Emergency Care - Advanced Clinical Practitioners

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.

Please note: a revised version of the guidance (2017 curriculum) was published in October 2022. It is now a requirement that four consultants must be present at each faculty educational governance meeting taking place from Autumn 2022 onwards and contribute to the FEG statement. It is also now mandatory for all ACPs to have an RCEM-trained ACP Educational Supervisor for their final year of training (submissions to the Autumn 2023 credentialing window onwards).

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

With the launch of the 2022 ACP Curriculum RCEM will be hosting ACP Supervisor Training days and ACP Supervisor Refresher Sessions.

Please note that spaces will be limited and are offered on a first come fist serve basis.

If you would like to book a space for one of our training days, please click here.

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 their workshop. 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.

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.

Advanced Clinical Practitioners working in Emergency Medicine, including Paediatric Emergency Care, are eligible to use the ePortfolio. The evidence collected through the ePortfolio will be used to supports an ACP’s credentialing application.

If you wish to obtain ePortfolio access you will need to complete the online application form available on the RCEM website. To access the application form and to obtain more information about the fees and process, please visit our membership pages.

Please note it is a requirement for those credentialing to obtain ePortfolio.

Kaizen’s structure, layout and functionality offers advantages in the submission of evidence for the credentialing process. To support the use of Kaizen the college host regular Zoom drop-in sessions for ACPs and their Supervisors. Please refer to the ‘Alerts’ section of your Kaizen dashboard for further details as to when this are hosted.

In addition to the drop-in sessions and guidance videos, we have created a Quick Guide to the Kaizen Platform which highlights some of the additional features that have been incorporated into Kaizen to assist with your credentialing application, such as the credentialing checklist and academic component declaration form. The guide also provides the latest advice for ACPs preparing to submit their credentialing application

We have also produced a user guidance video for ACPs which covers the dashboard, assessments and curriculum tagging. This can be viewed via the RCEM YouTube channel. A second video covering the credentialing checklist, academic component credentialing declaration, mandatory life-support certificates and Educational Supervisor sign-off will be uploaded to the channel shortly.

Please note that the Quick Guide should be read in conjunction with the Guide to Emergency Care ACP Credentialing, curriculum and credentialing checklists.

There are two credentialing application windows each year – in Spring and Autumn. ACPs who wish to apply must be confident, along with their named Educational Supervisor, that they will have appropriate evidence of acquisition of all required competences uploaded to their Kaizen ePortfolio before the end of the application window (any evidence submitted after the closing date will not be considered except in exceptional circumstances and at the sole discretion of the Chair of the ACP Credentialing Panel).

To submit your credentialing application, please complete the online application form available via the link below (please note the registration form will only be available for the duration of each application window). Details of the application fee structure can also be found below.

All portfolios must be signed-off by a named Educational Supervisor who meets the eligibility criteria stipulated in the guidance. Named Educational Supervisors must:

• be a member of the RCEM in good standing
• be on the GMC specialist register in Emergency Medicine
• be employed as a substantive consultant
• have completed RCEM ACP supervisor training
• be recognised by the GMC as a supervisor.

As from August 2022, ACPs credentialing in children only may now have a PEM Consultant as their named Educational Supervisor (with the authority to sign-off the portfolio), providing they:

• are a member of the RCPCH in good standing
• are on the GMC specialist register in Paediatrics with sub-specialty accreditation in Paediatric Emergency Medicine
• are employed as a substantive consultant
• have completed RCEM ACP supervisor training
• are recognised by the GMC as a supervisor.

Please note: ACPs may continue to upload evidence to their portfolio after completing the online registration form until the application window closing date.

If you have any questions regarding the application process, please email ACP@rcem.ac.uk

Spring and Autumn 2023 EC-ACP Credentialing application dates (2017 curriculum)

Please complete the online credentialing application form here. Please note that the form will only be available during the application window.

Application fee structure

Life support courses for ACPs credentialing in Autumn 2022

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 2022 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 10 May 2023. 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 2023 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.

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, paediatrics or adult & paediatrics. 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.

RCEM EC-ACP Academic Component Credentialing Declaration

All ACPs are required to demonstrate how the learning outcomes of the modules completed as part of their advanced practice qualification fulfil the learning outcomes required by the College for the topics of history and examination, and diagnostics and clinical reasoning. The RCEM EC-ACP Academic Component Credentialing Declaration form has now been incorporated into Kaizen and should be linked to the Academic Competences section of your checklist. Within this form you will need to map the relevant learning outcomes from your studied modules to the individual RCEM learning outcomes identified in the declaration by providing the name of the module and full text of the outcome.

Please note: if you have already completed the Word version of the Academic Component Credentialing Declaration which was previously available to download from the College website, please link this document from your documents library to the Academic Competences section of your checklist. You do not need to complete the Kaizen form of the same name.

Sign-off of the portfolio by the named Educational Supervisor

Prior to submission of your credentialing application, your portfolio of evidence must be signed off by your named Educational Supervisor to confirm that they have examined all the evidence and believe it is complete and meets the standard required. This sign-off process has now been incorporated into the checklist on Kaizen. Your named Educational Supervisor is required to mark each section of the checklist as ‘achieved’ once they have reviewed the evidence.

The sign-off by the Educational Supervisor is the final action to be completed prior to submission of your credentialing application.

Pre-Screening

Due to the volume of portfolios to be reviewed, a pre-screening process was introduced in 2020. 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.

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)
• Academic Component Credentialing 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:
• What is credentialing, why and how?
• Career and Academic Pathway to becoming an ACP [PDF]
• HEI implementation Focus group
• To register your interest for the Emergency Care ACP credentialing process, please complete the online registration form available from here. EC ACPs who register must also become a member of the College (category Associate Member (ACP)).
• Please see the tab above for FAQs on the Emergency Care ACP. This will be updated as questions are raised throughout the implementation of the curriculum and credentialing process.
• Have a question? Please write to acp@rcem.ac.uk

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