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EMLEADERS FRAMEWORK

A syllabus for Emergency Medicine leadership:

personal, professional and team leadership to improve patient care

EMLeaders National Faculty

1 EMLeaders Framework vs. 2 (2019.05.27)

Contents

1. Background ............................................................................................................................. 2

1.1. EMLeaders Framework ........................................................................................................... 2

1.2. How to use the EMLeaders Framework .................................................................................. 3

1.3. EMLeaders Programme and the upcoming RCEM curriculum ............................................... 4

2. Leadership in Emergency Medicine ........................................................................................ 6

3. EMLeaders Framework – summary ........................................................................................ 7

3.1. EM Leadership skills ................................................................................................................ 7

3.2. Working in teams .................................................................................................................... 8

3.3. Managing the Emergency Service ........................................................................................... 9

3.4. Growth and collaboration ..................................................................................................... 10

3.5. Developing excellence within your team .............................................................................. 11

4. EMLeaders Framework by Training stage ............................................................................. 12

4.1. CT1-CT2 ................................................................................................................................. 12

4.1.1. EMLeadership Skills ....................................................................................................... 12

4.1.2. Working in Teams ......................................................................................................... 14

4.1.3. Managing the Emergency Service ................................................................................. 16

4.1.4. Growth and collaboration ............................................................................................. 18

4.1.5. Developing excellence within your team ...................................................................... 19

4.2. CT3-ST4 ................................................................................................................................. 22


4.2.2. Working in Teams ......................................................................................................... 25




4.3. ST5-ST6 .................................................................................................................................. 34


4.3.2. Working in Teams ......................................................................................................... 37





1. Background

In October 2017, ‘Securing the Future Workforce for Emergency Departments in England’ was published. NHS Improvement, NHS England, Health Education England and the Royal College of Emergency Medicine outlined a plan to address workforce development and sustainability in Emergency Medicine.

The central aim of this plan was to further enhance the skills of Emergency Medicine trainees by producing an innovative and tailored ‘leadership programme’ - the EMLeaders Programme. The focus of this programme is on personal, professional and team leadership development when working not just within the Emergency Department, but also within the wider NHS.

Leadership is a key component in delivering good quality patient focused clinical care. Emergency Medicine is a multi-faceted specialty that interfaces with many clinical and non-clinical partners across all patient age groups and level of clinical acuity within a 24-hour service. All clinicians working in the Emergency Department must have the opportunity to develop their own leadership skills to support and enhance a robust, sustainable, healthy and enriched workforce.

1.1. EMLeaders Framework

The EMLeaders Framework was developed by the EMLeaders’ Steering Committee and the National Faculty from their collective knowledge and experience of Emergency Medicine and Leadership. The framework is based on ‘what an EM practitioner does/ experiences / has within their skill set to manage ANY shift in ED and aspects of the wider NHS'.

The information within this document provides a framework of Emergency Medicine leadership knowledge, behaviours, attitudes, skills and competencies referenced against the different stages of training. It has been devised by the EMLeaders National Faculty as they recognised the need to have a reference to proficiency that would allow School Leads, trainers and trainees across England to develop their local EMLeadership programme. The framework within this document covers the descriptors of proficiency by clinical leadership domain whilst adding granularity to reference aspects of development needs. The Framework is structured into five areas of clinical leadership:

1. EMLeader skills;

2. Working in teams;

3. Managing the Emergency Service;

4. Growth and collaboration; and

5. Developing excellence within your team.

Each aspect is further broken down into subcategories related to clinical leadership at core, intermediate and higher training: CT1-2, CT3/ST3-ST4, ST5-ST6. The descriptors reflect proficiency at a specific stage of training, with additional complexity challenging the trainee


as they progress from core to completion of higher training. In addition, both national and local training resources are referenced to allow signposting of training and educational opportunity that trainees may wish to use during this programme.

The descriptors should be used by the trainee to aspire to have developed that level of proficiency by the end training period. This allows the trainee to develop their preparedness and behaviours to facilitate progress into the next stage of training – ‘prepared before being promoted’. Those proficiencies described in ST5-ST6 can be developed further into the practitioners Consultant careers, since this framework details a continuum of leadership growth and development. There are no mandatory elements within this framework, since leadership is personal to the individual and progression through the framework, challenges, aspiration and development will vary.

1.2. How to use the EMLeaders Framework

The EMLeadership framework is a syllabus that details proficiency descriptors at three separate stages of training, identifies key EM specific priorities and learning resources. The threads of each element of the framework are part of the normal working day of any Emergency Medicine trainee and indeed established practitioner.

The EMLeaders programme is based on a 70:20:10 principle, thus the majority of the programme involves leadership conversations on the Emergency Department clinical shop floor and relies on contemporaneous evaluation, feedback and reflection (70%). This is reinforced by additional coaching conversations, and mentorship or personal learning out of the clinical environment (20%). Thus, only a small part of the programme is delivered by formal course or educational event (10%).

The framework therefore:

• provides reference for trainees and established Consultant practitioners to allow reflection on their progress and challenges, whilst establishing key skills and proficiency through programme;

• provides reference for trainers, mentors and those involved in coaching conversations to detail areas of proficiency, highlight good practice and progress as well as providing consistent commentary to detail further challenge and aspiration; and

• provides reference to HEE regional School EMLeadership leads and their faculty for local training or educational programmes.

The framework is not a curriculum, nor does it set itself to be evaluated by conventional workplace-based assessment. The descriptors can be used to guide current methods of assessment, such as the ESLE, and processes of feedback, such as the Faculty Educational Governance Statement. The framework provides consistent detailed language and reference


sources to direct objective personal development. The strength of the framework is in the knowledge of its existence, its use as a resource, being valued and embedded into all aspects of the leadership journey.

To assist those using the framework, it has been split into two:

1. Summary framework has a set level of detail that makes it useable as reference material for the ED clinical environment. Each section contains a hyperlink to the more detailed framework.

2. More detailed framework has a greater depth of descriptor that is useful for reflection and evaluation; it is also linked to resource opportunity to help trainee progression and attainment and is detailed by year of training.

1.3. EMLeaders Programme and the upcoming RCEM curriculum

The General Medical Council (GMC) require all Royal Colleges to describe ‘outcome- based’ curricula and to revise their content, embedding a suite of Generic Professional Capabilities, by 20201.

Developing an outcome- based curriculum requires a specialty to both consider its unique place within the health economy and to consider the clinical work its specialists must be able to undertake independently at its completion. This is the curriculum’s purpose.

The purpose of the Royal College of Emergency Curriculum is to train doctors to be Emergency Medicine Consultants, able to provide care to all undifferentiated patients attending Emergency Departments nationwide, 24/7, 365 days every year. To do this they must be able to care for individual patients as experts in clinical diagnosis and reasoning. They must also be able to lead.

The multi-professional resuscitation of sick and injured patients of all ages (from birth to advanced age and frailty) requires expert leadership. The management, guidance and support of a multi-disciplinary team, providing care across the full spectrum of both physical and mental health needs in a modern-day Emergency Department, lies within the remit of those trained as EM specialists and requires expert leadership too.

Emergency Medicine specialists must also be able to provide strategic leadership and set the culture within the Emergency Departments, improve quality, teach and supervise, and deliver key administrative tasks. Those following the new curriculum will be trained to

1 Excellence by Design GMC 2017


manage any situation, however complex or challenging, by making those challenges explicit and by supporting their individual development to meet them.

The EMLeaders programme interdigitates precisely with the aims of the new curriculum.

The EMLeaders’ framework offers a shared taxonomy for the knowledge, skills, behaviours and attitudes that are required to lead in the modern UK Emergency Department. The EMLeaders programme is investing in trainees and their trainers to help develop both better leaders, and also those who can train others in leadership skills. By doing so, the next generation of Emergency Medicine trainees will have the opportunity to have their leadership skills fed back to them, receive expert pointers on development and can reflect on this important aspect of development. An outcome-based approach requires this is available to trainees if they are to be able to meet their potential, so the timing of the EMLeaders programme is fortuitous.

There are many different types of effective EMLeaders. By making this part of the make-up of an Emergency Medicine specialist explicit and investing in its development, those following the next iteration of the RCEM curriculum will be well served in achieving what those designing the curriculum aimed for from the outset - a satisfying and sustainable career wherein Emergency Medicine specialists can grow and thrive, and meet the needs of the public.


2. Leadership in Emergency Medicine

During training and progress through the EMLeaders programme, the Emergency Medicine Specialty Trainee:

• will develop compassionate personal and professional leadership skills to include the EM team and their own role within the wider NHS;

• will practice with integrity, communicate clearly and effectively, be organised whilst maintaining their own and the team’s wellbeing;

• will understand the priorities of the ED service, how to manage people, resource and performance;

• will understand how to manage uncertainty and mitigate risk;

• will be actively engaged with process improvement, facilitating change and the development of service; and

• will show collaborative working to develop the team, facilitate change, improve patient care and enhancing the shared vision of the NHS.

This capability will apply to patients, carers and relatives, the ED team and clinical / non-clinical partners in the wider NHS. Indeed, each of these elements represent the key areas of leadership practice that an Emergency Medicine Consultant will continue to enhance and refine throughout their own career.


3. EMLeaders Framework – summary

3.1. EM Leadership skills

Training Stage CT1-2 CT3 - ST4 ST5 - ST6

ED leader skills Caring for self and the team Senior Decision Makers and the ED team Becoming the EM Consultant working within the wider NHS.

Managing self - organisation skills

can manage personal and professional workload can effectively manage the ‘shop floor’ takes on lead roles within the ED

Becoming self-aware aware of personal values, beliefs and principles demonstrates effective personal leadership style can uphold personal leadership style

Acting with integrity applies GMC duties of a doctor demonstrates positive role modelling can manage challenging conversations

Learning to communicate in ED

can develop a rapport and communicate clearly can engage the wider team maintains ED focus and representation

The power of reflection can reflect for effective, productive and developmental self-appraisal

can reflect for effective, productive and developmental team appraisal

uses personal and team reflections to drive change and quality improvement

Understanding and applying NTS (human factors) in an ED setting

shows personal situational awareness and vigilance

can prepare and brief the team for emergent situations

champions the development of non-technical skills within the wider ED team

Maintaining wellbeing strategies for the ED

practices wellbeing strategies and suitable work life balance

role models wellbeing strategies to the wider ED team

understands wellbeing risks and means to mitigate with the wider EM team

Developing empathy skills in an ED environment

Understands, adapts and responds to different personal and professional perspectives demonstrates emotional awareness can show emotional intelligence across all

levels of practice


3.2. Working in teams


ED leader skills ED leader skills - caring for self and the team

ED leader skills - Senior Decision Makers and the ED team

ED leader skills - becoming the EM Consultant working within the wider

NHS.

Understanding the ED team, structures and how they work

understands the clinical, managerial and governance structures within their department leads a shared process of care understands the clinical and managerial

multi professional team

Developing skills to engage with other specialties

develops and influences local teams shows ability to lead multi-specialty care in complex situations

supports service & pathway development across specialties

Building & maintaining relationships

demonstrates behaviours to encourage dialogue & trust directs the ED teams’ issues enhances the supervisory role and directs

others

Building supervision skills can communicate effectively, delegate and supervise appropriate tasks can give objective and effective feedback develops skills of educational supervision

for the multi professional team

Developing networks understands care pathways directs continuity of care directs and supports shared care strategies

Embedding a safety culture and sharing

understands clinical governance structures & incident reporting able to develop local and national guidance leads service improvement, incident

investigation and response

Optimising the learning and teaching environment

uses opportunities to learn integrates teaching opportunity with clinical care directs and delivers local teaching


3.3. Managing the Emergency Service




ED leader skills - becoming the EM Consultant working within the

wider NHS.

Understanding priorities in the service understands the process of clinical prioritisation

develops the Emergency Physician In Charge role (EPIC role) becomes effective in role as EPIC

Understanding clinical and managerial processes

can rationalise decision making to deliver consistent quality care can work with the ED team to provide solutions understands role and responsibility of

national bodies

Managing performance can raise concerns over quality, safety and performance

can manage concerns over quality, safety and performance can analyse and interpret data

Managing people creates a positive atmosphere that enhances clinical care

develop the conditions that supports the ED team

manages performance of others in the team

Managing resources shows appropriate use of clinical resources directs the team to maximise resource can implement & rationalise resource utilisation

Explaining and managing risk to key groups

can identify and escalate concerns and risk contributes to team action planning can identify risk and can communicate issues succinctly


3.4. Growth and collaboration




ED leader skills - becoming the EM Consultant working within the wider NHS.

Principles of process improvement

takes part in departmental, quality improvement

can work with the multidisciplinary team to develop process improvement

guides and develops others in the principles of process improvement

Encouraging improvement and innovation in the service

uses experience and perceptive analysis can improve care using a shared vision represents the specialty as the ‘ED expert’

Critically evaluating can articulate a balanced opinion can justify complex decision-making using evidence-based medicine

manages clinical uncertainty to mitigate risk within the wider context of EM

Embedding a learning and research culture

Shows educational progress and engages in research opportunity

embeds a positive learning environment within ED role models lifelong learning

Wellbeing strategies to constantly improve systems

encourages and shares wellbeing focus with the ED team

understands the link between wellbeing on the delivery of high-quality safe care empowers and motivates the team


3.5. Developing excellence within your team




ED leader skills - becoming the EM Consultant working within the

wider NHS.

Identifying context to become an EMLeader

can identify own strengths, challenges and development needs

embeds leadership skills into personal growth and attainment

Integrates EMLeaders behaviours to influence and guide the development of the team

Engaging with others to apply knowledge and evidence for collaborative change

is open to constructive discussion can facilitate the opinion of the team can influence high quality and safe care

Debriefing strategies for ED can constructively contribute to team debrief can lead team debrief distills and supports debriefing within the ED

Setting the shared vision can reference local and national strategy documents

formulates information to challenge current practice can give an informed ED perspective

Evaluating impact and progress completes audit cycle or patient safety project and provide recommendations for change

can use standards and quality matrices to drive change

critically appraises, generates ideas and overcomes barriers

Maintaining momentum shows ability to self-motivate to task & finish works with teams to deliver a common goal delivers tasks on time


4. EMLeaders Framework by Training stage

4.1. CT1-CT2

4.1.1. EMLeadership Skills

Activity Proficiency descriptions Resources

Managing self-organisation skills

• maintain reliability and punctuality • manage personal and professional workload • make contemporaneous notes • can plan breaks • develop strategies to manage own time including at

times of clinical surge and escalation • can plan own training year including examinations and

ARCP

Becoming self-aware

• aware of personal values, beliefs and principles • can learn from experience • understands personality types and group dynamics in

both ED and other clinical teams • aware of own leadership style • can recognise professional, socioeconomic, cultural

and religious differences that exist both with patients and within teams

Acting with integrity

• understands and applies GMC duties of a doctor and the principles of being fit to practice

• aware of own strengths and limitations, including when to ask for help



• can listen, reflect and respond appropriately • emotionally aware • able to clearly articulate views • able to develop a rapport with patients, relatives and

other partners e.g. Police / Coroner / Social Services / other colleagues

• understands viewpoints irrespective of professional, personal or cultural differences

The power of reflection

• has self-critical awareness • understands the need to be a reflective practitioner • can use reflective templates for effective, productive

and developmental self-appraisal • uses reflection to drive change and improvement


• is aware of own role, responsibility & capabilities within ED

• is conscious of the need for personal situational awareness and vigilance

• aware of risk/factors contributing to errors

Maintaining wellbeing strategies for the ED

• understands and practices wellbeing strategies such as eating well, regular exercise and sleep

• understands the effects of recreational or prescription drugs and alcohol consumption

• can recognise and mitigate against stress • can evaluate and implement suitable work life balance

options • understands impacts on family and relationships • recognizes and knows what to do when they are unwell • reflects on their own resilience


• demonstrates personal emotional awareness • understands and can respond to different personal and

professional perspectives


4.1.2. Working in Teams



• understands all roles within the ED team • understands roles in other clinical teams including those

in which they work • understands individual and team responsibilities • contributes to a shared process of care • understands the clinical, managerial and governance

structures within their department • maintains clinical continuity with effective handover • keeps up to date with policy and procedure


• can communicate effectively • appropriate referral and realistic expectation of re-

sponse • remains the patient’s advocate and can challenge deci-

sions in an objective & productive manner • maintains partnerships in clinical care • develops and influences local teams and peers in deliv-

ering good quality clinical care

Building & maintaining rela-tionships

• is aware of GMC professional standards • demonstrates behaviours to encourage dialogue & trust • maintains respect and acknowledges roles and exper-

tise

• can adapt and contextualise • communicates effectively • maintains focus and professionalism balanced against

emotive, contentious and volatile circumstance



• manages conflicts of interest • develops positive role modelling • maintains common purpose

Building supervision skills

• can communicate effectively • can listen, formulate and feedback information - devel-

ops a transferable skill set to supervise others • can appropriately delegate and supervise tasks e.g. with

medical students • promotes opportunity • knows own limitations • shows respect

Developing networks

• promotes a sharing of information and ED resource to maximise patient care

• engages with other clinical teams and shows respect • respects the opinions of patients and family • confronts tribalism and negative values • understands care pathways and role of other services

out with the ED and local Trust


• understands and engages with incident reporting sys-tems & duty of candor

• can access and contribute to the development of policy and guidelines

• can develop safe discharge plans and inform patients • undertakes effective handover • contributes to clinical quality improvement • integrates evidence-based practice into clinical care • can use all equipment in their clinical area safely • maintains safe prescribing • confirms patient identification at all times



• attends M&M, CG and MDT meetings • can complete incident report and respond • is aware of the risk management structure of ED and

Trust


• embeds own personal learning into the clinical environ-ment

• uses opportunities to learn and receive feedback • uses a range of resources to enhance learning • reflects on own role as an educator and methods of en-

hancing their own and others potential

4.1.3. Managing the Emergency Service


Understanding priorities in the service

• Understands the process of clinical prioritisation, streaming and triage

• is aware of inequalities in healthcare both locally and nationally and their effects on health

• can understand & rationalise how health care is deliv-ered and the limitations of service provision


• practices evidence-based medicine • can reference local and national guidelines • can rationalise decision making to deliver consistent

quality care • reflects on own efficiency within the process of care



Managing performance

• understands the factors that affect personal perfor-mance & the duties of a doctor

• understands factors that affect system performance • can raise concerns over quality, safety and performance • can understand the different Trust and RCEM qualitative

and quantitative performance metrics for ED • contributes to data collection and analysis of such met-

rics for service improvement e.g. RCEM audit

Managing people

• creates a positive atmosphere that enhances clinical care that supports the ED team

• is aware of how to escalate concerns • remains objective • uses strategies to manage situations e.g. empathy,

feedback, zero tolerance to unacceptable behaviours

Managing resources

• is aware of budgets and their value • maintains appropriate use of clinical and staffing re-

sources including investigations, prescribing and other therapeutic interventions

• can rationalise the use of equipment • understands how the NHS is funded and how resource

is then allocated • champions the effective use of ED resource within the

team • understands work schedules, junior doctors contract

and exception reporting • manages study leave appropriately


• can clearly communicate the risk and benefits of treat-ments to patients and family or carers



• can communicate difficult conversations in relation to escalation of care, DNACPR, unfavourable outcomes, procedural complication or refusal of treatment

• can identify concerns and risks when making onward specialty referral

• able to appropriately escalate concerns to seniors • shows ability to manage uncertainty

4.1.4. Growth and collaboration

Activity Proficiency description Resources

Principles of process im-provement

• starts to critically evaluate departmental, regional and national policy and procedure

• recognises and evaluates when a process doesn’t fit • can then identify and articulate areas of EM practice that

need improvement • takes part in departmental audit, quality improvement or

patient safety projects

Encouraging improvement and innovation in the ser-vice

• understands the components necessary to bring about change

• has a positive attitude and interest in change • can relate ideas leading to improvement and innovation • uses experience and perceptive analysis to highlight ar-

eas for development • maintains a pragmatic approach

Critically evaluating • can articulate a balanced opinion on treatment options to deliver best patient care



• can challenge established practice using evidence-based medicine

• remains aware of clinical uncertainty and how to miti-gate risk

• remains aware of own limitations and clinical accounta-bility structures in the areas that they work


• attends local and regional training opportunities • can access e-learning materials including FOAMEd and

other educational resources • uses best evidence practice • completes e-portfolio, curriculum requirements and ex-

aminations in a timely fashion • is a reflective practitioner and learns from events • identifies positive and negative aspects of a learning

culture and reflects on the personal impact this may have

Wellbeing strategies to con-stantly improve systems

• recognises that EM is high-risk high-pressure environ-ment

• recognises the need to develops personal wellbeing strategies

• encourages and shares wellbeing focus with the ED team

• supports and works with others to improve the working environment for patients, families, carers and staff

• recognises the value and need of civility in the work-place

• recognise the triggers and impact of violence and abu-sive behaviours in the workplace

4.1.5. Developing excellence within your team



Identifying context to be-come an EMLeader

• embeds the EMLeaders programme into personal growth and attainment as a clinician

• can identify own strengths and challenges • positive attitude towards feedback and reflection for de-

velopment • develops self-awareness • integrates EMLeaders skill development into clinical

practice and role • develops skills to critically appraise situations and chal-

lenge • can ask for help appropriately

Engaging with others to ap-ply knowledge and evi-dence for collaborative change

• remains receptive to the opinion of other team members or teams

• can articulate opinion and communicates well with pa-tients and the multi professional team

• uses best evidence or resources to make decisions • remains open to constructive discussion

Building a team strategy to support change • covered in Facilitating change management

Debriefing strategies for ED

• can understand the debrief framework • can constructively contribute to team debrief • can lead on elements within their capability, remit and

understanding • is empathic towards others • can reflect on own development needs and focus on as-

pects of good clinical practice • positive attitude towards feedback and reflection for de-

velopment



Setting the shared vision

• has read appropriate strategy documents e.g. NHS Plan • has read GMC Good Medical Practice and works within

its boundaries • is aware of Trust and ED mission statements / forward

plan • can reference local and national strategy documents

and start to formulate opinion e.g. RCEM vision 2020 / winter planning

• values the vision presented

Evaluating impact and pro-gress

• completes audit cycle or patient safety project • makes recommendation for change • completes project and follows implementation impact • can challenge and support the work of others giving

positive critique and solutions • is aware of the factors that affect sustainability

Maintaining momentum

• can appraise current training / educational / leadership progress and personal development needs

• remains self-aware and candid about progress • shows ability to self-motivate and task & finish

Dealing with obstacles and mitigating failure

• embeds principles relating to resilience and wellbeing within clinical practice

• maintains a positive approach using reflection to guide progress

• knows how to seek support and discusses failure openly • maintains self-esteem when dealing with obstacles, er-

ror and failure to progress • shares the ethos of a learning and development culture

to enhance progress avoiding blame


4.2. CT3-ST4



Managing self - organisa-tion skills

• can enhance core organisational skills to effectively pri-oritise and delegate

• aware of effects of increasing workload on the ED team and can develop optional appraisals whilst mitigating risk

• can effectively manage the ‘shop floor’ including own case load

• can direct the team and provide solutions to clinical co-nundrum

Becoming self-aware

• translates core skills into effective personal leadership style

• able to adapt to circumstance • can show responsibility in organising and managing

others whilst remaining supportive • can receive feedback and can critically self-appraise

being aware of own limitations • can manage difficult situations that have negative im-

pacts on the team to rebuild confidence • appropriately assertive




• is aware of and upholds professional ethics, profes-sional boundaries and effective working across multi-disciplinary teams within the ED

• demonstrates positive role modelling and directs re-sponses when ethical boundaries and values are com-promised

• can locally manage issues or escalate accordingly e.g. bullying and harassment


• Can productively manage conflict of opinion • maintains the interests of others and can engage the

wider team • encourages contribution • can negotiate and de-escalate challenging conversa-

tions • maintains objectivity and principle • can inform opinions being representative of the wider

ED team • maintains a corporate viewpoint


• integrates effective reflection as routine into clinical practice

• can support and direct others with their reflective prac-tice

• can lead team debrief




• is aware of the key components of an effective ED team

• can direct effective interactions • can prepare and brief the team for emergent situations • can manage and enhance team performance • is aware of potential and apparent risk & mitigates

against this e.g. when giving clinical opinion • undertakes supervised EPIC role

Maintaining wellbeing strat-egies for the ED

• can demonstrate wellbeing strategies and role model-ling to the wider ED team

• can recognise concern and provide directional support to others

• is aware of HR rules and regulations, work schedules, flexible working and LTFT options to work

• understands the process of escalating concerns, fitness to practice and duties of a doctor


• can demonstrate emotional awareness e.g. when giv-ing team feedback

• can demonstrate and lead difficult conversations e.g. breaking bad news

• can use empathy to de-escalate conflict • can intervene, maintain focus & professionalism with

the wider team





• leads a shared process of care • understands and values the clinical, managerial and

governance structures within their department and wider organisation in which they work

• contributes to the clinical, managerial and governance • can remain flexible in allocation of staff resources e.g.

individuals on shift and managing rotas • provides guidance and support to the team


• shows ability to lead multi-specialty care in complex pa-tients

• can direct and support decision making between clinical teams

• can identify areas for clinical service development and suggests further work

• negotiates best care whilst remaining as the patients advocate at all times

• provides solutions to clinical conundrum


• can use positive influence to de-escalate clinical situa-tions

• actively engages patients, families and carers in deci-sions relating to clinical care

• can intervene or direct the ED team with difficult pa-tient, family and team issues

• can give effective and objective feedback • remains supportive • directs the team’s common purpose




• uses the transferable skill set to supervise others • is aware of the balance between supervision and au-

tonomy • promotes appropriate opportunity and is aware of main-

taining patient safety • can intervene if required e.g. with procedural skill • gives effective feedback • directs personal development plans in others

Developing networks

• enhances the clinical network by directing clinical care, maintaining professionalism and valuing the opinion of others

• directs and rationalises appropriate continuity of care with primary, secondary and tertiary care partners

• manages tribalism and negative values by promoting shared care strategies with the patient as the focus of care

• contributes to clinical pathway development


• can critically appraise, develop and apply local and na-tional guidance and procedure

• Undertakes Quality Improvement • offers opinion and reinforces safe discharge planning • leads effective handover for the team • can teach others in safe equipment use • presents at M&M, CG and MDT meetings being able to

answer questions • can critically appraise incidents and formulate response • contributes to the rapid review process of incidents to

minimise patient risk




• continues to embed personal learning into the clinical environment

• promotes teaching opportunities referenced to the clini-cal case mix on shift

• integrates teaching opportunity with clinical care • can give effective and directional feedback to support

learning




• understands the finance, strategy and operation of how the NHS works

• demonstrates awareness of the political, social, tech-nical, economic, organisation of the professional envi-ronment in which they work

• develops command and control of the service that sup-ports the team and directs clinical care

• role-models ED values and maintains corporate vision


• can reflect on patient and other service user feedback • contributes to local planning of the ED service • is aware of the budgetary and resource limitations to

service • shows flexibility and adaptability in approach being

supportive of business management principles




• can raise and deal with concerns over quality, safety and performance, both for team and individual

• instils a ‘safe to challenge’ culture within the team • can intervene to prevent unsafe practice and mitigate

risk • understands the role of clinical line management and

the engagement of supervisor & support structures • contributes to ED performance strategy

Managing people

• understands the benefits of and can develop the con-ditions that support the ED team to provide mutual care and support, including managing conflict and times of high pressure

• can motivate the ED team • can intervene to support staff, patients and family or

carers with difficult conversations

Managing resources

• directs the team on a shift to maximise time, staffing and space utilisation

• manages staff allocation to clinical areas • directs evidence based clinical decisions • minimises waste & inefficiency and can contribute to

team developments to improve these areas • understands how ED and Directorate financial pres-

sures are managed • understands the difference between commissioning

and delivery of service


• understands the ED and corporate risk framework in-cluding reporting and action systems



• contributes to team action planning and ED improve-ment to mitigate risk / can direct the ED team and leads by example



Principles of process improve-ment

• can identify and apply methodologies to engage in process improvement

• can work with a varied multidisciplinary team, being able to use quality improvement methodology to de-velop process improvement and monitor change

• maintains an objective critical appraisal of outcomes • remains pragmatic


• can develop, communicate and engage the team with ideas

• can interest, engage and motivate the team and stakeholder to improve care using a shared vision

• can evaluate data, literature and other resource to relate ideas to promote innovation

• leads process and supports team members • maintains an inclusive approach to maximise en-

gagement of the team and other stakeholders



Critically evaluating

• can justify complex decision-making using evidence-based medicine

• can contribute to expert opinion on clinical care, ser-vice design and resource utilisation

• can reference resource to justify opinion • can critically appraise the medical literature • remains objective and supportive in managing chal-

lenge • can accept challenge and viewpoints of others • challenges with reason and empathy

Embedding a learning and re-search culture

• positively role models educational progress and at-tainment through the training year

• can provide formal and informal teaching opportuni-ties for the multi professional team

• can critically appraise the evidence and make a bal-anced judgement about best practice

• completes GCP training and can understand re-search principles

• embeds a positive learning environment within ED




• understands the link between wellbeing, resilience, the effects of service pressure and intensity on the delivery of high-quality safe care

• values and contributes to wellbeing innovation • can involve and empower members of the multi pro-

fessional team, patients, family and carers to for-ward ideas and innovation

• encourages feedback and point of view from many sources within and out with the ED environment

• understands the importance of stakeholder engage-ment when improving systems

• remains empathic, objective and can be impartial • is a patient and staff advocate • demonstrates zero tolerance to inappropriate behav-

iours including bullying and harassment




Identifying context to become an EMLeader


• extends leader role to a team focus • can show strategy to identify team strengths and

challenges / appraise situations pertinent to the team / challenge and make recommendation / lead on change

• reflects and develops own skills • can lead a team in a resuscitation environment • can lead the department in shadow EPIC or over-

night senior role • can a manage resources and team and adapt to sit-

uation • asks for help appropriately

Engaging with others to apply knowledge and evidence for collaborative change

• can facilitate the opinion of the team and develop positive outcome

• maintains an objective and evidence-based focus • remains receptive to the opinions of others, but can

use challenging argument to develop a collaborative opinion



• can lead team debrief • maintains focus, objectivity and empathy • can give effective feedback • understands how to develop the team and individual

members of that team



• can formulate a summary and action plan


• understands the detail of the shared vision • integrates this into data analysis to support quality

improvement • formulates information to challenge current practice

and references this against the shared vision • can identify emerging trends in healthcare relevant

to ED


• can undertake and complete quality improvement work using appropriate methodology and analytical tools

• can generates ideas to overcome barriers and in-centives to change

• critically appraises impacts and references this to the wider EM picture

• uses effective critical appraisal skills


• shows ability motivate staff • enhances approach to task and finish with a team

focus • can appraise challenges and deliver optional ap-

praisal


• role models a positive ethos of a learning and devel-opment culture to enhance progress avoiding blame

• maintains objectivity when managing obstacles and risk with a team focus

• provides solutions • directs response / still knows when to seek support

from seniors, other specialties or professional bodies


4.3. ST5-ST6



Managing self - organisation skills

• can organise own diary of clinical and non-clinical ac-tivity

• develops ED relevant specialist interests or takes on lead roles within the ED

• attends activities both locally and regionally that have strategic importance for ED or acute services

• can chair a meeting • can demonstrate commitment to task and effective

time management

Becoming self-aware

• can uphold personal leadership style and values even during challenge, whilst showing respect

• can manage challenge taking into account the values of individuals and the organisation

• shows respect for the culture, beliefs and abilities of others across all areas of the NHS

• demonstrates the authority to intervene • can define their own strengths and limitations when

working with clinical and none clinical partners • is aware of and can access support & expertise from

other sources


• is aware of both the wider corporate and NHS profes-sional identity

• can manage challenging conversations in an open and none discriminatory manner and knows how to manage unprofessional behaviours



• communicates to enhance multi-professional working relationship

• promotes equality and diversity


• promotes sharing of ideas and information with oth-ers

• engages professionals and patients, using varied techniques to facilitate effective communication

• maintains ED focus and representation by being aware of the local and national strategy

• can chair meetings, • shows effective leadership via communication with

organisational seniority (Trust Executive / Board / CQC / local MP), both on and off shop floor


• uses personal and team reflection to drive change and quality improvement

• uses reflection to empower the ED team • develops mentorship role / skills to become a coach /

engages with positive role modelling • enables others to take ED lead roles whilst providing

appropriate levels of supervision and support


• can debrief both individual and team with a critical appraisal of pertinent NTS factors

• undertakes EPIC role with independence • contributes to the development of the NTS skills of

the team through feedback, mentorship, delivering fo-cused training events

• writes ED policy and procedure as part of the quality framework for consistency of care



Maintaining wellbeing strate-gies for the ED

• can undertake ED rota design across all levels of practitioner

• is aware of the impact of shift patterns, work prac-tices, the clinical environment and intensity on well-being

• understands wellbeing risks e.g. burn out, and means to mitigate through corporate wellbeing strategy and effective job planning

• can influence, support and direct this corporate strat-egy e.g. Trust / HEE trainee forum


• can show emotional intelligence across all levels of practice

• shows ability in developing a caring NHS culture • builds and maintains relationships across clinical and

non-clinical partners • provides mentorship with support & guidance • understands the quality of service is affected by the

way the team feels





• can support the critical evaluation of the ED team structure in developing a quality service

• contributes to the development of the ED multi pro-fessional workforce

• understands service configuration including Direc-torate structure, Trust Boards and the role of the Medical Director

• understands nursing (Registered Nurse to Matron), allied health professional and medical staff roles in the multi professional team

• understands resource and financial implications on team structure


• takes support or lead role in elements of service or pathway development across specialities

• responds to joint management of incident reports and complaints involving teams

• attends and forms part of ED representation at Direc-torate meetings


• supports the development of networks involving pa-tients, specialties, commissioners of service, manag-ers, other non-clinical partners such as local press, MP, external bodies including CQC, networks e.g. trauma or educational, urgent care and frailty ser-vices

• enhances supervisory role and directs others




• develops skills of educational supervision for the multi professional team

• takes a lead role with faculty or placement supervisor group feedback

• signposts future learning • understands the process for remediation and devel-

ops own skills with feedback, coaching and mentor-ship

• completes an educational supervisor development course

• supports more junior trainees with QI Projects and portfolio development

Developing networks

• contributes to local and regional service development by working with partner organisations

• directs and supports shared care strategies within ED and the acute care service

• manages teams where care pathways interconnect


• implements national guideline into ED service • develops and writes local guidelines • Leads Quality Improvement • Chairs local meeting e.g. CG, M&M • Able to lead complaints and Sui investigation and re-

sponse • contributes to local rapid review safety group • evaluates ED quality metrics and contributes to de-

partmental, Trust and commissioning strategy


• leads impromptu teaching sessions on the shop floor - e.g. board rounds, 1-minute preceptor

• directs and delivers local teaching



• leads ED regional teaching session for regional train-ing programme

• supports local educational initiatives • represents EM at local, regional and national trainee

forums




• understands the challenges in delivering acute care relating to local & national financial and political strat-egy

• can challenge and support the direction of service modelling locally


• recognises role and responsibility of national bodies such as NICE, Royal Colleges, GMC, DoH, CQC etc.

• can formulate a cohesive viewpoint on the way care processes work that informs a strategic analysis


• can analyse and interpret performance data relating to individual practitioner, service, system and healthcare delivery

• supports a learning and action culture to enhance system performance

• can tackle and challenge difficult issues



• maintains sensitivity, awareness of wider issues whilst maintaining objectivity and a corporate view-point

Managing people

• understands work schedules • prepares rotas • is involved in recruitment and selection • develops mentoring & supervision skills • understands and can reference legislation whilst be-

ing aware of HR policies, resources and support within Trust and HEE. Can support and signpost oth-ers to appropriate support services

Managing resources

• understands the elements that form a business case and business plan

• can contribute to business case writing • understands how financial resource and budget plan-

ning affects service delivery • can implement & rationalise resource recommenda-

tions whilst maintaining quality and mitigating risk • understands the Consultant contract and job plan-

ning


• can monitor and assimilate outcomes following change

• maintains a risk focus using objective data or collec-tive expert opinion

• can identify apparent as well as less obvious poten-tial risk and communicate this succinctly to patients, carers, managers, clinical and none clinical partners

• can work in collaboration




Principles of process im-provement

• provides medical expertise to support multidiscipli-nary process improvement

• guides and develops others in the principles of pro-cess improvement

• remains innovative to actively support process change to improve quality of care for patients, staff and use of resources


• can lead, motivate, effect, evaluate and sustain change

• can critically appraise change and represents the specialty as the ‘ED expert’

Critically evaluating

• provides ‘the medical expert ED opinion’ when sup-porting the evaluation of both ED service & the multi-disciplinary delivery of acute care

• maintains a strategic relationship to ideas and ambi-tion

• shows perceptive analysis and insight manages clini-cal uncertainty to mitigate risk

• understands and can articulate implications of ser-vice and system change

• can reference local, regional or national strategy to support viewpoint




• completes FRCEM and curricular requirements • can provide formal and informal teaching opportuni-

ties for the multi professional team • leads on regional teaching sessions / local induction

programme • understands and applies research principles if under-

taking or supporting a research project • uses local and national quality metrics / data to de-

velop a positive learning culture • buddies / directs or mentors other levels of trainee in

relation to their educational progress


• creates the conditions to support wellbeing innova-tion

• motivates the wider team to support each other, em-powers the team to innovate and develop wellbeing strategies

• maintains advocacy for the wider ED team in multi professional settings

• contributes to organisational visits, providing the ED ‘clinical expert opinion’ e.g. with regional Dean’s Quality Management visits, CQC, GMC.

• Aware of HR polices e.g. bullying, harassment / E&D




Identifying context to be-come an EMLeader


• directs and supports others in their EMLeader journey • develops the skills to give effective feedback / mentor-

ship role modelling • can optional appraise the ED service • role models EMLeaders behaviours with complex re-

suscitation cases and individual patient care • integrates EMLeaders behaviours into standard prac-

tice to influence and guide others • works with senior leaders and other specialties as the

‘ED expert opinion’

Engaging with others to ap-ply knowledge and evidence for collaborative change

• can enhance and develop opinion to foster collabora-tion

• integrates role into the senior ED tier and wider man-agement or specialty structure to influence high qual-ity and safe care

• understands the NHS structure, roles and responsibil-ities and corporate process to foster collaboration

• applies skills in the workplace, positive role models e.g. EPIC



• can give effective feedback • provides support to members of the team following

debrief • mentors others to enhance ED debrief



• recognises and action plans individual and team chal-lenges monitoring longitudinal development


• contributes to organisational decision making refer-enced to ED shared vision

• can give an informed ED perspective • works with the senior leadership team to improve

quality standards • is empowered to contribute to ED local action plan in

relation to Trust / NHSI / NHSE / HEE / RCEM strat-egy documents

• attends and contributes to senior department meet-ings

• aware of different strategies for gaining a consensus


• can use national standards and quality matrices to benchmark local practices

• can appraise and find solutions to areas where local practice is outside national standards

• evaluates factors that impinge on sustainability and offers solutions to maintain progress


• develops role in leading future progress and vision for service

• appreciates that change takes time • maintains focus and momentum during periods of

change • builds long term strategies for development of excel-

lence • can delegate and support effectively • can individually, and as team leader, deliver tasks on

time to a high standard




• drives the departmental ethos of a learning and devel-opment culture to enhance progress avoiding blame

• role models personal and team resilience • provides support and direction for those negotiating

obstacles and failure within their professional career

emleaders framework€¦ · framework within this document covers the descriptors of proficiency by...

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