Emergency Medicine - Advanced Clinical Practitioner

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 EM-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 EM-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.

Emergency Medicine Advanced Clinical Practitioner Curriculum (2017)

The Emergency Medicine 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 Medicine Advanced Clinical Practitioner (ACP) curriculum provides an opportunity for standardisation and consistency.

• EM ACP curriculum (Adult and Paediatric)
• EM ACP curriculum (Adult only)
• EM 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 Medicine Advanced Clinical Practitioners (EM-ACP), established ACPs who wish to credential, and supervisors who are providing the clinical and educational support for the EM-ACP process should refer to The Guide to RCEM Emergency Medicine 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).

RCEM ePortfolio

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 RCEM 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 RCEM ePortfolio.

The structure, layout and functionality offers advantages in the submission of evidence for the credentialing process. To support the use of RCEM ePortfolio the college host regular Zoom drop-in sessions for ACPs and their Supervisors. Please refer to the ‘Alerts’ section of your RCEM ePortfolio 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 RCEM ePortfolio Platform which highlights some of the additional features that have been incorporated 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.

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

Application Process (2017 curriculum)

For information on the EM-ACP credentialing process for the 2022 ACP curriculum, including application window dates for 2024, please visit ACP Curriculum (2022).

The final opportunity to credential against the 2017 ACP curriculum will be Autumn 2024 (those receiving a ‘limited resubmission’ outcome in Autumn 2024 will be able to submit their additional evidence in Spring 2025 without having to transition to the 2002 ACP curriculum).

There will be two main credentialing opportunities in 2024 – in Spring and Autumn. Within each will be two separate application windows – one for ACPs submitting their first application or a full resubmission, and a later one for ACPs who received a ‘limited resubmission’ outcome within the previous credentialing opportunity and wish to submit their additional evidence to the following Panel for review.

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 RCEM ePortfolio before the end of the appropriate 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, you will be required to complete an online registration form once the application window opens. Details of the application fee structure can be found below.

All portfolios must be signed-off by a named Educational Supervisor who meets the eligibility criteria stipulated in the credentialing 2017 guidance. For ACPs submitting an adult or dual credentialing application, the named Educational Supervisors must:

• be on the GMC specialist register in Emergency Medicine
• be employed as a substantive consultant
• have completed RCEM ACP supervisor training (2017 curriculum)
• be a GMC-recognised trainer.

ACPs submitting an application to credential in children must have a named Educational Supervisor who either meets the criteria above OR:

• is on the GMC specialist register in Paediatrics or Emergency Medicine with sub-specialty accreditation in Paediatric Emergency Medicine
• is employed as a substantive consultant
• has completed RCEM ACP supervisor training (2017 curriculum)
• is a GMC-recognised trainer

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

2024 EM-ACP Credentialing application dates (2017 curriculum)

Application fee structure

Screening

Due to the volume of portfolios to be reviewed, all portfolios are screened upon submission.  This process, undertaken by the College staff, is designed to identify portfolios where there is evidence clearly missing. The screening criteria is listed in appendix 3 of the Guide to Emergency Care ACP Credentialing

Having confirmed the evidence is missing, the Chair of the ACP Credentialing Panel will reject the application and the ACP will be required 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.

Life Support Courses

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 2024 window, and you have been unable to certify or re-certify in one or more 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 09 November 2024 for Spring 2024 submissions and 05 May 2025 for Autumn 2024 submissions. 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.

Credentialing Checklist (2017 Curriculum)

The credentialing checklist is located on your RCEM ePortfolio dashboard and identifies those curriculum items for which the ACP Credentialing Panel requires a specific type of evidence to be included within the portfolio of evidence. For example, there may be elements for which a consultant summative assessment is mandated or, with regards to evidencing academic competences – the certificates, transcripts, learning outcomes, etc. Applicants must link the single most appropriate/relevant item (or items if more are specifically 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.

Please check that you have the correct checklist assigned to your RCEM ePortfolio 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 dashboard, please contact ePortfolio@rcem.ac.uk

We recommend that you tag evidence as you progress through training, rather than leave it until you are ready to submit your credentialing application, as you will be able to replace linked evidence with more appropriate evidence as you go. Please do not tag multiple items unless indicated.

The ACP credentialing checklist provides guidance on the minimum evidence required for credentialing. However, ACPs should not rely on the checklist alone but should also refer to the curriculum and the Guide to Emergency Care ACP Credentialing to guide the ACP in their personal development and for the ACP and their supervisor to determine what is required.

For reference only, copies of each checklist may be downloaded below. These must not be completed and uploaded to the portfolio in lieu of the electronic checklist on the ePortfolio dashboard.

• ACP credentialing checklist (2017 curriculum) – adults
• ACP credentialing checklist (2017 curriculum) – children
• ACP credentialing checklist (2017 curriculum) – adults and children

Academic 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 Academic Credentialing Declaration form is now available as an event to be created within the RCEM ePortfolio and should be linked to the Academic Competences section of the 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.

Patient Case Mix Logbook Templates

ACPs may find it helpful to use the templates below to provide a summary breakdown of their case mix. The templates 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

Hints and Tips for Successful Submission

To assist ACPs and their Supervisors, we have identified some common reasons why a credentialing submission may be unsuccessful. We recommend that ACPs refer to this guidance whilst curating their portfolios.

Common reasons for an unsuccessful submission (2017 curriculum)

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

• The Educational Supervisor signing off the portfolio must meet all eligibility criteria (see above) and have attended the RCEM ACP Supervisor Training for the 2017 curriculum
• An Academic Credentialing Declaration must be completed with the learning outcomes mapped
• The correct checklist must be completed, i.e. adult, paeds or dual adults and paeds
• There must be clear evidence in the CV of the equivalent of a minimum of 3 years (4 if credentialing in both adults and paeds), 30 hours per week of complete practice as a tACP at the time of submission
• Checklist has only one item linked per competence (two if adult and child), unless otherwise indicated
• Each curriculum item should have no more than 7 items of evidence (excluding e-learning and curriculum item ratings) – a maximum of 10 will be accepted for Common Competences.
• Where e-learning is submitted as evidence, there should be no more than 5 modules linked to any one curriculum item
• Common competences should be signed off at an appropriate level, i.e. the majority at level 2 with only a few higher. Where CCs are rated higher than level 2, the Panel will need to see clear evidence demonstrating why this is deemed appropriate.
• Mandatory courses are in date
• An STR and FEGS must be provided for each year of training declared (minimum of 3 required at regular intervals, with the final FEGS completed within 6 months of submission). If an ACP cannot provide 3 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 evidence has all patient identifiable information removed, including hospital numbers
• Examination of the joint must be a different assessment to the manipulation assessment
• 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.
• All applicants must have prescribing competences
• PP16 and PP17 must be different cases
• C3AP2a and C3AP2b require one for upper limb and one for lower limb
• There must be a minimum of 3 MSF summary reports, one for each year of training with the final MSF completed within 6 months of submission. Each MSF must have a minimum of 12 respondents, including 2 consultants.

The ACP Credentialing Panel has also produced a list of helpful hints from the Spring 2020 credentialing opportunity.

ACP Webinar

On 15 June 2023, a webinar was held for ACPs on the 2017 curriculum providing final tips for submission. See the recording of the webinar, and responses to questions asked during the session.

ACP Credentialing appeals procedure

All EM-ACPs who submit evidence for credentialing have the right to appeal an ‘unsuccessful’ or ‘limited resubmission’ outcome, providing that either one or both of the grounds for appeal, as described below, are met:

• There is evidence of a procedural irregularity (including administrative error);
• There were exceptional circumstances that adversely affected the EM-ACP’s submission.

Appeals will not be granted on the grounds that an EM-ACP:

• was not aware of, or did not understand, the regulations;
• considers that their efforts were mis-represented;
• seeks to question the academic or professional judgement of the ACP Credentialing Panel.

For further information on the appeals process and how to submit an appeal, please refer to the RCEM Emergency Medicine Advanced Clinical Practitioner (EM-ACP) Credentialing Appeals Procedure.

Emergency Medicine ACP Supervisor Training

All ACPs credentialing on the 2017 curriculum (adults, children or dual) are required to have an RCEM-trained Educational Supervisor (ES) who is eligible to complete the final sign-off of the portfolio prior to submission. It is recommended that ACPs have an RCEM-trained Educational Supervisor throughout the credentialing journey but must have an RCEM-trained ES for the final year of training as a minimum.

The final opportunity for ACPs to credential on the 2017 ACP curriculum is the Autumn 2024 credentialing window. Therefore, as it is expected that all Educational Supervisors will have completed RCEM ACP Supervisor training (2017 curriculum) prior to Autumn 2023, we will not be hosting any further live training sessions.

For Educational Supervisors who completed the training more than 2 years ago, and for those who would like a refresher, we have created an online learning session on the RCEMLearning platform. The module consists of 7 short videos which were recorded during a live virtual training session. Please note: to access the RCEM ACP Supervisor Training (2017 curriculum) module, you will firstly need to login to your RCEMLearning account.

Portfolio Sign-Off by the Named Educational Supervisor

Prior to submission of your credentialing application, your portfolio of evidence must be reviewed and signed off by your named Educational Supervisor confirming that they believe it is complete and meets the standard required. There are two parts to the sign-off process:

1. Curriculum item rating (formerly known as red man / blue man): Curriculum item ratings (CIRs) must be completed by the ES for all common competences, presentations and procedures in the curriculum and must include the level of competency / achievement and some narrative which demonstrates the ES has reviewed the evidence, seen the ACP in practice and, by referring to the descriptors in the curriculum, can confirm the ACP is at the appropriate level.
   Common competences should be assessed from level 1 – 4 (minimum of level 2 required for credentialing), and presentations and procedures assessed as either achieved, some experience or not achieved.  All practical procedures must have summative assessments using the DOPS tool – in most cases by a consultant (see curriculum and checklist for details). Consequently, it is expected that all procedures will be ‘achieved’. Recognising that in some departments the ACP may not be permitted to perform a particular procedure for local governance reasons, the Panel has identified 7 procedures for which a CBD will be permitted as the tool for assessment. In these instances, the ACP should be assessed as having ‘some experience’. However, the Panel will only accept a maximum of 4 of these 7 procedures to be assessed by CBD and there should always be an appropriate explanation from the Educational Supervisor as to why it is not possible to achieve a particular competence.

2. Credentialing Checklist: the Educational Supervisor must sign-off the checklist to confirm that the evidence presented by the ACP has been reviewed, is complete and meets the standard required for credentialing. The ES completes the sign-off by marking each section of the checklist as achieved and adding relevant comments, including any additional information the ES believes the Panel should be aware of.  The sign-off by the Educational Supervisor is the final action to be completed prior to submission of the credentialing application.

Please note: the RCEM ePortfolio platform provides supervisors with the ability to ‘mark’ each element of the curriculum, or ‘goal’, as achieved, partially achieved, not achieved or carried forward, and to add a ‘resolution comment’. This function must not be used as an alternative to Curriculum Item Ratings, and ACPs and Educational Supervisors should note that where ‘goal marking’ has been completed in lieu of CIRs, the portfolio will be rejected.

For further guidance on how to review and sign-off the portfolio of evidence prior to submission, please refer to the Quick guide to portfolio sign-off for Educational Supervisors (2017 curriculum). This guidance, which ACPs will also find helpful, provides information on the credentialing application process, initial screening, portfolio review, curriculum item rating and the credentialing checklist. A useful Educational Supervisor sign-off checklist is also included.

As many ACPs and supervisors are familiar with the previous ePortfolio platform (NES) terminology, we have also created a handy table, ACP and ACP Educational Supervisor sign-off, which compares the risr/advance ePortfolio sign-off requirements for both the 2017 and 2022 curriculum with the previous requirements in NES.