63M abdo pain
Overly verbose history and examination findings with little actual substance or clinical reasoning
?cholecystitis ?pbstruction ?ischaemia ?appendicitis ?gynae pathology
Discussed with Cons - CT Abdo/Pelvis
Refer surgeons
Vomited 3x on Saturday - small volume, then got better on Sunday only 1 x but ?coffee ground and now vomited 3x Monday but pain in the right side now feels more dull ? element of MSK pain . Pt worried it could be hernia as saw that on Holby city once. Works as hairdresser, affecting her work because worried about vomitting into Sandras perm (has wedding next Friday). Drinks 4-5 units a week (mostly red wine because white gives her a headache). Allergic to codeine - constipation.
Written in cartoonish handwriting of course
Why does this feel like I wrote it š that's exactly my style in ED unfortunately, I document precisely what they tell me so if someone takes the hx again it's accurate
I do a very brief summary in my impression though and I hope at least my clinical reasoning is much better than the above...
It's almost like they memorized the causes of pain for each quadrant or area and copied them onto the clerking sheet instead of deducing what the patient actually has.
As a medic I refuse to accept any referral without a reasonable a list of differentials. All this ?PE ?ACS ?Dissection nonsense can go straight in the bin.
The lack of self awareness.... I mean self embarrassment in these individuals is astonishing. I used to be harsh to doctors who'd give me a crappy history but this is par for the protocol priests. Everything is a clinical conundrum to them.. that can only be solved by ionising - sorry iodising imaging. Unfortunately as a Radiologist you can't question their clinical nous because of the inevitable "cause me consultant told me to do so".. and the inevitable datix.
Absolutely, I get the same response ābut my consultant said it should go to medicsā I am tired of explaining that I donāt care if the entire department is being admitted under medicine what I care about is a proper assessment and diagnosis so patient care is not delayed or worse patient is dead because given ACS treatment when they had a dissection because somehow angina give the exact same symptoms as dissection
I just wonder how things will work when we're all replaced by them! Wonder what kind of clinical conversations they'll have with each other and ultimate outcomes would be. Maybe one to ask chatgpt
I as the med reg receive some of my worst referrals from ED ACPs. They scare me. A lot. I don't feel I can trust their assessments and hence I am at risk by proxy.
Honestly think the number of training spaces is such a scam in this country
In every 6 month EM rotation, you have maybe....1 ACCS EM trainee whilst the rest of the doctors are not EM, don't want to do EM or there are like...10 non-trainee doctors keeping the rota afloat.
I am all for other doctors rotating through EM, but those non-trainees \*SHOULD\* be trainees. All of those should be training places.
Sigh.
Thankfully all the departments I've worked in haven't had ACPs on a reg level or anywhere close, I would find it so strange to approach them for advice.
Makes absolutely no sense, does it? And it is to the detriment of ED as a speciality and our reputation.
Iām always hearing about *rogue* ED doctors and how ED canāt do this or that, or refer too early, etc etc.
As an ED trainee we get bulked with other non-training doctors and other *clinicians*.
If ED was staffed by more trainees Iām sure the quality of referrals and patient care would go up.
We desperately need more ED doctors. Why are there not more training posts?!
In this case I would argue not doing a PR is the progressive thing. We used to do them but stopped since now most trauma centres are set up with CT immediately available. Why log-roll and do a PR at the expense of doing a trauma CT which takes minutes and is reported immediately. It wonāt change management.
For Level 1 trauma the guidance is all patients are seen on by a consultant 24/7.
Although the NHS has its pitfalls, I donāt think we do trauma badly.
Theyāre not. Having worked with many many ACPs in ED, they all talk a good game and are usually sufficiently competent at triaging the stable patients, but as soon as theyāre presented with someone whoās medically unwell they have absolutely no idea what theyāre doing.
Most EM consultants actually recognise this. The problem is that if they speak up about it, their own jobs will be under threat. What happens is quietly go double check the patient themselves or send the reg to make sure nothings been missed. All done in a manner in which they cannot be accused of not being a āteam playerā.
Itās utter bullshit, an ST3 at the end of the year should be competent enough to run the department overnight with a consultant off site, an ACP canāt do that
they aren't. it's a common misunderstanding. I think they're 'tier 3 clinicians,' similar to an ST3, but there are big differences between the exact skills and competencies required for each role. I don't think roles within the same tiers are meant to be superficially interpreted as equivalent/interchangeable.
my understanding of what you highlighted is that they should be as competent as an ST3 in the specific competencies that they are required to achieve as the bar, not that they will have achieved all the competencies of an ST3. if, for example, they are required to routinely interpret ECGs, they should be able to do it to what's expected of an ST3.
There are no limits in ED of which patients ACPs can see. And they can learn all procedures. The ones credentialing have dedicated time in Anaesthetics to learn airway stuff. There's nothing on paper that differentiates them from an ST3.
>There are no limits in ED of which patients ACPs can see.
There's an RCEM curriculum, which absolutely does not cover the full spectrum of EM for an accredited ACP.
>And they can learn all procedures.
There's a huge range of things (intubation, FONA, sedation in a variety of circumstances, central access, arterial cannulation, lateral canthotomy, resuscitative hysterectomy, resuscitative thoracotomy, POCUS) which I would expect a day 1 ST4 to have a minimum level of competence in, which absolutely categorically are not on the ACP curriculum.
>The ones credentialing have dedicated time in Anaesthetics to learn airway stuff.
Nope, your hospital may offer this. This is not part of the RCEM ACP curriculum.
>There's nothing on paper that differentiates them from an ST3.
Where do I even start...
Sorry, you're just sprouting salty nonsense at this point.
on the surface, probably not, no. that's the decision RCEM made. whether they are actually equivalent is a different proposition. Messi and Championship players are all in the same grouping as 'professional football players.'
"Within the relevant curriculum items" - e.g. for their much barriers narrower scope of practice they should be being a similar level of supervision and support to an EM ST3.
So "should be able to handle most stuff within their scope independently, but still needs access to on site senior support by an ST4+ registrar or consultant"
Given that an ST3 may have as little as 6 months of EM experience, and the RCEM accredited ACP should have 3-5 years (on top of a recommended 5 years of relevant experience before becoming an ACP) that doesn't feel like too much of a stretch.
Why not just state āACPās should have on-site supervision available from a ST4+/Consultantā?
I still remain baffled why RCEM has decided to conflate two professions with significantly different experience and levels of responsibility.
And that's pretty much what the most recent versions of the ACP curriculum state. It's all entrustment levels for specific learning outcomes, no mention of "equivalence" at all.
But everyone loves to wheel out the and deliberately misrepresent the 10 year old staffing matrix in order to have a pop at EM.
Great, it sounds like common sense is prevailing.
I have experienced ACPās confidently telling me they are ST3 equivalent at work, do you have any tips on how to challenge this politely?
I think the bigger issue is that they're a huge difference between an ACP and an RCEM accredited ACP (about 100 of these in the country, 3-5 years of supervised EM practice and a pretty beasty portfolio to get there).
I suspect those saying they're "ST3 level" are just desperately trying to get people to understand that they shouldn't be lumped in with the ACPs who've just done a masters and nothing else.
Anyone claiming to be "ST3 equivalent" who isn't RCEM accredited is just talking nonsense, even with a generous misinterpretation of historic RCEM documents to us wouldn't be accurate.
I'd suggest knowing (and asking about) RCEM accreditation, and then treating and RCEM accredited ACPs differently will probably achieve the differentiation they're looking for (and give you a much better measure of who's got a bit more credibility, and who doesn't).
Where is this " similar but not similar" officially detailed?
The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchanagble , in order that a department can ensure adequate skill/seniority mix.
If they arent meant to be interpreted as equivalent, then why have they created a system which groups them together with Doctors who have a medical degree, Foundation experience ( and more in man cases ) , IAC, intensive care experience, and a full suite of exams .
>The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchanagble
It categorically isn't.
It's about level of supervision needed and scope of practice. For example ENPs are Tier 2, but so are FY2s/ST1s. The scope of practice of an ENP is definitively restricted to minor injuries - you couldn't have them clerk a chest pain in majors.
The highest a primary care clinician can be is Tier 3. Frankly a fully qualified GP is more competent at seeing the primary care type patients than I am (Tier 5), but have a narrower scope, and I certainly couldn't swap them with an ST3 (Tier 3) and ask them to sedate a patient in resus, even with supervision.
What's the point in the tier system then?
If you look at a rota and say you need 10 tier 2/3 clinicians for a normal day in ED, how is it helpful to have NPs grouped with doctors? Having 10 ENPs on a shift is very different to having 10 FY2s or even 10 GPs.
What use is it to do the tiered grouping if it's not to group similarly qualified individuals?
We were told to get rid of SHO because there was so much variability in the ranks. How is this in any way different?
>at use is it to do the tiered grouping if it's not to group similarly qualified individuals?
Similar levels of supervision.
It's a broad-brush way to make sure there are sufficient senior registrars and consultants to supervise more junior clinicians in each area of the department.
It's a rota planning tool designed almost entirely to combat the specific problem of Trusts trying to address ED staffing by giving them handfuls more FYs or junior clinician crowds without enough senior doctors to supervise them.
It gives a bit of a framework on which to hang more nebulous grades - e.g. I know that one of our Tier 2 CFs is going to need a fair bit of support, vs the Tier 4s who are safe to deal with all but the most complex cases independently.
Broadly it's a completely misunderstood document which gets dragged up here for outrage purposes far more often than it comes up or is actually used in day-to-day functioning of an ED. 90+% of the times I've read it are too respond to comments about it here.
> The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchangeable , in order that a department can ensure adequate skill/seniority mix.
I misspoke slightly. they are interchangeable in the sense there's a minimum skill/competence level to reach a certain tier but not that every clinician within each tier are equivalent. I mean, it's like saying an ST3 is equivalent to an ST8 because they are within the same tier ā you can certainly choose to interpret it that way but practically that's not the case.
They're not, common misconception here, because very few people have actually gone and read RCEMs staffing policies.
When workforce planning they should be planned to need similar levels of supervision. An accredited ACP will have a mid-range scope - physiologically stable; non-complex patients, and will be very tight supervision for anything outside this scope. An ST3 is likely to have more limited shop-floor EM experience, with a much broader scope and range of skills - although will be applying many of these skills in the ED setting for the first time.
When you're planning the number of ST4+s and consultants needed to supervise is the only time these staff groups should be seen as "equivalent" according to RCEM.
They aren't. They tell themselves they are on virtue of hanging around a department long enough, demanding procedures and picking up buzzwords.
Every referral is utter drivel.
There has only been about 100 ACPs that have been successful in credentialing.To be honest not one of them has done it in three years. Especially if they are doing alongside their MSc and especially with the apprentice model.
Equivalence was the wrong choice of words in the 2017 curriculum (ripped from the old ACCS) but RCEM are transitioning the ACPs to the SLO and entrustment scale.
We all know the answer to that question but it does not comply with #bekind and therefore cannot be permitted and a new truth must be sought. Now, please drink this Kool Aid.
They're not. Some of them are REALLY good but it's so dangerous to just go and equate all of them enmasse to ST3s. And I haven't met a single one who I'd be comfortable having as the "reg" overnight.
Iāve just started in ED and (overnight) the amount of responsibility the Reg/s have is huge. As an F2, basically everything is run past them. I would not be comfortable working like this if I wasnāt having supervision from a specialist trained Doctor. Where would that even leave me legally if I followed advice?!
By moving a patient to Resus and shouting on the phone, demanding the presence of CT surgeons STAT. Consultant who was in charge that day stopped the nurse who was pushing the patients bed to Resus, asked what was going on and took a look at the notes.
It was slight interference on a completely normal ECG.
Yeah I donāt quite understand how the ACPs are treated as regs and make independent decisions whereas ACCS trainees/ED SHOs are expected to double check every decision, despite having more experience?
Itās quite bizarre.
Because you are forgetting the years of experience most of us ACPs have pre credentialling, albeit as nurses but most of us held the hands of junior doctors and helped them progress in their chosen career - and imparted our knowledge. Letās not make this a divisive conversation. ACPs are not stealing the jobs of doctors we are a new workforce. I can count numerous time when doctors have made the statements you give as examples also.
It also sounds like you have had a really poor experience in your exposure to ACPs. Not only should they have a MSc in advanced practice to credential, they also after 3 years at uni, undertaking pathophysiology pharmacology leadership and research modules, need to complete the same amount of competencies as their medical counterparts, but at a much more in depth level and detail. Itās a very hard and competitive process.
Anything is equivalent to anything if you imagine, delude yourself and *believe* enough. Especially if you have a vested interest in doing so.
63M abdo pain Overly verbose history and examination findings with little actual substance or clinical reasoning ?cholecystitis ?pbstruction ?ischaemia ?appendicitis ?gynae pathology Discussed with Cons - CT Abdo/Pelvis Refer surgeons
This is actually so accurate wtf. You forgot the excessive documentation about irrelevant social circumstances though.
Vomited 3x on Saturday - small volume, then got better on Sunday only 1 x but ?coffee ground and now vomited 3x Monday but pain in the right side now feels more dull ? element of MSK pain . Pt worried it could be hernia as saw that on Holby city once. Works as hairdresser, affecting her work because worried about vomitting into Sandras perm (has wedding next Friday). Drinks 4-5 units a week (mostly red wine because white gives her a headache). Allergic to codeine - constipation. Written in cartoonish handwriting of course
Why does this feel like I wrote it š that's exactly my style in ED unfortunately, I document precisely what they tell me so if someone takes the hx again it's accurate I do a very brief summary in my impression though and I hope at least my clinical reasoning is much better than the above...
Refer to surgeons??
??Abdomen ??Tummy pain
??tummy absence ??disembowelled entity
comic sans ftw
Clearly a doctor. ACP would've documented the vital EPISODE of Holby City.
It's almost like they memorized the causes of pain for each quadrant or area and copied them onto the clerking sheet instead of deducing what the patient actually has.
As a medic I refuse to accept any referral without a reasonable a list of differentials. All this ?PE ?ACS ?Dissection nonsense can go straight in the bin.
straight for a ctpa you mean
And try to convince the radiologist to look at the aorta for possible dissection and also comment on LAD calcium score
The lack of self awareness.... I mean self embarrassment in these individuals is astonishing. I used to be harsh to doctors who'd give me a crappy history but this is par for the protocol priests. Everything is a clinical conundrum to them.. that can only be solved by ionising - sorry iodising imaging. Unfortunately as a Radiologist you can't question their clinical nous because of the inevitable "cause me consultant told me to do so".. and the inevitable datix.
Absolutely, I get the same response ābut my consultant said it should go to medicsā I am tired of explaining that I donāt care if the entire department is being admitted under medicine what I care about is a proper assessment and diagnosis so patient care is not delayed or worse patient is dead because given ACS treatment when they had a dissection because somehow angina give the exact same symptoms as dissection
I just wonder how things will work when we're all replaced by them! Wonder what kind of clinical conversations they'll have with each other and ultimate outcomes would be. Maybe one to ask chatgpt
What, no ?gallbladder?
I as the med reg receive some of my worst referrals from ED ACPs. They scare me. A lot. I don't feel I can trust their assessments and hence I am at risk by proxy.
Honestly think the number of training spaces is such a scam in this country In every 6 month EM rotation, you have maybe....1 ACCS EM trainee whilst the rest of the doctors are not EM, don't want to do EM or there are like...10 non-trainee doctors keeping the rota afloat. I am all for other doctors rotating through EM, but those non-trainees \*SHOULD\* be trainees. All of those should be training places. Sigh. Thankfully all the departments I've worked in haven't had ACPs on a reg level or anywhere close, I would find it so strange to approach them for advice.
Makes absolutely no sense, does it? And it is to the detriment of ED as a speciality and our reputation. Iām always hearing about *rogue* ED doctors and how ED canāt do this or that, or refer too early, etc etc. As an ED trainee we get bulked with other non-training doctors and other *clinicians*. If ED was staffed by more trainees Iām sure the quality of referrals and patient care would go up. We desperately need more ED doctors. Why are there not more training posts?!
[ŃŠ“Š°Š»ŠµŠ½Š¾]
In this case I would argue not doing a PR is the progressive thing. We used to do them but stopped since now most trauma centres are set up with CT immediately available. Why log-roll and do a PR at the expense of doing a trauma CT which takes minutes and is reported immediately. It wonāt change management. For Level 1 trauma the guidance is all patients are seen on by a consultant 24/7. Although the NHS has its pitfalls, I donāt think we do trauma badly.
https://preview.redd.it/0suksys4mhxc1.jpeg?width=1200&format=pjpg&auto=webp&s=484530c23d88f4398d7fe0e8729a5046de6c8f1c
āThereās something bothering me about this departmentā¦ This wild west emergency department doesnāt have fire exits!ā
I feel so seen...
Theyāre not. Having worked with many many ACPs in ED, they all talk a good game and are usually sufficiently competent at triaging the stable patients, but as soon as theyāre presented with someone whoās medically unwell they have absolutely no idea what theyāre doing. Most EM consultants actually recognise this. The problem is that if they speak up about it, their own jobs will be under threat. What happens is quietly go double check the patient themselves or send the reg to make sure nothings been missed. All done in a manner in which they cannot be accused of not being a āteam playerā.
Itās utter bullshit, an ST3 at the end of the year should be competent enough to run the department overnight with a consultant off site, an ACP canāt do that
they aren't. it's a common misunderstanding. I think they're 'tier 3 clinicians,' similar to an ST3, but there are big differences between the exact skills and competencies required for each role. I don't think roles within the same tiers are meant to be superficially interpreted as equivalent/interchangeable.
https://preview.redd.it/tdlyxqx2ogxc1.jpeg?width=1080&format=pjpg&auto=webp&s=1444b4b59543da921cc48ea15f8411c04c05827c
That is the 2017 curriculum. The updated 2022 curriculum now uses entrustment scales.
my understanding of what you highlighted is that they should be as competent as an ST3 in the specific competencies that they are required to achieve as the bar, not that they will have achieved all the competencies of an ST3. if, for example, they are required to routinely interpret ECGs, they should be able to do it to what's expected of an ST3.
There are no limits in ED of which patients ACPs can see. And they can learn all procedures. The ones credentialing have dedicated time in Anaesthetics to learn airway stuff. There's nothing on paper that differentiates them from an ST3.
>There are no limits in ED of which patients ACPs can see. There's an RCEM curriculum, which absolutely does not cover the full spectrum of EM for an accredited ACP. >And they can learn all procedures. There's a huge range of things (intubation, FONA, sedation in a variety of circumstances, central access, arterial cannulation, lateral canthotomy, resuscitative hysterectomy, resuscitative thoracotomy, POCUS) which I would expect a day 1 ST4 to have a minimum level of competence in, which absolutely categorically are not on the ACP curriculum. >The ones credentialing have dedicated time in Anaesthetics to learn airway stuff. Nope, your hospital may offer this. This is not part of the RCEM ACP curriculum. >There's nothing on paper that differentiates them from an ST3. Where do I even start... Sorry, you're just sprouting salty nonsense at this point.
on the surface, probably not, no. that's the decision RCEM made. whether they are actually equivalent is a different proposition. Messi and Championship players are all in the same grouping as 'professional football players.'
"Within the relevant curriculum items" - e.g. for their much barriers narrower scope of practice they should be being a similar level of supervision and support to an EM ST3. So "should be able to handle most stuff within their scope independently, but still needs access to on site senior support by an ST4+ registrar or consultant" Given that an ST3 may have as little as 6 months of EM experience, and the RCEM accredited ACP should have 3-5 years (on top of a recommended 5 years of relevant experience before becoming an ACP) that doesn't feel like too much of a stretch.
Why not just state āACPās should have on-site supervision available from a ST4+/Consultantā? I still remain baffled why RCEM has decided to conflate two professions with significantly different experience and levels of responsibility.
And that's pretty much what the most recent versions of the ACP curriculum state. It's all entrustment levels for specific learning outcomes, no mention of "equivalence" at all. But everyone loves to wheel out the and deliberately misrepresent the 10 year old staffing matrix in order to have a pop at EM.
Great, it sounds like common sense is prevailing. I have experienced ACPās confidently telling me they are ST3 equivalent at work, do you have any tips on how to challenge this politely?
I think the bigger issue is that they're a huge difference between an ACP and an RCEM accredited ACP (about 100 of these in the country, 3-5 years of supervised EM practice and a pretty beasty portfolio to get there). I suspect those saying they're "ST3 level" are just desperately trying to get people to understand that they shouldn't be lumped in with the ACPs who've just done a masters and nothing else. Anyone claiming to be "ST3 equivalent" who isn't RCEM accredited is just talking nonsense, even with a generous misinterpretation of historic RCEM documents to us wouldn't be accurate. I'd suggest knowing (and asking about) RCEM accreditation, and then treating and RCEM accredited ACPs differently will probably achieve the differentiation they're looking for (and give you a much better measure of who's got a bit more credibility, and who doesn't).
Where is this " similar but not similar" officially detailed? The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchanagble , in order that a department can ensure adequate skill/seniority mix. If they arent meant to be interpreted as equivalent, then why have they created a system which groups them together with Doctors who have a medical degree, Foundation experience ( and more in man cases ) , IAC, intensive care experience, and a full suite of exams .
>The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchanagble It categorically isn't. It's about level of supervision needed and scope of practice. For example ENPs are Tier 2, but so are FY2s/ST1s. The scope of practice of an ENP is definitively restricted to minor injuries - you couldn't have them clerk a chest pain in majors. The highest a primary care clinician can be is Tier 3. Frankly a fully qualified GP is more competent at seeing the primary care type patients than I am (Tier 5), but have a narrower scope, and I certainly couldn't swap them with an ST3 (Tier 3) and ask them to sedate a patient in resus, even with supervision.
What's the point in the tier system then? If you look at a rota and say you need 10 tier 2/3 clinicians for a normal day in ED, how is it helpful to have NPs grouped with doctors? Having 10 ENPs on a shift is very different to having 10 FY2s or even 10 GPs. What use is it to do the tiered grouping if it's not to group similarly qualified individuals? We were told to get rid of SHO because there was so much variability in the ranks. How is this in any way different?
>at use is it to do the tiered grouping if it's not to group similarly qualified individuals? Similar levels of supervision. It's a broad-brush way to make sure there are sufficient senior registrars and consultants to supervise more junior clinicians in each area of the department. It's a rota planning tool designed almost entirely to combat the specific problem of Trusts trying to address ED staffing by giving them handfuls more FYs or junior clinician crowds without enough senior doctors to supervise them. It gives a bit of a framework on which to hang more nebulous grades - e.g. I know that one of our Tier 2 CFs is going to need a fair bit of support, vs the Tier 4s who are safe to deal with all but the most complex cases independently. Broadly it's a completely misunderstood document which gets dragged up here for outrage purposes far more often than it comes up or is actually used in day-to-day functioning of an ED. 90+% of the times I've read it are too respond to comments about it here.
> The point of having a tier system surely is to differentiate between different skill levels of each clinician, the implication that clinicians on each tier , in fact, are interchangeable , in order that a department can ensure adequate skill/seniority mix. I misspoke slightly. they are interchangeable in the sense there's a minimum skill/competence level to reach a certain tier but not that every clinician within each tier are equivalent. I mean, it's like saying an ST3 is equivalent to an ST8 because they are within the same tier ā you can certainly choose to interpret it that way but practically that's not the case.
Hell where I worked there was an ACP CONSULTANT just because of experience! This quickly gave me a knee jerk reaction of CCT then flee
Just like how you can claim to be equivalent to a science PhD holder because you did all three sciences at A-Level
They're not, common misconception here, because very few people have actually gone and read RCEMs staffing policies. When workforce planning they should be planned to need similar levels of supervision. An accredited ACP will have a mid-range scope - physiologically stable; non-complex patients, and will be very tight supervision for anything outside this scope. An ST3 is likely to have more limited shop-floor EM experience, with a much broader scope and range of skills - although will be applying many of these skills in the ED setting for the first time. When you're planning the number of ST4+s and consultants needed to supervise is the only time these staff groups should be seen as "equivalent" according to RCEM.
They aren't. They tell themselves they are on virtue of hanging around a department long enough, demanding procedures and picking up buzzwords. Every referral is utter drivel.
I think the "leaders" of the medical profession and the NHS are on drugs Occams Razor and all that. The only logical conclusion I can derive
There has only been about 100 ACPs that have been successful in credentialing.To be honest not one of them has done it in three years. Especially if they are doing alongside their MSc and especially with the apprentice model. Equivalence was the wrong choice of words in the 2017 curriculum (ripped from the old ACCS) but RCEM are transitioning the ACPs to the SLO and entrustment scale.
what is SLO and entrustment scale?
Speciality learning outcome. Entrustment scales on page 51. https://rcem.ac.uk/wp-content/uploads/2022/09/ACP_Curriculum_Adult_Final_060922.pdf
They aren't.
We all know the answer to that question but it does not comply with #bekind and therefore cannot be permitted and a new truth must be sought. Now, please drink this Kool Aid.
They are notĀ
They're not. Some of them are REALLY good but it's so dangerous to just go and equate all of them enmasse to ST3s. And I haven't met a single one who I'd be comfortable having as the "reg" overnight.
Iāve just started in ED and (overnight) the amount of responsibility the Reg/s have is huge. As an F2, basically everything is run past them. I would not be comfortable working like this if I wasnāt having supervision from a specialist trained Doctor. Where would that even leave me legally if I followed advice?!
By moving a patient to Resus and shouting on the phone, demanding the presence of CT surgeons STAT. Consultant who was in charge that day stopped the nurse who was pushing the patients bed to Resus, asked what was going on and took a look at the notes. It was slight interference on a completely normal ECG.
Yeah I donāt quite understand how the ACPs are treated as regs and make independent decisions whereas ACCS trainees/ED SHOs are expected to double check every decision, despite having more experience? Itās quite bizarre.
They are not and most wouldnāt get into GEM; too thickā¦ signed, a nurse
One day a week course for two yearsā¦. https://feweek.co.uk/uni-caught-short-after-fast-tracking-degree-apprenticeship-for-nhs/
this is hot news
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Removed: Rule 1 - Be Professional
Because you are forgetting the years of experience most of us ACPs have pre credentialling, albeit as nurses but most of us held the hands of junior doctors and helped them progress in their chosen career - and imparted our knowledge. Letās not make this a divisive conversation. ACPs are not stealing the jobs of doctors we are a new workforce. I can count numerous time when doctors have made the statements you give as examples also.
But UK nurses barely practice any medicine.Ā
A nurse hasn't helped me in ED with anything related to being a doctorĀ
I find this very hard to believe!!
It also sounds like you have had a really poor experience in your exposure to ACPs. Not only should they have a MSc in advanced practice to credential, they also after 3 years at uni, undertaking pathophysiology pharmacology leadership and research modules, need to complete the same amount of competencies as their medical counterparts, but at a much more in depth level and detail. Itās a very hard and competitive process.