The ACCS ProgrammePoole Hospital

Prepared by Dr Gary Cumberbatch ACCS Lead Poole Hospital

(Updated June 2011)

Contents

Summary of ACCS posts in Poole

Educational supervision

Acute Medicine

Anaesthetics

Emergency Medicine

Intensive Care Medicine

Work place based assessments

Preparation for the ARCP

Portfolios

Summary of ACCS posts in Poole

You will be rotating through the 4 ACCS specialities whilst here with 6 months in each post. You may start in any speciality first and this may not necessarily be in your base speciality. At the end of your 2 years you should gain sufficient skills and experience to be able to competently commence the management of most acutely ill or injured patients.

You will be offered a third year which will be spent doing your base speciality: for Acute Medicine trainees this will be in a CT3 post for 1 year in Poole doing 12 months in Medicine at SHO level; for Anaesthetic trainees this will be a further 12 months in Anaesthesia at CT2 level and may be at another hospital within Wessex; for Emergency Medicine trainees this will be for 12 months at CT3 level at Southampton or Portsmouth where there will be a 6 month focus on Paediatric Emergency Medicine.

You should have an Educational supervisor in your base speciality who advises you on your career path and a Clinical supervisor who is responsible for your clinical supervision whilst in the speciality you are doing. You should ideally meet with your Educational supervisor once every 6 months and 3 times with your Clinical supervisor in each speciality (initial, midpoint and final appraisals).

The lead educational supervisor for each speciality is as follows:

Acute Medicine Dr Elizabeth Williams Elizabeth.williams@poole.nhs.uk Telephone ext

Anaesthetics Dr Naeem Ahmed Naeem.ahmed@poole.nhs.uk Telephone ext 2385

Emergency Medicine Dr Gary Cumberbatch Gary.cumberbatch@poole.nhs.uk Telephone ext 2815

Intensive Care Medicine Dr Spike Briggsspike.briggs@poole.nhs.ukTel 07973149615

Dr Gary Cumberbatch is the Lead Consultant for the ACCS programme in Poole and you are encouraged to meet with him to discuss any problems regarding the rotation eg desire to swap when you do specialities, the gastro vs respiratory job in Medicine etc. Please liaise with him using the contact details above.

We hope that you will thoroughly enjoy your 2 years with us and any feedback you have about ways we can improve things would be welcomed. We would be grateful if you find any details within this document to be incorrect (as the jobs do change a little with time) to inform the speciality lead so that we can amend it so it remains up to date.

Emergency Medicine

You will spend almost all your time working within the Emergency Department and we encourage you to wear the Emergency Department (ED) scrubs. These are available to you via the sewing room and we would advise you to obtain these prior to starting with us.

Induction

You will be provided with an induction pack which you can again pick up before you start from the ED secretaries and this has all the details you need including your working rota; a Welcome booklet detailing how the Department works etc; an SHO handbook specifically written on how to manage the variety of cases that present to the ED (only available on the intranet); a small booklet on how to thrombolyse MIs.

It is essential that you meet or email Debbie Cook, our lead receptionist well in advance of your start date to decide which rota you wish to do (debbie.cook@poole.nhs.uk). Your annual leave is already booked as a 2 week block so to get the annual leave you want you need to choose a specific rota. Those trainees who ask late get what’s left!

On your first day you have to attend the Trust induction in the morning if this is your first post in Poole and from lunchtime the induction for the ED –the agenda for this will be in your induction pack.

Supervision

You will have Consultant presence prospectively within the ED between 8am -8pm Monday to Friday and for 3 to 4.5 hours each on Saturday and Sunday morning. We will hold “Board rounds” at 8am , 12 noon/ 2pm and 4 pm where you will need to present patients to us (or to a registrar out-of-hours).

The number of middle grades (SpRs/ ST4 and above/ Clinical fellows) varies from 6-8. There will always be a middle grade present within the Emergency Department for 24 hours.

Dr Cumberbatch will be your Educational supervisor for this post and if you are an Emergency Medicine trainee , he will be your supervisor for the entire 2 years.

TeachingThere is a formal teaching programme which is in protected time from 13:30 to 16:00 every Tuesday afternoon. The programme for this is in the induction pack. You will be expected to present a topic that you have chosen from a list provided.

There will be informal teaching at the Board rounds and obviously on patients you have seen and discussed.

Appraisals

It is essential that you meet with Dr Cumberbatch 3 times in the six month period (first within first 2 weeks; midpoint and in the last month).We will review your portfolio and go through courses/ audits you may need as well as ensure you have completed the necessary work place based assessments.

Acute Medicine

There are two posts and they are in Respiratory Medicine with Dr Mallawathantri and Gastroenterology with Dr Snook. You will have to liaise with your other ACCS colleague AND Dr Mallawathantri /Dr Snook to determine which post you wish to do. If for example you have already done a Respiratory post as F1 or F2 , you may wish to do the gastroenterology job – or the converse.

You will have your specific duties for each team explained to you when you start and when on call you will be responsible for receiving Medical referrals from the Emergency Department and GPs.

The Gastroenterology ACCS jobThe TeamYou will be part of the Gastroenterology team, made up of the following medical staff:4 Consultants: Drs Snook, Sharer and Parry/Williams (who both work 4 days and cross cover each other)2 SpRs3 SHOs (1 is ACCS)3 F1sThe Consultants have their offices based on A5 where most of their patients are but there are patients on almost all of the other Medical wards (Ansty, A4, C4, Portland). Two of the Consultants are ward-based at any one time. The third Consultant who is not ward-based may however admit patients from their clinic. Dr Parry does not work Mondays, and Dr Williams does not work Fridays. Each of the Consultants on the ward has a SpR.The SHOs and F1s are paired for the whole six months, such that one SHO should always be working with the same F1. In general each pair will rotate every two months in turn from being floater, to one ward-based Consultant and then the other ward-based Consultant. This ensures continuity with juniors, however does mean changing Consultants. Due to leave and nights, there are usually gaps on either Consultant’s side, so these are filled by whoever is on floater at that time. The Consultants know who their SHO is and will bleep them when they are not ward-based if they wish to admit one of their patients from clinic.

InductionDr Masding, Consultant in Acute Medicine/ diabetes (or in his absence one of the other Consultants), does induction at the beginning of the job which includes EPR, requesting investigations and your timetable. There is no specific induction for the Gastro job – you go to ward A5 and collect your bleep and start! There is however a written information pack for the Gastroenterology job and you should arrange to meet your Educational Supervisor within the first week or so. The F1s have the patient lists.

SHO Duties (9am -5pm)MondayAM SHO Ward round with the F1PM Ward jobsTuesday AM Dr Snook ward round

Dr Parry ward round (alternate weeks)Dr Sharer ward round

Lunch Journal club 12.30pmPM Ward jobs

Dr Parry ward round (alternate weeks)Wednesday AM SpR Ward round

Dr Sharer clinic (alternate weeks) Lunch Core Medical SHO teaching at 13.00PM Ward jobsThursdayAM SHO ward round with F1

Dr Parry ward round Lunch The Grand round (lunch from 12.30pm, GR at 13.00)PM Ward jobsFridayAM Dr Snook Ward round

Dr Sharer ward round (alternate weeks)Lunch X-ray meeting joint with surgeons at 12.45pmPM Ward jobs

Dr Sharer ward round (alternate weeks)Dr Williams normally bleeps her SHO or F1 to organise when to see her patients: this is on Mondays and Wednesdays. Dr Sharer alternates his ward round on Fridays to either am or pm, as does Dr Parry on Tuesdays.

ClinicsThere are no scheduled clinics for the SHO for Dr Snook, however you will be expected to cover the SpR if they are absent on that day. There is also plenty of opportunity to clinics for planned SpR absences, these are entirely optional and can the booking pattern can be set up to suit your experience, you should discuss whether you think this additional clinic experience would be relevant/appropriate with your educational supervisor. It is very useful to attend the clinic as you will learn a lot there and it also helps break up the routine of ward work.Dr Sharer’s SHO has an SHO clinic on alternate Wednesday mornings. There is also an opportunity to go to other Medical clinics as long as the all the ward jobs are completed for your own Consultant eg Endocrine clinics on Thursday PM

Ward workThis involves the following:1) Reviewing patients with the F12) Reviewing patients the nurses have highlighted as “sick”3) Supervise and support the F14) Carry out procedures such as ascetic drains, LPs and chest drainsAlthough there is not always a SpR there for support, the other gastroenterology SHOs may have more medical experience than you and can be called upon if you need support. Obviously the Consultants themselves are contactable if no-one else is able to support you.

On CallYou are given the on call Consultant rota at the beginning of the job and you are essentially on call whenever your Consultant is on call. The SHOs are expected to divide the on calls between themselves as the Gastroenterology Consultants do like their SHO to be on call with them and this works out at about one on call every 10 days.On the on call day:1) You must collect the on call bleep (0322) from the night SHO at 0900 hours2) You will need to accept/ clerk in referrals from GPs and the Emergency Dept3) You will be part of the Cardiac Arrest team and will be expected to immediately attend these and lead the team if there is no SpR present.4) You will need to handover to the night SHO at 20:30 hours5) You will be expected to take part in the Post Take ward round the next day,which starts at 0800 hour.

The SpR is on call and around for any problems/ advice but they will also be doing their routine day work at the same time so rarely get involved in clerking patients in the morning, but should be available in the afternoon. Similarly the F1 on call will be doing their routine day work but will be available to clerk in patients after they have done their “jobs”.You usually do not get time to help on the ward when you are on call.

WeekendsThese are split and you are generally on call with your own Consultant. You will be with one of the F1s and SpR for this.You either do the Friday with Post Take ward round (PTWR) on the Saturday morning at 0800 AND the Sunday (with the PTWR on the Monday at 0800)ORYou do the Saturday with the PTWR on Sunday at 0800.The weekends will have to be divided between the 3 SHOs and works out at about 4 weekends in 6 months.

NightsThese are seven consecutive nights starting from a Friday 20:30 to 08:00. You will be on with your own SpR and F1. The duties are the same as the on call day work. The nights are divided between the 3 SHOs and works out at about 2 or 3 weeks in the 6-month period.

Ansty weeksYou will work purely on Ansty for 2 or 3 separate weeks in the 6-month post.There is an acute medicine take parallel to the general medical take daily. Ansty is for patients who are expected to be in hospital for 48 hours or less.During the Ansty week you are expected to attend the daily PTWR with the Acute Medicine Consultant, the Ansty F1 and the Acute Medicine SpR and then carry out any jobs for this. It can be a lot of “paperwork” but is also a good opportunity for procedures like LPs.Whilst on Ansty week you may NOT take leave, and should not be doing on-calls. As the remaining gastro team are usually short-staffed, the Consultants prefer you not to take leave if one of the other SHOs is on an Ansty week.

The Medical Investigation UnitThis is based on C4 and patients come in for a variety of infusions; elective ascitic taps etc. The SHO is expected to help the F1 clerk these patients in and carry out the necessary investigations or treatments.

Annual LeaveYou are entitled to 14 working days plus lieu days in your 6-month period and 7.5 days study leave. The Consultants are normally happy to sign off any leave as long as there is enough cover on the ward between SHOs and F1s. As said above, they prefer not to allow leave when one SHO is on Antsy, but one SHO may take leave during a set of gastro nights, since this tends to be the quietest period.

Grand Round/Journal ClubEach Consultant will be responsible for Grand Round in turn: this will usually be based around a case, which one of the team will present, followed by a talk on a specific part of the case. It is a good idea to find out in plenty of time when your Consultant’s turn is coming up! For Journal club, one of the team should be responsible for presenting an interesting journal article. This rota, and the grand round rota are available in the post-graduate office.

The Respiratory ACCS Job

You will be working for Dr Sugamia Malawathantree who is one of three Respiratory consultants at Poole. The following information will help you arrange your time and understand the commitments of the job.

Induction

This is arranged by medical staffing.  You may have to contact them 1 week before change over if in the second half of the year to find out when induction for medicine is. I would recommend that you also ask for a copy of the on call rota early from medical staffing.

The Respiratory Firm

Dr Crowther (SDC)Dr Allenby (MIA)Dr Mallawathantri (SMW)2 speciality registrars, 3 SHO’s and 3 F1 doctors.

Secretaries are located on A4 ward: Christine Waller - SDC, Maureen Collacott – MI, Harriet Truslove – SMW.

Cross cover between teams is expected to cover sickness, annual leave and study leave.

On call

On average you will undertake about one on call per week. When on call you should not be expected to undertake other commitments. The on call rota is available from medical staffing or the secretaries offices. When not on call you have a normal working day 9-5. The exception is the day after on call when you will be expected to attend at 8am to partake in the post take ward round. On call is from 9am until 8.30pm. Night handover prompt at 8.30pm on Ansty. The on call rota is coded as per consultant, SDC= Crowther, MIA= Allenby, SMW= Mallawathantri. The on calls are split between the three SHO grade doctors and cover the above codes, ie the respiratory consultants. It is recommended but, neither possible or essential, that the SHO doctor doing the on call belongs to the consultant for that day.It is important to decide at the beginning of your 6 months post your on call commitments by allocating your name or a colour coding to the rota, this must be done in conjunction with the other SHO doctors in respiratory. Give a copy of this to the consultant secretaries above. Night shifts run from Friday to Friday ie. 7 nights. You will be expected to do two over the 6 months. Weekends are no different from week on calls and again on average you will do about two weekends in the 6 months. On call bleep 0322.

Ward work

Most respiratory patients will be on A4. It is highly likely you will also have patients on other wards. To locate your teams’ inpatient list use EPR. Ensure consultant Mallawathntri is selected in drop down box, and next drop down box is selecting all wards. This is the inpatient list. Note this will not show patients under other teams who the team has under review. Therefore current practice is to have a separate F1 maintained list

on the computer that is regularly updated with list of jobs and review patients.

Below is the time tables for Dr Mallawathantri and Dr Crowther.

Colour code.Red is essential and expected. Thus ward rounds, teaching. Note consultant ward rounds are twice weekly- on Monday or Tuesday and Thursdays AM or PMYellow is recommended. For example respiratory investigation reporting on Monday lunchtime is recommended but not necessarily expected. It should be encouraged that you attend at least one session in the first half of the 3 months. This will equip you with some basic knowledge of respiratory investigation. This skill will be required in the clinics..

Wednesday morning is the F1 ward round. You should be available via bleep for advice and attendance to sick patients. You may wish to shadow the F1 and give feedback or you can use this time to undertake an audit or further curricula work such as clinic attendance in area of interest. You must however be available to the F1 in case problems are encountered.

Dr Crowther Timetable  MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

AM Alternating Consultant

09.30   WARD ROUND 

or

10.00  THORACOSCOPY

WeeksSHO ward round

               or

09.30   Consultant    WARD ROUND

F1 ward round ST1 audit, admin, ward support

09.00 OPD PHFT / WIMBORNE

alt weeks

SHO ward round

SHO ward round

PM

12.30  Respiratory Investigation   reporting session14.00  BRONCHOSCOPY

Endoscopy Suite (x 2939)

12.00Journal Club

13.00 Lung Cancer meeting

14.30 – 15.30SDC student Teaching

12.30 SHO Teaching13.00    Grand Round

14.00 Consultant WARD ROUND

    

13.30  Xray meeting

Dr MallawathantriMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

0900-1200 WARD ROUND

(when covering SDC)or

THORACOSCOPY

0830-1230WARD ROUNDCystic Fibrosis(when covering

MIA)

0900-1230 0900-1300Ward Round

(when covering SDC)

0830-1230CYSTIC FIBROSIS

MDT & WARD ROUND

(when covering MIA)

1230-1400  Lung function

reporting

1230-1430Lung MDT

12.30 SHO teaching 1300-1400 Grand Round

1330-1400X-RAY MEETING

1415-1715OPD CLINIC

1430-1730BRONCHOSCOPY

(alternate weeks)

1330-1730 SWANAGE OPD(alternate weeks)

  1400-1730OPD CLINIC

(Yellow) x 2220

Clinics.

There are no Clinics for the SHOs to do for the Crowther team. You are expected to cover the clinics in red on the Mallawathantri team. This should be arranged between the SHOs. I recommend that you decide who does what clinic one month in advance and inform Harriet. Of course there is flexibility here but disputes do occur on who will attend and thus preparation in advance is advised.

Ansty Week

Over the time of acute medicine you will be expected to spend Monday to Friday 9am to 5pm on the acute medical admissions ward; also known as Ansty. This is expected on two occasions and again is on the on call rota under respiratory team. This should be decided between the respiratory ST doctors. This is a ward based job you are expected to see the triaged patients on the 9 am ward round with the acute medical consultant. The Ansty F1 and yourself will undertake the jobs from the ward round. This is often a good opportunity to undertake extra assessments in practical skills ie DOPs. The standard of care offered via the respiratory team is currently high. The free time should always be used to ensure discharges are planned, information is at hand and the ward round runs smoothly. If you have any questions Dr Crowther will be more than happy to answer them if possible. He is approachable and requires involvement in all areas of patient care that may be difficult and beyond your current skills. Of course you speciality registrar will also be available but when not Dr

Crowther will expect you to keep him up to date with important matters, for examples new diagnosis of lung cancers.

Hopefully this will help you get started. There is plenty of flexibility here. You can if you wish attend bronchoscopy or thoracoscopy. This should happen at least once as you may be required to explain the procedure and consent the patient. Teaching is recommended and with the new teaching room for the respiratory team regular presentations from the team, PORT team, and medical students should be taking place.   The most important thing is to enjoy this placement. If you are used to an hectic job then you will find that things tend to be quieter. This will allow you to have some free time within the working days, use this wisely, consider for example doing you college exam near the end of the 6 months, or an audit.

A few contact numbers for you

christine.waller@poole.nhs.uk EXT 8154harriet.truslove@poole.nhs.uk EXT 2162sugamya.mallawathant@poole.nhs.uksimon.crowther@poole.nhs.uk

SDC team bleeps F1 0064, F1 0176, SHO 0189, SPR 0915MIA/SMW bleep F1 0167, SHO 0180, SHO 0867, SPR 0728

Teaching

There is regular teaching within Medicine which you should attend:

Core Medical teaching programme from 1300-1400 each Wednesday

Grand round – 1300-1400 every Thursday (your team may be presenting)

Journal Club – 1230-1330 every Tuesday

Clinical Governance meetings- which occur monthly (you/ your team may present audits etc )

Competences These are different for those wishing to achieve level 1 GeneralInternal Medicine(GIM) competency and those not needing it.

Level 1 GIM is only required for:

1) ACCS trainees whose base speciality is Acute Medicine

2) Any other trainee who may wish later to dual accredit in their base speciality and Acute Medicine

Level 1 GIM is NOT required for:

1) ACCS trainees in Anaesthesia or Emergency Medicine unless theywish to dual accredit in Acute Medicine

2) Intensive Care Medicine

The specific competences and WPBA (work place based assessments) for Medicine are specified in the document we will email you titled “Summary of the ACCS curriculum requirements” .

Anaesthetics

Introduction

The anaesthetic department provides service and training for East Dorset, at both Poole Hospital and The Royal Bournemouth Hospital. Whilst service aspects of the post for ACCS trainees will only be carried out in Poole, your anaesthetic training will be delivered in both hospitals. The two hospitals provide complimentary aspects of training in anaesthesia and most consultants and all trainees work across both sites. Excellent training opportunities are also provided in community hospitals such as Wimborne and St Ann’s. A means of transport between the two main Trusts essential, and it is desirable to have a means of transport to the community hospitals.

Induction and Administration

On your first day you have to attend the Trust induction in the morning and from lunchtime the induction for anaesthesia –the agenda for this will be in your induction pack.

You will be provided a departmental handbook on your first day. You will meet with Mrs. Jackie Boyd, our departmental administrator who will explain the rota (both weekly and on-call) , as well as details of list start times and relevant policies etc. Whilst Jackie deals with the weekly rota administration, the on-call rota and leave booking system is carried out through Dr Tamsin Dodd, consultant anaesthetist. You will be given an explanation of how to book leave through this system, which is administered on-line. There are minimum numbers allowed away at any one time and sufficient notice must be given if you want to guarantee your leave, Requests for “not-on-call” will not be accepted and you must ensure that you arrange your own swaps with colleagues if you wish to take leave on a day when you were rostered on-call. The weekly rota will be emailed out to all anaesthetists in advance. Please ensure that Jackie has an up-to-date and correct email address for you and you must ensure that any swaps you have made with colleagues are fully communicated and agreed with her.

Those ACCS trainees whose base specialty is anaesthesia must register with the Royal College of Anaesthetists as soon as possible.

Supervision

For your first 3 months you will only administer anaesthetics under the direct supervision of a consultant anaesthetist. During this time you will be undergoing workplace based assessments in practical skills (DoPS), and case management (anaesthetic-CEX and CBDs). Only once you have been assessed as competent after this period of training will you be allowed to anaesthetise patients without direct supervision by a consultant and will you be able to participate in the evening or night shift rota without direct supervision. Even at this point you are only qualified to anaesthetise patients of ASA Grade 1 or 2 without direct supervision and you will be expected to discuss case management with a more experienced anaesthetist before you embark on an anaesthetic. You must ensure at all times that you have unimpeded access to a consultant for advice or assistance. During evening and night shifts you will have at the

very least, a more experienced trainee anaesthetist resident in the hospital for immediate advice or assistance.

Training Programme

Initial Assessment of Competence

The initial 3-month period of training is the “Initial Assessment of Competence.” During this training you will be expected to gain the knowledge and skills essential to safe anaesthetic practice. This must include

a) a working knowledge of Equipment: including breathing systems or “circuits”, the

anaesthetic machine, ventilators, airway devices including endotracheal tubes, laryngoscopes, laryngeal masks, facemasks, Bag-Valve Mask systems, oxygen supplies and safety checks of all equipment;

Drugs: including induction agents, sedating agents, muscle relaxants, analgesics, gaseous anaesthetic agents

Essential safety standards e.g. monitoring, anaesthetic assistance Basic anatomy for anaesthetists (airway, cannulation sites etc) Starvation policies Pre-operative assessment including airway assessment Management of post-operative acute pain Management of anaesthetic critical incidents including failed

intubation drill

b) Essential skills including Bag-valve mask ventilation Basic airway manoeuvres Use of airway adjuncts Insertion of laryngeal mask airway Endotracheal intubation, cricoid pressure and Rapid Sequence

Induction Basic anaesthetic techniques (spontaneous ventilation and IPPV) Management of induction and emergence Good practice in infection control

You are encouraged to “shadow” competent trainee anaesthetists on the evening shifts as much as possible prior to going onto the shift rota.

Teaching

There is a formal anaesthetic teaching programme held in protected time on Thursday mornings. Whilst sessions are facilitated by consultants you will be expected to read around the subject in advance and present a topic that has been allocated to you by the teaching co-ordinator. Teaching may be at either Poole or Bournemouth hospitals and so you must check your rota in advance.

You will have at least one Simulator training session in your 6 months for Rapid Sequence Induction and Critical Incident Management.

There will be opportunities for informal, practical –based teaching on every theatre list. Please take every opportunity to ask questions and get teaching from your consultants as well as completing Workplace Based Assessments as often as you are able. It is also imperative that you turn up on time for each teaching list and see the patients beforehand. This is not only courteous to the patient and consultant, but more importantly is integral to your training in anaesthesia in pre-operative assessment, equipment and drug checking and formulating anaesthetic care plans. The more actively involved in the patients’ care you are, the more you will gain in terms of learning and enjoyment.

Clinical Governance meetings are held monthly at either Poole or Bournemouth. As well as having educational value, these meetings also provide an opportunity for you to present any projects or audits you may have undertaken in the department, or to present interesting cases.

Morbidity and mortality meetings are also held in the evenings, approximately monthly. These are a friendly, informal and sociable way to present M&M and are usually followed by a meal out.

Appraisals

During your anaesthetics attachment you will be allocated an Educational (Clinical) Supervisor within anaesthetics, irrespective of your base specialty. You must meet with your anaesthetic Educational Supervisor within 2 weeks of the beginning of your post to establish a “learning agreement”. After this you must arrange to meet again at 3 and 6 months. At 6 months you will have a formal appraisal when you will receive formal feedback about your anaesthetic knowledge, skills and attitudes as judged by consultants. Please ensure that you arrange a date for appraisal with your Educational Supervisor and bring all relevant paperwork. This will include an anaesthetic case logbook, completed workplace based

assessments, your portfolio and any details of audits, projects, exams or courses undertaken during your placement. This information is essential for your Educational Supervisor to be able to complete your ARCP report accurately.

Intensive Care MedicineIntroduction

There are two ACCS posts in Intensive Care Medicine, for a period of six months. You will be part of the staff rota for the unit during that time, and the rota is administered by the anaesthetic department. It is essential, as always, to make sure your leave requests go in early, as there is a limit on how many can be away at any one time. Precedence always goes to those who book first. Details are included in the section on Anaesthesia (above) regarding the details for this process.

Induction

Each August, there is a comprehensive induction day to both the Trust, the Anaesthetic Department and Intensive Care. Trust induction takes place during the morning of the first day, and then to Anaesthesia and Intensive Care in the afternoon.

There is an Intensive Care Handbook for trainees, and it is essential that you start to work your way through this book on your arrival. It contains the structure of how the unit runs, and details of the many procedures and equipment that we use on the unit.

Over the first two weeks of your arrival, the Intensive Care Consultants provide lectures covering the essential topics that will be the basis for your work on Intensive Care. These include:

Inotropes Ventilation Cardiovascular monitoring Analgesia and sedation Renal support Nutrition Head injuries

These topics will be covered a number of times during your time with us.

Supervision

Your educational supervisor whilst on the unit will be Dr Briggs, to whom you should refer if you encounter any problems.

You will either be directly supervised, or have immediate access to the Intensive Care Consultant at all times during the day. There is also usually a Staff Grade doctor on the unit as well, who should have sufficient experience to supervise ACCS trainees. You will not be expected to practice independently on the Intensive Care Unit, and nor is it appropriate for you to do so.Your normal working day will start at 0800 with a handover ward round. There is the main ward round at 1030 with the Consultant and Senior Nurse on the unit. Your working day will usually finish at 1730, but occasionally you will finish at 2000. Between these hours, the level of supervision is reduced, but you will have access to the ‘senior’ registrar / Anaesthetic Consultant in theatre, and the on-call Intensive Care Consultant.

Teaching

There is a formal teaching program on the unit, which takes place every Wednesday afternoon at 1600, in the Intensive Care seminar room. You are encouraged to attend these teaching sessions, as they provide a comprehensive introduction to Intensive Care Medicine, and during the six months, most major topics will be covered. You may be asked to prepare a short outline for a particular topic.

In addition, there is much teaching that takes place at the bedside should the opportunity present itself, and also during the ward rounds. There are usually many procedures taking place on the unit, from intubation of sick patients, to insertion of all types of lines. These are very good

opportunities to complete DOPS, mini-CEX and CBD forms. Completion of these forms is your responsibility, and ideally you should ask to be assessed and get the forms signed as you go along. Presenting a number of forms several weeks after the event is not acceptable.

There is also a competency booklet, covering clinical practice of Intensive Care Medicine. As with the work-place assessment forms, these should be completed as you progress on the unit. All competencies must be completed by the end of your time on the unit. If you feel you are falling behind, please inform Dr Briggs, and we will endeavour to improve your exposure and experience. Intensive Care is an excellent environment for training, presenting many opportunities, but it is your responsibility to take advantage of them.

Whilst on the unit, we are very keen that you complete at least one audit, and present it at either the monthly departmental clinical governance meetings, or at the bi-annual ACCS training days. There is an on-going list of projects, but we welcome suggestions from you as well, if there is a particular project that interests you.

Appraisals

It is essential that you have an appraisal meeting within two weeks of arrival on the unit with Dr Briggs. You should also have an appraisal meeting after three months, and again at six months. These appraisals will comprise a systematic review of how far you have progressed, and will examine the work-place assessments and competencies completed.

We will also examine your involvement in audits and other projects, together with courses attended and exams, either sat or to be sat. You should also maintain an Intensive Care logbook covering patients with whom you have had direct contact, not every single patient you see on a ward round.

WORK PLACE BASED ASSESSMENTS

These have to be trainee driven. Trainers need to be asked to do them and you need to be clear beforehand that the case is a WPBA, not requested retrospectively. These should be done evenly over the 6 month period and not done as a last minute exercise as it is unfair on trainers to do many in a short period.

The exact WPBAs for each speciality are specified in the document you will be emailed titled “Summary of Requirements” and summarises the requirements of the ACCS Curriculum 2010.

The idea of these assessments is to encourage greater interaction between you and your trainers (these include SpRs who have had training in assessments). They are designed to improve your training and are only useful if you and your trainers perceive them as such – they are not a tick box exercise and you will always gain some added knowledge or skill having done it.

PREPARATION FOR YOUR ARCP

The annual review of competence progression (ARCP) is a mandatory process whereby a panel of trainers who are Consultants in Wessex from the specialities you have done/doing, review the paperwork (electronic ultimately) you have completed. If you have successfully completed all the requirements you may not necessarily need to attend the meeting (eg on annual leave ) but generally we encourage you to go as there is added value with a face-face interaction.

The “checklist” below lists the exact requirements for each speciality:

EMERGENCY MEDICINE

Ed supervisor completed and signed structured training report Y N Completed a personal development plan for identified deficiencies ** Y N Completed a minimum of 13 WPBAs as follows:4 Mini CEX Y N3 CBD Y N1 ACAT-EM Y N5 DOPS Y N -4 Mandatory DOPS: Airway maintenance Y N Primary survey trauma patient Y N Wound management Y N Fracture/ joint manipulation Y NSuccessfully completed at least 2 Major presentations with Consultant Y NSuccessfully completed at least 5 Acute presentations with Consultant Y N -Mandatory 5 APs: Abdominal pain Y N Breathlessness Y N Chest pain Y N Head Injury Y N Mental Health Y NCompleted a minimum of 10 Acute presentations using WPBAs Y NCompleted a minimum of 9 Acute presentations using other means *** Y NCompleted a satisfactory logbook of cases seen in the ED:Seen a minimum of 750 cases Y NNo patient identifiable material in logbook Y NLogbook divided or made clear the case mix (Resus/Majors/ambulatory) Y NLogbook divided or made clear the age range (Paeds vs adults) Y N

Completed an MSF with a summary by the Ed Supervisor (> 11 replies) Y N (only necessary if not done in Medicine)Completed an audit and ideally closed the loop (not essential) Y N(only necessary if not done in Medicine) Completed a patient safety project (if not done in Medicine) Y N For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR demonstrate plan to sit/resit the exam Y NIn date for all appropriate Life Support courses Y N

*These 25 core competences are individually listed in the structured training reports and need to be ticked off by your Ed supervisor at your final meeting.

**Deficiencies may have been identified within the multisource feedback or in the Educational supervisor’s report. This may also be apparent because of inability to complete any/some of the above requirements in the timeframe expected. It is essential that you demonstrate insight into these areas of concern by describing how you intend to address them in your personal development plan (on eportfolio or written for those where this is not available electronically).

***”other means” is by reflective entries in your portfolio (written/electronic) with a recorded learning outcome; successfully completed e-learning modules; teaching done/attended on the subject; audit or patient safety project done on the subject

ANAESTHETICSEd supervisor completed and signed structured training report Y N Completed a personal development plan for identified deficiencies ** Y N Successfully gained a Certificate of Initial Assessment of Competency Y NCompleted a minimum of 17 WPBAs as follows:5 Mini CEX Y N7 CBD Y N5 DOPS Y NHave also completed additional WPBAs OR have recorded learning outcomes in each of the following:

Anaesthesia for emergency surgery Y NConscious sedation Y NRegional anaesthesia Y NCompleted a satisfactory logbook of cases Y NHave documented an appropriate case-mix Y NNo patient identifiable material in logbook Y N Completed an audit and ideally closed the loop (not essential) Y N(only necessary if not done in ICM) Completed a patient safety project or activity (if not done in ICM) Y NCompleted an MSF with a summary by the Ed Supervisor (> 11 replies) Y N (only necessary if not done in ICM)For EM/AM trainees, to have successfully passed MCEM A/ MRCP 1 OR demonstrate plan to sit/resit the exam Y NFor Anaesthetic trainees to consider when they might sit the Primary FRCA Y N In date for all appropriate Life Support courses Y N

If you have not completed all the requirements the panel will decide whether or not you need additional training time. This will be based on not only what you’ve completed but also on your supervisor’s report.

It is a supportive process and we are here to not only train and assess you but also to support you if you are having any difficulties be these professional and/or personal.

Your clinical supervisor would be your first port of call. In the rare instance where you do not feel comfortable discussing problems with your clinical supervisor, you should discuss them with your educational supervisor (ie the Consultant of your base speciality). Where your clinical supervisor is also your educational supervisor you should confide in one of the other Consultants in the speciality with whom you have a good rapport.

PORTFOLIOS

You should be registered with the College of your base speciality. For Emergency Medicine and Acute Medicine trainees this will allow you to have an eportfolio with your respective Colleges. For the EM trainees this will be the nhseportfolio. We will now expect all EM trainees to do all their “paperwork” electronically. Acute Medicine trainees will need to have the RCP eportfolio.

Anaesthetic trainees will need to keep everything as paper-based until such time as the RCoA will have finished the Anaesthetic eportfolio.

Your portfolio should be reviewed at each of the meetings you have with your clinical supervisor to ensure you are completing the listed requirements.