Progression in Training

TA544 V12

 

 

This policy sets out the principles and requirements for progression in the FACEM Training Program and ACEM Paediatric Emergency Medicine (PEM) Training Program.

 

Progression is the process by which trainees advance in their training program, from Provisional Training or Training Stage 1 through to election to Fellowship as well as in relation to completion of PEM training. Progression decisions are completed by delegated Council of Education (COE) entities and are made at the accrual of the key progression milestones in a training program, as prescribed by Regulation B or Regulation G (as applicable).

Trainees who are identified as having not yet achieved the required standard are provided with additional training time as an opportunity to pause and refocus their training. Trainees may be identified as underperforming through:

1. • not completing the specified requirement(s) of a training stage or phase by the relevant timeframe; and/or
   • not meeting or maintaining the standard required of a trainee at the relevant stage or phase of training as outlined in the relevant Curriculum.

Additional training time is a mechanism to support those trainees who require further time and focused training to achieve the required standard.

 

3.1 Assessment requirements – FACEM Training Program

(trainees enrolled prior to 2022 and who, until such time as they transition to the 2022 FACEM Training Program, are governed by Regulation B)

Progression through the FACEM Training Program requires successful completion of all assessments mandatory for the relevant stage of training.

a. Provisional Training:

• • In-training Assessments (ITAs)
  • Structured References
  • Primary Examination (Written)
  • Primary Examination (Viva)

b. Advanced Training:

3. • ITAs
   • Emergency Workplace-Based Assessments (EM-WBAs)
   • Paediatric Requirement
   • Trainee Research Requirement
   •  Fellowship Examination (Written)
   •  Fellowship Examination (Clinical)

3.2 Assessment requirements – FACEM Training Program

(Trainees commencing from 2022 Training Year and governed by Regulation G)

Progression through the FACEM Training Program requires successful completion of all assessments mandated for completion by the end of a particular Training Stage.

a. Training Stage 1:

• • In-Training Assessments (ITAs)
  • Emergency Medicine Workplace-Based Assessments (EM-WBAs)
  • Primary Examination (Written)
  • Primary Examination (Viva)

b. Training Stage 2:

• • In-Training Assessments (ITAs)
  • Emergency Medicine Workplace-Based Assessments (EM-WBAs)
  • Training Stage 3:
  • In-Training Assessments (ITAs)
  • Emergency Medicine Workplace-Based Assessments (EM-WBAs)
  • Fellowship Examination (Written)

c. Training Stage 4:

• • In-Training Assessments (ITAs)
  • Emergency Medicine Workplace-Based Assessments (EM-WBAs)
  • Formal Teaching Presentation
  • Morbidity and Mortality (M&M) Presentation
  • Guideline/Protocol Review or Audit
  • Direct Observation of Procedural Skills (Core DOPS)
  • Paediatric Emergency Requirement*
  • Trainee Research Requirement*
  • Fellowship Examination (Clinical)

*successful completion required to be eligible to sit the Fellowship Examination (Clinical)

3.3 Assessment requirements

(for trainees enrolled prior to 2023 under Regulation B)

Progression through the ACEM PEM Training Program requires successful completion of all assessments mandatory for the relevant stage of training.

a. Paediatric ICU, General Paediatric Medicine and Adult ED:

• • ITAs

b. Paediatric ED:

• • ITAs
  • Final Paediatric ED Report

All assessments must demonstrate the trainee’s attainment of the required knowledge, skills and attributes for the applicable stage of training across all domains of the relevant Curriculum.

3.4 Assessment requirements – ACEM PEM Training Program
(for trainees enrolled from 2023 under Regulation G)

Progression through the ACEM PEM Training Program requires successful completion of all assessments mandatory for the relevant stage of training.

a. Paediatric ICU and General Paediatric Medicine:

• • ITAs

b. Paediatric ED and Adult ED:

• • ITAs
  • Paediatric Emergency Medicine Workplace-Based Assessments (EM-WBAs)

All assessments must demonstrate the trainee’s attainment of the required knowledge, skills and attributes for the applicable stage of training across all domains of the relevant Curriculum.

3.5 Progression points

Progression decisions are based on Trainee Progression Review (TPR) Panel review of training and assessment requirements completed in the workplace (and/or any relevant Additional Training Time requirements) and are undertaken when trainees reach progression milestones in the relevant program, as prescribed in the applicable College regulations.

3.6 Progression decisions

The outcome of a progress review is that the trainee has:

a. Achieved the Standard; or

b. Not yet achieved the standard.

Achieved the standard

A decision of ‘Achieved the standard’ means that the trainee is assessed as having met the required standard of performance and prescribed requirements for the applicable stage/phase of training.

Not yet achieved the standard

A decision of ‘Not yet achieved the standard’ means that the trainee is assessed as having not yet met the required standard of performance and/or the prescribed requirements for the applicable stage/phase of training and is required to undertake a period of Additional Training Time.

3.7 Progression start dates for FACEM training

Trainees who reach a progression milestone that is not aligned with the end of a medical term, have a number of options to align to medical term dates. ‘Medical term dates’ are those published by the College on the ACEM website. Depending on time fractions and placement durations, aligning to term dates may assist trainees in reaching their next milestone at the end of a medical term rather than mid‐term, potentially making it easier to determine future progression points and plan training placements.

Except as specified below, on progression, trainees have two options for starting the next phase/stage of their training:

1. Start the next phase/stage of training the day after the progression milestone date.
2. Start the next phase/stage of training from the start of the next/future applicable medical term date.

If this option is chosen, all training time and assessments completed in the period between the progression milestone date and the next medical term date will not be credited towards meeting training time or assessment requirements, however total training time will be extended by the length of time that is forfeited.

Trainees who progress from Provisional Training to Advanced Training or Training Stage 1 to Training Stage 2, where the Primary Examination (Viva) is the final requirement completed, have the following three options for commencing Advanced Training or Training Stage 2 as applicable:

1. Start the next phase/stage of training the Monday after the sitting of the Primary Examination (Viva).
2. Start the next phase/stage of training from the start of the next/future applicable medical term date.

All training time and assessments completed in the period between the date of the Primary Examination (Viva) and the next medical term date will not be credited towards meeting training time or assessment requirements, however total training time will be extended by the length of time that is forfeited.

3. Start the next phase/stage of training from the start of the current medical term (as at the date of the Primary Examination (Viva)).

All training time and assessments completed since the start of the medical term will be credited towards meeting training time or assessment requirements. This option is only available to trainees who have progressed to Provisional or Training Stage 1 Maintenance pathway before or at the last term date.

Option 1, as applicable for the trainee’s circumstances, will be the default applied to all trainees. Trainees will be required to advise ACEM, in writing, within seven (7) days of receipt of their outcome notification if they wish to backdate or forward‐date their progression.

Trainees who choose option 2 to progress on the next/future term date will have their training due dates extended by the length of time that is forfeited and are unable to have any training time and training requirements associated with the forfeited period reinstated at a later date.

Trainees who elect to forfeit time, backdate to a term date or agree to progress on a milestone date cannot use this as grounds for any future special consideration application(s) or reconsideration, review or appeal pursuant to College policies.

3.8 Grounds for a decision of not yet achieved the standard

A decision of not yet achieved the standard will be made for one or more of the following reasons:

FACEM Training Program

Not yet achieved the required standard of performance for the applicable stage of training;

a. Non-compliance with the training and/or assessment requirements for the applicable phase of training;

b. A combination of (a) and (b);

c. Not maintained the required standard of a maintenance pathway;

d. Non-compliance with the assessment requirements of a maintenance pathway;

e. Not satisfied the requirements of any required period of additional training time.

ACEM PEM Training Program

a. Not yet achieved the required standard of performance for the applicable stage of training;

b. Non-compliance with the training and/or assessment requirements for the applicable phase of training;

c. A combination of (a) and (b);

d. Not satisfied the requirements of any required period of additional training time.

3.9 Conditions of a period of Additional Training Time

3.9.1    All Additional Training Time required pursuant to this policy and Regulation B2.6, B7.3.5 or B7.3.6 or Regulation G2.5, G7.2.1 or G7.3 as applicable is mandatory additional time and does not contribute to the training time or other requirements completed at the workplace for the relevant Training Program as specified in College regulations and section 3.7 of this policy.

3.9.2    Site accreditation limits for placements do not apply to any period of Additional Training Time.

3.9.3    Additional Training Time completed in an ED or non-ED placements cannot be counted towards Discretionary time requirements.

3.9.4    Placements undertaken for the purposes of required Additional Training Time must meet the minimum term requirements and meet all other placement requirements as prescribed in the relevant College regulations.

3.9.5    A period of Additional Training Time must ordinarily be undertaken in uninterrupted ‘blocks’ of training time of not less than three (3) FTE months at a single site.

3.9.6    A six (6) FTE month period of Additional Training Time can be undertaken at two (2) separate sites if the two periods are each undertaken in uninterrupted blocks of not less than three (3) FTE months at a single site.

3.9.7    A period of Additional Training Time ordinarily begins at the next placement where the conditions outlined in the relevant regulations and section 3.7 of this policy can be met. This may result in the following:

10. • Additional Training Time Period begins from the start of the current placement - trainee’s current placement at the time of the TPR Panel decision can be considered the additional period if it meets all conditions.
    • Additional Training Time Period begins at a future date - trainee starts their additional period at a future date if a trainee’s current placement does not meet the conditions required for the additional period specified by the TPR Panel.

3.9.8    Where a trainee is unable to meet the requirements of Section 3.9.5 and/or 3.9.6 of this policy by completing the required Additional Training Time period in three (3) FTE month uninterrupted blocks, upon application by the trainee, a variation to these requirements may be approved by the relevant TPR Panel Chair.

3.9.8.1       Any trainee applying for a variation to Section 3.9.5 and/or 3.9.6 will need to demonstrate previous placement arrangements or prior plans that are unable to be altered.

3.9.8.2       Where a variation is approved, an ITA must be submitted at the end of the varied period. This may need to be manually generated. All other requirements as specified by the College for the Additional Training Time period must also be completed.

3.9.8.3       Applications seeking such a variation must be submitted to the ACEM Training Services team within seven (7) days of receipt of the Trainee Progression Review Panel outcome.

3.9.8.4       Factors to be considered by a TPR Panel Chair in reviewing an application and the granting of a variation include, but are not limited to the following:

11. • Consistency and continuity of supervision for the Additional Training Time period
    • Time completed to date within the Additional Training Time period
    • The duration of the Additional Training Time period
    • EM-WBAs to be completed within the Additional Training Time period
    • Availability of time to complete assessments

3.9.9    Trainees undertaking a period of Additional Training Time may undertake the Primary or Fellowship Examinations of the FACEM Training Program, subject to meeting all other eligibility criteria and College requirements for the examination in question.

3.9.10  Trainees undertaking a period of Additional Training Time may undertake and/or complete the Trainee Research Requirement of the FACEM Training Program.

3.9.11   During a period of Additional Training Time, no other outstanding training requirements performed in the workplace can be satisfied until the period of additional training time is completed. Outside the provisions of Regulation G2.5.3.11, training requirements such as those listed below, will not be counted towards core training;

12. • EM-WBAs completed above the required minimum for the period of Additional Training Time
    • PER EM-WBAs to meet the paediatric requirement
    • core DOPS completed
    • ED time completed at a type of training site e.g. Major referral, Urban District, Adult/Mixed
    • Formal Teaching Presentation, M&M Presentation or Guideline/Protocol Review or Audit.

3.9.12  A period of Additional Training Time is not deemed successful until a TPR Panel has reviewed the period and made a decision that the trainee has achieved the standard required for that phase of training.

3.9.13  A trainee undertaking a period of Additional Training Time due to not achieving the standard at a progression point for the FACEM Training Program is unable to have this period or assessments completed during this period certified to outstanding training time or assessment requirements of the ACEM PEM Training Program.

3.9.14  A trainee undertaking a period of Additional Training Time due to not achieving the standard at a progression point for the ACEM PEM Training Program is unable to have this period or assessments completed during this period certified to outstanding training time or assessment requirements of the FACEM Training Program.

3.10 Additional Training Time requirements

Additional Training Time requirements are determined by the relevant TPR Panel and are tailored to the individual trainee. At a minimum, all trainees undertaking a period of Additional Training Time are required to complete:

a. a specified period of training time.

• • If Additional Training Time is prescribed following review of a trainee’s performance in Discretionary training or Maintenance Pathway, the panel will determine whether the period of Additional Training Time is required to be undertaken in ED or Non-ED placements;
  • if Additional Training Time is prescribed following review of a trainee’s performance in Critical Care training, the panel will determine whether the period of Additional Training Time is required to be undertaken in Anaesthetics or Intensive Care Medicine;
  • if Additional Training Time is prescribed following review of a trainee’s performance in the Paediatric Emergency Requirement, the panel may also determine the number and type of additional cases that need to be logged and/or additional PER EM-WBAs that are required, and

b. Workplace-based Assessments as specified by the relevant TPR Panel.

EM-WBA requirements may include variations to the number and type of individual assessments; however, not less than three (3) EM-WBAs are required for each three (3) FTE month period (‘the base rate’).

For trainees assessed as Not Yet Achieving the Standard due to underperformance, the overall number of EM-WBAs required should not exceed the minimum base rate of EM-WBAs for the prescribed period of Additional Training Time.

For trainees assessed as not yet achieving the standard for non-compliance, the overall number of EM-WBAs should not exceed the minimum base rate plus outstanding EM-WBAs not completed for the phase of training.

For trainees assessed as not yet achieving the standard for both underperformance and non-compliance, the overall number of EM-WBAs required shall be the minimum base rate of EM-WBAs for the prescribed period of Additional Training Time, in addition to the outstanding EM-WBAs not completed for the phase of training.

In a three month period of Additional Training Time a trainee must have at least two (2) different assessors across all EM-WBAs.

In a six month period of Additional Training Time a trainee must have at least three (3) different assessors across all EM-WBAs.

Other options designed to support a trainee may include, but are not limited to:

a. Completion of a specified course, workshop, conference or other educational activity deemed to address an identified area of practice requiring improvement;

b. Development of relevant local support options to assist trainees and DEMTs/Supervisors in creating an appropriate set of educational resources.

3.11 Additional Training Time limits for FACEM training

Within the FACEM Training Program, the TPR Panel will specify the length of the period of Additional Training Time according to the conditions and the needs of the individual trainee.

For trainees who enrolled in the FACEM Training Program prior to the 2022 Training Year, pursuant to Regulation B2.6.3, they may undertake a maximum of two (2) periods of Additional Training Time for each of the below training stage/phases, irrespective of whether they have undertaken Additional Training Time in any other training stage/phase:

a. Provisional Training (including Maintenance Pathway)

b. Early Phase Advanced Training

c. Late Phase Advanced Training (including Maintenance Pathway)

d. Critical Care time

e. Non-ED time

f. Discretionary time

For trainees who enrol in the FACEM Training Program from the 2022 Training Year, pursuant to Regulation G2.5.3, they may undertake a maximum of two (2) periods of Additional Training Time for each of the below training stage/phases, irrespective of whether they have undertaken Additional Training Time in any other training stage/phase:

a. Training Stage 1 (including Maintenance Pathway)

b. Training Stage 2 (including Maintenance Pathway)

c. Training Stage 3 (including Maintenance Pathway)

d. Training Stage 4 (including Maintenance Pathway)

e. Critical Care time

f. Non-ED time

From the 2020 medical training year, trainees are permitted a maximum of four (4) periods of Additional Training Time across the entirety of their FACEM training.

Trainees may undertake concurrent periods of Additional Training Time in different training stage/phases, such as Additional Training Time in Early Phase Advanced Training at the same time as Additional Training Time in Critical Care.

A period of Additional Training Time undertaken while in a Maintenance Pathway will contribute to the maximum number of periods of Additional Training Time allowed for that training stage/phase.

 

After completion of a period of Additional Training Time, the trainee will be reviewed by the relevant TPR Panel at its next scheduled meeting.

4.1 Successful review

If the trainee has complied with all additional training time requirements and is assessed by the relevant TPR Panel as meeting the required performance standard, the trainee will progress to the relevant stage/phase of training within the Training Program.

4.2 Unsuccessful review

Pursuant to College Regulations, if the trainee has not complied with all requirements and/or not yet attained the required standard, they will be assessed as not yet achieved the Standard and required to undertake a second period of Additional Training Time. If the unsuccessful period of Additional Training Time was the trainee’s second such period in the same training time component or their fourth such period across the FACEM Training Program, dismissal proceedings will commence.

 

Specific to the ACEM PEM Training program, a trainee may undertake a maximum of two (2) periods of Additional Training Time as a result of a decision of ’Not Yet Achieved the Standard’ by the ACEM PEM TPRP across the entire ACEM PEM Training Program.

If the unsuccessful period of Additional Training Time was the trainee’s second such period in the, dismissal proceedings from the ACEM PEM Training Program will commence. This will not affect the trainee’s standing in their FACEM Training Program.

Additional Training Time periods specific to PEM training do not count towards the overall four (4) allowable periods permitted within the FACEM Training Program under Regulation B2.6.3.4 or Regulation G2.5.3.4.

 

17. • Regulation B (Trainees Commencing prior to 2022 Training Year)
    • Regulation G (Trainees Commencing from 2022 Training Year)
    • ACEM Curriculum Framework
    • Exceptional Circumstances and Special Consideration Policy
    • Reconsideration, Review and Appeals Policy

Joint Paediatric Emergency Medicine Curriculum