Competency Framework

The programme includes 50 Advanced Emergency Medicine Procedures, covering a broad range of clinical and practical competencies that every consultant-level EM physician must master.

Procedures include:

1. Endotracheal intubation (standard and difficult airways)
2. Needle cricothyroidotomy
3. Surgical cricothyroidotomy
4. Chest drain insertion (Seldinger and open techniques)
5. Central venous line insertion (internal jugular, subclavian, femoral)
6. Intraosseous access
7. Lumbar puncture
8. Paracentesis
9. Thoracocentesis
10. Pericardiocentesis
11. Arterial line insertion
12. DC cardioversion
13. External pacing
14. Temporary transvenous pacing
15. Emergency thoracotomy (clamshell approach)
16. Needle thoracostomy
17. Difficult airway management (bougie, video laryngoscopy, supraglottic devices)
18. Surgical airway in paediatrics
19. Lateral canthotomy
20. Reduction of major joint dislocations (shoulder, hip, knee, elbow)
21. Regional nerve blocks in the ED
22. Fasciotomy (for compartment syndrome)
23. Escharotomy (for burns)
24. Focused Assessment with Sonography in Trauma (FAST scan)
25. Extended FAST (E-FAST)
26. Point-of-care ultrasound (POCUS) for AAA, DVT, and PE
27. Ocular ultrasound
28. Cardiac ultrasound (basic echocardiography in the ED)
29. Vascular access ultrasound guidance
30. Advanced wound management and complex suturing techniques
31. Procedural sedation (adult and paediatric)
32. Advanced fracture management (plastering, traction, manipulation)
33. Insertion of Sengstaken–Blakemore tube
34. Management of massive haemorrhage with REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)
35. Airway management in burns and smoke inhalation
36. Foreign body removal (airway, ENT, ophthalmological, rectal, vaginal)
37. Advanced obstetric emergency procedures (e.g., perimortem C-section)
38. Management of penetrating neck injuries
39. Advanced trauma procedures (thoracotomy, laparotomy exposure in ED)
40. Paediatric advanced life support procedures
41. Neonatal resuscitation procedures
42. Management of flail chest with stabilisation techniques
43. Emergency burr hole (in extreme circumstances)
44. Advanced ophthalmological procedures (e.g., Seidel’s test, corneal foreign body removal)
45. Advanced ENT procedures (nasal packing, posterior epistaxis management, tracheostomy management)
46. Advanced toxicological procedures (lipid rescue therapy, haemodialysis initiation discussions)
47. Advanced simulation-based procedural training for rare scenarios
48. Team leadership during complex procedures
49. Integrating human factors into emergency procedures
50. Portfolio-based authentication of all procedures under consultant supervision

The clinical component ensures candidates achieve proficiency in core consultant-level competencies, including:

• Recognition and management of critically ill patients
• Advanced decision-making in complex medical, surgical, trauma, and paediatric cases
• Senior-level leadership in multi-disciplinary teams
• Advanced risk management and patient safety practices
• Ethical and legal responsibilities in high-pressure clinical environments

This module focuses on advanced knowledge and leadership in resuscitation and critical care scenarios.

Topics include:

1. Leading a cardiac arrest in complex circumstances
2. Peri-arrest recognition and management
3. Post-cardiac arrest care, including targeted temperature management
4. Advanced airway management and decision-making
5. Management of cardiac arrhythmias and complex ECG interpretation
6. Advanced management of septic shock and refractory sepsis
7. Polytrauma resuscitation, including damage-control resuscitation principles
8. Major haemorrhage protocol leadership
9. Advanced management of burns and inhalational injuries
10. Management of toxicological emergencies and antidote use
11. Advanced ventilatory strategies in ED (e.g., ARDS management, non-invasive vs invasive ventilation)
12. Management of paediatric resuscitation in complex cases
13. Management of obstetric emergencies, including maternal collapse
14. Advanced simulation training in cardiac arrest, trauma, paediatric, and obstetric scenarios
15. Incorporating human factors and CRM (Crisis Resource Management) into resuscitation leadership

Candidates will undergo structured ultrasound training aligned with RCEM and international standards. This includes:

• FAST & E-FAST for trauma assessment
• Cardiac ultrasound (basic echocardiography in ED)
• Aortic scanning for AAA
• DVT ultrasound
• Thoracic ultrasound for pleural effusions, pneumothorax, pulmonary oedema
• Abdominal scanning for free fluid and organ pathology
• Vascular access ultrasound for line placements
• Ocular ultrasound
• Paediatric ultrasound applications

At the end of training, participants will receive an Advanced EM Ultrasound Certification, validated and signed by FRCEM-qualified consultants.

Assessment is continuous throughout the programme and is designed to reflect consultant-level training standards.

Components include:

1. Direct Observation of Procedural Skills (DOPS) – logged and validated for all 50 advanced procedures
2. Mini-CEX (Clinical Evaluation Exercises) – multiple workplace-based assessments
3. Case-Based Discussions (CBDs) – reflecting senior-level decision-making
4. ACAT (Acute Care Assessment Tool) – consultant-level acute care evaluations
5. Multi-Source Feedback (MSF) – incorporating feedback from colleagues, juniors, and supervisors
6. Teaching Assessments – evaluating delivery of structured teaching to juniors
7. Reflective Practice Entries – documenting personal and professional growth
8. Portfolio Authentication – every competency signed and verified by FRCEM consultants