IrishCommitteeforEmergencyMedicineTrainingEmergencyMedicineTrainingOfficeRoyalCollegeofSurgeonsinIreland123St.StephensGreen,Dublin2,IrelandTel:+35314022240Fax:+35314022459Email:EMadministrator@rcsi.ie

DrGarethQuinProf.JohnRyanMr.JamesBinchyDean ViceDeanViceDean Chair,ICEMT AdvancedSpecialistTrainingProgrammeCoreSpecialistTrainingProgramme

IrishCommitteeforEmergencyMedicineTraining

TraininginEmergencyMedicine

inIreland

6thEditionOctober2014

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Contents1.0 ProfessionalbodiesresponsibleforEMtraininginIreland2.0 CoreSpecialistTraininginEmergencyMedicine(CSTEM)

2.1Overview2.2Eligibility2.3Recruitment2.4StructureofRotations2.5TrainingandEducation2.6AnnualAppraisal2.7MembershipofCollegeofEmergencyMedicine2.8ProgressiontoASTEM3.0 AdvancedSpecialistTraininginEmergencyMedicine(ASTEM) 3.1 Overview 3.2 Eligibilitycriteria 3.3CSTEMequivalence3.4 SpRrecruitment 3.5 DurationofASTEM 3.6 Retrospectiverecognitionoftraining 3.7 LocumAppointmentforTraining(LAT)posts 3.8 RecognitionofTrainingEmergencyDepartments

3.9 StructureoftheSpRrotations3.10 Flexibletraining3.11 AppraisalduringAST3.12 TheRecordofInTrainingAssessment(RITA)process3.13 Traininglogbook3.14 NonClinicalDays3.15 WorkPlaceBasedAssessment3.16 Clinicaltopicreview3.17 Fellowshipexamination3.18 FellowshipTraining3.19ResearchduringASTEM

4.0 PostCertificateofCompletionofTraining(CCT)employment5.0 SubspecialisationandDualAccreditation6.0 FurtherinformationandcontactsAppendicesAppendix1 ListofEmergencyDepartmentsinIrelandrecognisedforCore&AdvancedSpecialistTrainingAppendix2 MembershipoftheIrishCommitteeforEmergencyMedicineTraining

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1.0 ProfessionalbodiesresponsibleforEMtraininginIrelandEmergency Medicine (EM) training in Ireland is delivered through the NationalEmergencyMedicineTrainingProgramme.Thisprogrammehastwocomponents–Core Specialist Training in Emergency Medicine (CSTEM) and Advanced SpecialistTraininginEmergencyMedicine(ASTEM).Beforeoutliningthestructureandprocessofbothprogrammes,itisnecessarytodescribetherolesofthevariousprofessionalbodiesintheprocess.

• RoleoftheRoyalCollegeofSurgeonsinIreland

The Royal College of Surgeons in Ireland (RCSI) is the training bodyrecognisedunder theMedicalPractitionersAct2007underwhoseauspicestraining in EM currently falls. The Irish Surgical Postgraduate TrainingCommittee(ISPTC)isastandingcommitteeofCounciloftheRCSIwith interalia responsibility for postgraduate training. The Irish Committee forEmergencyMedicine Training (ICEMT) is a subcommittee of the ISPTC thatoversees EM training in Ireland and reports to the ISPTC. ICEMT includesrepresentatives from the specialty of Emergency Medicine (includingPaediatricEM)aswellasfromtheRCPIandRCSI.

• RoleoftheCollegeofEmergencyMedicineTheCollegeofEmergencyMedicine(CEM)setsandmaintainsthestandardsof training for the specialty of EM in the United Kingdom (UK). CEM hasproduced a curriculum for EM training and runsMembership (MCEM) andFellowship (FCEM)postgraduateexaminations. The speciality in IrelandhascloselinkswithCEM–theCEMcurriculumhasbeenadoptedbyICEMT,theMCEM examination is an entry requirement for ASTEM and the FCEMexaminationisusedasthemandatoryexitexaminationforASTEM.TheChairof ICEMT sits on the Examination committee of CEM. The vice dean forAdvanced Training sits on the Training Standards Committee of CEM. TheIrishNationalBoardofCEMisbasedinRCSIandhasformallinkswithICEMTandtheIrishAssociationforEmergencyMedicine(IAEM).

• RoleofICEMT

CSTEM and ASTEM are administered by ICEMT, based at RCSI. Thisadministration extends from recruitment, the Record of In trainingAssessment (RITA) process, organisation and development of the trainingrotations through to a final recommendation to the Medical Council forspecialistcertification.

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2.0 CoreSpecialistTraininginEmergencyMedicine

2.1 OverviewCore Specialist Training in Emergency Medicine (CSTEM) is a 3-year programme,consisting of a series of relevant posts at Non-Consultant Hospital Doctor (NCHD)levelthatlaytheprofessionalgroundworkforsubsequentspecialisation.Duringthistime,doctorsobtainawiderangeofexperienceinavarietyofspecialties,structuredas6-monthposts:

• Year1o EmergencyMedicineo Trauma&OrthopaedicSurgeryorPlasticSurgery

• Year2o PaediatricEmergencyMedicine(PEM)orAcuteGeneralPaediatricso AcuteMedicine

• Year3o Anaesthesiaand/orCriticalCareMedicine(CCM)o EmergencyMedicine

EMpostsonCSTEMarerestrictedtothoseEmergencyDepartments(EDs)inspectedand recognised for CSTEM. A nominated trainer in each department will act aseducationalsupervisorforCSTEMtraineesinthatunit–theCSTEMleadtrainer.EDsrecognisedforCSTEMare:

• AdelaideandMeathincorporatingtheNationalChildren’sHospital,Tallaght,Dublin

• BeaumontHospital,Dublin• CavanGeneralHospital• ConnollyHospital,Blanchardstown,Dublin• CorkUniversityHospital• MaterMisericordiaeUniversityHospital,Dublin• MidlandsRegionalHospital,Tullamore• UniversityHospitalLimerick• OurLady’sChildren’sHospital,Crumlin• OurLadyofLourdesHospital,Drogheda• SligoGeneralHospital• St.James’sHospital,Dublin• St.Vincent’sUniversityHospital,Dublin• UniversityHospitalGalway• UniversityHospitalWaterford

2.2 EligibilityCSTEM aims to offer doctors that are in the early stages of their careers theopportunity to obtain the necessary training to progress within EM. Thereforedoctorscanapplyduringtheinternyear.Therearenospecificentrycriteria,otherthan eligibility to be appointed to the training division of the Medical Register,

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althoughevidenceofpreviousinterestinEM,eitherasamedicalstudentorinternisdesirable.

2.3 RecruitmentRecruitmenttoCSTEMtakesplaceinJanuaryofeachyear.

• Applications–ApplicationFormsareavailableon-lineandcanbe returnedelectronically. Further information and the required application forms areavailableoncerecruitmentopensontheEMsectionoftheRCSIwebsite.

• Recruitment panel – the recruitment panel is organised by ICEMT andcomprisestheDeanofPostgraduateEMtraining,theViceDeansforCSTEMandASTEMandanumberofConsultanttrainersinEM(representativesfromeachtrainingED).

• Shortlisting–Candidatesareshortlistedonthebasisofundergraduateandpostgraduatemedicalexaminationresultsandonscoringofreferences.

• Interviews – Interviews take place in March of each year. Candidates areassessed in a number of specific domains, including knowledge of EM,previousexperienceandinterestinEM,communicationskillsandsuitabilityfora career in the specialty. Inaddition,a short clinical scenario isused toassessacandidate’sapproachtoaclinicalproblem.

• Outcome –marks from the stagesoutlinedaboveare combinedand thoseachievingthehighestmarksareappointed.

• Offers of Posts – Prior to interview, candidates are requested to expresstheir preferences for the rotations available on the programme. Offers ofposts are matched with candidate preferences based on ranking afterinterview. Offers of places to successful applicants are sent shortly afterinterview.

• Qualityassurance–feedbackfromeachrecruitmentepisodeisreviewedbyICEMTtomaximisetheeffectivenessandfairnessoftherecruitmentprocess.

2.4 StructureofRotationsWherepossible, rotationshavebeen constructed to allow successful applicants tostay in one town/city formost of the programme’s duration. ICEMT has plans toincrease the time spent inEMduringCSTEM.Thiswillmean thatnotall rotationswillhavethesameclinicalcomponents.

2.5 TrainingandEducationTraining and education based on the Curriculum of CEM will be delivered by anumberofmeans:

• LocaltrainingprogrammesineachED;• CSTEMworkshopsinRCSI;

• HumanfactorstraininginRCSI;

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• Attendance at life support courses that are mandatory for progression toASTEMi.e.ACLS,APLS,ATLS;

• RegulareducationalmeetingsofthetraineesectionofIAEM(IrishEmergency

Medicine Trainees Association (IEMTA)). These meetings will includeeducationally focused lectures and will also provide an opportunity fortraineestopresentinterestingresearchorauditprojects;

• Attendance at the IAEM Annual ScientificMeeting is expected. Each year,nationalandinternationalspeakersdeliverlecturesofeducationalbenefittoCSTEMtrainees.

http://www.iemta.ie/a/about-us/2.6 CSTEMAppraisal

TwiceyearlyappraisalmeetingswillbeheldforallCSTEMtraineeswithprogressionto further posts on the CSTEM programme dependent on satisfactory appraisal.Feedbackwillberequestedfromthetrainerineachspecialitytoassessprogressofeachtrainee.AttendanceatCSTEMworkshopsandHumanfactorstraining,aswellas MCEM and Life Support Course progress will be reviewed at each appraisalsession.

2.7 MembershipoftheCollegeofEmergencyMedicineEntry to the Membership Examination of the College of Emergency Medicine(MCEM) is based on regulations published on the College’s website. Theseregulations are updated regularly and candidates are advised to look at theregulationsforthedietofthecurrentandfutureexaminationsbeforeapplying.CSTEM culminates in eligibility to sit MCEM which is the only acceptedpostgraduate examination to confer eligibility to apply for ASTEM. MCEMcombinedwith specified CSTEM confers eligibility to apply to progress to ASTEM.TheMCEMexaminationisadministeredbyCEMandconsistsofthreeparts:PartA–MCQexaminbasicsciencesasappliedtoEM.PartAmaybetakenintheinternyear.PartB–DatainterpretationPartC–ObjectiveStructuredClinicalExaminations(OSCEs)PartsB&Cmaybetaken3yearsafterqualification (includingthe internyear).Atleast 6months of EmergencyMedicinemust have been completed in the 2 yearsafterachievingfullregistration.PartBisnormallytakenaboutsixweeksbeforePartC.Successintheformerisrequiredbeforeprogressiontothelatter.From2015,PartC(OSCEs)ofMCEMwillbereplacedwithaSituationalJudgementTest(SJT).IrishtraineescommencingCSTEMinJuly2014willsittheSJTratherthan

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OSCEs. Those already in training in July 2014 i.e. CSTEM2 and3will sit theOSCEexamination.

2.8 ProgressiontoASTEM

Theentry requirements forASTEMareCSTEM (orequivalent) andMCEM.For the2015 and 2016 ASTEM intakes, the recruitment process will follow the currentcompetitiveprocess(see3.1below).FromJuly2017,traineesonthenewseamlessprogramme (July 2014 CSTEM intake)will progress to ASTEM if they satisfactorilycompleteall elementsofCSTEM,passallpartsof theMCEMexaminationandaredeemedsuitableforprogressiontoadvancedtrainingfollowingaformalAsessmentofSuitabilityforAdvancedTraining(ASAT)process.TheASATwillincorporatemanyelementsofthecurrentmulti-stationrecruitmentprocessforASTEM.Because theSpringdietsofMCEMPartCare run in JanuaryandMarchofeveryyear,andASTEMapplicationistypicallyinDecemberoftheprecedingyear,ICEMThas agreed that candidates for MCEM Part C in the Spring diets may apply forprogressiontoASTEMinanticipationofsuccessatPartC,providedtheresultsoftheexamwillbeavailableatleast8weekspriortotheJulycommencementdate.

3.0 AdvancedSpecialistTraininginEmergencyMedicine3.1 Overview

DoctorsareeligibletoapplyforASTEMaftermeetingspecifiedcriteria.Thecurrentcompetitive recruitmentprocess includes shortlistingandamulti-station interviewprocessthatexploresavarietyofdomainsincludingacademicdevelopment,clinicalproblem solving, teaching and communication skills. This process is standardised,centrallyadministeredandqualityassured.

Advanced trainees, who are known as Specialist Registrars (SpRs), rotate throughaccreditedtrainingEDs.ArotationthroughadedicatedpaediatricEDiscompulsory.Trainees undergo regular RITA assessments and are required to pass the FCEMexamination to successfully complete training.At that stage, a recommendation ismadefromICEMTtotheISPTCthataCertificateofCompletionofTraining(CCT)beissued.ThedurationoftheASTEMprogrammeiscurrentlyfiveyears.FromJuly2017,theduration of ASTEM will be four years. This reflects changes to the training andassessmentprocessthatwillcomeintoforceoverthenexttwoyears.

3.2 Eligibilitycriteria

1. CSTEM(orequivalent)and

2. MembershipoftheCollegeofEmergencyMedicine–MCEM

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3.3 CSTEMequivalence

ICEMThasdefinedCSTEMequivalenceas:• 3yearspost-internshipexperiencecomprising:

o 12monthsinEM(SHOorRegistrarlevel)o 2periodsof6monthseachinanytwoofthenon-EMCSTEMspecialties–

acutemedicine, traumaorthopaedics,plastic surgery,acutepaediatrics,paediatricEMoranaesthesia/criticalcare

o A further 12 months in EM (SHO or Registrar level) or other hospitalbasedspecialties(postsmustbeatleast3monthsduration)

• Experiencemustbewithin5yearsofapplicationforASTEM(theclosingdatefor

applications)• Applicantswillberequestedtoseekandsubmitastructuredappraisalformfrom

theirsupervisingConsultantforeachpost• ApplicantsseekingCSTEMequivalenceonthebasisoftrainingexperienceother

thanthatoutlinedabovewillbeconsideredbyICEMTonacasebycasebasis.3.4 SpRrecruitment

EntrantstoASTEMarerecruitedusingthefollowingprocess:• Application – vacancies are advertised in Autumn/Winter and applications

aremadeonastandardisedform.BecausetheSpringdietsofMCEMPartCare run in January and March of every year, and ASTEM application istypically in December of the preceding year, ICEMT has agreed thatcandidates for MCEM Part C in the Spring diets may apply for ASTEM inanticipation of success at Part C, provided the results of the examwill beavailableatleast8weekspriortotheJulycommencementdate.

• Recruitment panel – the recruitment panel is organised by ICEMT andcomprises a nominee of the President of RCSI (as an independentchairperson),theDeanandViceDeansandanumberofConsultanttrainersinEM(representativesfromeachtrainingED).

• Shortlisting–short-listing iscarriedoutbytherecruitmentpanelaccordingtodefinedcriteria.

• Interview – interviews are carried out by the recruitment panelwith eachinterviewfollowingthesameformatandquestionsarestandardised.

• Outcome–marksfromthestagesoutlinedaboveareconsideredandthoseachievingthehighestmarksareappointed.

• Qualityassurance–feedbackfromeachrecruitmentepisodeisreviewedbyICEMTtomaximisetheeffectivenessandfairnessoftherecruitmentprocess.

From the July 2017 ASTEM intake onwards (i.e applicable to those commencingCSTEMinJuly2014),thoseontheformalCSTEMprogrammewillprogresstoASTEMprovidedtheyhavesatisfactorilycompletedallelementsofCSTEM,havepassedall

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parts of the MCEM examination and are deemed suitable for advanced trainingfollowinga formalAssessmentofSuitability forAdvancedTraining (ASAT)process.The ASAT will incorporate outcomes of the trainee’s CSTEM appraisals, trainerreferencesandrecommendations,academicactivityduringCSTEMandperformancein a multi-station assessment process modelled on the current ASTEM selectionprocess.

3.5 DurationofASTEM

DuringthefiveyearsofASTEM,traineesspendtimeworkinginaminimumofthreeEDs. Trainees are notified, in writing, of their expected date of completion oftrainingshortlyafterappointmenttotheprogramme.AsthevariousFCEMcomponentscanincreasinglybetakenearlierduringASTEM,itis anticipated that trainees will complete FCEM during their 4th ASTEM year andICEMT encourages undertaking a Fellowship (in Ireland or abroad) during the 5thyear,aftersuccessfulcompletionofFCEM.

3.6 Retrospectiverecognitionoftraining

Retrospectiverecognitionisconsideredinoneinstanceonly–pre-ASTexperienceinEMinaLocumAppointmentforTraining(LAT)post.OnentrytoASTEM,traineeswhowereinaLATpostmayapplytoICEMT,throughthe Vice Dean for ASTEM, for retrospective recognition of the relevant trainingcompleted prior to SpR appointment. Applications for retrospective recognition,with appropriate documentary confirmation from the training posts, will only beconsideredwithinthefirstsixmonthsofSpRtraining.EachapplicationisindividuallyassessedandrecommendationsmadebyICEMT.

3.7 LocumAppointmentforTraining(LAT)postsLATpostsarefixedterm(usually1year)appointmentsundertakeninpoststhatarerecognised for SpR training but are vacant on the SpR programme (i.e. no SpR isoccupying the post for the particular time period). LAT appointment criteria areidentical to thoseof anSpRpost inEM.ALATpost cannotbe filledbya traineewho was not deemed appointable at SpR interview. While in a LAT post, thetraineeshouldbetreatedasanSpR in relationtoeducationalactivity,non-clinicaldays etc.While LATsmay be appointed locally, the interview panelmust includeeithertheDeanorViceDeanforASTEM.EvidenceofsatisfactorycompletionoftheLAT,usingtheRITAprocess,isrequiredbeforeitcanberetrospectivelyrecognisedascontributingtoASTEM.ThemaximumretrospectionforLATpostsisoneyear.

3.8 RecognitionofTrainingEDs

Departments are recognised for ASTEM on the recommendation of ICEMT.InspectionsfortrainingrecognitionareundertakenbyICEMTonapplicationbytheprospectivetrainingsite.

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3.9 StructureoftheSpRrotationsTraineesrotatethroughseveralEDs(aminimumof3)duringASTEM.TherotationiscompiledbytheViceDeanforASTEM.Thegeneralgroundrulesfortherotationareasfollows:• Thefocusisonabalancedtraining:

o This balance is between adult-only, paediatric-only and mixed EDs;urbanandrural;andDublinandoutsideDublinunits;

o To facilitate exposure to EM in different settings, trainees will likelyspendatleastoneyearinDublinandatleastoneyearoutsideDublinduringASTEM;

• Decisions regardingplacementwill bemadeusing the transparentand faircriteria outlined above; individual preferences are not automaticallyaccommodatedbutareconsideredinthecontextofthecriteriaabove.

• In general, traineeswill be given aminimumof sixmonths notice of theirnext post on the rotation. Where possible, longer notice will be given;howeveritmustbeappreciatedthatcircumstancesmayarisewheretheViceDean has to change placements at shorter notice. Where possible SpRs’initialplacementwillbeforaminimumof18months.

3.10 FlexibletrainingforASTEMTrainees wishing to pursue flexible training must apply to the Health ServiceExecutive Medical Education & Training (HSE MET) Unit. Trainees should discusstheir application with the Vice Dean for ASTEM to help facilitate educationalapproval foreachplanned flexible trainingpost. Flexible traineeswork60%of thebasic hoursworkedby full time trainees (including at least 50% in clinical duties).Theirweeklytimetableshouldallowthemtoparticipateinformalteachingandauditprogrammes.Flexibletraineesareexpectedtoworkout-of-hoursbutnotnecessarilyprecisely pro-rata with full-time trainees. Time spent in flexible training will berecognisedonahalf-timebasise.g.oneyearinflexibletrainingisequivalenttosixmonthsinfull-timetraining.

3.11 AppraisalduringASTEM

Thereisadesignatedleadeducationalsupervisorduringeachpost.Thissupervisorisnominated locallyandapprovedby ICEMT.SpRsshouldmeetwiththeirsupervisorat the beginning of each post and at three-monthly intervals thereafter. Indepartments where there are multiple SpRs, it is possible for trainers to haveresponsibilityformorethanonetrainee.RecordsoftheoutcomesofthesemeetingsarecompletedelectronicallyontheRCSICollesPortal.

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3.12 TheRecordofInTrainingAssessment(RITA)processSpRshaveaninitialRITAattheendoftheirfirstsixmonthsandthereafteranannualRITA.TheRITAprocessisadministeredbyICEMT.

Prior to each RITA, trainers and trainees are asked to submit feedback formsoutliningthetrainee’sprogressaswellastraineeandtrainerfeedback.Traineesarealsoaskedtosubmitasummaryoftheiractivities/achievementsovertheprevioussix/twelvemonths.TheRITAprocessculminates inan interview,atwhich traineesare interviewed individuallybyapanelofConsultant trainers.During themeeting,the assessment forms, log book, summary of activity and previously identifiededucationalgoalsarereviewed.Newgoalsaresetfortheforthcomingyear.Traineesaregiventheopportunitytoprovidefeedbackonthestrengthsandweaknessesoftheir current post. The SpR’s current trainers are not present during the RITAinterview.Attheendoftheinterview,traineeswillbeprovidedwithalistofagreedgoals forthenextRITA,therelevantRITAformissignedbytheDeanandtheViceDeanforASTEM.Thetraineeformsareretainedinthetrainee’sfileatICEMT.TherearesevenRITAforms:RITA A – Contains core information on the trainee and is completed prior tocommencementoftheASTEMprogramme.RITA B – Contains changes to core information. This is completed at the annualreviewiftherearechangestoinformationrecordedonFormA.RITAC – This is a recordof satisfactoryprogresswithin theSpRgrade.This is theformthat,formosttrainees,issignedattheannualreview.AcompletedFormCforthe 3rd year of training is required before trainees may apply to sit the FCEMexamination.RITA D – This form documents recommendations for targeted training. SpRsidentifiedattheannualreviewasrequiringadditionaltraining(andforwhomaFormC is not therefore signed)maybeallowed conditional progress through the gradefollowing a specified period of targeted training. The specifics of this targetedtraining are recordedon FormD.A FormCmust be completed at the endof thetargetedtrainingperiodtoallowprogress.RITAE–Thisformdocumentsrecommendationsforintensifiedsupervision/relatedtraining.Thisformiscompletedwherethetrainee,havingundertakentheperiodofadditionaltrainingspecifiedinFormD,isrequiredtorepeatthatadditionaltraining.AFormCmustbecompletedattheendoftheadditionaltargetedtrainingperiodtoallowprogress.RITAF–Thisisarecordofout-of-programmeexperience.Completionisessentialtomaintain the validity of a National Training Number and to keep ICEMT formallyappraisedoftheprogresswiththeout-of-programmemodule/experience.RITAG – This is a final recordof satisfactory progress. This form is completedonsuccessfulcompletionoftheprogrammeandisessentialtoallowICEMTandISPTCtoaccreditcompletionoftraining.

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3.13 TrainingLogbookTraineeprogress,intermsofclinicalcasesseenandclinicalproceduresperformed,isnow recorded in anelectronic logbook (e-portfolio) available throughCEM (via anNHS portal). This differs from Colles Portal which is essentially a web-baseddocument management system for structured appraisal during ASTEM. BothelectronicresourcesneedtobeusedduringASTEM.Thee-portfolioshouldbereviewedatthethree-monthlyappraisalmeetingsandattheyearlyRITA interview. It is the trainee’s responsibility tosubmitelectronicandpapercopiesoftheircompleted3monthlyassessment/appraisalforms.

3.14 Non-clinicaldaysTraining departments are required to allow their SpRsonenon-clinical day (NCD)every two weeks (half-day per week). In practice, the combination of workingnights, leave and service requirements dictate that the average number of non-clinicaldaysoveraperiodisoftenlessthanstipulatedabove.ThepurposeofNCDsistofacilitateresearch,auditandeducationalactivitywithinthedepartmentandforthis reason trainees should ideally bephysically present in thedepartment duringtheirNCDsunlessattendingscheduledacademicactivityelsewhere.ICEMT recommends that the minimum number of NCDs a trainee should beprovidedinanysixmonthperiodiseight(8)fulldaysorfifteen(15)half-days,whilerecognisingthattheexigenciesoftheservicemay,onoccasion,meanthatthisfigureisnotreached.ConsistentproblemswithNCDsshouldbereportedtotheViceDeanforASTEMdirectlyandthroughtheRITAprocess.

TraineesshouldkeepaportfoliooftheiractivityduringNCDswhichwillbereviewedat the three-monthly meeting with their trainer and during the RITA interview.Problems in relation to granting or productivity of NCDs can be aired during theinterview.

There is a monthly national SpR training day. This process is organised by thetrainees and rotates around the various training EDs.Where at all possible, SpRsshouldbereleasedtoattend.NCDsshouldbetakentoattendthesemeetings.Traineeswhoaregranted ‘grace’extensions to their training, afterobtaining theirFCEMqualification,arenotentitledtoavailofNCDs.

3.15 Workplacebasedassessment(WPBA)TheCollegeofEmergencyMedicinehasintroducedWPBAtoEMtrainingintheUK.WPBA,asenvisagedbyCEM,hasbeenendorsedbyICEMTandwillbeintroducedinthefutureandthisdocumentupdatedaccordingly.

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3.16 ClinicalTopicReviewThe Clinical Topic Review (CTR) is part of the FCEM examination. To familiarisetraineeswiththeprocess,SpRsarerequiredtosubmitaCTRpriortotheirsecondyearRITA.ThisCTRcanbeusedasyourfinalCTRforFCEM.Guidanceisprovidedbythe Vice Dean and local trainers and this aspect of training is supported by theAcademicCommitteeof the IrishAssociation forEmergencyMedicine (IAEM). It isthiscomponentoftheFCEMexaminationthatcontinuestocausemostdifficultyforEMtrainees,andIrishEMtraineesarenodifferent.Thereasonsforthisareseveral,butessentiallyaredistilledintoalackoftimelypreparationfortheCTRonthepartofthetrainee.Tothatend,traineesarestronglyadvisedthefollowing:

• Onappointment toASTEMarrangemeetingswith theViceDean and yourlocaltrainertoexploreideasforCTRtopicsandbeappraisedofthedegreeofworkinvolvedintheentireprocess;

• Liaiseearlyandoftenwithseniorcolleagues toensureyouareprogressingappropriately(manytraineesseemtoobsesswithproducingaperfect‘draft’whenaone-pagesummationofideasismorethansufficient);

• Please differentiate betweenwhat is an acceptable CTR topic and originalresearch ideas – you need both for a successful CTR but they are not thesamething;

Inaddition,SpRsmustproducetheirfinaldraftCTRfortheViceDeanforASTEMtoreviewtwomonthsbeforeyourfinalsubmissiondateforFCEM. If thedraft isnotproducedbythattimetheViceDeanreservestherighttopreventyouapplyingfortheexam.

SpRs commencingASTEM from July 2014 onwardswill be required to complete aQuality ImprovementProject(QIP)ratherthanaCTR.Furtherguidance isavailableontheCEMwebsite.

3.17 FellowshipexaminationA trainee must pass the Fellowship Examination of the College of EmergencyMedicine (FCEM) before being eligible to be included on Register of MedicalSpecialists,DivisionofEMwiththeMedicalCouncil.Traineesareeligibletosit theCritical Appraisal SAQ part of the examination in the first year of ASTEM and theremaining parts of the examination following a successful 3rd year RITA. Althoughtrainees are encouraged to sit their FCEMexamwhile on theASTEMprogramme,theymaybeofftheprogrammeaftercompletingtheirpredeterminedSpRtraining.However,aCCTcannotbeawardeduntil training issignedoffandFCEMhasbeenpassed.ThereisnowalimittothenumberoftimestraineesmayattempttheFCEMexam - CEM permits candidates to attempt the examination up to four times inadditiontotheinitialattempt.Thewholeexaminationmustbecompletedwithin6diets(3years)ofthefirstsitting.

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3.18 FellowshipTrainingICEMTfirmlysupportsthepursuitofFellowshiptraininginotherhealthcaresystemsorinacademicresearch.WhileASTEMinIrelandwillultimatelyresultintheawardof a CCT, eligibility to be entered into the Register of Medical Specialists in thedivisionofEMandallowapplication foraConsultantpost inEM, there canbenodoubt that Fellowship experience is potentially highly rewarding, not only byenhancingclinicalexperiencebutalsofroma‘lifeexperience’perspective.WiththecurrentdurationofASTEMat5years,ICEMTsupportsFellowshipactivityinthe5thyear(withastrongrecommendationthatFCEMbepassedpriortocommencingtheFellowship).OncethedurationofASTEMisreducedto4years,Fellowshiptrainingcantakeplaceoncompletionofthe4years.Certain subspecialtiesofEMwillmandate fellowship-type traininge.g.PEM,acutemedicine,CriticalCareMedicineandpre-hospitalmedicine.Whilethereiscurrentlylittle or no formal fellowship training in EM in Ireland, it is likely that fellowshiptrainingprogrammeswilldevelopinthenextfivetotenyears.Therearemany international fellowshiptrainingprogrammesavailable to IrishEMtrainees. Many practising Consultants in EM in Ireland have completed theseprogrammesandthereisanextensive‘network’ofsupportavailabletothetraineewhowishestopursuefellowshiptraining.Ifa trainee is interested in fellowshiptraining, it is imperativethatthey liaisewiththeir current educational supervisor and the Vice Dean for ASTEM as early aspossible.Manyof theprestigious international fellowshipprogrammeswill requireatleasttwoyearsadvancepreparationandapplication.

ICEMTgenericallyconsidersOut-Of-ProgrammeExperience (OOPE)sub-optimal forthefollowingreasons:

• ItisimportantfortheSpRtohavetheirASTEMdeliveredinabalancedwaythroughrotationsinvariousIrishEDsofanappropriateduration;

• ThesystemofongoingappraisalofanSpR’sprogressthroughASTEMisbestfacilitatedbythatSpRbeinglocatedwithintrainingdepartmentsinIreland;

• TheFCEMexamrequiressignificantandlengthypreparationwhichwouldbepotentiallycompromisedbyOOPEinanotherhealthsystemorspecialty;

• ICEMTisoftheviewthatOOPE-typetrainingisbestpursuedat‘Fellow’levelaftercompletionoftheASTEMprogramme(orinthefinalASTEMyearwhilethedurationremainsat5years).

Notwithstanding the above, anOOPEwill be considered during ASTEM, especiallywhere trainees have set up a defined (and funded) programme of EM-relatedresearch (see below). To pursue OOPE during ASTEM, the Vice Dean for ASTEMneeds to be informed at least 6months in advance of same, and clear evidenceneeds to be provided that this experience is comparable to ASTEM experience inIreland. ICEMT will recognise up to a maximum of 12 months in OOPE. OOPEs

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notwithstanding, trainees must spend a minimum of 4 years on the ASTEMprogrammeinIreland.

3.19 ResearchduringASTEM

ICEMT recognises the importance of research activity within EM andwill supportstructured research activity accordingly. Strategically, ICEMT believes that thissupportofresearchshouldproducethefollowing:

• A baseline competency amongst all advanced trainees in EM in researchmethodologiesandtheprinciplesandpracticeofevidence-basedEM(thisisclearlydeliveredaspartofpreparationforFCEMe.g.CTR);

• Creationofanacademic ‘track’ foradvanced traineeswhohaveadeclaredinterestinpursuingaformalacademicpositioninEMpost-ASTEM.

However,giventherequirementsofSpRstoprovideaservicetoEDswhiletraining,ICEMTwillnotallowmorethan10%ofASTEMtraineestopursuefull-timeresearchatanyonetimee.g.with35traineesonASTEM,ICEMTwouldallowupto4ofthosetraineesundertakefull-timeresearch.While the creationof a formal academic track for certainhigher trainees in EM isaspirational at present, there have been (and actively are) several examples oftrainees taking time out of full-time clinical training to pursue full-time clinicalresearch. Trainees considering a research OOPE need to explicitly justify therationaleforthisandneedtonotifytheViceDeanforASTEMatleastsixmonthsinadvance of the intended start date of the research programme. ICEMT willultimately decide whether to grant permission to the trainee to pursue thisexperienceandthisdecisionwillbebasedonthefollowing:

• Clear scientific rationale, directly relevant to EM, for the proposedprogrammeofresearche.g.MD,PhD;

• Clearandstatedsupportofaneducationalsupervisor,ideallyfromwithinEM(if theprimarysupervisor isnot fromEMthenaco-supervisor fromEMisrequired);

• Claritywithrespecttothebreakdownofproposedtimespentinresearchandotheractivitiese.g.50%clinical:50%research;

• Obviousandrobust funding,specifically in termsof thetrainee’ssalary,fortheprogrammeofresearch.

OncethesecriteriaaresatisfiedandICEMTagreestotheproposal,thetraineemustagree to 6-monthly RITA appaisals during the research period. Furthermore, thetraineemustagreenottoundertakelocumworkwhichwouldadverselyimpactthechances of successful completion of the proposed programmeof research. ICEMTconsiders locumwork that comprisesgreater than10%of theoverallworkloadofthe researchprogrammeas inappropriate. Furthermore, ICEMTwillnot supportatrainee inundertaking researchwhere there is anything less thanaminimumof50%fullyprotectedtimeforresearch.

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Once approved by ICEMT, time spent in full time research during HSTEM isrecognisedonahalftimebasis,toamaximumofoneyear. ICEMTapprovalrefersnot only to initial approval but also to satisfactory completion of the period ofresearchbasedonthe6-monthlyRITAappraisals.OncethedurationofASTEMfallsto4years(fromtheJuly2017intakeonwards),therewillnolongerberecognitionofresearch time towards ASTEM training – all trainees will be required to spend aminimumof4years in full timeclinical trainingtobeeligible (incombinationwithFCEM)fortheawardofaCCT.Trainees shouldnote that FCEM regulations stipulate that traineesmust be in fulltimeclinicaltrainingatthetimeofsittingthefinalFCEM.

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4.0 Post-CCTemploymentGiventhatappointmenttoaConsultantpostmaytakesometime,employmentatSpR level may be extended for a maximum of 6 months after completion of thetrainingscheme.OncethedurationofASTEMisreducedto4years,thisextensionperiodwillbeextendedto1year.SpRswishingtoobtainthisextensionmustapplyin writing to ICEMT as soon as possible after the necessity to extend becomesapparent.Ifgranted,thegeographicallocationofthispostcannotbeconfirmeduntilafter other trainees’ needs have been addressed. Furthermore, the normalexamination-related entitlements of SpR training e.g. NCDs will not apply to this‘grace’period.

ShouldatraineebeunsuccessfulintheirFCEMexamination,theymayapplyforanextensionof their trainingwith a view to a repeat attempt. Theymust undergo afurtherRITAinterviewtoconfirmanupdatedtrainingstrategy.ShouldICEMTagreeto the extension, the geographical location of the postwill be determined by theVice Dean for ASTEM. Any subsequent training extensions are also subject toapprovalbyICEMT.Trainees may ‘act up’ in the Consultant role within 3 months of their CCT date,providedtheyhavepassedFCEM.

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5.0 SubspecialisationandDualAccreditationMostEMspecialiststrainexclusivelyinEmergencyMedicine.Sometraineeswillwishto develop a subspecialty interest and potentially pursue dual accreditation inEmergency Medicine and another specialty area. There is sometimes confusionsurrounding the termsSubspecialisation andDualAccreditation. Toprovide someclarity,considerPaediatricEmergencyMedicine(PEM)asanexample.ThejointPEMtraining programme outlined belowwill primarily provide subspecialisation e.g. apaediatric trainee who completes PEM subspecialty training will be eligible to beincludedintheRegisterofMedicalSpecialistsunderbothPaediatricsandPaediatricEmergency Medicine, but not Emergency Medicine. For the latter to occur, thetraineewouldneedtocompletetrainingofequivalencetoASTEMandpasstheexitexamination of ASTEM in Ireland, the Fellowship of the College of EmergencyMedicine(FCEM).Equally,ifanEMtraineewithPEMsubspecialtytrainingwishestobe included in the division of Paediatrics, the trainee would need to completeadditional trainingof equivalence to coreGeneral Paediatric training,while at thesame time passing the Membership of the Royal College of Physicians in Ireland(MRCPI)MedicineofChildhoodexamination.Itistheselatterprocessesthatdefinedual accreditation. This examplewould apply equally to other specialities such asAcuteMedicineorCriticalCareMedicine.Subspecialty training in Paediatric Emergency Medicine (PEM) is a developingprocessinIreland.ICEMT,IAEMandtheFacultyofPaediatricsoftheRoyalCollegeofPhysiciansofIrelandhavepublishedajointlyagreedtrainingpathwayfortraineesinbothEMandPaediatricswhowishtopursuesubspecialtytraininginPEM(Figure1).In the UK, PEM is a recognised sub-specialty of both Emergency Medicine andGeneral Paediatrics. PEM is not yet recognised as a sub–specialty by theMedicalCouncilbutthisislikelytochangeinthenearfuture.AmoredetaileddocumentonthedevelopmentofPEMinIrelandisavailableontheIAEMwebsite.

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ACEMT/IAEM/FacultyofPaediatrics

JointTrainingProgrammeinPaediatricEmergencyMedicine

CriticalCareMedicine(CCM)hasrecentlybeenrecognisedasasub-specialtybytheMedicalCouncil.Likelyessentialcriteriawill includeatleastoneyearexperienceinICMandhavingaDiplomainIntensiveCareMedicine(byexaminationoftheRoyalCollegeofAnaesthetists). Anaesthesiaand ICMareessentialelements in IrishEMtraining.TraineeswishingtoapplyfordualEM/ICMaccreditationwiththeMedicalCouncilshouldcompleteafellowshiponreceiptoftheirCCTinEM.

At present, theMedical Council does not recognise dual accreditation in EM andAcuteMedicineandthereisnomechanismtopursuethispathinIreland.IntheUK,the Intercollegiate Board for training in ICM has drawn up recommended entrycriteria and training pathways for specialist trainees in EM, Anaesthetics and ICMwhowish to develop an interest in AcuteMedicine. Consultants in EMwho havesuccessfully completed the additional trainingmaywork in teams at a Consultantlevelequivalenttotheiracutemedicinetrainedcolleagues,dealingwiththefirst24hoursofcare. It is likelythatthiswillnormallytaketrainees12months.LevelTwocompetencies in Acute Medicine will be ‘signed off’ but Acute Medicineaccreditationwillnotberecordedonthespecialistregister.

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6.0 Furtherinformationandcontacts RoyalCollegeofSurgeonsinIreland–www.rcsi.ie

IrishAssociationforEmergencyMedicine–www.iaem.ie CollegeofEmergencyMedicine–www.collemergencymed.ac.uk

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Appendices

Appendix1 EDsrecognisedforCore&AdvancedSpecialistTraining(September2014)ThefollowingEDsarecurrentlyrecognisedforCSTEMandASTEMinIreland:

EmergencyDepartmentsrecognisedforCore&AdvancedSpecialistTraininginEmergencyMedicine

OurLady’sChildren’sHospital,Crumlin

SligoGeneralHospital

StJames’sHospital,Dublin

UniversityHospitalGalway

StVincent’sUniversityHospital,Dublin

UniversityHospitalLimerick

BeaumontHospital,Dublin

CorkUniversityHospital

MaterMisericordiaeUniversityHospital,Dublin

UniversityHospitalWaterford

ConnollyHospital,Blanchardstown,Dublin

MidlandRegionalHospital,Tullamore

AdelaideandMeathincorporatingNationalChildren’sHospital(AMNCH),Tallaght,Dublin

MercyUniversityHospital,Cork(ASTEMonly)

CavanGeneralHospital(CSTEMonly)

OurLadyofLourdesHospital,Drogheda

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Appendix2 MembershipoftheIrishCommitteeforEmergencyMedicineTrainingIrishCommitteeonEmergencyMedicineTraining(ICEMT)CSTEMandASTEMareorganisedandoverseenby ICEMTundertheauspicesoftheRoyalCollegeofSurgeonsinIreland.CurrentmembershipofICEMTisasfollows:Name RoleDr Gareth Quin Consultant in EM, UniversityHospitalLimerick

Dean&ChairofICEMT

ProfJohnRyan,ConsultantinEM,StVincent’sUniversityHospital,Dublin

ViceDean,ASTEM

MrJamesBinchy,ConsultantinEM,UniversityHospitalGalway

ViceDean,CSTEM

MrMark Doyle, Consultant in EM,WaterfordRegionalHospital

President,IAEM

Dr Gerry McCarthy, Consultant in EM, CorkUniversityHospital

Chair,NationalBoardofCEMinIrelandNationalClinicalLead,EmergencyMedicineProgramme

Dr Jim Gray, Consultant in EM, AMNCH,Tallaght

Lead,CEMexamsinIreland

Dr RoisinMcNamara, Consultant in PaediatricEM,TempleStreetUniversityHospital

PaediatricEMrepresentative

Dr Darragh Shields, Consultant in EM, StJames’sHospital,Dublin

ProfessionalDevelopmentProgrammelead

Dr Mick Sweeney, Consultant in EM, SligoGeneralHospital

UltrasoundTrainingrepresentative

DrMartinRochford,ConsultantinEM,AMNCHTallaght

SimulationTrainingrepresentative

DrUnaKennedy,Consultant inEM,StJames’sHospital,Dublin

HumanFactorslead

Dr David Menzies, Consultant in EM, StVincent’sUniversityHospital,Dublin

Examslead

DrAlanWatts,SpecialistRegistrar,ASTEM Traineerepresentative

Mr Kieran Tangney, Associate Director ofSurgicalAffairs,RCSI

RCSIrepresentative

DrGeoffChadwick

RCPIrepresentative

MsOrlaMockler ASTEM&CSTEMadministrator