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ECP C&C document June 07

C
Chris Wintle

An Emergency Care Practitioner is a healthcare professional trained to work across settings like ambulances, GP surgeries, urgent care centers to provide treatment for less serious illnesses and injuries. The role aims to improve patient care by completing episodes of care when possible and referring patients to the most appropriate provider. Studies have found that Emergency Care Practitioners can reduce emergency department visits and hospital admissions by treating patients in their homes or in urgent care centers.

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The Competence and Curriculum Framework for the Emergency Care Practitioner better skills better jobs better health
2 DH INFORMATION READER BOX Work Area: Commissioning Purpose: For information Gateway Ref: 8399 Title: The Competence and Curriculum Framework for the Emergency Care Practitioner Author: ECP Team, Skills for Health Issue Date: June 2007 Target Audience: PCT CEs, NHS Trust CEs, SHA CEs Medical Directors, Directors of Nursing, PCT PEC Chairs, Directors of HR, Allied Health Professionals, Emergency Care Leads, Patient groups, professional bodies, trade unions, Higher Education Institutions, deaneries. All those involved in delivering or developing educational programmes leading to qualification as an ECP. Potential employers of ECPs. Those considering undertaking training to become an ECP. Circulation List: PCT CEs, NHS Trust CEs, SHA CEs, Foundation Trust CEs Description: The Competence and Curriculum Framework outlining the core nationally agreed education and training requirements of the Emergency Care Practitioner following review of previous curriculum guidance and formal consultation Cross Reference: Taking Healthcare to the Patient Right Skill, Right Time, Right Place Superseded Docs: The Competence and Curriculum Framework for Emergency Care Practitioner Consultation Document Action Required: N/A Timing: N/A Contact Details: Skills for Health 1st Floor Goldsmiths House Broad Plain Bristol BS2 0J Tel: 0117 922 1155 Fax: 0117 925 1880 E-mail: ECP@skillsforhealth.org.uk Website: www.skillsforhealth.org.uk
3 Contents Acknowledgements 4 Outline of document 5 1. Introduction 9 2. Positive outcomes identified during the development of the role 13 3. The competence framework 18 4. The curriculum framework 26 5. Educational assessment 36 6. Validation, accreditation and the evaluation of the programme 40 Appendix 1: The Competence Framework for Emergency Care Practitioners 42 Appendix 2: Learning Outcomes for Emergency Care Practitioners Working in Pre-Hospital, Primary and Acute Care Settings 57 Appendix 3: An Example of a Theory and Clinical Module for the Education of Emergency Care Practitioners 72 Appendix 4: Membership of Governance Groups 86 References 87
4 Acknowledgements The Competence and Curriculum Framework for the Emergency Care Practitioner is the fruition of four years work. Originating with the Coventry and Warwickshire pilot and then moving to the trial sites the overriding objective has been to develop a workforce fit for purpose to deliver urgent care across healthcare boundaries. This framework could not have been delivered without the unstinting support of Professor, Sir George Alberti and the members of the Strategy Group (see Appendix 4), the help of the Voluntary Regulatory Committee (see Appendix 4), the Benchmarking Group and the Emergency Care Practitioner Leads. We are indebted to them all. The recently concluded consultation process has led us to make several changes to our original framework and we now believe that we have a robust basis to launch the definitive document which will allow for the further development of this unique professional group. This process was supported by a number of national Reference Groups and overseen by the ECP Strategy Group. We would also like to express our gratitude to those practicing ECPs and the organisations who allowed us to use their images in this document. Skills for Health Emergency Care Practitioner Team: Chris Wintle Belle Connell John Gosnold Mark Bilby Hugo Minney
5 Outline of document This document represents the final stage in the development of the Emergency Care Practitioner role. The role is designed to support the changing needs of patients requiring urgent care and is the product of work undertaken since the Skills for Health Emergency Care Practitioner Team were originally commissioned by the Urgent Care Workforce Programme Board in May 2005 to develop the Competence and Curriculum Framework. Since that time, building on earlier work to develop a curriculum through a number of trial sites, the Emergency Care Practitioner Team have consulted widely including a Public Consultation on the Competence and Curriculum Framework and have revised it considerably, in the light of that consultation. Throughout the development of the Emergency Care Practitioner role the objective has been to produce professionals who were capable of working in new and more flexible ways, and, by removing traditional boundaries, develop a new role by matching the competence requirements of the role to the care requirements of patients. Should local organisations wish to introduce ECPs into their service provision we would recommend that they follow this framework. Within the framework of the competences, it is envisaged that Emergency Care Practitioners can be deployed in a number of ways to support local services. These might include working with Ambulance Services, in General Practitioner surgeries, conducting home and community visits, providing care in Urgent Care Centres and delivering Out of Hours services. Other areas of work being explored are Police Custody Suites and Prison Medical Services. This document outlines the knowledge, skills and core competences which all Emergency Care Practitioners must achieve at the point of qualification.
6 Foreword I welcome this document as a key milestone in the development and establishment of Emergency Care Practitioners (ECPs). It gives valuable advice and timely guidance to commissioners and providers on how to effectively use and deploy ECPs. It also provides confirmation of the educational process that needs to be undertaken by Higher Education Institutions in order to successfully deliver qualified ECPs. ECPs are one of a number of new roles to emerge following the publication of the NHS Plan (2000) 1 and more recently Transforming Emergency Care (2001) 2 . The provision of urgent care has needed to develop to better meet the needs of patients and communities as part of the wider reforms of the NHS. ECPs continue to have an important role to play in providing urgent care in an environment of increasing demand and increased patient expectation. ECPs can help to ensure that this care is provided at the right time and in a convenient location for them to access. There is sound evidence that the ECP role does not only meet the needs of patients, but that it, in addition, provides excellent career opportunities for staff. The ability of staff to proactively shape the way that services are provided is an integral element of the reform process. ECPs will be well placed to undertake these challenges across sectors, as well as within them. This Competence and Curriculum Framework provides commissioners, providers of NHS services and Higher Education Institutions with the tools to be able to develop ECPs who are both skilled and motivated to provide emergency and urgent care for all patients. Lord Philip Hunt OBE Minister of State for Quality
7 Prefaces The forthcoming framework for urgent and emergency care is being developed to support the providers of urgent care services, including primary care trusts, ambulance trusts, out of hour’s services and emergency departments in developing high quality services that are patient focused. The challenges for organisations in the provision of urgent care continue to be high profile and this care will no longer be provided just in emergency departments, or in General Practitioners surgeries. A flexible workforce and a flexible approach to skill mix – breaking down professional and traditional boundaries – are central to achieving these improvements in urgent care: patients should receive the highest standard of care, provided by an appropriately trained person, at an appropriate time, in the most appropriate setting for the patient. This document provides a national benchmark for a practitioner who can work across the urgent care pathway; it should be used by providers of services to introduce Emergency Care Practitioners, and by commissioners as it defines the minimum educational requirements for such a practitioner. I believe that Emergency Care Practitioners are one of the many significant developments in urgent care and have proved to be successful in supporting our common goal of improved urgent care for all who need it. Professor Sir George Alberti National Director for Emergency Access
8 Skills for Health was established as the Sector Skills Council for the health sector to help the whole sector develop solutions that deliver a skilled and flexible UK workforce in order to improve health and healthcare. The role of the Emergency Care Practitioner (ECP) was developed specifically to ensure that staff are equipped with the right skills to meet patient need. The role has been expressed through Skills for Health’s competences which were used to develop the original learning outcomes and national curriculum for the role. This curriculum was implemented by the seventeen health economies who originally trialled the role. Use of the competency framework has ensured consistency across trial sites and promoted national transferability of the role. Following the successful conclusion of these trials the curriculum has been reviewed and updated to ensure that all necessary competences are included. We believe that the development of Emergency Care Practitioners has demonstrated the benefits of competence-based role development which has led to improved outcomes for patients, service providers and staff alike. It has allowed staff to develop into clinical roles in level 6 and 7 of the Career Framework for Health which transcend the whole urgent and emergency care pathway. John Rogers Chief Executive Skills for Health
9 Introduction 1.1 Definition An Emergency Care Practitioner may be defined as a healthcare professional who works to a medical model, with the attitude, skills and knowledge base to deliver holistic care and treatment within the pre-hospital, primary and acute care settings with a broadly defined level of autonomy. 1.2 The role of the Emergency Care Practitioner Emergency Care Practitioners were developed out of the Practitioner in Emergency Care (PEC) concept, which was first suggested by the Joint Royal Colleges Ambulance Liaison Committee and the Ambulance Service Association3 . The Emergency Care Practitioner role is part of a wider reform of the way in which urgent care is delivered. The main focus of the role is to enhance the patients’ experience through their emergency, urgent and urgent care journey by providing emergency assessment, diagnosis, treatment and aftercare. The competence based education enables Emergency Care Practitioners to make independent decisions based on sound clinical assessment and judgement, to complete episodes of care in a range of settings, including the out of hospital setting, when it is safe and appropriate, and to arrange appropriate referrals. This not only improves capacity and efficiency across the emergency care network but also offers other staff in the elective care environment more time to concentrate on their own caseload. Emergency Care Practitioners currently come from the Nursing or Paramedic professions, and have completed the competence-based education programme developed by the NHS Modernisation Agency’s Changing Workforce Programme (CWP) in partnership with Skills for Health. Emergency Care Practitioners deliver care that is patient-focused, in the least intensive and most convenient and appropriate place for the patient. They can provide a rapid response to an episode of urgent care, in a number of different environments, (e.g. Ambulance Services, General Practice, Urgent Care Centres, Out of Hours Service, Rapid Response Vehicles, Walk in Centres and Emergency Departments), treat at the scene if appropriate and refer to other primary care professionals to prevent avoidable Emergency Department attendances or admissions to secondary care. In addition to this, Emergency Care Practitioners can also enhance primary care capacity; provide an alternative model of delivering urgent care out of hours and provide an alternative model of delivering prison health care4,5,6,7,8 .
10 The Emergency Care Practitioners support patients in making genuine choices and informed decisions about where they wish to receive treatment, quite often in the comfort of their own home. Patients can be referred to an Emergency Care Practitioner by General Practitioners (GPs) both in and out of hours, NHS Direct, nursing and residential homes, and either directly or indirectly via the 999 system. They treat patients who are unable to leave their home due to poor mobility, have dependents that are unable to be left, and where the outcome would potentially be of greater benefit from an Emergency Care Practitioner intervention rather than attending Emergency Departments (ED) or a GP service. The Emergency Care Practitioner role will enhance career opportunities and support a career framework based on the skills escalation model for professionals, in the health care sector. 1.3 The scope of practice of the Emergency Care Practitioner The Emergency Care Practitioner will: Work across current and future organisational and professional boundaries• Deliver care that is patient focused• Deliver the most appropriate care in the most appropriate place and/or ensure that• the patient is referred to the most appropriate health and social care professional Deliver care to patients in the most convenient and appropriate place for the• patient Provide an alternative pathway for the provision of urgent care•
11 Provide appropriate healthcare advice to both their patients and other relevant• groups and individuals Empower patients to take responsibility for managing their own care and• treatment where safe and appropriate to do so Undertake physical examinations based on a whole systems approach, taking a• full and appropriate patient history using a medical model Assess the social and mental status of a patient• Treat less serious illness and injury in pre-hospital, primary care and acute settings• Play a defined role at major incidents• Request appropriate investigations, including pathological investigations and• diagnostic imaging, in accordance with established procedures Ensure fewer inter-professional transfers for patients by enhanced communication• networks and cross boundary working Administer and supply medication in line with local Patient Group Directions• 1.4 The key points of the Competence Framework The Competences required of the Emergency Care Practitioner, to be delivered by an integrated academic and clinical programme, have been developed out of experience and trialled through 17 different pilot sites in the United Kingdom. They will be subject to continuing review by the Benchmarking Group and updated by Skills for Health. The Framework describes the level of responsibility that Emergency Care Practitioners will be expected to take for the diagnosis and management of a wide range of patient conditions. It sets out the core competences to be met by all Emergency Care Practitioners. These may be supplemented by locally determined competences, with the relevant training/education commissioned locally to meet service demands. 1.5 The key points of the Curriculum Framework The Curriculum Framework recognises that the development of a national standard on qualification requires: A flexible approach to the rigorous criteria necessary for entry to the programme• An intensive academic programme that will allow the time required for individual• professional development and which is subject to robust appraisal Agreed minimum levels of clinical experience• A common core knowledge base• Common core clinical competences• A national assessment process•
12 Ongoing Continuing Professional Development• Emergency Care Practitioners must complete an academic programme of 1400 hours designated study time of which a minimum of 400 hours is designated as theory learning (delivered at a minimum standard of Degree level – level 6 in the English Qualification Framework) and 1000 hours clinical learning in appropriate clinical settings. Only then will they be able to practice as an Emergency Care Practitioner in the clinical team, within a range of health care settings.
13 Positive outcomes identified during the development of the role 2.1 What is expected from the introduction of Emergency Care Practitioners? Since its inception the Emergency Care Practitioner role has been considered to be a key driver in the process of reforming urgent care. It has been seen as a means to reduce attendances to Emergency Departments, emergency ambulance transportation and urgent hospital admissions. In addition, by taking care to the home / patient environment, Emergency Care Practitioners can intervene earlier, refer patients to other pathways and enhance patient satisfaction9 . In order to achieve this, ECPs need to be able to complete many cases at the point of contact, as appropriate, and this requires them to have the skills to diagnose and treat various ailments plus being able to identify complicating factors that may require more advanced assessment. They may also refer the patient to another care pathway e.g. a community service, pharmacist or social service, which is more appropriate than a hospital attendance or admission. As well as reducing attendances to Emergency Departments the Emergency Care Practitioner is able to reduce hospital urgent admissions and bed days. 2.2 What has been achieved by Emergency Care Practitioners? Various studies have demonstrated a number of benefits 4,5,6,7,9 some anticipated whilst others have emerged as practice has developed. Emergency Care Practitioners working in Out of Hours services can act as the eyes and ears of Out of Hours doctors, deliver care and advice and obtain a prescription issued by the doctor in charge. In some cases they work under the supervision of doctors as one of the first points of contact with the Out of Hours service, including telephone advice, urgent care attendees and home visits. Emergency Care Practitioners can deliver: Considerable cost savings for incidents that do not require a doctor to attend in• person Improved response times when compared with GP home visits as they can be• achieved “in hours” One report includes an audit demonstrating an average response time for a home visit by an Emergency Care Practitioner of one hour and seven minutes 10 . This compares with an average response in another study of three hours for a GP home visit 8 . When faced with a long delay, patients may panic and unnecessarily attend an Emergency Department or call 999 for an ambulance.
14 Case Study – General Practice Visit – Admission Avoidance Incident: ECP requested by GP to visit long term care patient complaining of shortness of breath Examination: History of Chronic Obstructive Airways Disease established Drug history clarified Clinical examination= carried out and respiratory status established Management: Discussion over the phone with GP Salbutamol given by nebuliser Course of appropriate antibiotics dispensed Advice given on correct use of domiciliary oxygen Follow up visit arranged for next day Benefits: Partnership arrangements with GPs to avoid domiciliary visits More rapid visit to assess acute status of patient Avoidance of disruption to GP work schedule Patient satisfaction; treatment at home with use of PGDs Avoidance of potential ambulance transportation Emergency Department attendance avoided Ensuring patients are able to receive more care than when using 999 responders There is literature 8,11 to demonstrate that paramedics with extra training can provide safe and effective treatment at the point of need for a defined range of conditions. An Emergency Care Practitioner is able to provide even more care to the patient and can, on occasion, avoid hospital admission by offering telephone advice 12 . Allowing patients access to care pathways that cannot be accessed by 999 responders It is the norm that when a paramedic attends, the patient will be transported to a hospital Emergency Department (see below). If an Emergency Care Practitioner attends, there is a greater likelihood of the patient being treated in their own home without this transfer and, where necessary referred for Community Health or Social Care by way of follow up. Freeing up 999 crews to meet the demands of their particular service Across all Ambulance Trusts, in approximately 73% of incidents, at least one patient is taken to the Emergency Department. Emergency Care Practitioners can affect this considerably. Urban ambulance trusts report that the use of ECPs as first responders has halved the proportion of incidents that result in hospital admission although this varies dramatically. Where an Emergency Care Practitioner is available in the control room to take calls, they are able to diagnose some conditions over the phone and may be able to
15 close some Category C calls without sending a responder. They are also able to determine when attendance by an Emergency Care Practitioner is more appropriate than a paramedic. This can have a significant operational impact on the availability of responding crews to meet service demands. ECPs and major incidents ECPs have an important role or roles to play in Major Incidents. Whether this is at or near the scene, or supporting the core service in the locality is largely a consideration for their local employers. The competence set of the ECP gives them the flexibility to meet the requirements of a considerable number of scenarios. It is essential that the role of the ECP is properly considered and integrated into any planning processes. Case Study – Major Incident – Flexibility of the Role Incident: Major explosion and fire at oil distribution depot Large numbers of emergency personnel involved at incident 2000 residents evacuated 135 patients presented for care Benefits: 83 patients treated at scene or locally established treatment centre Scene treat and discharge facility available Local ED requested ECP presence to support local services Additional pressure on local ED avoided Patient satisfaction Evacuated patients assessed – care and pharmacy packages instituted
16 Career pathways At present the Emergency Care Practitioner role is only open to experienced health care professionals. One of the benefits of this is that it retains staff at the peak of their experience and value that might otherwise leave front line roles and move into management and training roles. By offering a career pathway to paramedics in a similar way to nurses this may encourage more people to begi n a career as a paramedic. Alternative areas of work In some Primary Care Trusts Emergency Care Practitioners are already providing a service to Prisons and Police Custody Suites with significant effect especially in a reduction in Emergency Department attendances. This reduces the pressure for Prison and Police Officers to escort patients to hospital. The Escorts and Bedwatches Research Project recently published by the Department of Health (November 2006)13 has identified several areas of potential service redesign in which Emergency Care Practitioners could be actively involved with significant financial implications to the Prison and Police Services: 1. Providing within the Prison or Custody Suite a wider range of the treatments and procedures normally provided by a GP practice in the community 2. Assisting with specific clinics to provide a more cost effective service 3. Addressing the area of injury and other trauma, which is the most common clinical reason for escort and bedwatch episodes, a reduction in unnecessary visits to Emergency Departments, could have marked effect on the current high levels
17 The full details of benefits analysis undertaken by Dr Hugo Minney, including references and data is available in Measuring the Benefits of Emergency Care Practitioners (2007) 8 .
18 The competence framework 3.1 The definition of competence in this context Competences describe the knowledge and understanding required to carry out a work activity effectively. They describe what an individual needs to know and to do regardless of who is performing the activity. Also known as National Workforce Competences (NWCs) they incorporate National Occupational Standards (NOS). Both share the same robust development process and are developed and approved for the health sector by Skills for Health. In addition the NOS are approved by education regulatory bodies. All criteria used in the framework for Emergency Care Practitioners follow the standard format which provides the following: a summary describing what the competence entails• the indicative KSF dimension and level• the origin which details the work area the competence is designed for and when it• was finalised the activity scope which describes client group(s) the competence is designed for• and the related presenting symptoms the performance criteria which describe what the practitioner must be able to do• knowledge and understanding which describes the knowledge the practitioner will• need to apply to practice in this competence area Examination of the detail behind each competence will show some overlap with competences in other groups. This is not considered to be a problem but serves to reinforce the need to follow a generic model of care which can apply to all age groups and conditions. The competences for Emergency Care Practitioners are shown in full at Appendix 1 3.2 The rationale for the use of competences based learning The competence basis of the training and education for Emergency Care Practitioners is essential as students will be drawn from differing professional backgrounds and, as a consequence, will have a variation in knowledge levels, in clinical and educational experience as well as in life experience. The competence base allows for a structured approach to ensure all students are therefore able to demonstrate both the knowledge base and an understanding of the scientific principles through an appropriate academic curriculum which can be based upon the knowledge and understanding contained within the competences.
19 To ensure quality and consistency in defining competences, Skills for Health worked closely with a number of pilot sites and have developed a Competence Framework for Emergency, Urgent and Scheduled Care. This framework alongside other related competences, for example communication and personal development, has been used to define the Emergency Care Practitioner role and devise a learning programme to support its development. 3.3 The competence requirements of the Emergency Care Practitioner The competences required by the Emergency Care Practitioner at the point of qualification to enable their name to be placed on the Voluntary Register is detailed below. The Emergency Care Practitioner is required to maintain this breadth of competence throughout their professional career. Any additional expertise they may acquire in particular fields, through experience or further training, is in addition to this general competence and not a substitute for it. The core competences outlined in Appendix 1 must be achieved by those undergoing Emergency Care Practitioner education before they take up the professional role. In keeping with the philosophy of life long learning in the NHS, further skills will be acquired and, after assessment, the Emergency Care Practitioner may then work in specialist areas. Arrangements for supervision in these areas and the delegation of duties and responsibilities will vary according to the level of overall experience of the Emergency Care Practitioner and expertise in the specialist clinical field, as with any other regulated healthcare professional working in a multi-disciplinary team. The detailed organisation of assessment of clinical competences and skills will be a matter for individual institutions, but must be rigorous and will include: OSCE: objective structured clinical examination (e.g. clinical skills laboratory,• simulated patients or, where appropriate, actual patients) skills stations to examine the knowledge of the ECP with diagnostic imaging,• ECGs, anatomy, pharmacology and a variety of clinical conditions direct observation of the student’s communication and interpersonal skills• direct observation of the student’s clinical and procedural skills in practice• evidence provided by other healthcare practitioners regarding the performance of• the student direct questioning by an assessor to check understanding of patient centred care,• health and safety procedures, technological interventions and interpretation of results, in addition to demonstrating core knowledge. The individual assessments must be completed prior to the “signing off” of the competences, and be part of the regular appraisal process
20 regular presentations, which will enable the student to demonstrate their ability to• research a set topic and present it to their peers a portfolio of evidence maintained by the student. This will include a record of• progress as well as reflective accounts of critical learning encounters. This will inform the final assessment process and its outcome summative assessment at prescribed times will take account of the development• of the student ECP against the specification set. In terms of providing evidence for the clinical competences, skills and conditions, the evidence must reflect that the ECP has demonstrated the skills in theory and worked with patients in the clinical setting Unseen written Biosciences Examination covering Anatomy, Physiology, Patho-• physiology, and Clinical Medicine Case Study – Urgent Care Centre – Flexibility of the Role Incident: Staffing problems in a local Urgent Care Centre leading to threat of temporary closure. An Emergency Care Practitioner transferred temporarily from Ambulance Centre to work in the centre Benefits: ECP able to use competence based education to manage a full caseload of patients across a whole age range ECP able to request diagnostic imaging and make decisions based on clinical findings ECP able to use Patient Group Directives to offer pharmacological alternatives to treatment Closure of local facility avoided Additional pressure on Emergency Department avoided Patient satisfaction
21 3.4 The Health Functional Map, Competences and Learning Outcomes Overall assessment of evidence in all forms must cover five key areas: Evidence must be: 1. Valid 2. Reliable 3. Current 4. Authentic 5. Sufficient In order to present some logic as to how the defined role of the Emergency Care Practitioner relates to the agreed competences the format of the Skills for Health Functional Map has been utilised. This aims to identify all of the functions which take place across the health sector and represents the combined range of all activities to be performed by all of the workers in and across the health sector however it is not presented as specific jobs or roles. By its very definition, however the Emergency Care Practitioner role will overlap with various other roles in the different services in the delivery of health care in the emergency urgent and unscheduled care setting so, in this instance, the Map is being used as a methodology to clarify the relationship between the Competences and the role. The Competences developed for the Emergency Care Practitioner have been mapped to the various functions of the role in a number of key areas and follow a medical model for
22 the management of the patient under their care. This should ensure the safety of the patient and the professional development of the Emergency Care Practitioner They are listed in the following key areas: 1. Assessment of the health and social status of the patient 2. Addressing the health and social needs of the patient 3. Documentation 4. Equipment and technology 5. Communication and IT skills 6. Health and Safety and security 7. Clinical Governance 8. Professional development 3.5 How to access and use the competences Information on how to use the Competences is available on the Skills for Health Website: www.skillsforhealth.org.uk Procedure: 1. Access the website 2. Click “Competences” 3. Click “Completed National Competences” 4. Click “Code” A list of Competences will be shown under a variety of headings, e.g.: EUSC (Emergency Urgent Scheduled Care), applicable to each Competence listed in Appendix 1. Or click on the orange box on the home page entitled “competence application tools” and use any of the tools or to find specific competences click on the competence search tool. Details are available for each competence listing a: Summary• Indicative NHS KSF Dimension & Level• Origin• Activity Scope• Performance criteria• Knowledge and Understanding•
23 Example EUSC_01: Take a presenting history from an individual to inform assessment Full Unit Code Emergency_Urgent_&_Scheduled_ Care_EUSC_01 Framework Emergency, Urgent and Scheduled Care Status National Occupational Standards (NOS) Summary This workforce competence covers gathering information to support and inform the assessment of the health status and needs of an individual requiring medical assistance. Users of this competence will need to ensure that practice reflects up to date information and policies. KSF Dimension & Level Health and wellbeing HWB6: Assessment and treatment planning Level 3: Assess physiological and psychological functioning and develop, monitor and review related treatment plans Origin This workforce competence was developed for Emergency Urgent and Scheduled Care by Skills for Health. Activity scope Individual who: a) is a child or young person b) is an adult of working age c) is an older person d) has communication difficulties Information on: a) the nature, severity and progress of the individual’s condition b) the effect the condition is having upon the individual’s ability to function effectively c) pre-existing medical conditions, personal details about the individual (including age, height, weight, religious beliefs affecting possible treatments etc.) d) medications and treatments being taken/followed; the name and address of the individual’s General Practitioner e) the individual’s preferred language and cultural practices Condition may involve: deterioration or loss of, or poor, functioning in relation to the activities of daily living Significant other the significant other could be: a) a carer b) family member or c) anyone else placed in a social or legal position of responsibility for the individual The significant other would generally have responsibility in situations where the individual, particularly a child or older person, has reduced capacity for comprehension and decision making.
24 Performance criteria You need to: 1. explain clearly: a) your role and responsibilities b) what information you need c) the reasons why you need the information d) with whom the information will be shared 2. obtain informed consent from the individual or any significant other with them if the individual is not in a position to provide this consent independently 3. obtain details of the individual’s prior health status and circumstances over a sufficient period of time to inform assessment, in accordance with the individual’s condition 4. use appropriate questions to explore, clarify and confirm any unusual or ambiguous information 5. record the information clearly and accurately in a systematic and logical manner that clearly shows the history of the individual’s condition 6. respect the individual’s privacy, dignity, wishes and beliefs 7. treat all information provided to you as confidential in accordance with organisational policy and practice 8. communicate with people in a manner which: a) is consistent with their level of understanding, culture, background and preferred ways of communicating b) acknowledges the purpose of the communication c) is appropriate to the context d) encourages their participation e) responds to communications of any kind from them 9. constructively manage any obstacles to communication Knowledge & Understanding You need to apply: Legislation, Policy and good practice K1: A factual awareness of the legislation (national and European) relating to the work being undertaken, the context in which it takes place and the individuals with whom one works; codes of good practice which support the implementation of legislation (such as the Data Protection Act); how to interpret and apply relevant legislation to the work being undertaken K2: A factual awareness of the reasons why your role and responsibilities should always be explained when taking information Care and Support of the Individual K3: A working understanding of how communication style may be modified to ensure it is appropriate to the individual’s level of understanding, culture and background, preferred ways of communicating and needs K4: A working understanding of what sort of obstacles to communication can arise and the actions to be taken to manage them in a constructive manner
25 Knowledge & Understanding (cont.) K5: A working understanding of why information needs to be gathered over a sufficient period of time and how this might vary from context to context K6: A working understanding of why it is important to establish consent to the sharing of information, where the individual or third party is able to provide this, and what steps can be taken when this is not provided K7: A working understanding of the steps you would take to ensure that the privacy, dignity, wishes and beliefs of the individual are maintained K8: A working understanding of the ways an individual’s belief system can influence their willingness to share personal information with you or others and why it is important that you respect these views Procedures and techniques K9: A working understanding of the steps you would take to try to clarify and confirm any information which is ambiguous or missing from an individual’s or third party’s narrative K10: A working understanding of the organisational policy and practices with regard to the confidentiality of information Specific health knowledge related to your area of practice K11: A working understanding of the types of information that need to be gathered and why each is necessary K12: A working understanding of clinical norms with regard to different groups of individuals and presenting symptoms for commonly experienced conditions K13: A working understanding of what sort of information it would be important to capture about the circumstances leading up to an individual requiring immediate medical assistance Records and Documentation K14: A working understanding of the importance of recording information clearly, accurately and in a systematic manner K15: A working understanding of record keeping practices and procedures in relation to diagnostic and therapeutic programmes/treatments
26 The curriculum framework 4.1 Introduction to the curriculum framework In the development of a new professional group, such as Emergency Care Practitioners, it is appropriate that the curriculum framework includes certain specifications of structure and content whilst addressing the nature of the educational process and experience. In due course it is anticipated that the Emergency Care Practitioner role will achieve Statutory Regulation, at which point the regulator will take over responsibility for setting standards of competence and standards of education and training, based on these frameworks. The regulator will also issue curriculum guidance, developed in conjunction with the professional body. It will ensure that it is made available to those Higher Educational Institutes which it will approve for education and training. For a new profession it is vital that all practitioners meet a transparent and agreed standard. The purpose of the curriculum framework is to make the standard explicit and to set out the criteria which any educational programme for the Emergency Care Practitioner must meet in order to ensure that standard can be achieved. It is clearly important that the document should identify the expected outcome of any such programme, the competences to be demonstrated by graduates and the clinical problems that they should be able to address using the Competence Framework It is not the purpose of this Framework however, to create homogeneity by placing unnecessary constraints on those Higher Educational Institutes who run Emergency Care Practitioner programmes. It is recognised that different institutions have their own constraints and opportunities and may well be tailoring programmes to specific groups. Variation in programmes is, in any case, to be welcomed, as an enrichment of the professional educational resource and the opportunity to develop and share areas of good practice. Such differences offer the students and the Benchmarking Group a source for development. The Learning Outcomes set out within this document are therefore a minimum, to which an individual institution may choose to add and determine the outcomes for their own graduates. The length of the programme and the hours of clinical exposure (both in general and in terms of particular fields) are equally set as minima. The educational process is directed towards equipping the professional to fulfil their role, rather than in terms of a specification for particular learning and teaching strategies. However tightly the specification of minimum standards might be worded, they are still open to differential interpretation by individual institutions, teachers and students. This document, therefore, also proposes that a national assessment of competence becomes a determinant of Voluntary Registration, without wishing to contest the right of
27 individual higher education institutions to determine the academic award for their own students. 4.2 The principles of learning and teaching The primary responsibility for the achievement of the required learning rests with the student. It is the responsibility of curriculum developers, programme organisers and teachers to provide educational structures and experiences through which the student can fulfil their responsibilities. This not only includes teaching, but also the facilitation of both individual and group work and the encouragement of self directed learning. The clinical environment provides many of the most important learning experiences for healthcare professionals. Unlike other learning environments, the education of the student is not the primary purpose of such environments and the student must learn how to make best use of the opportunities available without imposing upon patients or disrupting the provision of service. However, the employer/Healthcare Trust in taking on students on clinical placements, accepts a responsibility to provide learning opportunities and appropriate supervision, appraisal and assistance.
28 Case Study – Sprained Ankle Ottawa Guidelines Incident: 999 call to sports ground. A football player has twisted over on ankle, complaining of severe pain Examination: Patient able to weight bear Ottawa Guidelines followed and decision made that no x-ray is indicated Management: Patient reassured that no x-ray is indicated Patient taken home by ECP rather than transported to hospital Advice given on treatment: Ice; Compression; Elevation; Mobilisation Benefits: No need for transfer to hospital – ambulance transportation avoided Emergency Department attendance avoided Patient satisfaction with management The inter-relation of theory and practice is fundamental to the development of professional competence. Students must learn to: recognise clinical applicability whilst they are undertaking theoretical learning• apply the theory they have learnt when they are in the practice setting• reflect on practice to identify learning needs• theorise during practice (i.e. how to, during a particular practical incident,• formulate new ways of thinking and doing, which often go beyond what the text book can offer) theorise practice itself (i.e. how to recognise, in a particular piece of practice, the• principles, assumptions, beliefs and theories, which actually shaped that practice) Understand and recognise the management of risk• Learning in professional practice is a collaborative activity. Members of one profession or of a number of professions may achieve common learning needs by working together or may share their knowledge and skills to enable others to achieve their learning needs. This behaviour should be encouraged throughout the educational process. Professional practice involves living with uncertainty and decision making in situations where there is no single right answer and where professional judgement must be used to determine the appropriate response. Learning and teaching in the Emergency Care Practitioner programme needs to prepare students for this reality and to equip them to make and live with such decisions.
29 Learning is moulded and driven by appraisal and assessment and it is vital that both formative and summative assessments are designed in such a way that this direction coincides with the outcomes stated in the curriculum. 4.3 Learning Partnerships The establishment of effective learning partnerships between the student Emergency Care Practitioner and their clinical supervisors is vital to the professional learning process. To be effective, such individual partnerships must be supported by a partnership between the Higher Educational Institutes and the clinical service provider, which mutually values the role that both play in shaping and enabling learning. The learning partnership between the student Emergency Care Practitioner and their clinical supervisor moves beyond the traditional approach of apprenticeship. Learning is to be co-directed and questioning to be encouraged, so that both parties engage more thoughtfully in the processes of teaching and learning. This in turn should provide the basis for more motivated and better directed education. For the partnership to work effectively, the clinical supervisor must have an understanding of the future role of the ECP, of the educational principles and values underpinning the programme and a detailed understanding of student learning needs in the educational experience they facilitate. They should also have an understanding of how that experience fits in to the totality of the course. Clinical decision making is more complex than training in technical or factual matters. Where circumstances permit, the clinical supervisor should facilitate students in making a professional judgment rather than simply offering their own. Where the supervisor does offer their own professional judgment, they must be prepared for the student to question how that judgement was made. Students in turn must recognise that there is much professional knowledge that is tacit and may be difficult for the supervisor to elucidate. The student should also recognise that intuition and experience, as well as theoretical knowledge, form part of clinical decision making. Both supervisor and student should make efforts to adapt to the normal learning or teaching style of the other. The partnership should be guided by educational principle and must not be a collusion of ease. It is important that the clinical supervisor should allow the student to continue to learn independently (whether from patients or library/internet resources) even when this may be more time consuming and where it might involve a loss of control of the learning agenda by the clinical supervisor. Where the clinical supervisor is involved in processes of formative and summative assessment, they must recognise both the different and the common intentions of the two processes. Every effort must be made to make sure that the clinical supervisor fully understands their role and is “fit for purpose”. This curriculum framework supports the belief that the following principles are essential in shaping the education of the Emergency Care Practitioner:
30 An initial theory course which informs the underlying importance of biosciences• and patho-physiology A subsequent clinical period which allows for the student to experience• observation in clinical settings and which is directed so that student Emergency Care Practitioner learns to see, analyse and interpret all that occurs Action (rather than just observation) in the practical setting is essential to foster• learning Ongoing dialogue in the clinical setting between educator, clinical supervisor and• student Emergency Care Practitioner, is a vital part of the learning process The clinical supervisors should help the student Emergency Care Practitioner• investigate examples of professional judgment in both clinical and educational practice Problem-solving by the student Emergency Care Practitioner in a range of different• practical activities, using critical thinking, analysis, creativity and improvisation Clinical supervisors enable the student Emergency Care Practitioner to develop• their use of the processes of deliberation and reflection, encouraging self- knowledge and self-appraisal An ongoing system of appraisal throughout the whole course which allows the• student to identify his/her strengths and weaknesses, discuss them with their supervisor and plan their learning strategy accordingly.
31 4.4 The aims of the Emergency Care Practitioner programme As mentioned previously, this curriculum framework aims to identify the core competences that any Emergency Care Practitioner programme should enable students to meet. The statements included in this section constitute the core competences against which students on any particular programme are judged. The programme aims to produce clinicians who have the knowledge, skills and professional behaviours to function as an Emergency Care Practitioner (to have their qualification nationally recognised) and have the personal and intellectual attributes necessary for life-long professional development. Such clinicians will be: safe practitioners in a wide variety of clinical settings, with patients from diverse• social and ethnic backgrounds over the whole age range expert communicators who are empathetic in a manner appropriate to a• healthcare profession aware of health inequalities and the challenges of working in a multicultural• environment aware of the limits of their competence and determined to act within those limits• comfortable in the context of multi-professional working in a team environment• adept in the use of C&IT (Communication and Information Technology) skills for• healthcare capable and motivated lifelong learners continually engaged in active professional• development understanding of the need to maintain and promote health, as well as to cure or• palliate disease and aware of their obligations to the wider community as well as to individuals able to integrate theoretical and clinical learning• The complete list of Learning Outcomes for Emergency Care Practitioners is shown at Appendix 2. 4.5 The structure of the Emergency Care Practitioner programme The structure of the Emergency Care Practitioner programme will be almost entirely dependent on the institution running it and the nature of the catchment group for which the course is primarily intended. For this framework it is therefore only possible to state the minimum/core specification which all courses must meet. The length of the programme will be a minimum of 1400 hours of nominal study time. Of this time, a minimum of 400 should be designated as theory learning and 1000 designated as clinical learning.
32 Some programmes may choose to follow the standard semester pattern. Other programmes may compress the three semesters into a full time ten month course. Others may offer a more prolonged “blended learning” type of course. The clinical learning module may include some time learning in skills centres or return to the Higher Education Institute classroom but must include a minimum of 1000 hours spent in practice in the clinical area, in substantive attachments to a unit, to a doctor or a suitable qualified health professional. This includes time spent with the doctor or other clinical specialist in hospital or general practice, on ward rounds, in clinics, etc. as well as time spent in tutorials. It also includes independent learning in the clinical area that is facilitated by the doctor, or time spent with other healthcare professionals. It is intended that the Emergency Care Practitioner, on qualification, will be able to undertake the assessment and management of individuals presenting with undiagnosed, undifferentiated health care needs in Pre-hospital, Primary and Acute care settings. They could also provide cover in a Minor Injury Unit, provide ‘out of hours cover’ in hospital and primary care/community settings or work in Custody Suites, Prisons or other specialised areas of urgent healthcare work. Whilst recognising that the same competences can be demonstrated in many of these clinical areas, it is still felt appropriate to recommend certain core placements. As a guide these could be as follows; General Practice (including paediatrics) • Acute Medicine/Surgery • Emergency Department/Urgent Care Centre • Mental Health • Obstetrics & Gynaecology • Paediatrics (acute setting) • Out of Hours Work (including paediatrics) • Rapid Response Work• Some of the General Practice and Emergency Department Placement should be spent specifically on Paediatric issues in Primary Care. Within this framework of clinical attachment, students must have the opportunity to have experience relevant to a broad range of core areas. The length of time spent by the student in any one attachment area will depend upon their previous experience and decisions made during their appraisal process. Institutions will be encouraged to maintain flexibility in their programmes, that should allow individual students to spend further periods of time in a clinical area where they had experienced some difficulty in achieving their competences or, alternatively, in which they have a particular interest.
33 How the Emergency Care Practitioner progresses through the programme will largely be a matter for the Higher Education Institute to decide, but all institutions must ensure that they have in place a rigorous and formally constituted process to ensure that student progress is dependent on the demonstration of appropriate clinical skills and the development and maintenance of appropriate professional behaviour (fitness to practice) as well as on what might be considered the standard basis of academic performance. Since acceptance onto the Voluntary Register is dependent on other factors in addition to academic performance, it is proposed that the award of the academic qualification at the end of the Higher Education Institute programme should not confer automatic entry to the Voluntary Register. Registration will be dependent on the award of an appropriate academic qualification and a statement from the Institute regarding the candidate’s fitness to practice, in terms of professional behaviour, health, and clinical competence. The Voluntary Register will be the pre-cursor of a Statutory Register, and as such it will be necessary that it addresses all components of the candidate’s fitness to practise. An example of a Theory Module and a Clinical Module is shown at Appendix 3. 4.6 Criteria for entry to the programme It is envisaged that, during the early implementation of ECP programmes produced on the basis of this Framework, there will be two main groups from which student ECPs will be drawn – paramedics and nurses. Higher Education Institutes may tailor the programmes they offer to one or other group of candidates and select accordingly. In their selection processes for this programme, we would encourage universities, through the use of interview, to recognise and value life experience as well as proven academic ability. Whichever group a Higher Education Institute decides to draw a student from, it has a duty to ensure that the student it recruits to the programme is ‘of good character’ as well as academically capable of completing the course and undertaking the clinical role. As specified by the General Medical Council (GMC), with regard to undergraduate medical training: “Universities have a duty to make sure that no member of the public is harmed as a result of taking part in the training of their medical students. Medical students cannot complete the undergraduate curriculum without coming into close, and sometimes intimate, contact with members of the public who may be vulnerable or distressed. The vocational part of their training, which prepares them for clinical practice when they become registered doctors, is such that they may not be directly observed or supervised during all contact with the public, whether in hospitals, in general practice or in the community.” We consider this to be equally applicable to the Emergency Care Practitioner. Good practice would advise that all students be cleared with an enhanced CRB check and an appropriate occupational health check and that, in the Clinical Placement module,
34 an Honorary Contract be signed with the Trust to which the student is attached which complies with the national guidance. The means by which the character and capability of candidates is assessed is a matter for individual institutes or groups of institutes. However, in determining admission processes, institutes must be cognisant of developing practice in other healthcare professions and the need to offer opportunities to widen participation in both higher education and the NHS. However, account needs to be taken of the eventual acceptability of candidates to the Statutory Regulatory Body (e.g. candidates previously removed from a professional register; with a criminal record etc). There is no provision at present for Direct Entry to the profession. This is considered desirable for the future and is likely to become essential in view of future trends in the labour market. Proposals for Direct Entry will proceed as the profession becomes established and a revised curriculum will be developed in line with any proposals. It is possible that a number of already qualified Emergency Care Practitioners find that their initial programmes do not equip them to achieve the breadth of competence and /or accreditation set out in this document. They will need to apply to the Voluntary Register through a grand-parenting route and the Voluntary Regulatory Committee will assess their knowledge, skills and experience and decide whether or not any additional education is required. The required standard for entry via this route will only be for those Emergency Care Practitioners who received their training prior to a date to be set by the voluntary regulator to reflect when approved training became available and they will need to demonstrate lawful, safe and effective practice. This aspect will be further clarified by the Voluntary Regulatory Committee, but will follow the practice of grand-parenting laid down by the HPC and other Statutory Regulators. In view of the fact that the level required for the educational programme is set at Degree Level (level 6) some higher Educational Institutes may experience difficulties in allowing entry for some professional groups whose previous learning experience may have been set at Certificate Level (level 4). It is suggested that, under the AP(E)L process advised in the Burgess Report, greater credence be given to the value of experiential learning in achieving a level of ability in what is essentially a vocational profession. This can be achieved with less reliance on Academic Writing and Critical Analysis. Experience from courses delivered thus far has shown that members of the paramedic profession have performed at least as well as other professionals in the assessment process. The ability to complete the course and be successful in the assessment process should be the only criteria to be a competent practitioner. 4.7 The core syllabus Any division of curriculum content into separate subjects may suggest barriers which are not really there. Whether focusing on the domain level of knowledge, skills and
35 professional behaviours, or the discipline level of anatomy, ethics and immunology etc. the whole purpose of the curriculum is to provide graduates with an integrated platform from which to undertake the professional role. Whilst the following sections of this framework necessarily separate out the various strands of professional learning, for the purpose of specifying the core elements which must be included in the whole, any curriculum must be designed to facilitate the student in reintegrating these areas of study into a meaningful whole. As with the specification of clinical experience, it is not intended that there should be a national specification to identify the whole theoretical input that might be included in any given programme, but only those aspects which all Emergency Care Practitioner students should cover. Equally, the detailed structure and provision of such a programme of theoretical knowledge to students is not specified. The information is presented on the basis of standard academic subject areas (itself an unlikely structure for an Emergency Care Practitioner programme) so that individual institutions have a free rein to offer courses structured on a systems-based approach, problem based learning etc. For each academic discipline, the information is structured as shown in the list below. The list of theoretical knowledge subject areas to be covered in the core syllabus is as follows. The list is alphabetical and does not suggest chronological order or the subject’s priority or the amount of time it should be given within the programme. Anatomy• Biochemistry• Communication skills• Clinical pathology• Ethics and law• Health education• Healthcare policy• Human development through the whole age range• Immunology and microbiology• Information technology• Pathology• Patient Assessment Strategies• Pharmacology & Therapeutics• Physiology• Presentation Skills• Psychology• Sociology•
36 Educational assessment 5.1 The roles of assessment Assessment fulfils a number of roles in an educational programme leading to a professional qualification. These can be primarily divided into summative and formative roles. Summative assessment relates to the setting of standards and of assessments to judge whether they have been met, and thus protect the public and, in this case, the health service, by ensuring that all those qualifying from a course have achieved the required competences and knowledge, and the skills and professional behaviours that underpin them. Equally, it protects the Higher Educational Institute by ensuring that there is no devaluation of the degrees or other qualifications that they offer. Formative assessment is a ‘no stakes’ process, in as much as failure does not bar progress or affect grades or classification, but it is no less important for that. Its main purpose, within the appraisal process, is to provide feedback and enable students and educators to identify specific learning needs, so that they can focus their future efforts effectively. Formative assessment will be a largely continuous, rather than event based, process with a clinical portfolio playing a key role. The portfolio should include a log of experience and a reflective diary which will form the basis for Clinical Presentations and classroom discussion of cases. It must be structured in such a way that it encourages students to identify their weaknesses as well as to demonstrate their strengths and to determine their learning needs accordingly. Assessment and appraisal both have a role in shaping learning. Whilst appraisal may enable a student to prioritise learning in response to their current performance profile it is summative assessment that sets the learning agenda in the first place. All candidates look at what they are going to be tested on, and what form the test will take, as a major determinant of what they are going to learn. Assessment drives learning so there is a need to ensure that the syllabus is in concordance with the programme; in other words the pattern of assessment is what would be expected from the pattern and purpose of the curriculum. It is vital that assessment should drive students towards education which involves intellectual development and the application of knowledge and professional judgment, rather than training which is simply the accumulation of knowledge and the unquestioning use of protocols. In setting the standards to be tested, it is vital that knowledge, skill and professional behaviour, although they may be used together in the clinical environment, are seen as constituting separate domains for the purposes of assessment, that there can be no compensation between them and that a satisfactory standard must be demonstrated in
37 each. It is as inappropriate for a student who has ‘a good way with patients’ to be allowed to graduate despite a lack of knowledge. The nature of the assessment process appropriate to one domain may be entirely different from that for another. Students also need to demonstrate that they can perform a particular skill. Skills development takes longer for some students than for others and it may be perfectly appropriate for them to go several times around the learning, appraisal and assessment cycle until they have achieved the standard required. It may be perfectly appropriate for students to demonstrate, in an examination, that they can apply knowledge and professional judgment in a given scenario, but in terms of professional behaviour, they need to demonstrate that they habitually act in an appropriate way towards patients rather than that they can simply behave appropriately during the examination situation. Study – Head Injury – NICE Guidelines Incident: 999 call to residential home. Elderly resident fallen hitting head on bedside cabinet. Cut to forehead. Examination: Full neurological examination and general assessment Drug history analysed NICE head injury guidelines applied Management: Decision made that patient did not need to go to hospital as Home staff, after reassurance, felt able to observe for any complications. Wound closed using skin adhesive Tetanus immunological status checked Benefits: Patient able to stay in residential home No pressure on staff to accompany to hospital No ambulance transportation needed Emergency Department attendance avoided Admission to Medical Elderly Ward avoided 5.2 National assessment and accreditation In preparation for Statutory Regulation, it is proposed that there should be a national standard of assessment (theoretical and clinical) to be undertaken by all Emergency Care Practitioner students, to assess their core theoretical knowledge and clinical skills. A national standard of assessment is the only way to ensure commonality amongst all entrants to the Emergency Care Practitioner profession. It is proposed that a database of theory papers in biosciences, patho-physiology and clinical medicine, OSCEs covering a wide range of clinical conditions and skills stations,
38 be developed by the Emergency Care Practitioner Professional Body, which each Higher Educational Institute may use as appropriate in their assessment process. Voluntary Registration will be dependent on this assessment but must be followed by Continuing Professional Development and regular re-assessment on a 3 yearly cycle. Any Emergency Care Practitioner who does not demonstrate a continuing commitment to CPD or submit themselves for re-assessment will be removed from the Register. Future re-entry to the register will require evidence that the student has submitted themselves for a period of further education and assessment commensurate with the length of time they have been removed from the Register. It is this maintenance of general competence that maintains career flexibility and transferability for the Emergency Care Practitioner and offers a major advantage to the Primary and Emergency Care Network in which the Emergency Care Practitioner will work. 5.3 The criteria for assessment and standard setting Although the standards which the qualifying ECP is expected to achieve are set out in some detail in the competences and skills sections of this document, such specifications are still open to interpretation and a common standard for all registrants can only really be achieved through a common assessment process. As a minimum, it is proposed that the national examination database should be used for the assessment of knowledge and that there will be a national assessment of clinical competence. In addition, comprehensive national criteria will be set for the content of locally held assessment of competence, decision making, professional behaviour, etc.
39 Whilst a common standard is, in itself, very important it is equally important that the standard set is correct, that the assessment is reliable, that it is rigorous, that it is valid and it is congruent with the stated aims of all the curricula developed under this framework. 5.4 Professional competence and continuing professional development “Revalidation is a mechanism that allows health professionals to demonstrate that they remain up-to-date and fit to practice”14 . The above report endorses the requirements laid out in the earlier consultative document for Emergency Care Practitioners to demonstrate their continued fitness to practise. Ahead of independent regulation, which will be sought in due course, the Voluntary Regulatory Committee will act as the regulator for Emergency Care Practitioners. Given that Emergency Care Practitioners fall into the category of professionals presenting a possible higher risk to patients it is imperative that the continuous professional development is robust and open to scrutiny. Revalidation will take the form of evidence based self assessment, validated through risk based audit and employer appraisal.
40 Validation, accreditation and the evaluation of the programme Validation, accreditation and evaluation are central elements to the quality assurance process in professional education. Although the processes are interlinked in their aims, each is carried out separately by the body/group with the legitimate authority to do so. 6.1 Validation and accreditation Validation refers to the approval process applied by each university to the programmes they run. It will normally require the submission of detailed plans for the programme and for individual modules. The intention is that the programme is supported by effective management structures and resources, that it is fit for purpose in terms of the level and content of the education it purports to offer and that the process of assessment is sufficiently rigorous to differentiate appropriately between those students who have or have not achieved the required standard. The university will also need to assure itself that there is a market for the programme. Accreditation refers to the approval process as carried out by the relevant regulatory body. The purpose of accreditation is for the body to assure itself that all programmes conferring an award on those students qualifying will enable that student to achieve the nationally agreed minimum standard in relation to knowledge, skills and attitudes. In the case of the Emergency Care Practitioner it is the Voluntary Regulatory Committee, working in conjunction with any existing regulator, who may already regulate some ECPs in respect of other professional roles such as nursing or paramedic, which will carry out this function until the Emergency Care Practitioner is regulated through legislation by a statutory regulator. 6.2 Evaluation Universities will usually have their own processes by which they evaluate their programmes. These are usually related to the formal, cyclical processes of review, although review, in its turn, will require the submission of evidence from evaluation of the programme by individual students and their teachers/supervisors. Evaluation should take account of as wide a range of audiences as possible. It should cover all aspects of the programme and reports should be sought both verbally and in writing. The evaluation should be focused on the intentions of the programme, as expressed by the aims and objectives, the utility of teaching and any available learning opportunities for enabling the aims and objectives to be achieved. The university led processes of cyclical review should not usually be replicated by the professional body, which must have access to all relevant university reports. However,
41 such processes may, on occasion, be supplemented by the professional body (until the Emergency Care Practitioners are subject to Statutory Regulation), to explore any areas of reported concern or apparent failure on behalf of the university to achieve as suitable standard of education for the student. Again, subject to Statutory Regulation, it is expected that each university will continue to work with the Quality Assurance Agency for periodic review and that the Quality Assurance Agency will report their findings to the professional body responsible for the validation and accreditation of Emergency Care Practitioner programmes.
42 Appendix 1: The Competence Framework for Emergency Care Practitioners Working in Pre-hospital, Primary and Acute Care Settings Introduction In order to help understand the function and the work of the Emergency Care Practitioner and to assist in the planning of a curriculum of education the Learning Outcomes for this new role have now been arranged in the format of the Health Functional Map The Health Functional Map aims to identify all the functions that take place in an occupational area. The functions represent the combined range of activities performed by all the workers in that area but do not represent specific jobs or roles. The functions presented here are those identified for Emergency Care Practitioners working as part of a team in a variety of settings and cover several different methods of service delivery. Such settings could be: Minor Injury/Illness Units• Walk-in-Centres• General Practice• Primary Care• Out-of-Hours provision• Ambulance Service• Custody Suites• Prison Health Care• Emergency Departments• Urgent Care Centres• The Learning Outcomes associated with this Health Functional Map are those developed and agreed following the Coventry study in 2001, tested in 17 different pilot sites since then and reviewed by representatives of the different professional groups who attended the Leads meetings held regularly during that period. The Learning Outcomes have been matched to the competences in the various sections of the map.
43 The table lists the Learning Outcomes related to the Key Functions. A summary of the competences associated with these Learning Outcomes can be found in Chapter 4 and the detail behind the Competences is available on the Skills for Health website. Structure of the Health Functional Map Related functions are grouped into a number of key areas. Some of the function titles are supported by bullet points/notes to clarify their potential scope. Where applicable, functions are cross referenced to the Learning Outcomes and to the Knowledge and Skills Framework Key Areas and Functions 1. Assessment of the health and social status of the patient 1.1 Obtain consent 1.2 Take a relevant history from the patient and/or carers 1.3 Assess the social needs of your patient 1.4 Undertake a clinical examination of your patient 1.5 Undertake the necessary special tests to confirm the suspected diagnosis of your patient 1.6 Diagnose or suggest a differential diagnosis for your patient 2. Addressing the health and social requirements of the patient 2.1 Provide emergency care when indicated 2.2 Work as part of a team, recognising your scope of practice as an Emergency Care Practitioner 2.3 Use appropriate health and social care pathways 2.4 Work to national and local guidelines 2.5 Provide clinical/therapeutic interventions 2.6 Use clean, aseptic or antiseptic techniques where appropriate 2.7 Refer patients to appropriate healthcare specialists/specialist services and social services 2.8 Monitor the health status of the patients in your care 2.9 Advise on the health needs of your patient to the relevant carer
44 3. Documentation 3.1 Complete and maintain appropriate clinical notes and referral documentation, either written or electronic 3.2 Provide written statements and reports as required 3.3 Share information with other professionals and agencies 4. Equipment and Technology 4.1 Maintain a safe and clean environment 4.2 Maintain equipment and vehicles required for the transport of people, materials and equipment 4.3 Collect, transport and set down passengers and/or materials and equipment 4.4 Receive and store medication and other therapeutic materials 5. Communication and Information Technology skills 5.1 Maintain and ensure effective communication skills 5.2 Utilise or access appropriate interpretation and translation skills 5.3 Transmit and record information using electronic media 6. Health and safety and security 6.1 Protect individuals from harm and abuse 6.2 Support the Health and Safety of yourself and others 6.3 Handle and store equipment safely 6.4 Protect yourself and others from risk of violence at work 7. Clinical Governance 7.1 Act within the limits of your scope of practice, competence and authority 7.2 Ensure compliance with legal, regulatory, ethical and social requirements 7.3 Ensure your actions support the care, protection and well being of individuals 8. Professional development 8.1 Develop and maintain your own knowledge and competence to the level required to meet Professional and Regulatory requirements 8.2 Be in a position to demonstrate your continuing professional development in order to meet the requirements of regulation
45 8.3 Ensure your practice is current and evidence based Specific Areas and Functions 9. Paediatric and Child Health 10. Learning Disabilities 11. Mental Health 12. Care of the Elderly Functions not considered Core but which may be developed for Local Requirements 13. Custody settings 14. Arterial puncture and collection of arterial blood 15. Advanced Airway Support 16. Critical Care
KeyAreaFunctionCompetenceSkillsforHealthCode 46 1.AssessmentoftheHealth andSocialStatusofthe Patient  1.1 Takearelevant historyfromthe patientorcarers             A1. Obtainconsent:informedconsentforinterventionsand investigations CHEM10 A2. Planandagreeassessmentofanindividual’shealthstatusCHS38 A3. Takeapresentinghistoryfromanindividualtoinform assessment EUSC_01 A4. Obtainsupportinginformationtoinformtheassessmentofan individual EUSC_02 A5. AssessanindividualwithasuspectedhealthconditionCHS39 A6. Assessapatientssocialstatusandneeds  A7. ExamineandassessanindividualwhoisfeelingunwellEC-11/M  1.2 Undertakeaclinical examinationofthe patient A8. Examineandassessanindividualpresentingwithchestpain.EC05  A9. Examineandassessindividualswithsuspectedcoronaryheart diseaseandproduceadiagnosis CHDFA2   A10. Investigateanddiagnoseanindividualpresentingforemergency assistancewithbreathlessness EC11A   A11. Examineandassessanindividualpresentingwithabdominal pain EUSCPhase3   A12. Examineandassessanindividualpresentingwithdiarrhoeaand vomiting     A13. Examineandassessanindividualpresentingwithgenitourinary symptoms   A14. Investigateanddiagnoseanindividualpresentingforemergency assistancewithalteredconsciousness,dizziness,faintsandfits EC11G   A15. Examineandassessanindividualpresentingwithheadache    A16. Identifyhypoglycaemicemergenciesandhelpothersmanage them Diab_HD4   A17. Identifyhyperglycaemicemergenciesandhelpothersdealwith them   GeneralCompetences
KeyAreaFunctionCompetenceSkillsforHealthCode 47   A18. Investigateanddiagnoseanindividualpresentingfor emergencyassistancewithfever EC11I   A19. Investigateanddiagnoseanindividualpresentingforemergency assistancewithbleedingandfluidloss EC11B   A20. Investigateanddiagnoseanindividualpresentingforemergency assistancewithpain,includingdentalpain EC11C   A21. Investigateanddiagnoseanindividualpresentingforemergency assistancewithtoxicingestion EC11F   A22. Investigateanddiagnoseanindividualpresentingfor emergencyassistancewithskinrashes/dermatologicalfeatures EC11E   A23. Investigateanddiagnoseanindividualpresentingfor emergencyassistancewithear,noseandthroatproblems EC11K   A24. UndertakeexaminationoftheexternalearCHS20   A25. Investigateanddiagnoseanindividualpresentingforemergency assistancewitheyeproblems     A26. MeasurevisualacuityDiab_HC2   A27. Investigateanddiagnoseanindividualpresentingforassistance withsofttissueinfectionsandinflammations   A28. Investigateanddiagnoseanindividualpresentingforemergency assistancewithtissuetrauma EC11D   A29. Investigateanddiagnoseanindividualpresentingforemergency assistanceastheresultofafall EC11J   A30. UndertakephysiologicalmeasurementsCHS19   A31. Obtain&testspecimensfromindividuals(CHS7)CHS7
KeyAreaFunctionCompetenceSkillsforHealthCode 48  1.3. Undertakethe relevantand necessaryspecial teststoconfirmthe diagnosis           A32. Obtain&testcapillarybloodsamples(BDS2)BDS2  A33. Obtainavenousbloodsample(BDS11)BDS11  A34. Understandtheindicationsforandbeabletofollowlocaland nationalguidelineswhenrequestingdiagnosticimages    A35. Understandtheindicationsforandbeabletoperform Electrocardiographs    A36. Haveaknowledgeofandbeabletotakeswabsfor microbiologicaltesting    A37. Establishadiagnosisofanindividual’shealthconditionCHS40  1.4. Diagnoseorsuggest adifferential diagnosisforthe patient         A38. Assessanindividual’sneedsforpsychological,emotionalor socialsupportandrehabilitation EUSC_52  A39. Coordinatefurtherassessmentsandinvestigationsofan individualpriortoinitiationofanintervention EUSC_03  A26. Identifyindividualswithoratriskofdevelopinglongterm conditionsorrelatedillhealth CHS42  A27. Recogniseindicationsofsubstancemisuseandreferindividuals tospecialists AA1  B1. ManageemergencysituationsthatoccurasaresultofanEUSC intervention EUSC_17 2.AddressingtheHealth andSocialRequirementsof thePatien 2.1. Provideemergency carewhenindicated   B2. ProvidefirstaidtoanindividualneedingemergencyassistanceCHS35 B3. ProvidebasiclifesupportCHS36 B4. ProvideintermediatelifesupportEUSC63 B5. Contributetointerimpersonalandemotionalsupportfor affectedindividualsduringemergencysituations EUSC83 B6. ProvideautomatedexternaldefibrillationE18  B7. PerformadvancedlifesupportforanindividualEUSC_16   B8. ContributetotheeffectivenessofteamsHSC241
KeyAreaFunctionCompetenceSkillsforHealthCode 49  2.2. Workaspartofa team B9. GainaccesstoandensureindividualshomesaresecurHSC229   B10. PlayadesignatedrolewithintheresponsetoamajorincidentEUSC72   B11. WorkwithcommunitynetworksandpartnershipsHSC3102  B12. SupporttheoperationofpatientpathwaysEUSC_71  2.3. Useappropriate healthcarepathways   B13. Prioritiseindividualsforfurtherassessment,treatmentandcareEUSC_07  B14. PrioritisetheinterventionstobeperformedforanindividualEUSC_08   B15. Directrequestsforassistance,careortreatmentusingprotocols andguidelines EUSC_62   B16. HaveaknowledgeofNationalguidelinesandthereportingof CommunicableDiseases  2.4. Worktonationaland localguidelines B17. ObtaininformedconsentforinterventionsorinvestigationsCHEM10  2.5. Provideclinicaland therapeutic intervention   B18. Move&positionindividualsCHS6  B19. Prepareindividualsforclinical/therapeuticactivitiesGEN4  B20. PerformintravenouscannulationCHS22   B21. Providemusculo-skeletalsupportEUSC_34   B22. RemovewoundclosurematerialsfromindividualsCHS14   B23. Undertaketreatmentsanddressingsrelatedtothecareof lesionsandwounds CHS12  B24. Extractand/orexcisesurfaceandsubcutaneousforeignbodies fromanindividual EUSC_29   B25. Reducedislocatedjointsusingnon-surgicaltechniques,subject tolocaldirectives EUSC_36   B26. Re-alignbonesEUSC_37
KeyAreaFunctionCompetenceSkillsforHealthCode 50   B27. EnableindividualstotaketheirmedicationasprescribeCHD_HL1   B28. PreparefortheadministrationofmedicationEUSC_12   B29. CarryoutintravenousinfusionCHS23   B30. EstablishandmaintainpainreliefEUSC_77   B31. HelpindividualstouseoxygensafelyandeffectivelyCHD_HL2   B32. Discontinueinfusedand/orinhaledpharmaceuticalinterventionsEUSC_44   B33. SupportindividualswhoaredistressedHSC226   B34. SupportindividualswhereabusehasbeendisclosedHSC431   B35. ContributetothecareofadeceasedpersonHSC239   B36. SupportrelativesofthedeceasedHSC_AP9  2.6. Useclean,asepticor antiseptictechniques whereappropriate B37. PrepareadischargeplanwithindividualsEUSC_10  2.7. Referpatientsto appropriate healthcarespecialists orspecialistservices     B38. Referindividualsforfurtherassessment,treatmentandcareEUSC_09  B39. Referindividualstotherelevantagencytosupporttheirsocial needs  B40. Referindividualstospecialistservicestopromotetheirhealth andwell-beingandreducehealthrisks OP_F&S_2  2.8. Monitorthehealth statusofthepatient intheircare B41. Provideclinicalcareadviceandinformationtoindividualsand otherswhoareawaitingtreatmentorcare EUSC_68  2.9. Adviseonthehealth needsofthepatient totherelevantcarer B42. Provideadviceandinformationtoindividualsonhowtomanage theirowncondition GEN14
KeyAreaFunctionCompetenceSkillsforHealthCode 51 3.Documentation3.1. Completeand maintainappropriate clinicalnotes,either writtenorelectronic C1. Collectandvalidateinformationusingthemedicalmodelasa frameworkfordocumentation HI53  3.2. Providewritten statementsand reportsasrequired   C2. ProvideexpertadviceforlegalpurposesF3.2.11  C3. Provideclinicalandprofessionaladvicetointernalandexternal contacts HSCFunctionJ6   C4. Research,analyseandreportinformationCFA310  3.3. Shareinformation withother professionalsand agencies C5. CollateandcommunicateinformationinresponsetoqueriesEUSC_88 4.Equipmentand Technology 4.1. Maintainasafeand cleanenvironment D1. MaintainasafeandcleanenvironmentHSC246 D2. CalibrateandverifyequipmentpriortoclinicaluseHCS_A3   D3. Conductroutinepreventativeandcorrectivemaintenanceon equipmentinclinicaluse HCS_A4   D4. OperateequipmentrequiredtosupportaninterventionEUSC_51   D5. Provide&fitprescribedassistivedevicesforindividualuseAHP4   D6. EnableindividualstouseassistivedevicesAHP5  4.2. Maintainequipment andvehiclesrequired forthetransportof people,materialsand equipment D7. Monitor,handleandmaintainmaterialsandequipmentHSC243  4.3. Collect,transportand setdownpassengers and/ormaterialsand equipment D8. Checkandpreparevehiclesforthetransportofpeople, materialsandequipment GEN9
KeyAreaFunctionCompetenceSkillsforHealthCode 52  4.4. Receiveandstore medicationandother therapeuticmaterials D9. Handleandstoremedicalequipmentandconsumableswithin acceptedandsafelimits HSC-A5 5.Communicationand InformationTechnology   5.1. Maintainandensure effective communicationskills   E1. PromoteeffectivecommunicationforandaboutindividualsHSC31 E2. Discusstheprogressandoutcomesofservicesprovidedto individuals EUSC_90  5.2. Utiliseoraccess appropriate interpretationand translationskills E3. Supportindividualstocommunicateusinginterpretingand translationservices HSC371  5.3. Transmitandrecord informationusing electronic communication media   E4. Captureandtransmitinformationusingelectronic communicationmedia EUSC_92  E5. Adviseonthehealthstatusandhealthcareneedsofindividuals atadistantlocationusingelectroniccommunicationmedia EUSC_93 6.HealthandSafetyand Security   6.1. Protectindividuals fromharmandabuse   F1. Prepare&dressforworkinclinical/therapeuticareasGEN2 F2. Prepareenvironments&resourcesforuseduringclinical/ therapeuticactivities GEN6   F3. Monitorandmanagetheenvironmentandresourcesduringand afterclinical/therapeuticactivities GEN7   F4. ContributetotheprotectionofindividualsfromharmandabuseHSC337  6.2. SupporttheHealth andSafetyofselfand others F5. SupportthehealthandsafetyofyourselfandindividualsHSC22   F6. Evacuateandtransportindividualstootherlocationsforfurther assistance,treatmentorcare EUSC_86   F7. Maintainhealth&safetyinaclinical/therapeuticenvironmentGEN3
KeyAreaFunctionCompetenceSkillsforHealthCode 53   F8. Promote,monitorandmaintainhealth,safetyandsecurityinthe workingenvironment HSC32   F9. AssessandrespondtoaccidentsGEN11  6.3. Handleandstore equipmentsafely F10. Handleandstoremedicalequipmentandconsumableswithin acceptedandsafelimits HSC_A5  F11. StoreandtransportmedicalgascylinderssafelyCHD_HC1   F12. ReceiveandstoremedicationandproductsCHS1  6.4. Protectselfand othersfromriskof violenceatwork F13. ProtectyourselffromtheriskofviolenceatworkENTO_W7 7.ClinicalGovernance7.1. Actwithinthelimits ofscopeofpractice, competenceand authority G1. ActwithinthelimitsofyourscopeofpracticeandauthorityEUSC_91  7.2. Ensurecompliance withlegal,regulatory, ethicalandsocial requirements G2. Ensurecompliancewithlegal,regulatory,ethicalandsocial requirements M&LB8  7.3. Ensureactions supportthecare, protectionandwell beingofindividuals G3. Ensureyourownactionssupportthecare,protectionandwell- beingofindividuals HSC24 8.ProfessionalDevelopment8.1. Developandmaintain yourownknowledge andcompetenceto thelevelrequiredto meetprofessional andregulatory requirements H1. GivepresentationstogroupsGEN18
KeyAreaFunctionCompetenceSkillsforHealthCode 54 AdultSpecificCompetences KeyAreaFunctionCompetenceSkillsforHealthCode   ASC1Reviewpresentingconditionsanddeterminetheappropriate interventionfortheindividual EUSC_05   ASC2VerifyanexpecteddeathPSL10   ASC3Performmanualexternaldefibrillationonanadultorolder person EUSC66  ASC4Insertandsecureurethralcathetersandmonitorandrespond totheeffectsofurethralcatheterisation CHS8  8.2. Beinapositionto demonstrate continuing professional developmentinorder tomeetthe requirementsof regulation H2. AssistotherstoplanpresentationstoenablelearningGEN19  8.3. Ensureyourpractice iscurrentand evidencebased   H3. DevelopyourknowledgeandpracticeHSC23  H4. Reflectonandevaluateyourownvalues,priorities,interests andeffectiveness GEN12   H5. Takeresponsibilityforthecontinuingprofessionaldevelopment ofselfandothers HSC43
KeyAreaFunctionCompetenceSkillsforHealthCode 55   PSC1Workwithchildrenandyoungpeopletoassesstheirhealthand well-being CS2   PSC2Developappropriaterelationshipswithchildrenandyoung people CHS33   PSC3Communicatewithchildrenandyoungpeople,andthose involvedintheircare CS1   PSC4CommunicateandinteractwithbabiesMCN_1   PSC5Investigateanddiagnoseanunwellchildoryoungperson presentingforemergencyassistance EC_11M   PSC6Recogniseandmanageadversesignsandsymptomsinbabies, childrenandyoungpeople CS15   PSC7Plan,implement,monitorandreviewinterventionswithchildren andyoungpeople,andthoseinvolvedintheircare CS7   PSC8AdministermedicationtobabiesandchildrenMCN_21   PSC9Providehelpforchildrenandyoungpeopletounderstandtheir healthandwellbeing CHS34   PSC10Enablechildrenandyoungpeopletounderstandtheirhealth andwell-being CS11   PSC11Performmanualexternaldefibrillationonachildoryoung person EUSC67   PSC12Contributetoprotectingchildrenandyoungpeoplefrom danger,harmandabuse HSC325   PSC13Createanenvironmenttosafeguardchildrenandyoungpeople fromabuse CS9   PSC14SafeguardchildrenandyoungpeopleatriskofabuseCS10 PaediatricSpecificCompetences
KeyAreaFunctionCompetenceSkillsforHealthCode 56   ESC1CommunicatewitholderpeopleandtheircarersOP1   ESC2Investigateanddiagnoseanunwellolderpersonpresentingfor emergencyassistance EC_11L   ESC3ProtectolderpeoplefromabuseOP11   ESC4CreateanenvironmenttoprotectolderpeoplefromabuseOP10 MentalHealthSpecificCompetences KeyAreaFunctionCompetenceSkillsforHealthCode   MHSC1IdentifypotentialmentalhealthneedsandrelatedissuesMH_14   MHSC3AssessriskofsuicideordeliberateselfharmMH16 Competenceswhicharenotincludedbutarerecommendedforlocaldevelopmentsubjecttoservicerequirements KeyAreaFunctionCompetenceSkillsforHealthCode AssistintheadministrationofmedicationCHS2 CarryoutarterialpunctureandcollectarterialbloodCHS24 Usepre-plannedmethodstomanagebloodlossEUSC_20 PerformendotrachealintubationEUSC_78 (Thereisaseparatecompetenceforextubatinganindividual.)  UndertakeendotrachealextubationwithinanEUSCenvironmentEUSC_18 Operateandcontrolvehiclesandcollect,transportandsetdown passengersand/ormaterials&equipment GEN10 CareoftheElderlySpecificCompetences ThecompetenceswhichdonothaveaSkillsforHealthcodeareeitherindevelopmentorsubjecttorationalisation.
57 Appendix 2: Learning Outcomes for Emergency Care Practitioners Working in Pre-Hospital, Primary and Acute Care Settings Introduction In order to help understand the function and the work of the Emergency Care Practitioner and to assist in the planning of a curriculum of education the Learning Outcomes for this new role have now been arranged in the format of the Health Functional Map The Health Functional Map aims to identify all the functions that take place in an occupational area. The functions represent the combined range of activities performed by all the workers in that area but do not represent specific jobs or roles. The functions presented here are those identified for Emergency Care Practitioners working as part of a team in a variety of settings and cover several different methods of service delivery. Such settings could be: Minor Injury/Illness Units• Walk-in-Centres• General Practice• Primary Care• Out-of-Hours provision• Ambulance Service• Custody Suites• Prison Health Care• Emergency Departments• Urgent Care Centres• The Learning Outcomes associated with this Health Functional Map are those developed and agreed following the Coventry study in 2001, tested in 17 different pilot sites since then and reviewed by representatives of the different professional groups who attended the Leads meetings held regularly during that period. The Learning Outcomes have been matched to the competences in the various sections of the map.
58 The table lists the Learning Outcomes related to the Key Functions. A summary of the competences associated with these Learning Outcomes can be found in Chapter 4 and the detail behind the Competences is available on the Skills for Health website. Structure of the Health Functional Map Related functions are grouped into a number of key areas. Some of the function titles are supported by bullet points/notes to clarify their potential scope. Where applicable, functions are cross referenced to the Learning Outcomes and to the Knowledge and Skills Framework Key Areas and Functions 1. Assessment of the health and social status of the patient 1.1 Obtain consent 1.2 Take a relevant history from the patient and/or carers 1.3 Assess the social needs of your patient 1.4 Undertake a clinical examination of your patient 1.5 Undertake the necessary special tests to confirm the suspected diagnosis of your patient 1.6 Diagnose or suggest a differential diagnosis for your patient 2. Addressing the health and social requirements of the patient 2.1 Provide emergency care when indicated 2.2 Work as part of a team, recognising your scope of practice as an Emergency Care Practitioner 2.3 Use appropriate health and social care pathways 2.4 Work to national and local guidelines 2.5 Provide clinical/therapeutic interventions 2.6 Use clean, aseptic or antiseptic techniques where appropriate 2.7 Refer patients to appropriate healthcare specialists/specialist services and social services 2.8 Monitor the health status of the patients in your care 2.9 Advise on the health needs of your patient to the relevant carer
59 3. Documentation 3.1 Complete and maintain appropriate contemporanious clinical notes and referral documentation, either written or electronic 3.2 Provide written statements and reports as required 3.3 Share information with other professionals and agencies 4. Equipment and Technology 4.1 Maintain a safe and clean environment 4.2 Maintain equipment and vehicles required for the transport of people, materials and equipment 4.3 Collect, transport and set down passengers and/or materials and equipment 4.4 Receive and store medication and other therapeutic materials 5. Communication and Information Technology skills 5.1 Maintain and ensure effective communication skills 5.2 Utilise or access appropriate interpretation and translation skills 5.3 Transmit and record information using electronic media 6. Health and safety and security 6.1 Protect individuals from harm and abuse 6.2 Support the Health and Safety of yourself and others 6.3 Handle and store equipment safely 6.4 Protect yourself and others from risk of violence at work 7. Clinical Governance 7.1 Act within the limits of your scope of practice, competence and authority 7.2 Ensure compliance with legal, regulatory, ethical and social requirements 7.3 Ensure your actions support the care, protection and well being of individuals 8. Professional development 8.1 Develop and maintain your own knowledge and competence to the level required to meet Professional and Regulatory requirements 8.2 Be in a position to demonstrate your continuing professional development in order to meet the requirements of regulation
60 8.3 Ensure your practice is current and evidence based Specific Areas and Functions 9. Paediatric and Child Health 10. Learning Disabilities 11. Mental Health 12. Care of the Elderly Functions not considered Core but which may be developed for Local Requirements 13. Custody settings 14. Arterial puncture and collection of arterial blood 15. Advanced Airway Support 16. Critical Care
61 KeyAreaFunctionLearningOutcomes 1.Assessmentofthe HealthandSocialStatus ofthePatient   1.1 Takearelevant historyfromyour patientorcarers   Undertakeaholisticassessmentofpatientsinarangeofsettingsincorporatingthe elementsofhistorytaking,conductingthe‘interview’anddevelopingatherapeutic relationship Demonstratearangeoftechniquesaskingkeyquestionstoelicitacomprehensivehistory frompatients  1.2 Undertakeaclinical examinationofyour patient General:  Developknowledgeoftherelevantappliedanatomyandphysiologypertainingtothebody systemscoveredwithinthecourse,includingvariationsacrossthelifespan   Analysethephysiologicalandpatho-physiologicalprocessesandchangesthatoccurin patientsacrossthelifespan   Explorethegeneralanatomyandphysiologyoftheupperlimbsanddemonstratefamiliarity withrelatedterminology   Explorethegeneralanatomyandphysiologyofthelowerlimbsanddemonstratefamiliarity withrelatedterminology   Analysetheeffectsofdiseaseprocessessuchasrenalfailure,chestinfectionsand cardiovascularconditions   Criticallyexaminetheclinicalsignificanceofvitalsignsinallages   Examination:   Demonstrateanunderstandingofthefourkeyassessmentskillsofinspection,palpation, percussionandauscultation,andrecognisetheimportanceofhistorytakingasakey componentinanypatientassessmentsituation   Demonstrateeffectiveclinicalassessmentandexaminationskillsinvolvingtheuseofa stethoscope,sphygmomanometer,auroscope,ophthalmoscope,torchandthermometer  Illness:Cardio-vascular:   Demonstratetheabilitytoperformathorough,systematicassessmentandexaminationof thecardiovascularsystem,notinginparticularkeysymptomsandsignssuggestiveof underlyingdiseaseprocessese.g.chestpain,shortnessofbreath,palpitationsetc.   Demonstratetheabilitytoperformathoroughsystematicassessmentandexaminationof theperipheralvascularsystem,notinginparticularkeysymptomsandsignssuggestiveof ischaemiclimb,varicoseveinsetc.
KeyAreaFunctionLearningOutcomes 62   Respiratory:   Demonstratetheabilitytoperformathorough,systematicassessmentandexaminationof therespiratory,notinginparticularkeysymptomsandsignssuggestiveofunderlying diseaseprocessese.g.cyanosis,shortnessofbreath,cough,clubbingetc.   DemonstrateaclearunderstandingoftheapplicationoftheNationalGuidelinesforthe managementofthepatientwithasthma  DemonstrateaclearunderstandingoftheapplicationoftheNationalGuidelinesforthe managementofthepatientwithCOAD   Demonstrateaclearunderstandingofthemanagementofapatientwithanacuterespiratory conditionsuchaspneumonia,pleurisyandbronchitis.   Demonstrateaclearunderstandingoftheassessmentandmanagementofthepatientwith apulmonaryembolus   Gastrointestinal:   Demonstratetheabilitytoperformasystematicassessmentandexaminationofthe abdominalandgastrointestinalsystems,inparticularhavingtheabilitytorecognisepatients withanacuteabdomen   Demonstratecompetenceindealingwithpatientspresentingwithconstipation   Genito-urinary:   Demonstratetheabilitytoperformasystematicassessmentandexaminationofthegenito- urinarysystems,inparticularhavingtheabilitytorecognisepatientswithacuteretentionof urineandotheracutecomplaintssuchasrenalcolic   Demonstratecompetenceindealingwithpatientspresentingwithurinarytractinfections   Demonstrateknowledgeinassessingandmanagingpatientswhopresentwitharangeof gynaecological/obstetricemergenciesincludingvaginalbleeding,dysmenorrhoea,pre- eclampsia,thesignificanceofante-partumhaemorrhageincludingsuspectedectopic pregnancy,managementofemergenciesduringdeliverypriortothearrivalofspecialist maternityservicesandpostpartumcomplications   Nervoussystem:   Demonstratetheabilitytoassessandexaminepatientswithconditionsaffectingthe nervoussystem,bothcentral&peripheral
63 KeyAreaFunctionLearningOutcomes   Assesspatientswhopresentwithheadachesincludingmigraineheadaches,identify differentialdiagnosesandbeabletotreat,referordischargeasappropriate   ENT:   Demonstratefamiliaritywitharangeofcommonear,noseandthroatproblemsandassess, treatandreferordischargepatientsasappropriate,providingarationaleforallactionsand interventionstaken   Ophthalmic:   Performasimpleeyeassessmentandbeabletoreferasappropriatethosepatientswho presentwitha‘redeye’orasaconsequenceofoculartrauma   Endocrine:   Carryoutanassessmentandexaminationpertainingtotheendocrinesystem   Demonstratetheabilitytoassessandexaminepatientswithconditionsaffectingthe endocrinesystem.   Skin:   Demonstratetheabilitytoassessandexaminetheskin.   Demonstratetheabilitytorecognisecommonskinrashesandhaveknowledgeofthe appropriatemanagement   Assess,treatandreferordischargepatientswithmildallergicreactions   MentalHealth:   CriticallyanalysethecomponentsoftheMentalHealthActandtheirapplication.   Demonstratetheabilitytocarryoutamentalhealthassessmentonarangeofpatients notinganydeviationfromnormal,andtheabilitytodeviseappropriateactionplanstaking noteofothersinvolved(e.g.depressionanditsseverity,deliberateselfharmandthedegree ofriskinvolved,anxietydisorders,phobias,acuteandchronicpresentations)   Undertakeassessmentofpatientswhopresentundertheinfluenceofdrugsand/oralcohol, andbeabletodeterminenormalpresentationsandthosethatdeviatefromnormal
64 KeyAreaFunctionLearningOutcomes   Dental:   Analysearangeofdentalemergenciesandoralproblems,andbeabletoassess,treatand referordischargepatientsasappropriate   AllergiesandAnaphylaxis:   Demonstratecompetenceindealingwithpatientspresentingwithallergicreactions;for examplerhinitis,pyrexia,localisedinfection,andthemoresevereproblemsofanaphylaxis  Musculo-skeletal:   Demonstratetheabilitytoassessandexaminepatientswhopresentwithmusculo-skeletal painandtreat,referordischargethemasappropriate,providingarationaleforallactions taken   Paediatrics:   Assessandmanagethecrying/inconsolablechildandhis/hercarers,anddemonstratethe abilitytoconductacomprehensivepatientassessment  Injury:Musculo-skeletal:   Criticallyanalysetheimportanceofdeterminingthemechanismofinjuryinrelationto patternsofinjuryandclinicalpresentations   Assesspatientswhopresentwitharangeofminorinjuriesusingastructuredapproach(e.g. thelook,feelmoveapproach)andtreat,referordischargethemasappropriate   Undertakeassessmentofthecervicalspineandbeabletoidentifyanydeviationsfrom normal   Demonstratecompetenceintheassessmentandmanagementofpatientswithbonyand softtissueinjuriesoftheupperlimbsincludingthehand,wrist,forearm,elbowandshoulder   Demonstratecompetenceintheassessmentandmanagementofpatientswithbonyand softtissueinjuriesofthelowerlimbsincludingthefoot,ankleandknee   Analysethedifferencesinfracturesandtheirmanagementinadultsandchildren   Criticallyappraisethemanagementofsimple,uncomplicateddislocationsinpatientsofall ages
65 KeyAreaFunctionLearningOutcomes   Skin:   Demonstratecompetenceintheassessment,treatmentandmanagementofwoundsand lacerations,andbeabletoprovidearationaleforallactionsandinterventionstaken   Demonstratecompetenceinwoundcleansingtechniquesandtheselectionandapplication ofarangeofwoundcareproductsanddressings   Demonstratecompetenceintheassessment,treatmentandmanagementofminorinjuries includinganimalandhumanbites,stings,andminorburnsandscalds   ClinicalImaging:   Criticallyexaminetheindicationsforrequestingbasicradiologicalinvestigationsandrefer patientsasappropriate,withdueregardtotheIRMARegulations  1.3 Undertakethe relevantand necessaryspecial teststoconfirmthe diagnosis Makesenseofandassimilateclinicalfindingstoenableworkingorprovisionaldiagnosesto beestablishedinrelationtoarangeofpresentations  Demonstratetheabilitytointerpretbasicinvestigationsincludingurinalysis,bloodtests, glucometers,andbeabletoidentifyappropriatethepathologicalinvestigationsrequiredfor commonconditionsandtoobtainappropriatespecimensinrelationtothese   Undertakea12leadECG   Criticallyevaluate12leadECGsandreactinaneffectiveandtimelymannerinrelationto findings  1.4 Diagnoseor suggesta differential diagnosisforyour patient Exploretheconceptofadifferentialdiagnosisandbeabletomakesafeandeffective decisionsincludingreferralstoappropriatespecialistsorotherclinicalteammembers 2.AddresstheHealthand SocialRequirementsof thePatient   2.1 Provideemergency carewhen indicated Criticallyappraisethesignificanceofredflagmarkersinrelationtoclinicalfindingsandact accordingly 2.2 Workaspartofa team Demonstratefamiliaritywiththeprocessesinvolvedindeliveringprimarycareservices includingbookingsystemsandtherolesofallteammembers,includingGeneral Practitioners,DistrictNurses,HealthVisitors,PracticeNursesandReceptionists
66 KeyAreaFunctionLearningOutcomes  2.3 Useappropriate healthcare pathways Demonstrateeffectiveclinicaldecision-makingskillsandtheapplicationofsoundclinical judgmentbasedonclinicalfindings  2.4 Worktonational andlocalguidelines CriticallyexamineandapplytheOttawaAnkle,KneeandCervicalSpineRulesandtheNICE guidelinesforthemanagementofHeadInjury  DemonstrateknowledgeofandconfidenceinusingtheOttawaguidelinesinrelationto musculoskeletalinjuriesofthelowerlimbs  2.5 Provideclinicaland therapeutic intervention Criticallyanalyseaclearunderstandingofthelegalandprescribingrulesassociatedwiththe prescribing,administrationandsupplyofmedicines  Criticallyappraiseabroadbasedunderstandingofdrugscommonlyusedintheroutine managementofmedicalconditions,andtheabilitytorefertoappropriateinformation sourcesforfurtherinformation  Criticallyreflectontheeffectsthatthedynamicsofagehaveondrugeffectivenessandthe necessaryprecautionstoavoidpatientharm  CriticallyanalysetheprinciplesandpracticeunderpinningtheuseofPatientGroup Directions(PGDs)includingtheirlegalstatus  Criticallyreflectontheprinciplesofsafeprescribingandmechanismsforreportingadverse drugreactions   Criticallyexaminecommonlyusedandmisuseddrugs/substances,andtheirphysical manifestations   Demonstratetheabilitytoobjectivelyassesspaininpatientsacrosstheagecontinuum usingarangeofassessmenttools.   Demonstratecompetenceinidentifyingtheneedforandapplicationofarangeofsplints andsupportsincludingslings,collarsandbandages   Criticallyanalysetheindicationsforimmobilisation,thetechniquesinvolved,potential problems,andinstructionsforongoingcare  2.6 Administer medication Administerpharmacologicalandnon-pharmacologicalanalgesiatoachieveeffectivepain control  Criticallyappraisetheindicationsforthrombolysisinbothhospitalandout-of-hospital settings,thevariousagentsinvolvedandtheassociatedrisks
67 KeyAreaFunctionLearningOutcomes  2.7 Referpatientsto appropriate healthcare specialistsor specialistservices Demonstratefamiliaritywithreferralprocessesinrelationtothewiderhealthandsocialcare communityandhowthesemaybeutilisedbytheECP  Criticallyappraisereferralprocessesandpathwaysacrossthehealthandsocialcare economy,andtheindicationsforreferringpatients  Deviseappropriateactionplanswherenecessary,includingreferraltoothersinthehealth andsocialcareteam.  2.8 Monitorthehealth statusofthe patientinyourcare Demonstrateanabilitytobeabletocontinuetheobservationandcareofthepatientinyour care,beawareofthesignificanceofchangeinthoseobservationsandbeabletoact accordingly  2.9 Adviseonthe healthneedsofthe patienttothe relevantcarer Demonstratetheabilitytoperformanassessmentofpatientsdomesticandsocialsupport networks 3.Documentation3.1 Completeand maintain appropriateclinical notes Demonstrateaccurateandeffectivedefensibledocumentationoffindingsfromthehistory takingandphysicalassessmentprocessinsuchawaythatthiscanbeunderstoodbyall membersofthemulti-disciplinaryteam  3.2 Providewritten statementsand reports Demonstrateanabilitytoprepareandwritestatementsorreportsbasedonyourclinical noteswhenrequestedforlegalpurposes,foreitherthecriminalorcivilcourt.  3.3 Work collaborativelywith otherprofessionals andagencies     Criticallyreviewinter-serviceworkinginvolvingalltheemergencyservices,including collaborationandcommunication,andunderstandingoftheroleandcontributionofthe widermulti-disciplinaryteamtothedeliveryofemergency/unscheduledcare  CriticallyreviewthepublichealthroleofECPsandtheknowledgeneededtoprovidethe correctadvicetopatients  AnalysetherolesandresponsibilitiesoftheECPinrelationtosuddendeathandthoseof thecoroner,hisofficers,funeraldirectors,andthepreservationofforensicevidence,bothat thesceneandbeyond. 4.Equipmentand Technology 4.1 Maintainasafeand cleanenvironment Understandtheindicationsfortheuseofwalkingaidsincludingelbowcrutchesandaxillary crutches,walkingsticksandZimmerframes,andbeabletodemonstratesafetechniques foruse
KeyAreaFunctionLearningOutcomes 68  4.2 Maintainvehicles forthetransportof people,materials andequipment Demonstratefamiliaritywithequipmentparticulartotheambulanceorout-of-hospitalsetting including:extricationdevices(e.g.KEDandRED),longboards,spinalimmobilisation devices,carrychairs,liftingcushions,patientsslides,portableventilationsystems,manual andelectricsuctiondevices,splints(e.g.vacuum,box,ortraction),andtheadvantagesand disadvantagesofthevariousmodesoftransport  4.3 Collect,transport andsetdown passengersand/or materialsand equipment     Criticallyreflectonscenesafety,mechanismsofinjuryandpatientextricationtechniquesin theout-of-hospitalsetting  Demonstrateawarenessofguidanceonparkinguponarrivalatincidentscenes  Exploretheprinciplesofscenesafetyandsceneprotection  CriticallyexamineHAZCHEMcodesandtheimportanceoftheUNnumber  4.4 Receiveandstore medicationand products Beawareoftheregulationsregardingthestorageofmedicationsinyourcarewhichyou mayneedtodispensetothepatientusingthelocalPatientGroupDirectives 5.Communicationand InformationTechnology 5.1 Maintaineffective communication skills DemonstratefamiliaritywiththeprioritisationsystemsandprocessesusedinClinical settings,includingtriage,streamingand‘see&treat’  5.2 Develop appropriate interpretationand translationskills Demonstratetheabilitytoarticulateclinicalfindingsinrelationtonormalandabnormal presentations   Demonstrateeffectiveandenhancedcommunicationandinterpersonalskillswhendealing withpatientsacrossthelifespan,includingthosewithspecialneeds  5.3 Transmit informationusing electronic communication media Criticallyanalysethevariousstructuresandprocessesunderpinningtheorganisationofthe ambulanceserviceincludingcommunications,prioritydispatchsystems,radioprocedures, therangeofemergencyresponsevehiclesavailableandactivationprocedures   Exploretheuseandbenefitsoftelemetryandtelemedicineinthedeliveryofemergency/ unscheduledcare
69 KeyAreaFunctionLearningOutcomes 6.HealthandSafety6.1 Protectindividuals fromharmand abuse   CriticallyreflectonthelocalGuidelinesandProceduresagreedbytheAreaReview CommitteefortheProtectionofAdultsinyourareaofwork  Criticallyreflectontheissuesassociatedwithdomesticviolence,non-accidentalinjury(inall ages),elderabuseandthoseinthevulnerablegroups,andbeabletodeviseactionplans and/ormakereferralsasappropriate  6.2 SupporttheHealth andSafetyofself andothers Criticallyappraisethelegalrequirementsandmechanismforreportinganydiagnosismade ofacommunicabledisease.  6.3 Handleandstore equipmentsafely Demonstrateanunderstandingofandexploretheregulationsregardingthehandlingand storageofequipmentyoumayuseinthecareofyourpatientorcarersofyourpatient  6.4 Protectselfand othersfromriskof violenceatwork Criticallyreflectonwaysinwhichviolentorpotentiallyviolentsituationsmaybemanaged anddefused 7.ClinicalGovernance7.1 Actwithinthelimits ofyour competenceand authority   CriticallyexaminetherolesandresponsibilitiesoftheECPinrelationtoClinicalGovernance  Criticallyanalysethelegal,professionalandethicalissuespertainingtoEmergencyCare Practitioners   Criticallyreflectonthecorrecthandlingandstewardshipofconfidentialpatientinformation, andfamiliaritywiththeDataProtectionActandtheroleoftheCaldicottGuardian   CriticallyexploretheCodeofProfessionalConductandscopeofprofessionalpracticeof theECPandtheirsignificanceinrelationtothedevelopmentofclinicalpractice   Criticallyreflectonwhatismeantbyaccountability,responsibility,delegation,supervision, liability,vicariousliabilityandprofessionalregulation   Criticallyanalysetheprofessional,legalandethicalframeworkswithinwhichout-of-hospital careispractised   Criticallyreflectonthetermsconsent,capacity,confidentialityanddisclosure,andtheir applicationinemergency/unscheduledcaresettingstopatientsacrossthelifespan   Reflectonthepurposeandfunctionoftherangeofsettingsinwhichemergency/ unscheduledcareisdelivered,includingtheambulanceservice,primarycare,out-of-hours facilities,Walk-in-Centres(WICs),MinorInjuryUnits(MIUs),NHSDirect(NHSD),and EmergencyDepartments(EDs),UrgentCareCentres(UCCs)andCustodysettings
KeyAreaFunctionLearningOutcomes 70  7.2 Ensurecompliance withlegal, regulatory,ethical andsocial requirements   Criticallyreflectontherolesandvaluesofthoseinvolvedindeliveringemergency/ unscheduledcareanddevelopadirectoryoflocalnetworksacrossthehealthcommunity, includingrelevantcontactdetails,bothin-hoursandout-of-hours  Exploretherolesandresponsibilitiesofcoronersandtheirofficials,inrelationtosudden death,andthelegalandprofessionalresponsibilitiesofpractitionersinrelationtothe preservationofevidence  7.3 Ensureactions supportthecare, protectionandwell beingofindividuals AnalysetheexpandingscopeofECPpracticeinthearenaofphysicalassessment,andthe impactofthesenewrolestoprofessionalpractice
71 Pediatric Specific Learning Outcomes Demonstrate effective and enhanced communication and interpersonal skills when dealing with children. Demonstrate a range of techniques to use in eliciting a comprehensive history from children and carers Demonstrate confidence in the assessment and recognition of the sick child, and initiate immediate and ongoing treatment as required including early specialist referral Make sense of and assimilate clinical findings to enable working or provisional diagnoses to be established in relation to a range of presentations Analyse the clinical significance of vital signs in all children Assess, treat and refer or discharge children with allergic reactions Assess, treat and manage febrile children, taking particular note of relevant past medical history Assess, treat and refer as appropriate those children who present as a consequence of toxic ingestion, and those who present with respiratory, cardio-vascular or urinary symptoms, vomiting, diarrhoea and/or dehydration Demonstrate assessment and examination of the nervous system, both central and peripheral in children Critically explore meningitis and meningococcal disease, and their related symptoms, signs and immediate treatment Critically appraise local child protection procedures, including the Child Protection Register and the Children’s Act, and be familiar with indicators of non-accidental injury
72 Appendix 3: An Example of a Theory and Clinical Module for the Education of Emergency Care Practitioners Degree in Healthcare Sciences (Emergency Care Practitioner) Theory Module 1. Title: Emergency Care Practitioner Clinical Practice 2. Module Leader: Joe Bloggs 3. Credits: 40 4. Level: Level 6 5. Post-requisites: This module must be undertaken with Module 12345 (ECP Clinical Practice) in order to complete the ECP Programme and be eligible for the award. 6. Rationale: This Module forms part of the Emergency Care Practitioner (ECP) Programme. It complies with the requirements stated within the Skills for Health Emergency Care Practitioner Competence and Curriculum Framework. This was initially developed as part of the National Changing Workforce Programme and also fitted with the Reforming Emergency Care Programme. The ECP role has been shown to significantly reduce Ambulance journeys and Accident and Emergency admissions. An ECP has been defined as ‘…a healthcare professional who works to a medical model, with the attitude, skills and knowledge base to deliver holistic care and treatment within the pre-hospital, primary and acute care settings with a broadly defined level of autonomy.’ (Skills for Health 2006) This module will prepare the student for their future role as an ECP.
73 7. Aims and distinctive features : This module is full time study, with students attending the University several days a week, and having directed study for the remainder of the time. This module will prepare and equip students with an expanded knowledge base composed of underpinning theoretical concepts, practice skills and physical assessment skills to enable them to undertake the role of Emergency Care Practitioner. It will develop effective therapeutic communication skills and promote effective clinical decision making in relation to professional judgment and diagnostic reasoning. The content will foster an evidence-based approach to professional practice in a variety of environments, which may often be unknown until the time the practitioner arrives at the scene. The Aims of the Programme as listed in the Skills for Health Competence and Curriculum Framework specify that the ECP should be: safe practitioners in a wide variety of clinical pathways, with patients from diverse• social and ethnic backgrounds over the whole age range expert communicators who are empathetic in a manner appropriate to the• healthcare professional aware of health inequalities and the challenges of working in a multicultural• environment aware of the limits of their competence and determined to act within those limits • comfortable in the context of multi-professional working in a team environment• adept in the use of C & IT (Communication and Information Technology) skills for• healthcare capable and motivated lifelong learners continually engaged in active professional• development understanding of the need to maintain and promote health, as well as to cure or• palliate disease aware of their obligations to the wider community as well as to individuals• able to integrate theoretical and clinical learning• 8. Learning outcomes : On completion of the module students will be able to: 1. demonstrate an understanding of the relevant anatomical and physiological concepts and theoretical constructs which underpin a safe and effective patient consultation. 2. critically examine key relevant concepts and theoretical constructs in order to effectively manage a range of clinical conditions; to maintain and promote health; to cure or palliate disease in the wider community as well as individuals.
74 3. demonstrate an insightful understanding of the communication and interpersonal skills necessary to effectively and safely deal with patients/ significant others, relating effectively to other health care professionals. 4. critically appraise knowledge of key treatment options to examples from practice 5. demonstrate an ability to apply the underlying concepts and principles relating to the Codes and Standards required for Professional Conduct, Clinical Governance, medico-legal implications and their relevance to practice. 6. demonstrate an ability to utilise communication information technology skills to undertake critical analysis of data used in health care 9. Learning and teaching strategy : The delivery of module content will be through the use of interactive lectures, practical demonstrations, discussions, reflective practice, simulated clinical examinations, seminar presentations and tutorials. The strategy chosen will ultimately depend on the subject matter. A number of speakers, both internal and external, will be used in this module to ensure that there is an emphasis on practice. There will also be directed student tasks throughout the module. Peer group sharing of information and experience will be utilised to reinforce the students’ confidence. The use of an ongoing academic supervision process will also help to ensure that the student is aware of any deficiencies in his/her learning process or, indeed, their competence on a month by month basis. 7.1.1.1 Type Length in Hours 7.1.1.2 Learning Outcome 7.1.1.3 Interactive Lecture / Seminar Presentation 344 1 – 6 7.1.1.4 Discussion 24 1 – 6 Reflective Practice 24 1 – 6 7.1.1.5 Simulated Clinical Exams 5 1 – 6 7.1.1.6 Tutorials 3 1 – 6 10. Arrangements for revision and private study See above. Pre and intra-modular reading lists will support sessions. 11. Methods of assessment Summative: 1. A three hour unseen written exam covering biosciences – Anatomy & Physiology, patho-physiology, and Clinical Medicine. (60% of total mark)
75 2. Diagnostic interpretive examinations, e.g.. ECG interpretation, radiographic interpretation, short answer questions on pictures, bones and pharmacology. (Pass / Fail) 3. Two 15 –20 min Biosciences / Clinical Medicine Presentations (40% of total mark: 20% each Presentation) 12. Methods of reassessment (if different to 11) Students must successfully complete all assessments. Should the student be referred in any of the above assessments, he/she is permitted one further attempt at that assessment. Should the student be referred in more than two of the assessments, they will be required to undergo the full series of assessments again. Their final result will then be not more than 40%. Students’ assessed work will be subject to the regulations and requirements of the University including the code of practice on unfair means. 13. Programme outcomes Programme outcomes Module outcomes Assess method 1 Assess method 2 Assess method 3 1, 7, 8 1, 2, 4, 5 Biosciences & Clinical medicine Examination 1, 2, 3, 4, 5, 8 2, 3, 4, 6 Diagnostic interpretive examination 1, 2, 5, 6, 9 1, 2, 4 Presentations KEY: CP: Clinical Portfolio CPR: Clinical Presentation CF: Competence Framework OSCE: Objective Structured Clinical Examination 14. Assessment Specification The student is required to: Relates to learning outcome Demonstrate detailed knowledge of anatomy, physiology and patho-physiology. Demonstrate skills in the independent analysis of theoretical constructs to a range of clinical presentations based on ECG tracings, pictures, bones or pharmacology questions. 1 Critically examine key relevant concepts and theoretical constructs to a range of clinical conditions. 2
76 Demonstrate an insightful understanding of the communication and interpersonal skills required for thorough history taking and clinical assessment of patients with a range of conditions. 3 Demonstrate advanced clinical decision making which encompasses the concept of safe and effective evidence based practice in the management of a range of conditions. 4 Demonstrate the ability to understand safe and effective evidence based practice in the management of clinical conditions across the age range. 5 Demonstrate an ability to utilise communication information technology skills to undertake critical analysis of data used in health care 6 15. External examiner Appointed Name: Joe Bloggs Awaiting confirmation Name: Not identified 16. Programme – module learning outcomes – mapping to internal/external reference points Programme outcomes Module outcomes Subject benchmarks QAA 2001, (Emerging Health Profession) Subject benchmarks QAA 2001, Registered Health Care Professional, (Nursing) ECP Competence and Curriculum Framework. (Appendix 1. Learning Outcomes) NHS Knowledge and Skills Framework outcomes (core and specific) 1 2, 3, 5 A1.4, A2.4, A3.2, A3.4, B1.3, B3.2, B3.4, C2.5, A2.1, A3.1, B3.2, B3.4, B3.5, B3.6, B3.14, C1.2, C2.1 3, 8, 9,10, 11, 12,13,14,15, 16,17, 18,19, 20, 21 HWB1,2,3,4,5,6, 7,10; IK1,2,3 2, 6 6 A2.1, A2.3, A4.1, B2.1, B2.2, A3.3 A2.1, A2.2, A2.4, B2.4 6 5; HWB8; IK1, 2, 3 3, 4, 5, 7 4 ,A3.7, A4.3, B4.3, B4.4, C1.4, C2.2, A4.3, B3.10, B3.11, B3.13, C2.6 5 2, 5, 6 8 9 A2.3, B2.6, B2.5, C1.2, C2.1, A4.1, A4.2, B2.2, B3.3, C1.3, C2.3, C2.4, C2.5 1 5; HWB7; G2 17. Indicative content The role of the ECP within the wider health care team• Study skills• Anatomy, physiology and patho-physiology of disease• Evidence based practice•
77 Analysis of the ECP role and its implications for patients, peers and colleagues• Clinical Medicine• The paediatric patient• Understanding the scope of practice of the ECP and the associated professional,• legal and ethical issues Mental health• 18. Indicative reading Students will be encouraged to read widely throughout the course. In addition to text books, they will be encouraged to access journal articles, National Guidelines and web based material.  The following list includes a selection of books that are recommended as appropriate for students on this course. It is not necessary to use all of these references; in some categories more than one book is recommended. Each student will have a personal preference as to which text is preferred. Anatomy / Physiology & Pathophysiology Martini,F, (2002), Fundamentals of Anatomy and Physiology, Pearson, Benjamin Cummings, Porth,Carol Mattson, (2002), Pathophysiology, Concepts of Altered Health States,   Lippincott, Philadelphia. Abrahams, P, Craven,J & Lumley, J, (2005), Illustrated Clinical Anatomy, Hodder Education, London. Clinical Medicine Kumar,P.& Clark,M. (2002), Clinical Medicine , Elsevier Science Ltd, Edinburgh. Longmore, M, Wilkinson, I, Rajagopalan, S, (2004) The Oxford Handbook of Clinical Medicine,London. Clinical Examination Epstein,O, Perkin,G,D, Cookson,J & De Bono,D,P, (2003), Clinical Examination, Mosby, London. Paediatrics Hull, D, Johnston, I, (1999), Essential Paediatrics, London. Miall, L, Rudolf, M & Levene, M, (2003), Paediatrics at a Glance, Oxford: Blackwell Science.
78 Minor Injuries McRae, Ronald, Clinical Orthopaedic Examination, Oxford, Churchill Livingstone. Purcell, D, (2003), Minor Injuries: A Clinical Guide for Nurses, Oxford, Churchill Livingstone. Sakthivel-Wainford, K, (2006), Self Assessment in Limb X-ray Interpretation, Cumbria, M&K Publishing. Miscellaneous: Ogden, J, (2004), Health Psychology- A Textbook, 3 rd ed, Open University Press. Read M T F (2000), A practical guide to sports injuries, Oxford: Butterworth Heinemann. Reveley S, Walsh M & Crumbie A, (1999) Nurse Practitioners Clinical Skills and Professional Issues, Oxford: Butterworth Heineman,
79 Degree in Healthcare Sciences (Emergency Care Practitioner) Clinical Practice Module 1. Title: Emergency Care Practitioner (Clinical Practice) 2. Module Leader: Joe Bloggs 3. Credits: 40 4. Level: Level 6 5. Pre-requisites: This module must be undertaken with Module Number 12345 (ECP Theory), in order to complete the ECP Programme and be eligible for the award. 6. Rationale: This Module forms part of the Emergency Care Practitioner (ECP) Programme. It complies with the requirements stated within the Skills for Health Emergency Care Practitioner Competence and Curriculum Framework. This was initially developed as part of the National Changing Workforce Programme and also fitted with the Reforming Emergency Care Programme. The ECP role has been shown to significantly reduce Ambulance journeys and Accident and Emergency admissions. An ECP has been defined as ‘…a healthcare professional who works to a medical model, with the attitude, skills and knowledge base to deliver holistic care and treatment within the pre-hospital, primary and acute care settings with a broadly defined level of autonomy.’ (Skills for Health 2006) This module will prepare the student for their future role as an ECP. 7. Aims and distinctive features : This module will be made up of full time clinical placements with additional University based study days. The module will consolidate the expanded knowledge base of the underpinning theoretical concepts and skills / techniques provided within ECP Theory module (23456). It will provide the opportunity to develop skills and enhance the student’s clinical decision making, diagnostic reasoning and professional judgement in a range of settings. It will enable students to develop and consolidate the requisite skills / expertise to become a safe and effective ECP in practice.
80 8. Learning outcomes: On completion of the module students will be able to critically evaluate underpinning knowledge and demonstrate: 1. safe practice in a wide variety of clinical settings, with patients from diverse social and ethnic backgrounds over the whole age range 2. expert communication skills which encompass an empathetic manner appropriate to the healthcare professional 3. awareness of health inequalities and the challenges of working in a multicultural environment 4. awareness of the limits of their competence and a determination to act only within those limits 5. an ability to work effectively in the context of a multi-professional team environment 6. competence in the use of C & IT (Communication and Information Technology) skills for healthcare 7. a motivation for lifelong learning and a willingness to continually engage in active professional development 8. an understanding of the need to maintain and promote health, as well as to cure or palliate disease 9. awareness of their obligations to the wider community as well as to individuals 10. an ability to integrate theoretical and clinical learning 9. Learning and teaching strategy: This module consists of a series of practice placements during which the student is supported by a Clinical Supervisor in the clinical setting along with a University Academic Supervisor who, together, will ensure clinical learning needs are met and that the student is appropriately supported throughout the 6 month period. The student will be encouraged to complete a reflective journal to identify learning and development throughout the module. The key role of the Clinical Supervisor will be to continue the learning process commenced in the theory module (23456), and to sign off the listed competences when they consider the student to be competent. They will also liaise closely with the Academic Supervisor to identify any shortcomings of the student at the earliest possible stage. There will be regular study days during the module which will: 1. consist of interactive lectures and seminars
81 2. allow the student to participate in clinical presentations, which will prepare the student for the summative assessment and enable peer group sharing of information and experience that will be utilised to reinforce student confidence 3. consolidate advanced practice requisites including decision making and diagnostic skills 7.1.1.7 Type Length in Hours 7.1.1.8 Learning Outcome 7.1.1.9 Clinical placement 840 1 – 10 Study days will include the methods below: 7.1.1.10 Interactive Lecture, 60 7, 8,9,10 7.1.1.11 Seminars / Presentations 30 2, 3, 6 7.1.1.12 Discussion 8 4, 5 Reflective Practice 60 1 – 10 7.1.1.13 Tutorials/Placement 2 1- 10 10. Arrangements for revision and private study See above. Pre and intra-modular reading lists will support sessions. 11. Methods of assessment Summative: 1. Competence Framework: Competences are assessed by the Clinical and the Academic Supervisor and completion of all elements will be verified by the University. (Pass / Fail) 2. Clinical Portfolio: 3 case studies from practice, written in appropriate academic style and presentation to Level 6, which will include details of the care of a patient from point of contact to point of departure. This will include: a. history b. physical examination c. relevant investigations d. differential diagnoses e. management plan f. outcome g. discussion and analysis of case, outcome and clinical decisions In total the 3 case studies must cover the full age range of patients likely to be encountered by the ECP in the practice setting, i.e. across the full age continuum.
82 Each case study will be a maximum of 1500 words and the student must achieve the pass mark required by the University. The discussion component of each case study must comprise not less than 60% of the word count. Total written component (wordage) of the 3 case studies in the portfolio will be 4500 words max. 3. The student will be required to choose one of the case studies included within the Clinical Portfolio to be the subject of a Clinical Presentation, (viva voce examination) during the final study week. This clinical presentation will be of 15 minutes duration and will be marked using the grading criteria required by the particular University (40% of total module mark) 4. 5 x 20 minute Objective Structured Clinical Examinations to cover the whole age range and a range of commonly presenting and emergency conditions. This will also be marked using the grading criteria required by the particular University. (Pass / Fail) 12. Methods of re-assessment (if different to 11) Students must successfully complete all assessments. Should the student be referred in any of the above assessments, he/she is permitted one further attempt at that assessment. Should the student be referred in only one OSCE assessment, he/she will be permitted one further attempt at that or an equivalent OSCE. Should the student be referred in 2 or more OSCEs, they will be required to undergo the full series of OSCEs again. Their final result for this part of the assessment will then be not more than 40%. Students’ assessed work will be subject to the regulations and requirements of the University including the Code of Practice on unfair means. 13. Programme outcomes Programme outcomes Module outcomes Assess method 1 Assess method 2 Assess method 3 Assess method 4 1, 3, 8-10 3, 4, 7 CP 1 – 3, 6, 8-10 2, 6 CPR 1 – 10 1, 4, 8-10 CF 1 – 4, 8-10 1, 2, 5 OSCE
83 KEY: CP: Clinical Portfolio CPR: Clinical Presentation CF: Competence Framework OSCE: Objective Structured Clinical Examination 14. Assessment Specification The student is required to: Relates to learning outcome Successfully achieve all competences within the Competence Framework 1 – 10 Identify and critically examine key areas of practice within the ECP role and make recommendations for future practice based on this work. 1, 3, 5, 8-10 Demonstrate a high level of communication and interpersonal skills during history taking and clinical assessment of patients with a range of undifferentiated and undiagnosed conditions. 1, 2, 4 Demonstrate advanced clinical decision making which encompasses the concept of safe and effective evidence based practice in the management of a range of conditions across the age range. 1, 8-10 Demonstrate an ability to evaluate theories, concepts and evidence underpinning health care interventions. 7 Demonstrate an ability to utilise communication and information technology skills within the practice setting. 6 15. External examiner Appointed Name: Joe Bloggs Awaiting confirmation Name: Not identified 16. Programme – module learning outcomes – mapping to internal/external reference points Programme outcomes Module outcomes Subject benchmarks QAA 2001, (Emerging Health Profession) Subject benchmarks QAA 2001, Registered Health Care Professional, (Nursing) ECP Competence and Curriculum Framework. (Appendix 1. Learning Outcomes) NHS Knowledge and Skills Framework outcomes (core and specific) 1 2, 3, 5 A1.4, A2.4, A3.2, A3.4, B1.3, B3.2, B3.4, C2.5, A2.1, A3.1, B3.2, B3.4, B3.5, B3.6, B3.14, C1.2, C2.1 3, 8, 9,10, 11, 12,13,14,15, 16,17, 18,19, 20, 21 HWB1, 2,3,4,5,6,7,10; IK1,2,3 2, 6 6 A2.1, A2.3, A4.1, B2.1, B2.2, A3.3 A2.1, A2.2, A2.4, B2.4 6 5; HWB8; IK1, 2, 3
84 3, 4, 5, 7 4 ,A3.7, A4.3, B4.3, B4.4, C1.4, C2.2, A4.3, B3.10, B3.11, B3.13, C2.6 5 2, 5, 6 8-10 9-10 A2.3, B2.6, B2.5, C1.2, C2.1, A4.1, A4.2, B2.2, B3.3, C1.3, C2.3, C2.4, C2.5 1 5; HWB7; G2 17. Indicative content Role of the ECP in health assessment• Advanced therapeutic relationships with patients• Autonomous decision-making skills• Developing confidence in clinical assessment skills and physical examination• techniques in relation to a range of clinical conditions and presentations across the lifespan Developing understanding of, and confidence in, normal and abnormal• physiological presentation of body structures throughout the age continuum Reflective practice• Differential diagnoses in relation to clinical findings• Pharmacology• Developing a more inquiring and insightful approach to patient assessment• Problem-solving skills• 18. Indicative reading Students will be encouraged to read widely throughout the course. In addition to text books, they will be encouraged to access journal articles, National Guidelines and web based material.  The following list includes a selection of books that are recommended as appropriate for students on this course. It is not necessary to use all of these references; in some categories more than one book is recommended. Each student will have a personal preference as to which text is preferred. Anatomy / Physiology & Pathophysiology Martini,F, (2002), Fundamentals of Anatomy and Physiology, Pearson, Benjamin Cummings, Porth,Carol Mattson, (2002), Pathophysiology, Concepts of Altered Health States,   Lippincott, Philadelphia. Abrahams, P, Craven, J & Lumley, J, (2005), Illustrated Clinical Anatomy, Hodder Education, London.
85 Clinical Medicine Kumar,P.& Clark,M. (2002), Clinical Medicine , Elsevier Science Ltd, Edinburgh. Longmore, M, Wilkinson, I, Rajagopalan, S, (2004) The Oxford Handbook of Clinical Medicine,London. Clinical Examination Epstein,O, Perkin,G,D, Cookson,J & De Bono,D,P, (2003), Clinical Examination, Mosby, London. Paediatrics Hull, D, Johnston, I, (1999), Essential Paediatrics, London. Miall, L, Rudolf, M & Levene, M, (2003), Paediatrics at a Glance, Oxford: Blackwell Science. Minor Injuries McRae, Ronald, Clinical Orthopaedic Examination, Oxford, Churchill Livingstone. Purcell, D, (2003), Minor Injuries: A Clinical Guide for Nurses, Oxford, Churchill Livingstone. Sakthivel-Wainford, K, (2006), Self Assessment in Limb X-ray Interpretation, Cumbria, M&K Publishing. Miscellaneous: Ogden, J, (2004), Health Psychology- A Textbook, 3 rd ed, Open University Press. Read M T F (2000), A practical guide to sports injuries, Oxford: Butterworth Heinemann. Reveley S, Walsh M & Crumbie A, (1999) Nurse Practitioners Clinical Skills and Professional Issues, Oxford: Butterworth Heineman,
86 Appendix 4: Membership of Governance Groups Membership of the ECP Strategy Group (June 2007) Prof. Sir George Alberti (Chair) National Director for Emergency Access Karen Middleton DH Chief Health Professions Officer Ros Meade DH Regulation Branch Dr Chris Carney Chief Executive East of England Ambulance NHS Trust & Chair AETAG Dr Hugo Minney Yorkshire Academy Ian Weller Workforce Review Team Kathryn Glover DH Ambulance Policy Dr Jim Wardrope President, College of Emergency Medicine Dr Fiona Jewkes GP, Medical Director Wiltshire Ambulance, President BPA & member JRCALC Peter Grummitt DH Workforce Branch Prof. Janice Sigsworth DH Deputy Chief Nursing Officer Sarah Goodson Associate Director, Basingstoke and North Hampshire NHS Foundation Trust Prof. Nigel Sparrow Royal College of General Practitioners Dr John Gosnold Development Manager, Skills for Health Mark Bilby Development Manager, Skills for Health Chris Wintle Associate Director, Skills for Health Membership of the ECP Voluntary Regulatory Committee (June 2007) Dr John Gosnold (Chair) Skills for Health Mark Bilby Skills for Health Erica McGregor North West Ambulance Service Dr Hugo Minney Lay Member Dave Taylor North West Ambulance Service Gavin Reader Great Western Ambulance Service Roland Furber British Paramedic Association Dave Coates Great Western Ambulance Service Julie Turner North Lincolnshire PCT Sarah Goodson Mike Hayward Royal College of Nursing Rob Slee London Ambulance Service Jason Somerville South Central Ambulance Service Neil Storey East of England Ambulance Service Belle Connell Lay Member
87 References 1 The NHS Plan: a plan for investment, a plan for reform. July 2000, HMSO 010481829: London 2 Reforming Emergency Care in England, A report by Professor Sir George Alberti (Department of Health April 2007 Gateway Ref 8178) 3 The future role and education of paramedic ambulance service personnel (subcommittee of Joint Royal Colleges Ambulance Liaison Committee and the Ambulance Service Association 5 Jan 2000) [http://www.asancep.org.uk/future_role.htm] 4 The Emergency Care Practitioner Report – Right Skill, Right Time, Right Place (Department of Health October 2004) http://www.dh.gov.uk/PublicationsAndStatistics/ Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/ en?CONTENT_ID=4093086&chk=oDUTvB 5 A national evaluation of the clinical and cost effectiveness of Emergency Care Practitioners – Phase one (Mason S, Coleman P, Ratcliffe J, Turner J, Nicholl J. ScHARR University of Sheffield) July 2004 6 A national evaluation of the clinical and cost-effectiveness of Emergency Care Practitioners – Phase 2 Mason S, O’Keeffe C, Coleman P, Edlin R, Nicholl J) ScHARR report November 2005 7 The evolution of the emergency care practitioner role in England: experiences and impact (Mason S, Coleman P, O’Keeffe C, Ratcliffe J and Nicholl J) Emergency Medicine Journal 2006;23:435-439 8 Measuring the Benefits of Emergency Care Practitioners, A report written by Dr Hugo Minney (Skills for Health June 2007 Gateway Ref 8382) 9 Patients’ experiences of care provided by emergency care practitioners and traditional ambulance practitioners: a survey from the London Ambulance Service (Halter M, Marlow T, Tye C and Ellison GTH) Emergency Medicine Journal 2006;23:865-866 10 These figures were calculated during the preparation of the research for The ECP Report (see reference 4) and were discussed with Out of Hours providers. Subsequent calculations e.g. for Taking Healthcare to the Patient have supported this benefit 11 Taking Healthcare to the Patient – Transforming NHS Ambulance Services (Department of Health Gateway Ref 5133) June 2005 12 Emergency Care Practitioner “Telephone Assessment and Treatment in the Out of Hours Service” Sedgefield Primary Care Trust / Durham Dales PCT. (Moran J) internal report reported on NHS Networks Demand Management April 2006 13 A twelve-month study of prison healthcare escorts and bedwatches (Department of Health / HM Prison Service Gateway Ref 7182) November 2006 14 Trust, Assurance and Safety – The Regulation of Health Professionals in the 21 st Century (Department of Health Gateway Ref 7823) February 2007
Skills for Health 1st Floor Goldsmiths House Broad Plain Bristol BS2 0JP Tel: 0117 922 1155 Fax: 0117 925 1800 E-mail: ECP@skillsforhealth.org.uk Website: www.skillsforhealth.org.uk Skills for Business is an employer-led network consisting of 25 Sector Skills Councils and the Sector Skills Development Agency. Through labour market intelligence, the identification of skills needs at all levels and its influence on the UK’s education and learning infrastructure, the network aims to increase productivity in business and public services.

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ECP C&C document June 07