Appendix 2 ACCS Specialty Specific Assessments forms & and EM Work Place Based Assessment ...

82 Pages·2016·2.14 MB·English

Appendix 2

ACCS Specialty Specific
Assessments forms
&
and EM Work Place Based
Assessment Forms

RCEM
July 2015
Table of Contents Page
ACCS -Emergency Medicine WPBA forms
MiniCex
Summative Mini-CEX form 4
Formative Mni-CEX 5
Mini-CEX Descriptor of unsatisfactory performance 6
ACCS Mini-CEX Summative Descriptors for Major Presentation 8
1. Anaphylaxis 8
2. Unconscious patient 10
3. Shock 12
4. Major trauma 13
5. Sepsis 14
ACCS Mini-CEX Summative Descriptors for Acute Presentation 16
1. Chest pain 16
2. Abdominal pain 17
3. Breathlessness 18
4. Mental Health 19
5. Head injury 21
CbD
Summative CbD form 22
Formative CbD form 23
CbD descriptors 24
DOPs
EM DOPs form 25
Practical procedures DOPs descriptors 26
1. Airway 26
2. Primary survey 26
3. Wound assessment 27
4. Fracture and large joint dislocation 28/29
ACAT-EM
Instructions for use of ACAT-EM 30
ACAT-EM form 32
MSF – EM 33
Patient survey tool - EM 34
ACCS-Acute Medicine WPBA forms 35
1. Mini-CEX 36
2. CbD 37
3. DOPS 40
4. ACAT 42
5. Audit assessment 45
6. Teaching Observation 47
Specialty specific assessments for Anaesthesia
Initial Assessment of Competence Certificate 49
Assessments to be used for the initial Assessment of Competence 51
1. A-CEX 52
2. DOPs 53
3. CbD 55
Specialty specific assessments forms for ICM
1. Mini-CEX 58
2. CbD 59
3. DOPS 60
4. MSF 61
Adult EM ST3
1. ST3 Resuscitation Mini-CEX 63
2.ST3 Resuscitation CBD 66
EM ST3-6 -Generic forms
1. ESLE 69
2. ST3-6 Mini-Cex 77
3. ST3-6 CBD 80
3
Royal College of Emergency Medicine
Summative Mini-Clinical Evaluation Exercise - Mini-CEX

Name of trainee: Year of Training:

Assessor: GMC No:

Grade of assessor: Date / /
Case discussed (brief description) Diagnosis
Focus of assessment –
History Examination Diagnosis Management Communication

Demonstrates good practice
Further core Demonstrates
Please TICK to indicate the standard
learning needed excellent practice
of the trainee’s performance in each Not observed Must address Should address
area learning points learning points
highlighted below highlighted below

Initial approach

History and information gathering

Examination

Investigation

Clinical decision making and judgment

Communication with patient, relatives,
staff

Overall plan

Professionalism

For summative Mini-CEX Unsuccessful Successful
Things done particularly well
Learning points
Action points
Assessor Signature: Trainee Signature:
4
Royal College of Emergency Medicine
Formative Mini-Clinical Evaluation Exercise - Mini-CEX

Name of trainee: Year of Training:

Assessor: GMC No:

Grade of assessor: Date / /
Case discussed (brief description) Diagnosis
Focus of assessment –
History Examination Diagnosis Management Communication

Demonstrates good practice
Further core Demonstrates
Please TICK to indicate the standard
learning needed excellent practice
of the trainee’s performance in each Not observed Must address Should address
area learning points learning points
highlighted below highlighted below

Initial approach

History and information gathering

Examination

Investigation

Clinical decision making and judgment

Communication with patient, relatives,
staff

Overall plan

Professionalism
Things done particularly well
Learning points
Action points
Assessor Signature: Trainee Signature:
5
Mini-CEX Descriptors for Unsatisfactory Performance

Dimension Descriptors of satisfactory Descriptors of unsatisfactory
performance performance
History taking • Recognised the critical History taking was not
symptoms, symptom focused
patterns
• Failed to gather all the
• Clear context to history important information
gathering, related to from the patient, missing
differential diagnosis of important points
presenting complaint
• Did not engage with the
• Engagement with the patient
patient where possible
• Was unable to elicit the
history in difficult
circumstances- busy,
noisy, multiple demands
Physical examination A methodical approach with Failed to detect /elicit and
mastery of key examination interpret important physical
skills signs
Maintains patient comfort Did not maintain dignity and
and dignity throughout privacy
Communication Communication skills with Communication skills with
colleagues colleagues
• Listens to other views • Rude to colleagues
• Discusses issues with the • Inconsiderate of the rest
team of the team
• Follows the lead of others • Was not clear in referral
when appropriate process- was it for
opinion, advice, or
• Gives clear and timely
admission
instructions

Communication with patients
Communication with patients
• Did not encourage patient
• Elicits the concerns of the
involvement/ partnership
patient, their
in decision making
understanding of their
illness and what they
expect
• Informs and educates
patients/carers
Clinical judgement-clinical • Identifies the most likely • Did not select the most
decision making diagnosis in a given effective treatments
situation
• Did not make decisions in
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• Was discriminatory in the a timely fashion
use of diagnostic tests
• Decisions did not reflect
• Constructs a clear understanding of
comprehensive and likely underlying principles
differential diagnosis
• Did not reassess the
• Correctly identifies those patient
who need admission and
• Did not anticipate
those who can be safely
interventions and slow to
discharged.
respond
• Recognises atypical
• Did not review effect of
presentation
interventions
• Recognises the urgency of
the case
Professionalism • Respects confidentiality • Insensitive to patients
opinions/hopes/fears
• Protects patient dignity
•
• Explains plans and risks in
a way the patient could
understand
Organisation and Able to work effectively Was slow to progress the case
efficiency through the case
Overall care • Ensures patient was in a • Did not follow infection
safe monitored control measures
environment
• Did not safely prescribe
• Anticipated and
recognised complications
• Focussed on safe practice
• Used published standards
guidelines or protocols
where available
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ACCS Mini-CEX Summative Descriptors for Major Presentations
1. Anaphylaxis
2. Unconscious/Altered Mental State
3. Shock
4. Trauma
5. Sepsis

Note that MP2 - Cardio Respiratory Arrest can by covered during anaesthesia as part of the Initial
Assessment of Competence sign off.

1 Anaphylaxis

Descriptor of Satisfactory Performance Descriptor of Unsatisfactory
performance

Initial approach • ABCD approach, including GCS
• Asks for vital signs including SPaO2,
blood sugar
• Requests monitoring
• Recognises physiological
abnormalities
• Looks for obvious cause of shock
e.g. bleeding
• Secures iv access
History • Obtains targeted history from • History taking was not focused
patient
• Did not recognise the critical
• Obtains collateral history form symptoms, symptom patterns
friends, family, paramedics- cover
• Failed to gather all the important
PMH
information from the patient,
• Recognises the importance of missing important points
treatment before necessarily
• Did not engage with the patient
getting all information
• Was unable to elicit the history in
• Obtains previous notes
difficult circumstances- busy, noisy,
multiple demands
Examination Detailed physical examination which • Failed to detect /elicit and
must include physical signs that would interpret important physical signs
differentiate between haemorragic,
• Did not maintain dignity and
hypovolaemic , cardiogenic and septic
privacy
causes for shock
Investigation Asks for appropriate tests-
• arterial blood gas or venous gas and lactate
• FBC,
• U&Es,
• clotting studies,
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• LFTs, toxicology,
• Cross match as indicated
• blood and urine culture,
• CK and troponin,
• ECG,
• CXR,
• Familiar with use of US to look for IVC compression and cardiac
tamponade
Clinical decision Forms diagnosis and differential • Did not identify the most likely
making and diagnosis including: diagnosis in a given situation
judgement
• Trauma-haemorrhagic, blood • Was not discriminatory in the
loss control form direct use of diagnostic tests
pressure, pelvic splintage,
• Did not construct a
emergency surgery or
comprehensive and likely
interventional radiology
differential diagnosis
• Gastrointestinal - upper and
• Did not correctly identify
lower GI bleed, or fluid loss
those who need admission and
form D&V
those who can be safely
• Cardiogenic - STEMI, tachy and discharged.
brady dysrhythmia
• Did not recognise atypical
• Infection- sepsis, knows sepsis presentation
bundle
• Did not recognise the urgency
• Endocrine - Addison’s disease, of the case
DKA
• Did not select the most
• Neurological - neurogenic effective treatments
shock
• Did not make decisions in a
• Poisoning - TCAs, cardio toxic timely fashion
drugs
• Decisions did not reflect clear
understanding of underlying
principles
• Did not reassess the patient
• Did not anticipate
interventions and slow to
respond
• Did not review effect of
i i
Communication Effectively communicates with both Communication skills with colleagues
patient and colleagues
• Did not listen to other views
• Did not discuss issues with the
team
• Failed to follow the lead of
others when appropriate
• Rude to colleagues
• Did not give clear and timely
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instructions
• Inconsiderate of the rest of the
team
• Was not clear in referral
process- was it for opinion,
advice, or admission
Communication with patients
• Did not elicit the concerns of
the patient, their
understanding of their illness
and what they expect
• Did not inform and educate
patients/carers
• Did not encourage patient
involvement/ partnership in
decision making

Organisation and • Was slow to progress the case
efficiency
Overall plan Identifies immediate life threats and • Did not ensure patient was in a
readily reversible causes safe monitored environment
Stabilises and prepares for further • Did not anticipate or recognise
investigation, treatment and admission complications
• Did not focus sufficiently on
safe practice
• Did not follow published
standards guidelines or
protocols
• Did not follow infection control
measures
• Did not safely prescribe
Professionalism Behaves in a professional manner • Did not respect confidentiality
• Did not protect the patients
dignity
• Insensitive to
patients
opinions/hopes/fears
• Did not explain plan and risks
in a way the patient could
understand

2 Unconscious/altered mental status

Descriptor of Satisfactory performance
Initial approach • ABCD approach, including GCS
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