How WPBA's Work in ED
All non-Consultant doctors and practitioners (ACP) are expected to complete WBPA. Non training and CESR doctors will be expected to complete the same number (and spread) of WBPA as their training equivalent. We recommend that wherever possible the assessment forms are completed immediately following the assessment rather than tickets being completed at a later date.
DOPS (Direct Observation of Procedural Skills)
The majority of DOPS will be completed on the “shop floor” during working shifts on patients.
RCEM RCGP, RCPCH and foundation curriculums state that some rarer procedures can be carried out in a training environment. Should a doctor/practitioner believe that they need to complete a DOPS in a training environment rather than on a patient – this need should be discussed with their Clinical/Educational Supervisor who if in agreement will liaise with the Education team to see if this is possible.
CBD (Case Based Discussions)
In order to maximise the learning opportunity CBDs are completed off the shop floor in dedicated and protected CBD Clinics. These clinics are booked in advance on EM3.org.uk. If you are working clinically you are allowed to book one 30 minute clinic spot, if you are attending during non-clinical or even your own time you are allowed to book 2 x 30 minute spots (i.e. 60 minute total) per clinic.
At the time of booking you will be expected to supply the theme of your case. Before attending the clinic we asked you to send a ticket to the Doctor that is facilitating the clinic (this is to improve the efficiency of the clinic in order to ensure that your assessment is complete prior to the end of your session). If for any reason you need to cancel your clinic slot please let Roshni know as soon as possible – if you have to cancel more than 2 slots at less than 24hours an email will be sent to your clinical supervisor.
Please note that specialist clinics are run at times – please make sure that your case is suitable if booking into one of these clinics. All higher specialist trainees need to have their CBD completed in consultant led clinics. If you are not a higher specialist trainee please ensure you utilise the full range of clinics available.
Mini CEX & ACAT
These assessments are facilitated either during normal clinical work (with the facilitating senior also working in their normal clinical shift) or during dedicated shop floor teaching sessions. In the dedicated shop floor teaching sessions –the “junior” practitioners is completing their normal working shift but the facilitating senior is supernumerary to numbers and is on a dedicated teaching shift (see shop floor teaching section for more information).
ESLE (Extended Structured Learning Event)
Who needs to do them?
The RCEM curriculum states that:
CT3 trainees need to do 2 a year (at the LRI we expected these to be done in your 6 months of “general” ED rather than PEM)
ST4 trainees need to do 3 in the year
ST5+ trainees need to do 2 a year
We ask CESR doctors (working at CT3 or above) to do 2 a year
What are ESLEs?
They are 1 to 1 training sessions that focus on non-technical skills. Each should take a total of 3 hours to complete, 2 hours of observation and a further hour of discussion/feedback (including the completion of the form).
Where do they take place?
The 2 hours of observation should occur on the shop floor
The trainee should be working as normal (done during their clinical shift)
The Consultant should be 100% supernumerary (i.e. not clinical)
Feedback should occur away from the shop floor
iPads are available from the Education team to aid completion of the form if required
Which consultants can do an ESLE?
All FRCEM consultants can do ESLE for the RCEM portfolio. The first ESLE for all trainees must be done with their Educational or Clinical supervisor within 3 months of commencing their post. 2nd or 3rd ELSE can then be done by any consultant.
How is the initial ESLE organised?
The trainee and consultant set a date at the initial supervision meeting
It is the trainees’ responsibility to inform Roshni (education administrator) of when this is happening so it can be logged in the education diary (this includes if for any reason the timing of the session is changed)
How are the 2nd and 3rd ELSE organised?
Consultants organise times when they are available to do ESLE and inform Roshni who updates the education diary. Trainees book into these slots via Roshni (this will shortly be changed to an electronic system on EM3).
If a slot is vacant 48 hours before the session – it will be cancelled and rearranged. If a session needs to be cancelled or moved (barring exceptional circumstances) then 48 hours notice must be given to Roshni (who will inform the other party involved).
Training by Grade
Each different grade/role has unique learning needs and educational requirements. The department’s expectations are laid out in separate training grade summary sheets and are available for:
F1 doctors (scroll down)
The following grades don’t have a formal summary sheet as yet (they may be available during your time with us) and guidance should be sort from your clinical supervisor at your initial meeting:
Advance Clinical Practitioners
Doctors working on EDU only
ED – Paeds subspecialty doctors
ED – pre-hospital subspecialty doctors
Paediatric – EM grid trainees
Foundation Year 1 Doctors
LRI ED will has 2 FY1 doctors every 4 months. They are supernumerary in our numbers and will work Monday to Friday 8-4. Unlike other juniors in the dept their rota does not include annual leave or study leave.
How will they work in the ED?
There are 2 distinct roles:
Role A – EDU/EFU
Role B – Adult ED
The doctors work 4 weeks in each role before rotating to the other role, in total 8 weeks will be completed in each role.
Role A: 2 weeks to be spent with the EDU and EFU teams respectively. It is expected they will work in a similar role as the F2’s. So with support they are learning to manage a ward, prioritise workload as well as review patients, and participate in on-going clinical care whilst on EDU. They should not be left as the only doctor on the unit.
The FY1 in post B will work as follows:
Monday – Majors
Tuesday – Minors
Wednesday – Resus
Thursday – Majors
Friday – Resus
In this post we anticipate the doctors working in the following ways:
Minors: paired with a senior doctor or senior ENP (not a junior doctor), participate in review clinics as well as seeing minors patients
Resus: see patients as part of the team, complete specific tasks e.g. taking blood, ordering and chasing tests. The acutely unwell patient is an important part of their curriculum and A-E assessments should be a focus
Majors: will see patients independently, but every patient is to be reviewed by the bedside by a CT3 or above
FY1 can only write inpatient prescriptions
FY1 cannot make discharge decisions
In the adult ED all their patients (if seen independently) must be reviewed in person by a CT3 or above
The area they are allocated to work in cannot be changed
They are encouraged to follow at least 5 patients through the whole ED experience (we would encourage that they could follow the patient to a ward/ITU/theatre if the accepting team is ok with this)
As they are supernumerary, they should be released for the following educational activities...
Local FY2 teaching
Quality and safety meetings
M&M meetings where juniors are invited
Participate in the in situ simulation (initially helping in delivery and then near end of job active participation)
Can help in other departmental teaching e.g. simulation days as actors
Experience/taster half days – permission needs to be sort in advance
6 WBPA (2 DOPS, 2 CBD, 2 mini CEX)
Involvement in an Audit orMini QIP