Emergency Care Advanced Clinical Practitioners

Advanced Clinical Practitioners - Emergency Care

In 2015, the Royal College of Emergency Medicine opened a pilot scheme for credentialing Advanced Clinical Practitioners in Emergency Medicine. The pilot completed in summer 2017 and the process is now an accepted part of College activity.

Health Education England (HEE 2016) defines Advanced Clinical Practitioners as “professionals from a range of backgrounds including nursing, pharmacy, paramedic and occupational therapy. ACPs hold Masters level education, as well as having skills and knowledge to allow them to take on expanded roles and scope of practice caring for patients”.

RCEM EC-ACPs

  • Look after patients with a wide range of pathologies from the life-threatening to the self-limiting
  • Are able to identify the critically ill and injured, providing safe and effective immediate care
  • Have expertise in resuscitation and are skilled in the practical procedures needed
  • Establish the diagnosis and differential diagnosis rapidly, and initiate or plan for definitive care
  • Work with all the in-patient and supporting specialties as well as primary care and prehospital services
  • Are able to correctly identify who needs admission and who can be safely discharged.

(RCEM EC ACP Curriculum V2 2018)

This standard is achieved through Masters level education and a national Curriculum and E-Portfolio demonstrating both clinical competencies as those of leadership, education and research.

A document has been written for Advanced Clinical Practitioners in Emergency Medicine around Wellbeing and Sustainable Careers, and can be found here

Emergency Care Advanced Clinical Practitioner Curriculum

The Emergency Care Advanced Clinical Practitioner (ACP) Curriculum has been developed by the Royal College of Emergency Medicine (RCEM) and Health Education England (HEE) with full endorsement by the Royal College of Nursing (RCN). Higher Education Institutions provide high quality Masters level courses in advanced practice; however these do not include specialty specific competences or nationally defined curricula. There is variation in the range of competences acquired, and no standardisation of the level of competence of the practitioner. The Emergency Care Advanced Clinical Practitioner (ACP) curriculum provides an opportunity for standardisation and consistency.

EC ACP curriculum (Adult and Paediatric)

EC ACP curriculum (Adult only)

EC ACP curriculum (Paediatric only)

An Assessment Descriptors document is a supplement to the curriculum.

A formal credentialing process has now been established in order that Emergency Care ACPs can demonstrate the competences required within the curriculum.

Trainee Emergency Care Advanced Clinical Practitioners (EC-ACP), established ACPs who wish to credential, and supervisors who are providing the clinical and educational support for the EC-ACP process should refer to The Guide to RCEM Emergency Care ACP Credentialing for further guidance on the process and documentation to be used.

ACP Forum

The Emergency Medicine Advanced Clinical Practitioners’ Forum is a new and exciting initiative intended to provide a focus and representation for ACPs and trainee ACPs (tACPs) within the College.

More information can be found here.

ACP Forum meetings

We are undertaking virtual meetings at the moment, due to the COVID-19 crisis.

Online ACP Teaching sessions

We are also holding online teaching sessions for ACPs.

You can access recordings of these sessions here. Please note that this access is only available to current members of RCEM.

ACP Programmes

The College is committed to supporting a multi-professional workforce, including Advanced Clinical Practitioners. Developing a programme of development for ACPs is a huge amount of work and is not simply about preparing for credentialing. The work cannot be underestimated and it may be helpful to visit or speak to leads where there are established programmes to hear about the challenges and solutions. Most regions also have an ACP lead or a long established site where there will be someone to give advice – this practical programme advice is not within the remit of the ACP Credentialing Panel or the ACP Forum.

Supervision

The clinical and educational supervision of an individual ACP is also a time-consuming role, usually over three years or more. This is not unlike developing our medical trainees or any other group, so similar principles apply of enabling attendance at formal teaching, shop floor supervision, completion of workplace-based assessment and some kind of annual review of practice and keeping up-to-date. Supervision is about feedback and support for developing skills and must not focus only on the portfolio and evidence, but on the individual developing clinical competence to the ST3 equivalent level.

We recommend that all Educational Supervisors of ACPs complete the RCEM ACP Supervisor Training but recognise that this may not have been possible at the beginning of supervision for current tACPs. The final sign-off for credentialing must be by a trained RCEM supervisor who understands the final credentialing process. This should be the Educational Supervisor who has worked with the ACP over the years and is able to evaluate their performance in the workplace and agree, with the other members of the supervising faculty, that they are ready to credential. In exceptional circumstances it may be possible for an Educational Supervisor who has been trained from a neighbouring department to complete the sign-off if there is no one formally trained at the site. However, this will only be acceptable if there has been a documented meeting with the local ES and ACP and that there is evidence that the visiting supervisor has properly reviewed all evidence and seen the ACP in practise at some point. This is likely to take 6-8 hours and a meeting of a minimum of 2 hours to discuss the evidence.

Emergency Care ACP Supervisor Training Day

The next EC-ACP Supervisor Training Day will take place on 14 October 2021, 09:00 to 13:00. This will be hosted remotely due to Covid-19.

Following participant feedback from previous ACP Supervisor training sessions, the structure has been changed to enable the training to become more interactive, including additional break-out sessions.

Participants will be asked to complete a limited amount of pre-course preparation prior to the workshop on 16 September. This will consist of a series of multiple-choice questions based on The Guide to RCEM Emergency Care ACP Credentialing, a requirement to review a pre-assigned section of an example ACP portfolio and watching two videos.

The registration window will open on Thursday 22 July 2021 and will close once spaces are full.

Please note that this training is aimed at ACP Supervisors who will be signing off the final ACP credentialing checklist. It is not suitable for ACPs intending to credential. If you are a credentialed ACP currently supervising tACPs and wish to attend this training, please email acp@rcem.ac.uk prior to registering.

The event is now fully booked and there are no more spaces available.

Emergency Care ACP credentialing process

A new process was introduced in 2018 following a successful pilot. From 2018 there will be no face-to-face meeting between assessors and applicants and there will be no detailed feedback before the credentialing day. ACPs who wish to apply must be confident, along with their supervisors, that they will have appropriate evidence on ePortfolio before the end of the application window (anything uploaded afterwards will not count) of acquisition of all required competences. Please refer to the guidance for further information.

New credentialing application fee structure from Autumn 2020

A new application fee structure has been introduced:

New application: £295

Full resubmission (for ACPs who have received a prior “unsuccessful” outcome, or a “limited resubmission” outcome awarded prior to the previous credentialing window): £295

Limited resubmission (for ACPs who received a “limited resubmission” outcome in the the previous credentialing window): £75

NB: if a “limited resubmission” outcome was awarded prior to the previous credentialing window, the application will be recognised as a “full resubmission”.

ACPs, Credentialing and COVID

Due to the ongoing challenges resulting from the pandemic, ACPs who are nearing completion of the portfolio may be anxious about access to mandatory courses and workplace-based assessments. We recognise that there is a significant reduction in opportunities for WPBAs and possibly for supervision meetings. The chief priorities are clinical safety and patient/staff wellbeing. We would recommend virtual supervision meetings as it is critical to continue to seek the guidance and support of your Educational Supervisor at this time.

Candidates for the Autumn 2021 window should continue to collect evidence in their portfolio and work towards submission for credentialing. However, as the process for credentialing is purely based on examination of evidence, there will be no opportunity for a change in the amount and type of evidence required. This may mean that applicants will need to defer their application. We will apply the rules for currency of evidence (all within 5 years and the majority within 3) flexibly for each individual.

Life support courses for credentialing in Autumn 2021

We are aware that some ACPs are currently having difficulty in accessing mandatory life support courses. If you are intending to submit a credentialing application within the Autumn 2021 window, and you have been unable to certify or re-certify in any of the mandatory life support courses, you will still be able to apply providing you are able to provide evidence of a place allocated on a course within 6 months of the credentialing date, i.e. by 19 July 2022. If you are successful in your credentialing application, the credential will be approved once evidence is received of successful completion of the life support course in the College office. Guidance for the Spring 2022 credentialing window will be reviewed nearer the time once the situation is clearer.

The guidance on the RCEM website will provide information on all other aspects of credentialing.

Autumn 2021 EC-ACP Credentialing application dates (updated 20 August 2021)

Following the migration to the new ePortfolio platform (Kaizen) in August 2021, the College is aware that some ACPs, who are intending to submit their credentialing application in the Autumn 2021 window, may be feeling apprehensive about completing their portfolios of evidence by 05 October 2021 at the same time as familiarising themselves with the new platform. Kaizen’s structure, layout and functionality offers advantages in the submission of evidence for the credentialing process and, therefore, to ensure that all ACPs have time to become accustomed to its features and are given the best opportunity to credential successfully, the Autumn 2021 application window will be delayed.

The new application window will open Friday 05 November 2021 and the closing date for evidence submission will be Sunday 21 November 2021. Evidence that would have been valid as at 05 October 2021 but will have fallen outside the timeframe for evidence submission by 21 November 2021 will still be accepted.

Autumn 2021

Dates

Application window opens

00:01, Friday 05 November 2021

Application window closes

23:59, Sunday 21 November 2021

Credentialling Panel

Wednesday 19 January 2022

To further support ACPs with the transition to Kaizen as they prepare to credential, the College will be hosting drop-in Zoom sessions specifically for ACPs for four weeks commencing 25 August 2021. Sessions will be held on Wednesdays from 3-5pm and Fridays from 11am-1pm and you can find the zoom link in Kaizen.

Checklists

The RCEM is committed to supporting ACPs in gaining their recognition as credentialed ACPs. We have had numerous comments on the checklist and concerns about what is perceived as changes to the requirements. The checklist is developed as a guide to the evidence required – but each individual application is considered as a unique application recognising that there is considerable local variation in context, case mix and working practises.

The checklist is designed to be a helpful guide to the minimum required, it is continuously reviewed to ensure it is clear – after every panel there may be elements that the panel believe need clarifying. However the minimum requirements for credentialing do not significantly change between iterations of the checklists and applicants are strongly advised not to rely on the checklist alone but to use the curriculum to guide the ACP in their personal development and the Guide to Emergency Care ACP Credentialing for the ACP and their supervisor to determine what is required.

Following migration to the Kaizen ePortfolio platform, applicants are no longer required to complete the checklist that was previously available to download form the College website and upload it as a Word document to the personal library. The checklist has now been incorporated into Kaizen and can be located on your dashboard. Please check that you have the correct checklist assigned to your Kaizen account for the curriculum against which you are intending to submit your credentialing application, e.g. adult, paeds or adult & paeds. If an incorrect checklist has been added to your Kaizen account, please contact ePortfolio@rcem.ac.uk

Applicants should link the single most appropriate/relevant item (or two if requested) to each item (event target) in the checklist that the ACP wishes to be considered as the primary evidence for the mandated assessments/elements.

The checklists may still be downloaded (below) as pdf documents for reference but should not be completed by the ACP and uploaded to the portfolio. The ACP Credentialing Panel will only refer to your Kaizen checklist.

Please note that a new pre-screening process and an updated academic declaration form were introduced in 2020:

  • Academic Component Declaration Form: this now requires the ACP to indicate which module of their level 7 Advanced Practice degree met each RCEM academic learning outcome. Failure to complete this new form will mean the portfolio is not considered. Previous versions of this form will not be accepted.
  • Pre-screening: Due to the volume of portfolios to be reviewed, a pre-screening process has been introduced. This process, undertaken by the College staff, will identify portfolios where there is evidence clearly missing according to the screening checklist.

Having confirmed the evidence is missing, the Credentialing Panel will reject the application and the ACP will have to resubmit (for a full fee and against the guidance and checklist valid at the time) within a future credentialing window. A small administrative charge will be retained from the application fee.

Self-entered forms

Please note that as from 07 December 2020, self-entered forms for summative CBD, Mini-CEX and DOPs will not be accepted as evidence.

Self-entered forms completed prior to 07 December must either be repeated by the original assessor (using the outcome of the original self-entered form if they are in agreement) or a new assessment should be completed. Alternatively, the Clinical or Educational Supervisor may ‘link’ a comment to the self-entered form confirming that it represents the assessment and that the standard has been met (if it has).

Patient case mix logbook templates

ACPs may find it helpful to use these example templates to provide a summary breakdown of their case mix. Use of this template is not mandatory but will give guidance on the type of information required. ACPs may also submit their raw anonymised data but must include a summary table.

Adult case mix logbook template
Paediatric case mix logbook template

Credentialing applicants should pay particular attention to the following elements of their portfolios of evidence:

  • Supervisor signing off the portfolio must have attended the RCEM ACP Supervisor Training (please see above)
  • Correct academic declaration is completed with the learning outcomes mapped
  • The correct checklist is completed on Kaizen (as above)
  • There is clear evidence in the CV of three years of complete practice as a tACP at the time of submission (minimum 30 hours per week pro-rata in EM)
  • Checklist has only one item linked per competence (or two if adult and child)
  • Each item in curriculum should have max 7 items (excluding e-learning) - more may be accepted for Common Competences (within reason)
  • Common competences are signed off at appropriate level – i.e. the majority at level 2 with only a few at level 4
  • Mandatory courses are in date
  • FEGS and STR are present for each year of training - three required over three years. If an ACP cannot provide three FEGS/STRs, the final FEGS and STR must explain why there is no training record for the previous years.
  • There is an appropriate balance of mini-CEX and CBD in consultant assessments – approx. 50:50
  • Scanned documents should be PDF format
  • MSF: this should be the summary report only - not individual forms
  • All documents have any patient identifiable information removed, including hospital numbers
  • Examination of the joint must be a different assessment to the manipulation assessment
  • If adult and child application – there must be evidence of experience in children in the patient log/CV and some additional evidence of paediatric cases within the adult competences that are not replicated in the children’s curriculum
  • All applicants must have prescribing competences

ACPs should also note the following clarification issued for Autumn 2020:

  • STR and FEGS: an STR and FEGS must be provided for each year of training declared (three required over three years). Previous checklists stipulated that an STR and FEGS should be provided for each year of training but did not specify the number. If an ACP cannot provide three FEGS/STRs, the final FEGS and STR must explain why there is no training record for the previous years.
  • For ACPs wishing to credential in both adults and children, there must be sufficient evidence relating to the care of children. There should be evidence in all competences of consideration of children with this presentation and approximately 25% of all mandated adult assessments must have an additional assessment in a child.
  • PP16 and PP17 must be different cases. This was also clarified in the Spring 2020 checklists.
  • C3AP2a and C3AP2b require one for upper limb and one for lower limb. This has always been the requirement, but this is further clarified in the Autumn 2020 checklists.
  • There must be three MSF summary reports – one MSF per year. Previous checklists indicated that one MSF was required per year but did not specifically state three were required.

The ACP Credentialing Panel has also produced a list of helpful hints from the Spring 2020 credentialing opportunity which can be viewed here.

Further information

  • Presentations from our recent Emergency Care ACP Conference:  

For information on access to the RCEM e-portfolio adapted for Emergency Care ACPs/Associate Membership (ACP), please see the initial application form.

RCEMLearning


The College has an eLearning resource, RCEMLearning, content of which has been mapped to the curriculum.  For information about accessing the RCEMLearning site, please contact RCEMLearning@rcem.ac.uk

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