mental state (and also that of the parents, relatives or carers when appropriate) and how this may impair their capacity for informed consent

C, D, M 1

Skills Presents all information to patients (and carers) in a format they understand, allowing time for reflection on the decision to give consent

T, C, I 1, 3

Provides a balanced view of all care options T, C, I 1, 3, 4 Behaviours Respects a patient’s rights of autonomy even in situations where their decision might put them at risk of harm

T, C, I 1

Keeps within the scope of authority given by a patient T, C, I 1 Provides all information relevant to proposed care or treatment in a competent adult T, C, I 1, 3, 4 Shows willingness to seek advance directives T, C, I 1, 3 Shows willingness to obtain a second opinion, senior opinion, and legal advice in difficult situations of consent or capacity

T, C, I, M 1, 3

Scope of Practice


• Demonstrates understanding that consent should be sought ideally by the person undertaking a procedure and in the absence of the patient’s consent, by someone competent to undertake the procedure

• Demonstrates understanding of the consent process • Always checks for consent for the most simple and non-invasive processes e.g. history taking • Understands the concept of ‘implicit consent’ • Obtains consent for straightforward treatments with appropriate regard for patient autonomy • Is able to explain complex treatments meaningfully in layman's terms and thereby to obtain

appropriate consent • Checks patients and relatives/carers (where relevant) understanding • Responds appropriately when a patient declines consent even when the procedure would on

balance of probability benefit the patient.

3.17 Legal framework for practice

III - 27

Objective: • To understand the legal framework within which healthcare is provided in the UK in order to ensure that personal

clinical practice is always provided in line with this legal framework.


Methods GMP

Knowledge

All decisions and actions must be in the best interests of the patient T, C, I,

HEI 1

Understands the legislative framework within which healthcare is provided in the UK – in particular • death certification and the role of the Coroner/Procurator Fiscal • child protection legislation; mental health legislation (including powers to detain a patient

and giving emergency treatment against a patient’s will under common law); advanced directives and living Wills

• withdrawing and withholding treatment • decisions regarding resuscitation of patients • surrogate decision making; organ donation and retention • communicable disease notification • medical risk and driving • Data Protection and Freedom of Information Acts • provision of continuing care and community nursing care by a local authorities

T, C, I, HEI

1, 2

Understands the differences between legislation in the four countries of the UK C, HEI 1 Understands sources of medical legal information T, C, I 1 Understands disciplinary processes in relation to malpractice T, C, I, M 1 Understands the role of the practitioner in relation to personal health and substance misuse, including understanding the procedure to be followed when such abuse is suspected

T, C, I, M 1

Skills Cooperates with other agencies with regard to legal requirements – including reporting to the Coroner’s Officer, Procurator Fiscal or the proper officer of the local authority in relevant circumstances

T, C, I 1

Prepares appropriate statements for submission to the Coroner’s Court, Procurator Fiscal, Fatal Accident Inquiry and other legal proceedings and be prepared to present such material in Court

C, M 1

Incorporates legal principles into day to day practice T, C, I 1 Practices and promotes accurate documentation within clinical practice T, C, I 1, 3 Behaviours Shows willingness to seek advice from the employer, legal bodies (including defence unions), and their regulator on medico-legal matters

T, C, I, M 1

Promotes reflection on legal issues by members of the team T, C, I, M 1, 3 Demonstrates that all decisions and actions must be in the best interests of the patient C, M 1

Scope of Practice


• Demonstrates knowledge of the legal framework associated with qualification and practice and the responsibilities of registration.

• Demonstrates knowledge of the limits to professional capabilities

3.18 Ethical research

III - 28

Objective: • To ensure that research is undertaken using relevant ethical guidelines


Methods GMP

Knowledge

Outlines the GMC guidance on good practice in research T, C 1 Outlines the differences between audit and research Audit, C,I 1 Describes how clinical guidelines are produced C, HEI 1 Demonstrates a knowledge of research principles C, I, HEI 1 Outlines the principles of formulating a research question and designing a project C, I, HEI 1 Comprehends principal qualitative, quantitative, bio-statistical and epidemiological research methods

C, HEI 1

Outlines sources of research funding C 1 Skills

Develops critical appraisal skills and applies these when reading literature C, HEI 1 Demonstrates the ability to write a scientific paper C, HEI 1 Applies for appropriate ethical research approval C 1 Demonstrates the use of literature databases C, HEI 1 Demonstrates good verbal and written presentations skills C, D 1 Understands the difference between population-based assessment and unit-based studies and should be able to evaluate outcomes for epidemiological work

C, HEI 1

Behaviours

Follows guidelines on ethical conduct in research and consent for research C 1

Shows willingness to the promotion of involvement in research C 1 Scope of Practice


• Defines ethical research and demonstrates awareness of GMC guidelines • Differentiates audit and research • Knows how to use databases • Demonstrates critical appraisal skills

Standards of care and education It is the responsibility of each practitioner to ensure that they are aware of relevant developments in clinical care and also ensure that their practice conforms to the highest standards of practice that may be possible. An awareness of the evidence base behind current practice and a need to audit one’s own practice is vital for the ACCP.

3.19 Evidence and guidelines

Objectives: • To make the optimal use of current best evidence in making decisions about the care of patients

• To develop the ability to construct evidence based guidelines and protocols in relation to medical practice Competence

Assessment Methods

GMP

III - 29

Knowledge

Knows how to apply statistics in scientific medical practice C, HEI 1 Understands the advantages and disadvantages of different study methodologies (randomised control trials, case controlled cohort etc)

C, HEI 1

Outlines the principles of critical appraisal C, HEI 1 Outlines levels of evidence and quality of evidence C, HEI 1 Understands the role and limitations of evidence in the development of clinical guidelines C, HEI 1 Understands the use of, and differences between, the basic measures of risk and uncertainty C, HEI 1 Understands the processes that result in nationally applicable guidelines (e.g. NICE and SIGN) C, HEI 1 Knows the principles of service development C, HEI 1 Skills

Demonstrates ability to search the medical literature including use of PubMed, Medline, Cochrane reviews and the internet

C, HEI 1

Appraises retrieved evidence to address a clinical question C, HEI 1 Applies conclusions from critical appraisal into clinical care C 1 Contributes to the construction, review and updating of local (and national) guidelines of good practice using the principles of evidence based medicine

C, HEI 1

Behaviours

Keeps up to date with national reviews and guidelines of practice (e.g. NICE and SIGN) C 1 Aims for best clinical practice (clinical effectiveness) at all times, responding to evidence based medicine

T, C, I 1

Recognises knowledge gaps, and keeps a logbook of clinical questions Portfolio 1 Recognises the necessity to practice outside clinical guidelines at times T, C, I 1 Communicates risk information, and risk-benefit trade-offs, in ways appropriate for individual patients

C, I 3, 4

Encourages discussion amongst colleagues on evidence-based practice T, C, I, M 1 Proposes and tests ways to improve patient care T, C, I, M ??1

Scope of Practice


• Participates in departmental or other local journal club • Critically reviews an article to identify the level of evidence • Undertakes a literature review in relation to a clinical problem or topic

3.20 Audit Objective: • To perform an audit of clinical practice and to apply the findings appropriately and complete the audit cycle


Methods GMP

Knowledge Understands the different methods of obtaining data for audit including patient feedback questionnaires, hospital sources and national reference data

Audit, C 1

Understands the role of audit in improving patient care, risk management etc Audit, C 1 Understands the steps involved in completing the audit cycle Audit, C 1 Describes the working and uses of national and local databases used for audit such as ICNARC C, HEI 1

III - 30

and SICSAG., and the working and uses of local and national systems available for reporting and learning from clinical incidents and near misses in the UK Skills Designs, implements and completes audit cycles Audit, C 1, 2 Contributes to local and national audit projects as appropriate (e.g. NCEPOD, ICNARC, SICSAG)) C 1, 2 Supports audit by junior medical trainees and within the multi-disciplinary team Audit, C 1, 2 Behaviours Recognises the need for audit in clinical practice to promote standard setting and quality assurance

Audit, C 1, 2

Scope of Practice


• Attends departmental audit meetings • Contributes data to a local or national audit • Identifies a problem and develops standards for a local audit • Understands the principles of Quality Improvement (QI) • Describes the Plan, Do, Study, Act (PDSA) cycle and takes an audit or QI project through the first

steps. • Compares the results of an audit with criteria or standards to reach conclusions

Personal attitudes and behaviours The individual practitioner has to have appropriate attitudes and behaviours that help deal with complex situations and to work effectively providing leadership and working as part of the healthcare team.

3.21 Personal behaviour Objectives: • To demonstrate the behaviours that will enable the ACCP to become a senior leader able to deal with complex

situations and difficult behaviours and attitudes

• To work increasingly effectively with many teams and to be known to put the quality and safety of patient care as a prime objective

• To demonstrate the attributes of someone who is trusted to be able to manage complex human, legal and ethical problems

• To be someone who is trusted and is known to act fairly in all situations.


Methods GMP

Knowledge Outlines the main methods of ethical reasoning: casuistry, ontology and consequential T, C, I, M 1, 2, 3, 4 Knows the overall approach of value based practice and how this relates to ethics, law and decision-making

O, M 1, 3, 4

Defines the concept of modern professionalism C 1 Outlines the relevance of professional bodies (Faculty of Intensive Care Medicine, NMC, PSC, GMC, specialist societies, defence organisations)

C 1

III - 31

Skills Practice with: • integrity • compassion • altruism • continuous improvement • aspiration to excellence • respect of cultural and ethnic diversity • regard to the principles of equity

T, C, I, M 1, 2, 3, 4

Work in partnership with members of the wider healthcare team T, C, I, M 3 Liaises with colleagues to plan and implement work rotas T, M 3 Promotes awareness of the ACCP role in utilising healthcare resources optimally T, C, I, M 1, 3 Recognises and responds appropriately to unprofessional behaviour in others T, C 1 Is able to provide specialist support to hospital and community based services T, C, M 1 Behaviours Recognises personal beliefs and biases and understands their impact on the delivery of health services

T, C, I, M 1

Appropriately refers patients where ACCP’s own personal beliefs and biases could impact upon professional practice

C, I, M 1. 3

Recognises the need to use all healthcare resources prudently and appropriately T, C, I 1, 2 Improves clinical leadership and management skills T, C, I 1 Recognises situations when it is appropriate to involve professional and regulatory bodies T, C, I 1 Acts as a mentor, educator and role model T, C, I, M 1 Deals with inappropriate patient and family behaviour Respects the rights of children, elderly, people with physical, mental, learning or communication difficulties Adopts an approach to eliminate discrimination against patients from diverse backgrounds including age, gender, race, culture, disability, spirituality and sexuality Places needs of patients above own convenience Behaves with honesty and probity Acts with honesty and sensitivity in a non-confrontational manner

C, I, M 1, 2, 3

Accepts mentoring as a positive contribution to promote personal professional development T, C, I 1 Participates in professional regulation and professional development C, I, M 1 Takes part in 360 degree feedback as part of appraisal C, M 1, 2, 4 Recognises the right for equity of access to healthcare T, C, I 1 Demonstrates reliability and accessibility throughout the healthcare team T, C, I, M 1

Scope of Practice


• Works as a valued member of multi-professional teams. • Listens well to others and takes other viewpoints into consideration. • Supports patients and relatives at times of difficulty e.g. after receiving difficult news. • Is polite and calm when called or asked to help • Acknowledges the skills of all members of the team • Responds to criticism positively and seeks to understand its origins and works to improve. • Praises staff when they have done well and where there are failings in delivery of care provides

constructive feedback. • Wherever possible, when appropriate, involves patients in decision making • Recognises when other staff members are under stress and not performing as expected and

provides appropriate support for them. • Takes action necessary to ensure that patient safety is not compromised

III - 32

Management and leadership Working within the health service there is a need to understand and work within the organisational structures that are set.

3.22 Management and NHS structure Objective: • To understand the structure of the NHS and the management of local healthcare systems in order to be able to

participate fully in managing healthcare provision.


Methods GMP

Knowledge Understands the structure of NHS systems in your locality recognising the potential differences between the four countries of the UK

T, C 1

Understands the structure and function of healthcare systems as they apply to your specialty T, C 1 Understands the consistent debates and changes that occur in the NHS including the political, social, technical, economic, organisational and professional aspects that can impact on provision of service

C 1

Understands the importance of local demographic, socio-economic and health data and its use to improve system performance

C 1

Understands the principles of: • Clinical coding • European Working Time Regulations • National Service Frameworks • Health regulatory agencies (e.g., NICE, Scottish Government) • NHS Structure and relationships • NHS finance and budgeting • Resource allocation • The role of the Independent sector as providers of healthcare

T, C, I 1

Understand the principles of recruitment and appointment procedures C 1 Skills Participates in managerial meetings T, C 1 Works with stakeholders to create and sustain a person and patient-centred service T, C, I 1 Employs new technologies appropriately, including information technology T, C, I 1 Behaviours Recognises the importance of just allocation of healthcare resources C 1, 2 Recognises the role of ACCP as active participants in healthcare systems T, C, I 1, 2 Responds appropriately to health service targets and takes part in the development of services T, C, I 1, 2 Recognises the role of patients/carers as active participants in healthcare systems and service planning

T, C, I, PS 1, 2, 3

Takes an active role in promoting the best use of healthcare resources T, C, I 1 Shows willingness to improve managerial skills (e.g. management courses) and engage in management of the service

C, M 1

Scope of Practice

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• Describes in outline the roles of primary care, including general practice, public health, community, mental health, secondary and tertiary care services within healthcare.

• Describes the roles of members of the clinical team and the relationships between those roles. • Participates fully in clinical coding arrangements and other relevant local activities. • Can describe the relationship between CCGs/Health Boards, General Practice, Health Boards and

Trusts including relationships with local authorities and social services. • Participates in team and clinical directorate meetings including discussions around service

development. • Discuss the most recent guidance from the relevant health regulatory agencies in relation to the

specialty.

Teaching and supervising competencies An ACCP will ensure that knowledge possessed is communicated effectively. In the formal setting of teaching and training specific competencies will have to be acquired to ensure that the practitioner recognises the best practise and techniques.

3.23 Teaching and training Objectives: • To develop the ability to facilitate learning through a variety of different means across a range of contexts

• To develop the ability to plan and deliver programmes of education and training

• To develop the ability to use assessment to promote learning and to evaluate the effectiveness of own teaching Competence

Assessment Methods

GMP

Knowledge Describes educational theories and principles relevant to clinical and medical education: C, HEI 1 Differentiates between, and understands the purposes of appraisal, performance review and assessment

C, HEI 1

Differentiates between formative and summative functions of assessment and defines their role in clinical education

C, HEI 1

Demonstrates knowledge of relevant literature relevant to developments in clinical education C, HEI 1 Outlines the structure of the effective appraisal interview C 1 Defines the roles of the various bodies involved in ACCP education C 1 Outlines the workplace-based assessments in use and the appropriateness of each C 1 Knows the principles of service development and CPD C 1 Skills Demonstrates the application of education literature relevant to teaching C, HEI 1 Identifies the needs of learners and plans educational activities to meet these C, HEI 1 Uses appropriate and current curricula to inform teaching practice C 1 Varies teaching format and stimulus, appropriate to situation and subject C 1 Provides effective feedback after teaching, and promotes learner reflection C, M, HEI 1 Conducts developmental conversations to promote learner reflection through appraisal, supervision and mentoring

C, M, HEI 1

Demonstrates effective lecture, presentation, small group and bed side teaching abilities C, M, HEI 1, 3 Provides appropriate career advice, or refers trainee to an alternative effective source of career information

C, M 1, 3

Participates in strategies aimed at improving patient education e.g. talking at support group C, M 1

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meetings Be able to lead departmental teaching programmes including journal clubs C 1 Recognises the trainee in difficulty and takes appropriate action C 1 Contributes to educational research or projects e.g. through the development of research ideas of data/information gathering

C 1, 2

Is able to manage personal time and resources effectively to the benefit of the educational C 1, 3 faculty and the needs of the learners

Behaviours In discharging educational duties acts to maintain the dignity and safety of patients at all times C, M 1, 4 Recognise the importance of the role of the ACCP as an educator within the multi-professional healthcare team and uses medical education to enhance the care of patients

C, M 1

Balances the needs of service delivery with the educational imperative C, M 1 Demonstrates willingness to teach trainees and other health and social workers in a variety of settings to maximise effective communication and practical skills

C, M 1

Encourages discussions with colleagues in clinical settings to share knowledge and understanding C, M 1, 3

Maintains honesty and objectivity during appraisal and assessment C, M 1 Shows willingness to participate in workplace-based assessments C, M 1 Shows willingness to take up formal tuition in education and respond to feedback obtained after teaching sessions

C, M 1, 3

Demonstrates a willingness to become involved in the wider medical education activities and fosters an enthusiasm for education activity in others

C, M 1

Recognises the importance of personal development as a role model to guide trainees in aspects of good professional behaviour

C, M 1

Demonstrates willingness to advance own educational capability through continuous learning C, M 1 Acts to enhance and improve educational provision through evaluation of own practice C, M 1, 3 Demonstrates consideration for learners including their emotional, physical and psychological well-being with their development needs

C, M 1

Scope of Practice


• Develops basic PowerPoint presentation to support educational activity • Seeks and interprets simple feedback following teaching • Is able to supervise a medical student, nurse or colleague through a procedure • Is able to perform a workplace based assessment including being able to give effective feedback • Delivers small group teaching to medical students, nurses or colleagues • Is able to teach clinical skills effectively

Demonstrates knowledge of

• The basic principles of how adults learn

4. Specialist Intensive Care Medicine Competencies

Within the National Education and Competence Framework [2008] each competence statement defines the scope of practice expected at three levels as follows:

• Is able to perform independently • Is able to perform with indirect/direct supervision

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• Demonstrates knowledge of The level ‘Is able to perform independently’ refers to competences that are considered essential for the role and remit of an ACCP working within any critical care setting. The level ‘Is able to perform under supervision’ refers to competences that require a level of supervision, from the critical care consultant or designated deputy, due to either the risk associated with the practice element or policy requirements. Supervision falls into two levels:

• Indirect – where the supervisor is contactable but does not need to be physically present with the Advanced Critical Care Practitioner. This level of supervision requires attendance of the supervisor within 5 to 30 minutes. The time allowed for the supervisor to attend would depend on the experience of the individual Advanced Critical Care Practitioner, the clinical condition of the patient and local circumstances

• Direct – where the supervisor is present with the Advanced Critical Care Practitioner The level ‘Demonstrates knowledge of’ refers to those competences that are not considered core requirements of the ACCP role. However, some competences designated to this level may be appropriate to develop further if appropriate to local circumstances. The competences reflect the specific requirements of the role and are intended to complement the existing mandatory requirements of employer/employee responsibilities for standing obligations such as:

• Equipment training • Infection control • Health and safety • Risk management • Cardiopulmonary resuscitation • Handling and moving • Fire safety

The core competences identified in this document are divided into four main domains:

• Clinical • Professional • Leadership • Teaching and supervision

There are a number of competences that may be relevant to more than one domain; however, in order to reduce repetition they have been placed in the most appropriate domain.

Clinical competencies

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• Resuscitation and first stage management of the critically ill patient • Interpretation of clinical data and investigations in the assessment and management of critical

care patients • Diagnosis and disease management within the scope of critical care • Therapeutic interventions/organ system support • Practical procedures • Peri-operative care • Patient comfort and psychological care • Discharge planning and rehabilitation • End of life care • Patient transport

Professional competencies

• Patient safety and healthcare governance • Health system management • Professionalism

Leadership competencies

• Professional relationship with members of the healthcare team • Development of clinical practice

Teaching and supervising competencies

• Participates in multi-disciplinary teaching and assessment of others

Clinical competencies The competences are presented as broad statements and do not specify the individual skills required to undertake a particular competence. Patient care at this level is much more than a list of practical tasks and the use of these overarching statements more clearly reflects the skills required of an Advanced Critical Care Practitioner. Local users may find it helpful for particular instances or particular trainees to break some of these stems down to their component tasks; further guidance on these is available in the detailed syllabus within the CoBaTrICE framework13. Although there is an expectation that the Advanced Critical Care Practitioner will make an initial differential diagnosis, their diagnostic skills will be predominantly physiologically based, definitive diagnosis of the underlying disease process in what maybe a complex clinical scenario is not within their defined scope and remains the remit of the broader medical team. In order for the Advanced Critical Care Practitioner to manage any situation there are a number of common elements they need to undertake as part of an ordered approach to the assessment and management of the critically ill patient, including to:

• Develop a systematic approach to the recognition, assessment and initial management of the critically ill patient including assessment and recognition of signs and symptoms of acute physiological instability

• Order relevant investigations and monitoring

13 www.cobatrice.org.

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• Identify life-threatening conditions and institute appropriate measures to promote physiological stability • Appreciate importance of taking a structured history and performing a targeted clinical examination and

creation of a working differential diagnosis • Recognise importance of definitive treatment in addition to supportive therapy • Understand pathophysiology and altered physiology • Initiate management strategies and care plans • Make and agree a management plan • Give an accurate handover • Know when and how to call for help • Apply protocols and care bundles • Instigate appropriate ‘referral on’ mechanisms to the appropriate healthcare professional

These specialist competencies draw on the Common Competencies of History Taking (3.1); and Clinical Examination (3.2). 4.1 Resuscitation and first stage management of the critically ill patient Objective: The Advanced Critical Care Practitioner will be required to manage a critically ill patient who has acutely deteriorated, often in circumstances where the specific cause or underlying medical diagnosis is unclear. The Advanced Critical Care Practitioner will be required to recognise, diagnose and manage the presenting signs and symptoms in order to prevent further deterioration and stabilise the patient’s condition.

Scope of Competence Assessment

Methods GMP

The altered physiology which the Advanced Critical Care Practitioner may be expected to recognise and to manage as part of the multi-disciplinary team includes:

• Cardiovascular instability including hypotension and hypertension, shock (cardiogenic, hypovolaemic, septic), acute chest pain, common rhythm disturbances

• Respiratory impairment including bradypnoea, hypoventilation, tachypnoea, hyperventilation, dyspnoea, the unprotected airway, pulmonary oedema, hypoxaemia, hypercarbia, collapse or consolidation, pleural effusion, pneumothorax (simple and tension), upper and lower airway obstruction

• Gastrointestinal impairment including abdominal pain and distension, upper and lower GI haemorrhage, diarrhoea and vomiting

• Metabolic, hormonal and toxicological derangement including electrolyte and Acid– base disturbances, hypothermia, hyperthermia

• Neurological impairment including altered consciousness, acute confusional states, coma, acute seizures

• Haematological impairment including severe anaemia, coagulation disorders • Musculoskeletal impairment including burns • Genito-urinary and renal impairment including altered renal function

D, C, M 1, 2, 3

Scope of Practice


• Can recognise, assess, stabilise and manage a critically ill patient who has acutely deteriorated or collapsed

• Can diagnose cardio-respiratory arrest and manage cardiopulmonary resuscitation to advanced life support provider level to include the management of common arrhythmias

• Can manage the post-resuscitation period including the management of the airway, circulation, dysrhythmias and metabolic state

• Can triage and prioritise patients appropriately within the critical care environment

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These specialist competencies draw on the core knowledge of History Taking (3.1); Clinical Examination (3.2); and Decision making and clinical reasoning (3.5).

4.2 Interpretation of clinical data and investigations in the assessment and management of critical care patients

Objective: The Advanced Critical Care Practitioner will be required to synthesise large amounts of data in order to promote an informed assessment and management plan.


Methods GMP

The ACCP’s development of an informed assessment and management plan will include the ability to make a proper physical examination of the following systems in the context of critical care:

• Cardiovascular • Respiratory • Gastrointestinal • Metabolic • Neurological • Nutritional state • Musculoskeletal

• Genito-urinary and renal

D, C, M, S 1, 2, 3

Scope of Practice


• Can obtain a history of the current condition and previous health status and perform an accurate clinical examination

• Can undertake timely and appropriate investigations including microbiological sampling • Can perform, interpret and adjust respiratory management plans according to blood gas analysis • Within legal frameworks can order and interpret chest x-rays • Can monitor appropriate physiological functions and recognise and manage trends in variables • Can integrate clinical findings with laboratory investigations to form a differential diagnosis of

organ dysfunction • Can initiate and manage basic organ support as defined in the Critical Care Minimum Dataset

Is able to perform under indirect supervision (indirect = onsite and off-site)

• Can integrate clinical findings to advanced organ support after consultation with critical care consultants


• Indications for Computerised Tomography (CT) imaging • Indications for Ultrasound Scan (USS) imaging • Indications for Magnetic Resonance Imaging (MRI) • Indications for Echocardiography (transthoracic/transoesophageal)

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4.3 Diagnosis and disease management within the scope of critical care Objective: The Advanced Critical Care Practitioner will need to make accurate initial diagnosis to ensure the immediate treatment and support of the patient within their scope of practice. The Advanced Critical Care Practitioner will be required to review the patient’s clinical progress and modify treatments according to the patient’s response.


Methods GMP

Critical care diseases and conditions should be specified according to national and local need but may include, for example:

• Sepsis including shock syndromes, inflammatory response, common infection-causing organisms, multi-organ failure sequelae

• Cardiovascular disorders including crescendo or unstable angina, acute myocardial Infarction, left ventricular failure, right ventricular failure, pulmonary embolus, cardiac tamponade, atrial tachycardia, ventricular tachycardia, atrial and ventricular fibrillation, pacing failure

• Respiratory disorders including pneumonia, asthma, chronic obstructive pulmonary disease, ARDS, TRALI

• Gastrointestinal disorders including altered nutritional states (bariatric to cachectic), pancreatitis, jaundice, hepatobiliary disorders, gut failure, bleeding

• Metabolic and endocrine disorders including diabetes, adrenal insufficiency, thyroid dysfunctionand electrolyte disorders

• Neurological and neuromuscular disorders including traumatic brain injury, intracranial bleeding including subarachnoid haemorrhage, stroke, meningitis/encephalitis, epilepsy, brain death, Guillain-Barre syndrome, critical illness neuropathy.

• Haematological disorders including major blood transfusion, immunosuppression pneutropenic sepsis

• Renal disorders including acute renal failure, hyperkalaemia and metabolic acidosis

D, C, I 1, 2, 3

Scope of Practice


• Can manage the care of the critically ill patient with the specific medical conditions listed above • Can manage the care of the critically ill patient with chronic and co-morbid diseases and identify

the implications of chronic disease on the critically ill patient • Can manage the patient with pulmonary infiltrates including acute lung injury syndromes

(ALI/ARDS) and their causative factors • Can manage the care of the septic patient • Can identify and minimise factors contributing to impaired renal function • Can identify and minimise factors contributing to impaired liver function


• How to manage a patient in the critical care environment following trauma • How to manage a patient in the critical care environment following burns • How to manage a patient in the critical care environment following spinal injuries • The implications of critical illness in the context of pregnancy • How to manage a patient in the critical care environment following intoxication with drugs or

environmental toxins • How to identify significant rises in intracranial pressure • How to manage a patient preparing for or following organ transplantation • How to manage a patient with malignant disease

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These specialist competencies draw on the core knowledge of Therapeutics and Safe Prescribing (3.3); Decision making and clinical reasoning (3.5); and Valid consent (3.17).

4.4 Therapeutic interventions/organ system support Objective: The Advanced Critical Care Practitioner will be required to initiate, manage and perform interventions for continued patient organ support and patient treatment within the critical care environment.


Methods GMP

In order for Advanced Critical Care Practitioners to undertake patient organ support and treatment they need to apply an ordered approach to the initiation and delivery of therapeutic interventions, which takes account of a number of key elements including the ability to:

• Describe and identify relevant anatomy • Understand pathophysiology and altered physiology • Understand the implications and associated risks • Describe and perform methods and techniques • Ensure safe use and management of equipment and monitoring devices • Order relevant investigations and monitoring • Initiate therapeutic strategies and care plans including modification according to patient

response • Instigate appropriate ‘referral on’ mechanisms to the appropriate healthcare professional

National legal frameworks for authorisation of blood products and for non-medical drug prescribing exist and must be adhered to.

D, C, I, S 1, 2, 3, 4

Scope of Practice


• Can independently prescribe drugs and therapies • Can manage and wean patients form invasive ventilatory support • Can initiate, manage and wean patients from non-invasive ventilatory support • Can manage fluids and vasoactive drugs to support the circulation, including the drug groups

vasopressors and inotropes • Can authorise and administer blood and blood products • Can correct electrolyte, glucose and acid-base disturbances • Can assess for and prescribe nutritional support • Can manage acute renal replacement therapy


• Can manage the care of the critically ill patient with specific acute medical conditions • Can initiate non-invasive ventilatory support • Can initiate acute renal replacement therapy • Can manage antimocrobial drug therapy in consultation with appropriate medical teams • Can manage multiple organ dysfunction (MODS) and the interactions between organ system

support interventions


• Mechanical assist devices to support the circulation • Mechanisms for prescribing blood and blood related products

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These specialist competencies draw on the core knowledge of Prioritisation of Patient Safety (3.7); Infection Control (3.10); and Valid consent (3.17).

4.5 Practical procedures Objective: The Advanced Critical Care Practitioner will be required to initiate and perform practical procedures necessary to facilitate organ support and therapeutic interventions. Legal frameworks for consent need to be considered locally.

N.B. The list of practical procedures detailed here includes a number of fundamental elements e.g. immediate airway assessment and support, ALS, peripheral cannulation and a number of more advanced procedures such as central venous cannulation. The core practical skills are generic but the decision to train more advanced airway skills and vascular access will depend on local circumstances. The rate of acquisition of these skills will also vary between training centres and individual practitioners.

Skills trainers and simulation can play an important part in acquisition of these skills however an ACCP must be able to demonstrate competent performance of practical skills on patients.


Methods GMP

In order for the Advanced Critical Care Practitioner to undertake the relevant practical procedures they need to undertake an ordered and safe approach to the execution of the procedures that takes account of a number of key elements, including the ability to:

• Take informed consent and use appropriate consent documentation • Describe and identify relevant anatomy and physiology • Understand the implications, risks and complications associated with the procedure(s) • Describe and understand methods and techniques • Ensure safe use and management of equipment including aseptic techniques • Order relevant investigations • Prioritise workload order • Prepare the patient and environment for the procedure • Ensure a safe approach to, and execution of, the procedure • Initiate therapeutic strategies and care plans including modification according to patient

response • Manage procedure aftercare and complications • Request help from appropriate healthcare professional when required

D, S 1, 2, 3

Scope of Practice

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• Can perform comprehensive airway assessment • Can perform emergency airway management to ALS provider standard • Can initiate and manage oxygen administration devices • Can perform needle thoracocentesis for immediate management of tension pneumothorax • Can initiate and manage appropriate methods for measuring cardiac output and derived

haemodynamic variables • Can perform peripheral venous catheterisation • Can perform arterial catheterisation and arterial blood sampling • Can perform external cardiac pacing • Can perform defibrillation and cardioversion • Can perform electrocardiography (ECG) • Can perform nasogastric tube placement in a critically ill patient • Can perform urinary

catheterisation


•


• • •

• •

How to recognise and manage difficult intubation How to manage a failed intubation How to perform thoracocentesis via a chest drain for pleural effusions using Seldinger technique Invasive and non-invasive methods of measuring cardiac output The principles of Sengstaken tube use (or equivalent) and placement and the management of portal hypertension

• The indications for and safe conduct of gastroscopy

• How to manage the airway during percutaneous tracheostomy

• Thoracocentesis via chest drain for pleural effusions using Seldinger technique under USS guidance

These specialist competencies draw on the core knowledge of Team working and patient safety (3.8).

4.6 Perioperative care

Objective: The Advanced Critical Care Practitioner will be required to manage peri-operative patients within their scope of practice in collaboration with multi-professional teams.


Methods GMP

In specialist units and after appropriate extra training practitioners may manage the care of patients following specialist surgery e.g. cardiac.

D, I, C, M, S

1, 2, 3

Scope of Practice


• Can manage and optimise the pre-operative care of the high risk patient • Can manage and optimise the pre-operative care of the elective patient • Can manage the post-operative care of patients following high risk, emergency and elective

surgery

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• How to manage the care of the patient following cardiac surgery • How to manage the care of the patient following craniotomy • How to manage the care of the patient following solid organ transplantation

These specialist competencies draw on the core knowledge of Therapeutics and Safe Prescribing (3.3; The patient as central focus of care (3.6); and Communication (3.12-3.15). 4.7 Patient comfort and psychological care

Objective: The Advanced Critical Care Practitioner will be required to support patients and dependants in a compassionate and understanding manner during the period of the patient’s critical illness


Methods GMP

In addition to the core skills the Advanced Critical Care Practitioner will need to:

• Communicate effectively and explain difficult clinical information using terms and language understandable to the patient and relatives

• Enable patients and relatives to make informed choices and understand the consequences of the choices they make

• Provide supportive care and coaching (distraction techniques) through difficult procedures

D, I, C, M, S

1, 2, 3, 4

Scope of Practice


•

•

Can identify and aim to minimise psychological sequelae of critical illness for patients and dependents Can recognise the risks of sedative and neuromuscular drugs in the critically ill patient and limitations of assessment in the setting of multiple organ dysfunction or failure

• Can manage the appropriate use of sedation and neuromuscular blockade, including the assessment of both


•

•

Can manage the assessment, prevention and treatment of pain including the use and prescription of patient controlled analgesia Can manage the administration of analgesia via an epidural catheter including top-up analgesia, the management of overdose and inappropriate placement

These specialist competencies draw on the core knowledge of Managing long term conditions and promoting patient self-care (3.11).

4.8 Discharge planning and rehabilitation Objective: The Advanced Critical Care Practitioner will be required to support the rehabilitation process of the critically ill patient which starts on admission to critical care and continues after discharge.


Methods GMP

The Advanced Critical Care Practitioner within their scope of practice needs to minimise the physical and psychological consequences of critical illness. C, M 1, 2, 3

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Scope of Practice


• Can identify and minimise the long term consequences of critical illness • Can inform patients and carers about the requirements for continuing care after discharge

from critical care • Can manage the safe and timely discharge of patients from the ICU/HDU


• The physical and psychological challenges for rehabilitation • The significance and relevance of critical care patient follow-up both within hospital and

following discharge

These specialist competencies draw on the core knowledge of Legal framework for practice (3.18); Breaking bad news (3.13); and Communication with colleagues and cooperation (3.14). 4.9 End of life care Objective: The Advanced Critical Care Practitioner within their scope of practice may be required to actively participate in the management of the dying patient. This involvement will include situations where management and care plans include the limitation or withdrawal of treatment to a critically ill patient where the emphasis of care is placed on the minimisation of distress to both the patient and their dependants.


Methods GMP

In addition to the core skills, the Advanced Critical Care Practitioner will need to:

• Take account of ethical issues • Minimise the distress to patients and dependants

I, C, M, S 1, 2, 3, 4

Scope of Practice


•

•

Can identify and aim to minimise psychological sequelae of critical illness for patients and dependents Can recognise the risks of sedative and neuromuscular drugs in the critically ill patient and limitations of assessment in the setting of multiple organ dysfunction or failure

• Can manage the appropriate use of sedation and neuromuscular blockade, including the assessment of both


•

• Can manage the assessment, prevention and treatment of pain including the use and prescription of patient controlled analgesia Can manage the administration of analgesia via an epidural catheter including top-up analgesia, the management of overdose and inappropriate placement

4.10 Transport

Objective: The Advanced Critical Care Practitioner may be required to transport critically ill patients safely, both intra- and interhospital.


Methods GMP

The Advanced Critical Care Practitioner must consider national and local transportation guidelines including those produced by the Intensive Care Society. D 1, 2, 3

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Scope of Practice


• Can undertake transport of the critically ill patient outside the ICU/HDU including the mechanically ventilated and spontaneously breathing patient in accordance with local guidelines and standards.

Professional competencies

These specialist competencies draw on the core knowledge of Principles of quality and safety management (3.9); Prioritisation of patient safety in clinical practice (3.7); and Complaints and medical error (3.15). 4.11 Patient safety and health systems management Objective: The Advanced Critical Care Practitioner will have a responsibility to promote and help ensure the safety of patients, colleagues, visitors and staff. This responsibility involves a professional approach to the maintenance and improvement of healthcare systems, standards and processes in the delivery of the service.


Methods GMP

In order for the Advanced Critical Care Practitioner to contribute to patient safety and healthcare management systems they need to undertake an ordered approach which takes account of a number of key elements, including the ability to:

• Behave in a professional manner • Identify and minimise risk in the work environment • Apply protocols and guidelines • Adhere to local and national policy and guidelines • Communicate and document appropriately • Develop collaborative care plans • Participate in monitoring processes

C, M, S 1, 2, 3, 4

Scope of Practice


• • • • • • •

Can participate in a daily ward round as part of the multidisciplinary team Can comply with local infection control measures Can identify environmental hazards and promote safety for patients and staff Can identify and minimise risk of critical incidents and adverse events Can organise a case conference with multidisciplinary team involvement Can apply protocols, guidelines and care bundles Can apply appropriate critical care scoring systems for assessment of severity of illness, case mix and workload

• Can demonstrate an understanding of the Advanced Critical Care Practitioner position within the wider and local organisation including clinical responsibilities, levels of accountability and systems of working

These specialist competencies draw on the core knowledge of Communication (3.12-3.15); and Personal behaviour (3.22). 4.12 Professionalism Objective: The Advanced Critical Care Practitioner will be expected to function as an autonomous practitioner within a specialist healthcare team. The professional behaviour required includes maintaining competence and standards of care delivery,

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the maintenance of ethical standards, critical appraisal and continuing personal and professional development.


Methods GMP

Professionalism includes elements of communication, professional relationships with patients and relatives, and self-governance as described below:

Communication • Understands communication is a two-way process • Is sensitive to the reactions and emotional needs of others • Is able to communicate at all levels • Gives accurate information and ensures comprehension, clarifies ambiguities • Listens and hears • Uses appropriate non-verbal communication

Professional relationships with patients, relatives and carers • Is caring • Focuses on the needs of the patient, family and carers • Maintains trust and reassures appropriately • Listens • Is polite • Seeks the views and opinions of the patient • Shows respect for the patient’s wishes, privacy, dignity and confidentiality • Is unprejudiced • Views each patient as an individual

Self-governance • Accepts responsibility for safe patient care, including continuity of care • Shows initiative and adopts a proactive, problem-solving approach • Manages stress • Is decisive when action is needed • Respects and applies ethical principles • Promotes the highest quality of practice, education and research • Is unbiased • Is interested and motivated • Seeks learning opportunities and has insight into personal educational needs, strengths and limitations • Seeks help, appropriately acknowledges and learns from mistakes

C, M 1, 2, 3, 4

• Recognises and seeks to address unprofessional behaviour in others • Manages time and organises self effectively • Wears appropriate attire and has good personal hygiene • Is accessible, punctual and reliable

Scope of Practice


• Can communicate effectively with patients, relatives and carers • Can communicate effectively with members of the multi-professional healthcare team and

other agencies • Can maintain accurate and legible records • Can involve patients, dependants and carers in decisions about care and treatment as

appropriate to the critical care setting • Can respect cultural and religious beliefs and demonstrate an awareness of the impact of

these beliefs on care of the critically ill patient and their dependants and carers • Can ensure patient confidentiality and apply legal frameworks related to patient information • Can take responsibility for safe patient care appropriate to level of practice

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• Can formulate clinical decisions within their area of practice with respect for ethical and legal principles in the multidisciplinary team context

• Is aware of the implications of consent and relevant issues as applied to the critical care environment

Leadership competencies These specialist competencies draw on the core knowledge of Personal behaviour (3.22). 4.13 Professional relationships with members of the healthcare team Objective: The Advanced Critical Care Practitioner will be approachable and will lead and delegate appropriately. This includes the promotion of respect and value of others’ roles, effective exchange of information, and support of all members of the multidisciplinary team. The Advanced Critical Care Practitioner will be punctual and reliable and arrange cover for their absence. The individual practitioner will behave as a good ambassador for the role of Advanced Practitioners, acting professionally and behaving considerately towards other professionals and patients, acting as a role model.


Methods GMP

Professional Values for Advanced Nurse Practitioners Adapted from NES Developmental Needs Analysis Tool for Advanced Nurse Practitioners & DOH (2008) The Education and Competence Framework for Advanced Critical Care Practitioners Accountability

• Demonstrates a high level of awareness and accountability regarding scope of professional practice for advanced nurse practitioners.

• Participates in and influence local policy making activities that relate to sphere of professional practice.

Change Management and quality improvement

• Establish the need for, lead and manage change. • Monitors the effectiveness and impact of change for patients, next of kin and

multidisciplinary team to ensure the delivery of high quality best practice care. • Leads on developments to improve patient safety

Communication

• Uses expertise in advanced communication strategies to develop and enhance therapeutic relationships with patients and next of kin.

• Uses interpersonal skills to develop, inform and promote a climate within the multidisciplinary team which enables person centred compassionate care.

• Collaborates, consults and promotes team-working. • Audit • Uses local and national guidelines and research to develop, implement and audit policy

C, M, S 1, 2, 3, 4

and protocols to improve clinical practice. • Identifies and minimises risk of critical incidents and adverse events

Teaching, coaching and mentoring

• Seeks learning opportunities and integrates new knowledge into clinical practice including clinical decision making.

• Has insight into personal educational needs, strengths and areas for development. • Initiates and provide a skilled supporting learning infrastructure for members of the team

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and peers. Scope of Practice


• Can collaborate, consult and promote team working • Can ensure continuity of care through effective communication with the multidisciplinary

team • Can appropriately supervise, and delegate to others, the delivery of patient care as

appropriate to their level of expertise and practice • Can support clinical staff outside the critical care unit to enable the delivery of effective care

as appropriate to the Advanced Critical Care Practitioner scope and level of expertise

These specialist competencies draw on the core knowledge of Management and NHS structure (3.23). 4.14 Development of clinical practice Objective: Dynamic development of clinical practice is essential for the Advanced Critical Care Practitioner to deliver high quality patient care. Transparent evaluation and audit of the service delivered provides crucial evidence for the improvement of clinical standards, not only enhancing local care delivery but also adding to the body of knowledge, promoting best practice within the wider critical care community.


Methods GMP

This competence will include elements relating to: • Current developments in clinical practice and guiding principles of critical care

professional and specialist organisations • Current developments and guiding principles of the local NHS trust, Health Board and

regional critical care network

C, M 1, 2, 3, 4

Scope of Practice


• Can seek learning opportunities and integrates new knowledge into clinical practice, including that of clinical decision making

• Can take a lead to develop clinical and professional practice relevant to the role in order to ensure the delivery of high quality best practice care

• Can participate in research or audit and quality assurance activities under supervision • Can support patients (and their dependants and carers, as appropriate) in understanding the

evidence base for their care and clinical management in terms of their personal circumstances

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preface · web viewswot analysis should be conducted in order to allow the trainee to address any...

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