ACEM Accreditation Standards for Special Skills Placement

AP638 V3

This document aims to define the educational standard placements that must be provided to become accredited as special skills placements by ACEM. These standards apply to all special skills placements. This document does not apply to ACEM critical care placements. Further details on each individual special skills placement can be found in the relevant guidelines on the ACEM website.

The FACEM Training Program aims to produce emergency specialist doctors with the clinical knowledge, skills, and attitudes necessary to function safely and independently. These are described in the FACEM Curriculum.

Within the FACEM Training Program structure is mandated non-ED training time. This is further subdivided into mandatory critical care training time and general non-ED training time.

If a site wishes to be accredited for training stage four (TS4) for the 2022 FACEM training program, it must demonstrate that it meets the TS4 learning outcomes. This also applies to Category T applications for the TS4 elective placement.

Under the relevant section of Regulation G, acceptable general non-ED training placements include those accredited by other colleges recognised by the Australian Medical Council and the New Zealand Medical Council for the purposes of training in another speciality, and other special skills placements approved by ACEM.

There are two types of special skills placement accreditation categories approved by ACEM:

A Special Skills Placement (SSP) Guideline outlines specific information for that discipline and should be read in conjunction with this document. The approved Special Skills Placement Guidelines can be found on our website: https://acem.org.au/Content-Sources/Training/Training-site-accreditation.

The overarching principle is that the site must provide supervision and facilities to promote the health, welfare and interests of all trainees who train at that site. Specifically, the following standards apply.

4.1 Supervisor

Every Special Skills Placement (Category A or T) will have a nominated supervisor.

This person is required to have qualifications and credentials within the discipline. The supervisor will have a minimum of three (3) years post Fellowship experience. At the discretion of the Accreditation Committee, supervisors with extensive experience and expertise in the relevant special skills discipline will be accepted as having equivalent skills required to be an approved supervisor for the SSP. For Category A placements, SSP supervisors should also be familiar with any specific criteria related to their role as outlined in the relevant SSP Guideline for their discipline. The supervisor must be employed a minimum of 0.3 FTE at the site or as stipulated in the relevant SSP guidelines.

The SSP supervisor is the main point of contact for both the trainee and the College. Regular formal contact between the supervisor and the trainee is required throughout the placement. This is defined as a minimum of once per week to ensure the trainee gets adequate feedback about their progress and development. The supervisor is responsible for:

• ensuring trainees are appropriately orientated to the training site at the start of the placement, including relevant operational and governance processes,
• completing a learning development plan at the start of the placement with the trainee to define the learning outcomes of the placement which are expected to be achieved,
• co-ordinating the provision of an appropriate education and training program to achieve the learning outcomes,
• viewing and verifying any learning activities, mid-term assessments, and/or formative assessments have been completed, such as a learning portfolio or logbook,
• performing end of term assessments. The end of term assessment is an ACEM generated In-Training Assessment (ITA). The SSP supervisor will be notified via email to complete the ITA in the ACEM Member Portal.

A change in SSP supervisor must be approved by the College. All new SSP supervisors must forward a focused and relevant up-to-date curriculum vitae to This email address is being protected from spambots. You need JavaScript enabled to view it. for approval.

4.2 Facilities

The site must provide adequate facilities to promote the training of trainees. Whilst this primarily involves providing safe patient care, other considerations need to be met, including access to educational resources (on-site or online) and access to other specialists of that discipline. Where appropriate, facilities to support the wellbeing of trainees, particularly if they do after hours training, need to be in place. The SSP Guidelines have further details for each specific special skills placement.

4.3 Caseload

Clinical SSPs seeking to be accredited for the FACEM Training program must ensure there is an adequate range of patients (both number and variety) to fulfil the learning outcomes for that SSP. The minimum number of patients that a trainee should manage is not specified in this document rather, case numbers are provided in the specific SSP guideline. It is expected that the placement be completed at a minimum PGY4 level, involving active patient management, such that it enables the trainees to meet the learning outcomes of non-ED ITA criteria.

For Non-Clinical SSPs, see the relevant specific guideline for minimum activity requirement.

All patient cases/ activities must be relevant to the SSP discipline. General emergency medicine is excluded unless specified in a particular SSP guideline. Delivery of training beyond the emergency department is highly encouraged to ensure that trainees understand the link between emergency medicine and the overall health system.

Special Skills Placements must be structured to permit trainees to undertake all their time on duties that relate directly to the special skills focus on, and not core ED activities. Specific special skills guidelines may permit a variation to this educational standard. If so, this will be detailed in the documentation for that specific Special Skills Placement.

Special Skills Placements are generally accredited up to the maximum training time equivalent to six (6) months at 1.0 FTE. It should be recognised that longer placement durations will entail additional learning objectives and expectations.

5.1 Education program

The site will outline the Education Program to be delivered. It will cover all the aspects listed below and show the clear linkage between the learning activities and the learning outcomes.

Specifically, the Education Program will include:

• The purpose and outcomes of the Education Program
• An alignment mapping to the FACEM Curriculum
• The delivery and supervision mode of the Education Program
• A rubric demonstrating how outcomes will be assessed. A cohesive educational pedagogy that links the learning activities, assessments, and outcomes.

5.2 Learning outcomes

• The site will provide learning outcomes to be achieved by the end of the placement.  These learning outcomes must be concordant with the eight domains of the FACEM Curriculum as listed on the generic non-ED ITA. 
• Additional learning outcomes specific to each Category A SSP should be included and are found in the relevant SSP guideline. 
• Category T SSP should also have additional learning outcomes relevant to that placement. 
• All additional learning outcomes must be set at Training Stage 2 level as a minimum, found within the I.

For a site wishing to be accredited as a Training Stage 4 site, it must meet all the non-ED Training Stage 4 learning outcomes and requirements:

Training Stage 4 Learning Outcomes

Training Stage 4 (the final 12 months of FACEM training) enables trainees to focus on the developing and consolidating of management and leadership skills.  By the end of Training Stage 4, trainees should be competent and confident in the operational management of the floor, including patient flow, the clinical supervision of junior medical staff, and departmental management encompassing clinical governance and quality assurance. Whilst these skills are best enhanced during ED training, it is recognised that placements in appropriate non-ED settings can also provide opportunities to focus on leadership skills.

Please refer to the AC808 TS4 Accreditation Requirements guide for specific details on learning outcomes and requirements.

5.3 Learning activities

The site will provide appropriate activities and learning opportunities to meet the specified learning outcomes outlined in 5.1.1.  This includes the following:

1. Opportunistic teaching: Teaching during the course of their duties (e.g. formative assessments such as supervised procedures and workplace-based assessments, bedside patient reviews with a consultant, etc). 
2. Formal didactic education: Participating in a relevant formal pre-structured education program.  The education program may include tutorials, case presentations, simulation and morbidity and mortality sessions.

5.4 Learning development plan

The purpose of the Learning Development Plan (LDP) is to provide documented evidence of the completion of the learning activities provided in the placement, which are directly linked to the defined learning outcomes of that placement.  It will be highly recommended that the trainee completes an LDP. It should be viewed as another learning activity that encourages reflective learning. If used, the supervisor is expected to review the portfolio with the trainee once every month and sign the portfolio document as a record thereof.

The Portfolio has the following functions:

• It provides trainees with a personal record of the education and training experiences that contribute to the requirements for satisfactory completion of the placement. All opportunistic teaching should be recorded in the portfolio if used.
• An educational function through deliberate reflection on activities, encounters, and experiences, often guided in the presence of the SSP supervisor. 

Notes:

• Supervisors will use the information contained in the LDP to facilitate monitoring of the trainee's experience to ensure it is appropriate for the level of training and aid them in providing an informed completion of the trainee's ITA.
• ACEM may use the information contained in the LDP to monitor trainees' training experience whilst they are in that placement.
• ACEM may use the information contained in the LDP to ensure the quality and integrity of the placement.

The LDP can be completed online using the Learning Development Plan (LDP) available in the member's portal.

5.5  ITA

The trainee and supervisor will complete an In-Training Assessment (ITA) – Generic Non-ED at the end of a three-month placement, and, in the case of a six-month placement, a mid-term assessment at the three-month point.

Notes:

• The supervisor uses the ITA to assess the trainee against learning outcomes. 
• The supervisor uses the global comments box in the ITA to comment on the extent to which the additional SSP-specific learning outcomes have been achieved.