Faculty of Emergency Medicine GCPS · 2018-11-26 · emergency medical care and within the province and expertise of almost all medical practitioners. Emergency Medicine has been

Faculty of Emergency Medicine

GCPS

Membership Curriculum

This curriculum outlines what knowledge, skills and attitudes would be expected at the

Membership level of training, and which are required to attain the level of practice expected

of a Member of the Faculty of Emergency Medicine. To be admitted to the Membership

program trainees must have the competencies expected at the end of Housemanship

training, therefore this curriculum may be read in conjunction with the curriculum for

Housemanship training.

This curriculum indicates the types of learning opportunities and the assessment methods -

including workplace based assessment which will be used. Competencies expected at the

end of Membership training included in this document.

Please send any comments to:-

Dr George Oduro

Komfo Anokye Teaching Hospital

Kumasi

Copied to Rector, GCPS at the College office

Contents 1. Preface....................................................................................................................................................... 9

2. Introduction ............................................................................................................................................ 10

2.1. THE SPECIALTY OF EMERGENCY MEDICINE ..................................................................................... 10

3. COMPETENCIES, KNOWLEDGE AND SKILLS ............................................................................................. 11

3.1. CORE COMPETENCIES OF THE EMERGENCY PHYSICIAN .................................................................. 11

3.1.1. PATIENT CARE .......................................................................................................................... 11

3.1.1.1. Triage ................................................................................................................................ 11

3.1.1.2. Primary assessment and stabilisation of life threatening conditions .............................. 11

3.1.1.3. Focused medical history................................................................................................... 12

3.1.1.4. Secondary assessment and immediate clinical management ......................................... 12

3.1.1.5. Clinical decision making ................................................................................................... 12

3.1.1.6. Clinical documentation .................................................................................................... 12

3.1.1.7. Re-evaluation and further management ......................................................................... 12

3.1.2. MEDICAL KNOWLEDGE AND CLINICAL SKILLS .......................................................................... 12

3.1.3. COMMUNICATION, COLLABORATION AND INTERPERSONAL SKILLS....................................... 13

3.1.3.1. Patients and relatives ....................................................................................................... 13

3.1.3.2. Colleagues and other health care providers .................................................................... 13

3.1.3.3. Other care providers such as the police, the fire department and social services .......... 13

3.1.3.4. Mass media and the general public ................................................................................. 13

3.1.4. PROFESSIONALISM AND OTHER ETHICAL AND LEGAL ISSUES ................................................. 13

3.1.4.1. Professional behaviour and attributes ............................................................................. 13

3.1.4.2. Working within a team or as a leader of a team.............................................................. 14

3.1.4.3. Delegation and referral .................................................................................................... 14

3.1.4.4. Patient confidentiality ...................................................................................................... 14

3.1.4.5. Autonomy and informed consent .................................................................................... 14

3.1.4.6. The competent/incompetent patient .............................................................................. 14

3.1.4.7. Abuse and violence .......................................................................................................... 14

3.1.4.8. Do not attempt resuscitation (DNAR) and limitations of therapeutic interventions ...... 14

3.1.4.9. Medico-legal issues .......................................................................................................... 14

3.1.4.10. Legislation and ethical issues in Emergency Medicine .................................................... 15

3.1.5. ORGANISATIONAL PLANNING AND SERVICE MANAGEMENT SKILLS ....................................... 15

3.1.5.1. Case management............................................................................................................ 15

3.1.5.2. Quality standards, audit and clinical outcomes ............................................................... 15

3.1.5.3. Time management ........................................................................................................... 15

3.1.5.4. Information management ................................................................................................ 16

3.1.5.5. Documentation ................................................................................................................ 16

3.1.6. EDUCATION AND RESEARCH .................................................................................................... 16

3.1.6.1. Self-education and improvement: ................................................................................... 16

3.1.6.2. Teaching skills .................................................................................................................. 16

3.1.6.3. Critical appraisal of scientific literature ........................................................................... 16

3.1.6.4. Clinical and basic research ............................................................................................... 16

3.2. SYSTEM-BASED CORE KNOWLEDGE ................................................................................................. 16

3.2.1. CARDIOVASCULAR EMERGENCIES IN ADULTS AND CHILDREN ................................................ 17

3.2.2. DERMATOLOGICAL EMERGENCIES IIN ADULTS AND CHILDREN .............................................. 17

3.2.3. ENDOCRINE AND METABOLIC EMERGENCIES IN ADULTS AND CHILDREN .............................. 17

3.2.4. FLUID AND ELECTROLYTE DISTURBANCES ............................................................................... 17

3.2.5. EAR, NOSE, THROAT, ORAL AND NECK EMERGENCIES IN ADULTS AND CHILDREN ................ 18

3.2.6. GASTROINTESTINAL EMERGENCIES IN ADULTS AND CHILDREN ............................................. 18

3.2.7. GYNAECOLOGICAL AND OBSTETRIC EMERGENCIES ................................................................ 18

3.2.8. HAEMATOLOGY AND ONCOLOGY EMERGENCIES IN ADULTS AND CHILDREN ........................ 18

3.2.9. IMMUNOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN ................................................ 19

3.2.10. INFECTIOUS DISEASES AND SEPSIS IN ADULTS AND CHILDREN ............................................... 19

3.2.11. MUSCULO-SKELETAL EMERGENCIES ........................................................................................ 19

3.2.12. NEUROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN .................................................... 20

3.2.13. OPHTHALMIC EMERGENCIES IN ADULTS AND CHILDREN ....................................................... 20

3.2.14. PULMONARY EMERGENCIES IN ADULTS AND CHILDREN ........................................................ 20

3.2.15. PSYCHIATRIC AND BEHAVIOUR DISORDERS ............................................................................ 21

3.2.16. RENAL AND UROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN .................................... 21

3.2.17. TRAUMA IN ADULTS AND CHILDREN ....................................................................................... 21

3.3. COMMON PRESENTING SYMPTOMS ............................................................................................... 22

3.3.1. ACUTE ABDOMINAL PAIN ........................................................................................................ 22

3.3.2. ALTERED BEHAVIOUR AND AGITATION ................................................................................... 22

3.3.3. ALTERED LEVEL OF CONSCIOUSNESS IN ADULTS AND CHILDREN ........................................... 23

3.3.4. BACK PAIN ................................................................................................................................ 23

3.3.5. BLEEDING (NON-TRAUMATIC) ................................................................................................. 24

3.3.6. CARDIAC ARREST ...................................................................................................................... 24

3.3.7. CHEST PAIN .............................................................................................................................. 24

3.3.8. CRYING BABY ............................................................................................................................ 24

3.3.9. DIARRHOEA .............................................................................................................................. 25

3.3.10. DYSPNOEA ................................................................................................................................ 25

3.3.11. FEVER AND ENDOGENOUS INCREASE IN BODY TEMPERATURE .............................................. 26

3.3.12. HEADACHE IN ADULTS AND CHILDREN .................................................................................... 26

3.3.13. JAUNDICE ................................................................................................................................. 27

3.3.14. PAIN IN ARMS .......................................................................................................................... 27

3.3.15. PAIN IN LEGS ............................................................................................................................ 27

3.3.16. PALPITATIONS .......................................................................................................................... 27

3.3.17. SEIZURES IN ADULTS AND CHILDREN ....................................................................................... 28

3.3.18. SHOCK IN ADULTS AND CHILDREN ........................................................................................... 28

3.3.19. SKIN MANIFESTATIONS IN ADULTS AND CHILDREN ................................................................ 29

3.3.20. SYNCOPE .................................................................................................................................. 29

3.3.21. URINARY SYMPTOMS (DYSURIA, OLIGO--ANURIA, POLYURIA) ............................................... 29

3.3.22. VERTIGO AND DIZZINESS.......................................................................................................... 30

3.3.23. VOMITING ................................................................................................................................ 30

3.4. SPECIFIC ASPECTS OF EMERGENCY MEDICINE ................................................................................ 31

3.4.1. ABUSE AND ASSAULT IN ADULTS AND CHILDREN ................................................................... 31

3.4.2. INJURY PREVENTION AND HEALTH PROMOTION .................................................................... 31

3.4.3. ANALGESIA AND SEDATION IN ADULTS AND CHILDREN.......................................................... 31

3.4.4. DISASTER MEDICINE ................................................................................................................. 31

3.4.5. ENVIRONMENTAL ACCIDENTS IN ADULT AND CHILDREN ....................................................... 31

3.4.6. FORENSIC ISSUES...................................................................................................................... 31

3.4.7. PATIENT MANAGEMENT ISSUES IN EMERGENCY MEDICINE ................................................... 32

3.4.8. TOXICOLOGY IN ADULTS AND CHILDREN ................................................................................. 32

3.4.9. PRE-HOSPITAL CARE ................................................................................................................. 32

3.4.10. PSYCHO-SOCIAL PROBLEMS ..................................................................................................... 32

4. Curriculum Standards .............................................................................................................................. 33

4.1. Goals ................................................................................................................................................ 33

4.2. Use of the curriculum by trainees .................................................................................................... 33

4.3. Content of Learning ......................................................................................................................... 34

4.4. Model of Learning ............................................................................................................................ 34

4.5. Learning Experiences ....................................................................................................................... 34

4.6. Supervision and Feedback ............................................................................................................... 35

4.7. Curriculum Implementation, Review and Updating ........................................................................ 36

5. SYLLABUS ................................................................................................................................................. 38

5.1. Generic Competencies supporting Good Clinical Care .................................................................... 38

5.1.1. History and examination .......................................................................................................... 38

5.1.2. Documentation ........................................................................................................................ 39

5.1.3. Diagnosis .................................................................................................................................. 40

5.1.4. Decision Making ....................................................................................................................... 41

5.1.5. Time Management ................................................................................................................... 43

5.1.6. Safe Prescribing ........................................................................................................................ 44

5.1.7. Continuity of care ..................................................................................................................... 45

5.1.8. Therapeutic interventions ........................................................................................................ 46

5.2. Communication ................................................................................................................................ 47

5.2.1. Communicating with colleagues .............................................................................................. 47

5.2.2. Communication skills when making or receiving referrals ...................................................... 48

5.2.3. Communicating with patients and their carers ....................................................................... 49

5.2.4. Breaking bad news ................................................................................................................... 50

5.2.5. Communication for effective team working ............................................................................ 51

5.3. Maintaining good medical practice ................................................................................................. 52

5.3.1. Lifelong learning ....................................................................................................................... 52

5.3.2. Critical appraisal of evidence & development of clinical guidelines ....................................... 54

5.3.3. Information management ........................................................................................................ 56

5.3.4. Risk management ..................................................................................................................... 57

5.3.5. Maintaining confidentiality ...................................................................................................... 58

5.4. Professional behaviour and probity ................................................................................................. 59

5.4.1. Professional behaviour and probity – professional attributes ................................................ 59

5.4.2. Career and professional development ..................................................................................... 60

5.5. Ethics and legal ................................................................................................................................ 61

5.5.1. Informed consent ..................................................................................................................... 61

5.5.2. Do Not Attempt Resuscitation (DNAR) and advanced directives ............................................ 62

5.5.3. The competent adult ................................................................................................................ 63

5.5.4. Medico-legal issues .................................................................................................................. 64

5.6. Education ......................................................................................................................................... 65

5.6.1. Developing others’ learning ..................................................................................................... 65

5.6.2. Assessment and appraisal ........................................................................................................ 66

6. Specialty specific competencies .............................................................................................................. 68

6.1. Resuscitation .................................................................................................................................... 68

6.1.1. Airway ...................................................................................................................................... 69

6.1.2. Cardiac Arrest / Peri-arrest ...................................................................................................... 71

6.1.3. Resuscitation of the Shocked patient ...................................................................................... 73

6.1.4. Patients presenting with Coma ................................................................................................ 75

6.2. Anaesthetics and Pain Relief ............................................................................................................ 76

6.2.1. Pain Management .................................................................................................................... 76

6.2.2. Local Anaesthetic Techniques .................................................................................................. 78

6.2.3. Safe Conscious Sedation .......................................................................................................... 79

6.3. Wound Management ....................................................................................................................... 80

6.4. Major Trauma .................................................................................................................................. 82

6.4.1. Head Injury ............................................................................................................................... 83

6.4.2. Chest Trauma ........................................................................................................................... 85

6.4.3. Abdominal Trauma ................................................................................................................... 87

6.4.4. Spinal Injury.............................................................................................................................. 88

6.4.5. Maxillo-facial Trauma............................................................................................................... 90

6.4.6. Burns ........................................................................................................................................ 92

6.4.7. Generic objectives for musculoskeletal conditions ................................................................. 93

6.4.7.1. Upper limb ....................................................................................................................... 94

6.4.7.2. Lower limb and Pelvis ...................................................................................................... 97

6.4.7.3. Spinal conditions ............................................................................................................ 100

6.5. Vascular Emergencies - Arterial ..................................................................................................... 102

6.6. Vascular Emergencies - Venous ..................................................................................................... 103

6.7. Abdominal conditions - Undifferentiated Abdominal Pain............................................................ 104

6.7.1. Abdominal conditions - Haematemesis / melaena ................................................................ 104

6.7.2. Abdominal conditions - Anal Pain and Rectal Bleeding ......................................................... 106

6.8. Urology ........................................................................................................................................... 107

6.9. Sexually Transmitted Disease ........................................................................................................ 109

6.10. Eye problems .............................................................................................................................. 110

6.11. ENT conditions ........................................................................................................................... 113

7. Procedural Competencies ..................................................................................................................... 116

7.1. CPR SKILLS ...................................................................................................................................... 116

7.2. Airway ............................................................................................................................................ 116

7.3. ANALGESIA AND SEDATION SKILLS ................................................................................................ 116

7.4. BREATHING AND VENTILATION MANAGEMENT SKILLS ................................................................. 117

7.5. CIRCULATION: CIRCULATORY SUPPORT AND CARDIAC SKILLS AND PROCEDURES ....................... 117

7.6. DIAGNOSTIC PROCEDURES AND SKILLS ......................................................................................... 118

7.7. ENT SKILLS AND PROCEDURES ....................................................................................................... 118

7.8. GASTROINTESTINAL PROCEDURES ................................................................................................ 118

7.9. GENITOURINARY PROCEDURES ..................................................................................................... 118

7.10. DECONTAMINATION AND INFECTION CONTROL SKILLS AND PROCEDURES ............................. 118

7.11. MUSCULOSKELETAL TECHNIQUES ............................................................................................. 119

7.12. NEUROLOGICAL SKILLS AND PROCEDURES ................................................................................ 119

7.13. OBSTETRIC AND GYNAECOLOGICAL SKILLS AND PROCEDURES ................................................. 119

7.14. OPHTHALMIC SKILLS AND PROCEDURES ................................................................................... 119

7.15. TEMPERATURE CONTROL PROCEDURES .................................................................................... 119

7.16. TRANSPORTATION OF THE CRITICALLY ILL PATIENT .................................................................. 119

7.17. WOUND MANAGEMENT ............................................................................................................ 119

7.18. Other procedures ....................................................................................................................... 120

8. The Training Programme for Emergency Medicine .............................................................................. 121

8.1. TRAINING PROCESS ........................................................................................................................ 121

8.2. Training structure ........................................................................................................................... 121

8.3. Duration of training........................................................................................................................ 121

8.4. Entry Requirements ....................................................................................................................... 122

8.5. Working conditions ........................................................................................................................ 122

8.6. TEACHING AND LEARNING METHODS ........................................................................................... 122

8.7. MANDATORY TRAINING COURSES ................................................................................................. 123

8.8. Independent self-directed learning ............................................................................................... 124

8.9. SUPERVISION AND FEEDBACK ........................................................................................................ 124

8.10. EXPECTED TRAINING OUTCOMES MEMBERSHIP/FELLOWSHIP................................................. 125

9. ASSESSMENT METHODS AND TOOLS .................................................................................................... 125

9.1. Introduction ................................................................................................................................... 125

9.2. Formative assessment and Documentation .................................................................................. 125

9.2.1. Summative assessment .......................................................................................................... 126

9.2.2. Examinations ............................................................................... Error! Bookmark not defined.

9.2.2.1. Primary Examination: .......................................................... Error! Bookmark not defined.

9.2.3. Membership Examination: .......................................................... Error! Bookmark not defined.

9.2.4. Fellowship Final Examination: ..................................................... Error! Bookmark not defined.

9.2.4.1. Dissertation ......................................................................... Error! Bookmark not defined.

9.2.5. Levels of competence expected at Fellowship level ................... Error! Bookmark not defined.

10. MANAGING THE CURRICULUM ............................................................................................................. 127

11. GLOSSARY OF ABBREVIATIONS ............................................................................................................. 131

12. RECOMMENDED READING LIST ............................................................................................................ 132

13. APPENDICES .......................................................................................................................................... 134

1. Preface

Emergency Medicine has long been established as a primary medical specialty in Australasia, Canada,

Ireland, the United Kingdom and the United States. It is sometimes seen to be synonymous with

emergency medical care and within the province and expertise of almost all medical practitioners.

Emergency Medicine has been defined as the Specialty which is based on body of knowledge required

for prevention, diagnosis, management of acute and urgent aspects of illness and injury affecting all

age groups, with a full spectrum of episodic undifferentiated physical and behavioural disorders. It

further encompasses an understanding of the development of prehospital and in-hospital emergency

medical systems and the skills necessary for this development.

The specialty of Emergency Medicine incorporates the resuscitation and management of all

undifferentiated urgent and emergency cases until discharge or transfer to the care of another

physician. Emergency Medicine is therefore an inter-disciplinary specialty, one which is

interdependent with all other clinical disciplines. It complements and does not seek to compete with

other medical specialties.

The essential features of a clinical specialty include a unique field of action, a defined body of

knowledge and a rigorous training programme. Emergency Medicine has a unique field of action, both

within the Emergency department and in the community, and this curriculum document does not only

incorporate the relevant body of knowledge and associated competencies, but also establishes the

essential principles for a rigorous training programme. This Curriculum presents a guideline for the

development and organisation of a recognised training programme of comparable standard

worldwide. The development of this document took into consideration the existing programmes in

Europe, the United States, and elsewhere.

2. Introduction

2.1. THE SPECIALTY OF EMERGENCY MEDICINE Emergency Medicine is a medical specialty based on the knowledge and skills required for the

prevention, diagnosis and management of the acute and urgent aspects of illness and injury

affecting patients of all age groups with a full spectrum of undifferentiated physical and

behavioural disorders. It is a specialty in which time is critical.

The practice of Emergency Medicine encompasses the pre-hospital and in-hospital reception,

resuscitation and management of undifferentiated urgent and emergency cases until

discharge from the Emergency Department or transfer to the care of another physician. It also

includes involvement in the development of pre-hospital and in-hospital emergency medical

systems.

This curriculum is adopted from the European Emergency Medicine training and is adapted to

take the Ghanaian and African environment into consideration. The curriculum sets out the

intended aims and objectives, content, experiences and outcomes and processes of the

educational programme intended to provide emergency physicians with adequate knowledge

and sufficient clinical experience to be safe, expert and independent practitioners functioning

at senior specialist or consultant level within the Ghana Health Service.

The curriculum includes a description of the training structure, such as entry requirements,

length and organisation of the programme including its flexibilities, and assessment system

and a description of the expected methods of learning, teaching, feedback and supervision.

The curriculum covers both generic professional and specialty specific areas; it is centred on

the Emergency Department as the principal learning environment for trainees.

3. COMPETENCIES, KNOWLEDGE AND SKILLS

The curriculum covers knowledge, skills and expertise which the trainee in Emergency

Medicine must achieve and includes:

Core Competencies of the Emergency Physician

System-Based Core Knowledge

Common Presenting Symptoms

Special Aspects of Emergency Medicine

Core Clinical Procedures and Skills.

3.1. CORE COMPETENCIES OF THE EMERGENCY PHYSICIAN The core areas of competency in Emergency Medicine may be defined [5,6,7], as:

Patient care

Medical knowledge

Communication, collaboration and interpersonal skills

Professionalism, ethical and legal issues

Organisational planning and service management skills

Education and research.

3.1.1. PATIENT CARE Emergency Physicians (EP) care for patients with a wide range of pathology from the life-

threatening to the self-limiting and from all age groups. The attendance and number of these

patients is unpredictable and they mostly present with symptoms rather than diagnoses.

Therefore, the provision of care needs to be prioritised, and this is a dynamic process. The

approach to the patient is global rather than organ specific. Patient care includes: physical,

mental and social aspects. It focuses on initial care until discharge or referral to other health

professionals. Patient education and public health aspects must be considered in all cases. To

ensure the above patient care, EPs must particularly focus on the following:

3.1.1.1. Triage

EPs must know the principles of triage which is the process of the allocation and medical

prioritisation of care for the pre-hospital setting, the Emergency department and in the event of

mass casualties. It is based mainly on the evaluation of vital parameters and key symptoms to

prioritise and categorise patients according to severity of injury or illness, prognosis and

availability of resources.

3.1.1.2. Primary assessment and stabilisation of life threatening conditions

The ABCDE approach must be the primary assessment tool for all patients and does not

require a diagnostic work-up. It is a structured approach with which to identify and resuscitate

the critically ill and injured.

EPs must be able to assess, establish and maintain:

Airway [A],

Breathing [B],

Circulation [C],

Disability [D] and

full Exposure [E] of the patient.

3.1.1.3. Focused medical history

EPs must focus the initial medical history on presenting complaints and on clinical findings as

well as on conditions requiring immediate care.

3.1.1.4. Secondary assessment and immediate clinical management

EPs must perform secondary assessment with a timely diagnostic work-up focusing on the

need for early action. Clinical management must also include further aspects of health

(physical, mental and social).

3.1.1.5. Clinical decision making

EPs must be able to make clinical decisions including:

re-triage

immediate and/or definitive care provided in the ED

planning for admission or discharge.

3.1.1.6. Clinical documentation

EPs must make contemporaneous medical records which focus on:

relevant medical history

main complaints and abnormal findings

provisional diagnosis and planned investigations

results of investigations

treatment

conclusions and management decisions

patient information.

3.1.1.7. Re-evaluation and further management

EPs must perform continuous re-evaluation of the patient, with adjustment of the provisional

diagnosis and care when it becomes necessary.

3.1.2. MEDICAL KNOWLEDGE AND CLINICAL SKILLS Emergency Physicians (EPs) need to acquire the knowledge and skills described in sections

3.2, 3.3, 3.4 and 3.5.

3.1.3. COMMUNICATION, COLLABORATION AND INTERPERSONAL SKILLS Emergency Medicine is practised in difficult and challenging environments. Effective

communication is essential for safe care and for building and maintaining good relationships

avoiding barriers such as emotions, stress and prejudices. EPs must be able to use both

verbal and non-verbal communication skills, as well as information and communication

technology. In the case of a patient who is incompetent by virtue of age or mental capacity,

communication should be with a parent or other legal representative.

EPs must be able to demonstrate communication and interpersonal skills that include the

following:

3.1.3.1. Patients and relatives

EPs should give special attention to involving the patient in decision-making, seeking informed

consent for diagnostic and therapeutic procedures, sharing information, breaking bad news,

giving advice and recommendations on discharge and also communicating with populations

with language barriers.

3.1.3.2. Colleagues and other health care providers

Important skills for an EP are sharing information on patient care, working as a member or the

leader of a team, referring and transferring patients.

3.1.3.3. Other care providers such as the police, the fire department and social services

EPs must give attention to respecting patient confidentiality.

3.1.3.4. Mass media and the general public

EPs must be able to interact with the mass media in a constructive way, giving correct

information to the public and at the same time respecting the privacy of the patient.

3.1.4. PROFESSIONALISM AND OTHER ETHICAL AND LEGAL ISSUES

3.1.4.1. Professional behaviour and attributes

The general professional behaviour and attributes of Emergency Physicians must not be

adversely influenced by working in stressful circumstances and with a diverse patient

population. They must learn to identify their educational needs and to work within their own

limitations. They must be able to self-motivate even at times of stress or discomfort. They

must recognise their own as well as system errors and value participation in the peer review

process [8,9].

3.1.4.2. Working within a team or as a leader of a team

EPs must understand the role of colleagues in other specialties and must be able to lead or to

work effectively even in a new or large team often under considerable stress.

3.1.4.3. Delegation and referral

EPs must understand the responsibilities and potential consequences of delegating, referring

to a colleague in another discipline or transferring the patient to another doctor, health care

professional or health care setting.

3.1.4.4. Patient confidentiality

EPs must understand the law regarding patient confidentiality and data protection. They must

know what confidentiality problems arise when dealing with relatives, the police, EMS

communication, telephone discussions and the media.

3.1.4.5. Autonomy and informed consent

EPs must respect the right of competent patients to be fully involved in decisions about their

care. They must also value the right of competent patients to refuse clinical procedures or

treatment. They must understand how the ethical principles of autonomy and informed

consent affect emergency practitioners.

3.1.4.6. The competent/incompetent patient

EPs must be able to assess whether a patient has the competence to make an informed

decision. They must also understand the legal rights of a guardian or adult with power of

attorney and when they treat minors. They must be familiar with those aspects of mental

health legislation which relate to competence.

3.1.4.7. Abuse and violence

EPs must be able to recognise patterns of illness or injury which might suggest physical or

sexual abuse or domestic violence to children or adults. They must be able to initiate

appropriate child or adult protection procedures. They must also learn to prevent and limit the

risks of violence and abuse to staff working in an emergency setting.

3.1.4.8. Do not attempt resuscitation (DNAR) and limitations of therapeutic

interventions

EPs must learn to discuss with colleagues and in a professional and empathic manner with

relatives the initiation or possible discontinuation of active interventions when this is

considered to be medically appropriate [10]. They must understand when and how they should

use advance directives such as living wills and durable powers of attorney.

3.1.4.9. Medico-legal issues

EPs must operate within the legal framework of the country in which they are working.

3.1.4.10. Legislation and ethical issues in Emergency Medicine

EPs should have an understanding of ethics and law, as well as the legal aspects of bioethical

issues in Emergency Medicine. They must be able to make a reasoned analysis of ethical

conflicts and develop the skills to resolve ethical dilemmas in an appropriate manner. They

must also look to the law for guidance, although the law does not always provide the answer

to many ethical problems. Ethics in Emergency Medicine help to prepare EPs to face new

ethical dilemmas in their practice [9,11]. The use of ethical analysis provides the framework for

determining moral duty, obligation and conduct. EPs must learn to identify, refine, and apply

general moral principles to their practice related to:

Patient autonomy (informed consent and refusal, patient decision making capacity, treatment of minors, advance directives, the obligations of the Good Samaritan statutes).

End of life decisions (limiting resuscitation, futility).

The physician-patient relationship (confidentiality, truth telling and communication,

compassion and empathy).

Issues related to justice (duty, ethical issues of resuscitation, health care rationing,

moral issues in disaster medicine, research, resuscitation issues in pregnancy).

3.1.5. ORGANISATIONAL PLANNING AND SERVICE MANAGEMENT SKILLS This competence is needed to enhance the safety and quality of patient care and work

environment. Emergency Physicians must continuously adapt and prioritise existing and

available resources to meet the needs of all patients and maintain the quality of care.

3.1.5.1. Case management

EPs must be able to provide and balance the different care processes between the individual

patient and the total case-mix. After assessment, they must re-orientate non urgent patients to

an adequate point of contact within the health care or social network. They must provide clear

guidance to those patients discharged without formal follow up.

3.1.5.2. Quality standards, audit and clinical outcomes

It is important that EPs use evidence-based medicine and recognise the value of quality

standards to improve patient care which is effective and safe. They must be able to undertake

audit and use clinical outcomes, including critical incident reporting, as ways of continuously

improving clinical practice.

3.1.5.3. Time management

EPs must be able to manage the individual patient as well as the overall patient flow in a

timely manner which is dependent upon available resources, accepted medical standards and

public expectation. EPs must also learn to manage their own time in an effective way.

3.1.5.4. Information management

EPs often manage patients for whom limited information is available. They may need to

communicate with other agencies to obtain relevant information whilst respecting the

confidentiality of the patient. Patient data collected during the process of care must be

accessible to all involved health care professionals through adequate documentation. EPs

need a broad knowledge of the latest advances in medicine and must be able to access and

manage information relevant to the specific care of an individual patient.

3.1.5.5. Documentation

EPs are responsible for clear, legible, accurate, contemporaneous and complete records of

patient care where the author, date and time are clearly identified. Documentation is a

continuous process and all entries must be made in real time as far as possible.

3.1.6. EDUCATION AND RESEARCH

3.1.6.1. Self-education and improvement:

EPs must develop their knowledge and practice in EM by continuous education. They have to

identify areas for personal improvement and learn to implement patient care based on

scientific evidence.

3.1.6.2. Teaching skills

EPs must be involved in teaching undergraduate, graduate and post graduate health care

students, and the general population. They must also continuously develop the skills to be

effective teachers.

3.1.6.3. Critical appraisal of scientific literature

EPs must be able to investigate and evaluate their own practice. They must learn to use

evidence-based medicine and guidelines, where applicable, and become familiar with the

principles of clinical epidemiology, biostatistics, quality assessment and risk management.

3.1.6.4. Clinical and basic research

EPs must understand the scientific basis of emergency medicine, the use of scientific methods

in clinical research, and the fundamental aspects of basic research. They must be able to

critically review research studies and be able to understand, present and implement them into

clinical practice. They should understand the process of developing a hypothesis from a

clinical problem and of testing that hypothesis. They should also understand the specific

aspects of obtaining consent as well as the ethical considerations of research in emergency

situations.

3.2. SYSTEM-BASED CORE KNOWLEDGE

This section of the curriculum gives an index of the system-based core knowledge appropriate

to the management of patients presenting with undifferentiated symptoms and complaints.

The lists are mostly given in the following sequence:

congenital disorders,

inflammatory and infectious disorders,

metabolic disorders,

traumatic and related problems,

tumours,

vascular disorders, ischaemic and bleeding disorders.

These lists cannot be exhaustive.

3.2.1. CARDIOVASCULAR EMERGENCIES IN ADULTS AND CHILDREN

Arrhythmias

Congenital heart disorders

Contractility disorders, pump failure o cardiomyopathies, congestive heart failure, acute pulmonary oedema,

tamponade, valvular emergencies

Inflammatory and infectious cardiac disorders o endocarditis, myocarditis, pericarditis

Ischaemic heart disease o acute coronary syndromes, stable angina

Traumatic injuries

Vascular and thromboembolic disorders o aortic dissection/aneurysm rupture, deep vein thrombosis, hypertensive

emergencies, occlusive arterial disease, thrombophlebitis, pulmonary embolism, pulmonary hypertension

3.2.2. DERMATOLOGICAL EMERGENCIES IIN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders • Skin manifestations of

o immunological disorders, systemic disorders, toxic disorders

3.2.3. ENDOCRINE AND METABOLIC EMERGENCIES IN ADULTS AND CHILDREN

• Acute presentation of inborn errors of metabolism • Adrenal insufficiency and crisis • Disorders of glucose metabolism

o hyperosmolar, hyperglycaemic state, hypoglycaemia, ketoacidosis

• Thyroid disease emergencies

o hyperthyroidism, hypothyroidism, myxoedema coma, thyroid storm

3.2.4. FLUID AND ELECTROLYTE DISTURBANCES

• Acid-Base disorders • Electrolyte disorders

• Volume status and fluid balance

3.2.5. EAR, NOSE, THROAT, ORAL AND NECK EMERGENCIES IN ADULTS AND CHILDREN

• Bleeding • Complications of tumours

o airway obstruction, bleeding

• Foreign bodies

• Inflammatory and Infectious disorders

o angio-oedema, epiglottitis, laryngitis, paratonsillar abcess

• Traumatic problems

3.2.6. GASTROINTESTINAL EMERGENCIES IN ADULTS AND CHILDREN

• Congenital disorders o Hirschsprung’s disease, Meckel’s diverticulum, pyloric stenosis


o appendicitis, cholecystitis, cholangitis, diverticulitis, exacerbations and

complications of inflammatory bowel diseases, gastritis, gastroenteritis, gastro-

oesophageal reflux disease, hepatitis, pancreatitis, peptic ulcer, peritonitis

• Metabolic disorders

o hepatic disorders, hepatic failure

• Traumatic and mechanical problems

o foreign bodies, hernia strangulation, intestinal obstruction and occlusion

• Tumours

• Vascular disorders: Ischaemia and Bleeding

o ischaemic colitis, upper and lower gastrointestinal bleeding, mesenteric

ischaemia

• Other problems

o complications of gastrointestinal devices and surgical procedures

3.2.7. GYNAECOLOGICAL AND OBSTETRIC EMERGENCIES

• Inflammatory and Infectious disorders o mastitis, pelvic inflammatory disease, vulvovaginitis

• Obstetric emergencies

o abruptio placentae, eclampsia, ectopic pregnancy, emergency delivery, HELLP

syndrome during pregnancy, hyperemesis gravidarum, placenta praevia, post-

partum haemorrhage

• Traumatic and related problems

o ovarian torsion

• Tumours


o vaginal bleeding

3.2.8. HAEMATOLOGY AND ONCOLOGY EMERGENCIES IN ADULTS AND CHILDREN

• Anaemias

• Complications of lymphomas and leukaemias

• Congenital disorders

o haemophilias and Von Willebrand’s disease, hereditary haemolytic anaemias,

sickle cell disease


o neutropenic fever, infections in immuno-compromised patients


o acquired bleeding disorders (coagulation factors deficiency, disseminated

intravascular coagulation), drug induced bleeding (anticoagulants, antiplatelet

agents, fibrinolytics), idiopathic thrombocytopenic purpura, thrombotic

thrombocytopenic purpura

• Transfusion reactions

3.2.9. IMMUNOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Allergies and anaphylactic reactions • Inflammatory and Infectious disorders

o acute complications of vasculitis

3.2.10. INFECTIOUS DISEASES AND SEPSIS IN ADULTS AND CHILDREN

• Common viral and bacterial infections • Food and water-born infectious diseases

• HIV infection and AIDS

• Common tropical diseases

• Parasitosis

• Rabies

• Sepsis and septic shock

• Sexually transmitted diseases

• Streptococcal toxic shock syndrome

• Tetanus

3.2.11. MUSCULO-SKELETAL EMERGENCIES

• Congenital disorders o dislocated hip, osteogenesis imperfecta


o arthritis, bursitis, cellulitis, complications of systemic rheumatic diseases,

necrotising fasciitis, osteomyelitis, polymyalgia rheumatica, soft tissue

infections


o complications of osteoporosis and other systemic diseases

• Traumatic and degenerative disorders

o back disorders, common fractures and dislocations, compartment syndromes,

crush syndrome, osteoarthrosis, rhabdomyolysis, soft tissue trauma

• Tumours:

o pathological fractures

3.2.12. NEUROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders o brain abscess, encephalitis, febrile seizures in children, Guillain-Barrè

syndrome, meningitis, peripheral facial palsy (Bell’s palsy), temporal arteritis


o complications of CNS devices, spinal cord syndromes, peripheral nerve trauma

and entrapment, traumatic brain injury

• Tumours

o common presentations and acute complications of neurological and metastatic

tumours


o carotid artery dissection, stroke, subarachnoid haemorrhage, subdural and

extradural haematomata, transient ischaemic attack, venous sinus thrombosis

• Other problems

o acute complications of chronic neurological conditions (e.g. myasthenic crisis,

multiple sclerosis), acute peripheral neuropathies, seizures and status

epilepticus

3.2.13. OPHTHALMIC EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders o conjunctivitis, dacrocystitis, endophthalmitis, iritis, keratitis, orbital and

periorbital cellulitis, uveitis • Traumatic and related problems

o foreign body in the eye, ocular injuries,


o retinal artery and vein occlusion, vitreous haemorrhage

• Others

o acute glaucoma, retinal detachment

3.2.14. PULMONARY EMERGENCIES IN ADULTS AND CHILDREN

• Congenital o cystic fibrosis


o asthma, bronchitis, bronchiolitis, pneumonia, empyema, COPD exacerbation,

lung abscess, pleurisy and pleural effusion, pulmonary fibrosis, tuberculosis


o foreign body inhalation, haemothorax, tension pneumothorax,

pneumomediastinum

• Tumours

o common complications and acute complications of pulmonary and metastatic

tumours,

• Vascular disorders

o pulmonary embolism

• Other disorders

o acute lung injury, atelectasis, ARDS, spontaneous pneumothorax

3.2.15. PSYCHIATRIC AND BEHAVIOUR DISORDERS

• Behaviour disorders o affective disorders, confusion and consciousness disturbances, intelligence

disturbances, memory disorders, perception disorders, psycho-motor disturbances, thinking disturbances.

• Common psychiatric emergencies

o acute psychosis, anorexia and bulimia complications, anxiety and panic

attacks, conversion disorders, deliberate self-harm and suicide attempt,

depressive illness, personality disorders, substance, drug and alcohol abuse

3.2.16. RENAL AND UROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders o epididymo-orchitis, glomerulonephritis, pyelonephritis, prostatitis, sexually

transmitted diseases, urinary tract infections


o acute renal failure, nephrotic syndrome, nephrolithiasis, uraemia


o urinary retention, testicular torsion

• Tumours


• Other disorders

o comorbidities in dialysis and renal transplanted patients, complications of

urological procedures and devices, haemolytic uraemic syndrome

3.2.17. TRAUMA IN ADULTS AND CHILDREN

• Origin of trauma: o burns, blunt trauma, penetrating trauma

• Anatomical location of trauma:

o head and neck, maxillo-facial, thorax, abdomen, pelvis, spine, extremities

• Polytrauma patient

• Trauma in specific populations:

o children, elderly, pregnant women.

3.3. COMMON PRESENTING SYMPTOMS This section of the Curriculum lists the more common presenting symptoms of patients in the

emergency setting. The differential diagnoses are listed according to the systems involved and

then in alphabetical order. The diagnoses requiring immediate attention, in terms of potential

severity and need of priority, are highlighted in bold. These lists of possible diagnoses cannot

be exhaustive.

3.3.1. ACUTE ABDOMINAL PAIN

• Gastrointestinal causes o appendicitis, cholecystitis, cholangitis, acute pancreatitis, complications of

hernias, diverticulitis, hepatitis, hiatus hernia, inflammatory bowel disease, intestinal obstruction, ischaemic colitis, mesenteric ischaemia, peptic ulcer, peritonitis, viscus perforation

• Cardiac/vascular causes

o acute myocardial infarction, aortic dissection, aortic aneurysm rupture

• Dermatological causes

o herpes zoster

• Endocrine and metabolic causes

o Addison’s disease, diabetic ketoacidosis, other metabolic acidosis,

porphyria

• Gynecological and Obstetric causes

o complications of pregnancy, ectopic pregnancy, pelvic inflammatory disease,

rupture of ovarian cyst, ovarian torsion

• Haematological causes

o acute porphyria crisis, familial mediterranean fever, sickle cell crisis

• Musculo-skeletal causes

o referred pain from thoraco-lumbar spine

• Renal and Genitourinary causes

o pyelonephritis, renal stones

• Respiratory causes

o pneumonia, pleurisy

• Toxicology

o poisoning

• Trauma

o abdominal

3.3.2. ALTERED BEHAVIOUR AND AGITATION

• Psychiatric causes o acute psychosis, depression

• Cardiac/Vascular causes

o hypertension, vasculitis


o hypoglycaemia, hyperglycaemia, electrolyte imbalance, hyperthermia,

hypoxaemia

• Neurological causes

o cerebral space-occupying lesions, dementia, hydrocephalus, intracranial

hypertension, CNS infections

• Toxicology

o alcohol and drug abuse, poisoning

3.3.3. ALTERED LEVEL OF CONSCIOUSNESS IN ADULTS AND CHILDREN

• Neurological causes o cerebral tumour, epilepsy and status epilepticus, meningitis, encephalitis,

stroke, subarachnoid haemorrhage, subdural and extradural haematomata, traumatic brain injury

• Cardiovascular causes

o hypoperfusion states, shock


o electrolyte imbalances, hepatic coma, hypercapnia, hypothermia, hypoxia,

hypoglycaemia/ hyperglycaemia, uraemia


o eclampsia

• Infectious causes

o septic shock

• Psychiatric causes

o conversion syndrome


o respiratory failure

• Toxicology

o alcohol intoxication, carbon-monoxide poisoning, narcotic and sedative

poisoning, other substances

3.3.4. BACK PAIN

• Musculo-Skeletal causes o fractures, intervertebral disc strain and degeneration, strain of muscles,

ligaments and tendons, spinal stenosis, arthritides, arthrosis • Cardiovascular causes

o aortic aneurysm, aortic dissection


o osteomyelitis, discitis, pyelonephritis, prostatitis


o Paget’s disease

• Gastrointestinal causes

o pancreatitis, cholecystitis


o herpes zoster

• Gynecological causes

o endometriosis, pelvic inflammatory disease

• Haematological and Oncological causes

o abdominal or vertebral tumours

• Neurological cause:

o subarachnoid haemorrhage


o renal abscess, renal calculi

• Trauma

3.3.5. BLEEDING (NON-TRAUMATIC)

• Ear, Nose, Throat causes o ear bleeding (otitis, trauma, tumours), epistaxis


o haematemesis and melaena (acute gastritis, gastro-duodenal ulcer, Mallory

Weiss syndrome, oesophageal varices) rectal bleeding (acute diverticulitis,

haemorrhoids, inflammatory bowel disease, tumours)


o menorrhagia/metrorrhagia (abortion, abruptio placentae, tumours)


o haematuria (pyelitis, tumours, urolithiasis)


o haemoptysis (bronchiectasisis, pneumonia, tumours, tuberculosis)

3.3.6. CARDIAC ARREST

• Cardiac arrest treatable with defibrillation o ventricular fibrillation, pulseless ventricular tachycardia

• Pulseless electric activity

o Acidosis, hypoxia, hypothermia, hypo/hyperkaliaemia, hypocalcaemia,

hypo/hyperglycaemia, hypovolaemia, tension pneumothorax, cardiac

tamponade, myocardial infarction, pulmonary embolism, poisoning

• Asystole

3.3.7. CHEST PAIN • Cardiac/vascular causes

o acute coronary syndrome, aortic dissection, arrhythmias, pericarditis,

pulmonary embolism


o pneumonia, pneumomediastinum, pneumothorax (especially tension

pneumothorax), pleurisy


o Gastro-oesophageal reflux, oesophageal rupture, oesophageal spasm

• Musculo-Skeletal causes

o costosternal injury, costochondritis, intercostal muscle pain, pain referred from

thoracic spine


o anxiety, panic attack


o herpes zoster

3.3.8. CRYING BABY • I – Infections

o herpes stomatitis, meningitis, osteomyelitis, urinary tract infection

• T –

o testicular torsion, trauma, teeth problems,

• C – Cardiac

o arrhythmias, congestive heart failure

• R –

o reaction to milk, reaction to medications, reflux

• I –

o immunisation and allergic reactions, insect bites

• E – Eye

o corneal abrasions, glaucoma, ocular foreign bodies

• S – Some gastrointestinal causes

o hernia, intussusception, volvulus

3.3.9. DIARRHOEA • Infectious causes

o AIDS, bacterial enteritis, viral, parasites, food-born, toxins

• Toxicological causes

o drugs related, poisoning (including heavy metals, mushrooms,

organophosphates, rat poison, seafood)


o carcinoids, diabetic neuropathy


o diverticulitis, dumping syndrome, ischaemic colitis, inflammatory bowel

disease, enteritis due to radiation or chemotherapy


o toxicity due to cytostatic therapies

• Immunology

o food allergy

• Psychiatric disorders

o diarrhoea “factitia”

3.3.10. DYSPNOEA • Respiratory Causes

o airway obstruction, broncho-alveolar obstruction, parenchymal diseases,

pulmonary shunt, pleural effusion, atelectasis, pneumothorax

• Cardiac/vascular causes

o cardiac decompensation, cardiac tamponade, pulmonary embolism

• Ear, Nose, Throat causes

o epiglottitis, croup and pseudocroup

• Fluid & Electrolyte disorders

o hypovolaemia, shock, anaemia


o hiatus hernia

• Immunological causes

o vasculitis

• Metabolic causes

o metabolic acidosis, uraemia


o myasthenia gravis, Guillain Barrè syndrome, amyotrophic lateral sclerosis

• Psychiatric disorders

o conversion syndrome

• Toxicology

o CO intoxication, cyanide intoxication

• Trauma

o flail chest, lung contusion, traumatic pneumothorax, haemothorax

3.3.11. FEVER AND ENDOGENOUS INCREASE IN BODY TEMPERATURE • Systemic infectious causes

o sepsis and septic shock, parasitosis, flu-like syndrome

• Organ-specific infectious causes

o endocarditis, myocarditis, pharyngitis, tonsillitis, abscesses, otitis, cholecystitis

and cholangitis, meningitis, encephalitis

• Non-infectious causes

o Lyell syndrome, Stephen-Johnson syndrome, thyroid storm, pancreatitis,

inflammatory bowel disease, pelvic inflammatory disease, toxic shock


o leukaemia and lymphomas, solid tumours


o arteritis, arthritis, lupus, sarcoidosis


o osteomyelitis, fasciitis and cellulitis


o cerebral haemorrhage


o factitious fever


o pyelonephritis, prostatitis

• Toxicology

3.3.12. HEADACHE IN ADULTS AND CHILDREN • Vascular causes

o migraine, cluster headache, tension headache, cerebral haemorrhage,

hypertensive encephalopathy, ischaemic stroke


o brain tumours


o temporal arteritis, vasculitis


o abscesses, dental infections, encephalitis, mastoiditis, meningitis, sinusitis


o cervical spine diseases, temporomandibular joint syndrome


o trigeminal neuralgia

• Ophthalmological causes

o optic neuritis, acute glaucoma

• Toxicology

o alcohol, analgesic abuse, calcium channel blockers, glutamate, nitrates, opioids

and caffeine withdrawal

• Trauma:

o head trauma

3.3.13. JAUNDICE • Gastrointestinal causes

o cholangitis, hepatic failure, pancreatic head tumour, pancreatitis, obstructive

cholestasis


o chronic cardiac decompensation


o haemolytic anaemias, thrombotic thrombocytopenic purpura, haemolytic

uraemic syndrome, disseminated intravascular coagulation


o malaria, leptospirosis

• Gynaecological causes

o HELLP syndrome

• Toxicology

o drug induced haemolytic anaemias, snake venom

3.3.14. PAIN IN ARMS • Cardiac/Vascular causes

o aortic dissection, deep venous thromboembolism, ischaemic heart disease

• Musculo-skeletal causes

o periarthritis, cervical spine spondylosis/arthrosis

• Trauma

3.3.15. PAIN IN LEGS • Cardiac/Vascular causes

o acute ischaemia, arteritis, deep venous thrombosis, superficial thrombophlebitis


o polymyositis


o arthritis, cellulitis, necrotising fasciitis, osteomyelitis


o sciatalgia


o sciatica

• Nervous system causes

o peripheral nerve compression

• Trauma

3.3.16. PALPITATIONS • Cardiac/Vascular causes

o brady-arrhythmias (including sinus and AV blocks), extrasystoles, tachyarrythmias

(including atrial fibrillation, sinus tachycardia, supraventricular tachycardia, ventricular

tachycardia)


o thyrotoxicosis

• Toxicology

o drugs

3.3.17. SEIZURES IN ADULTS AND CHILDREN • Neurological causes

o generalised epilepsy, partial complex or focal epilepsy, status epilepticus


o hypertensive encephalopathy, syncope, dysrhythmias, migraines


o metabolic seizures


o eclampsia


o febrile seizures in children


o narcolepsy, pseudo-seizures


o respiratory arrest

• Toxicology

o drugs/toxins

3.3.18. SHOCK IN ADULTS AND CHILDREN • Anaphylactic

• Cardiogenic

• Hypovolaemic

• Obstructive

• Septic

• Neurogenic


o cardiogenic shock, arrhythmias


o Addison’s crisis

• Fluid and Electrolyte disorders

o hypovolaemic shock


o vomiting, diarrhoea


o toxic shock


o anaphylactic shock


o septic shock


o neurogenic shock

• Trauma

o hypovolaemic shock, neurogenic shock.

3.3.19. SKIN MANIFESTATIONS IN ADULTS AND CHILDREN • Dermatological causes

o eczema, psoriasis, skin tumours


o vasculitides, urticaria, Stevens-Johnson syndrome, Lyell syndrome


o viral exanthematas, meningococcaemia, herpes zoster/simplex, abscesses of

the skin


o Self-inflicted skin lesions or from abuse

• Toxicology


o idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura

3.3.20. SYNCOPE • Cardiac/vascular causes

o aortic dissection,

o cardiac arrhythmias (including brady-tachy syndrome, Brugada syndrome, drug

overdose, long QT syndrome, sick sinus syndrome, torsades de pointes,

ventricular tachycardia),

o other causes of hypoperfusion (including ischaemia, valvular, haemorrhage,

obstruction: e.g. aortic stenosis, pulmonary embolism, tamponade)

o orthostatic hypotension


o Addison’s disease


o hypovolaemia


o vomiting, diarrhoea


o autonomic nervous system disorder, epilepsy, vasovagal reflex,

• Toxicology

o alcoholic or drug consumption

3.3.21. URINARY SYMPTOMS (DYSURIA, OLIGO--ANURIA, POLYURIA) • Renal and Genitourinary causes

o acute renal failure, acute urinary retention, cystitis and pyelonephritis,

prostatitis


o cardiac decompensation


o diabetes mellitus, diabetes insipidus


o hypovolaemia

3.3.22. VERTIGO AND DIZZINESS • Ear and Labyrinth causes

o benign postural vertigo, Meniere’s disease, otitis, vestibular neuritis, viral

labyrinthitis


o arrhythmias, hypotension


o hypoglycaemia


o anaemias

• Nervous system causes

o acoustic neuroma, bulbar or cerebellar lesions, multiple sclerosis, temporal

epilepsy


o anxiety


o hypoxia

• Toxicology

o alcohol abuse, drugs and substances

3.3.23. VOMITING • Gastrointestinal causes

o appendicitis, cholecystitis, gastroparesis, gastric obstruction and retention,

gastroenteritis, hepatitis, pancreatitis, pyloric stenosis, small bowel obstruction


o myocardial ischaemia

• Ear, Nose, Throat causes

o vestibular disorders


o diabetic ketoacidosis, hypercalcaemia


o hypovolaemia

• Gynaecological and Obstetric causes

o pregnancy


o sepsis, meningitis


o cerebral oedema or haemorrhage, hydrocephalus, intracranial space-occupying

lesions

• Ophthalmological causes

o acute glaucoma


o eating disorders


o renal calculi, uraemia

• Toxicology

3.4. SPECIFIC ASPECTS OF EMERGENCY MEDICINE

3.4.1. ABUSE AND ASSAULT IN ADULTS AND CHILDREN • Abuse in the elderly and impaired

• Child abuse and neglect

• Intimate partner violence and abuse

• Sexual assault

• Patient safety in emergency medicine

• Violence management and prevention in the emergency department

3.4.2. INJURY PREVENTION AND HEALTH PROMOTION • Collection and interpretation of data related to prevention and health promotion

• Epidemiology of Accidents and Emergencies

• Formulation of recommendations

3.4.3. ANALGESIA AND SEDATION IN ADULTS AND CHILDREN • Pain transmission (anatomy, physiology, pharmacology)

• Pain assessment

• Pharmacology of sedative and pain relieving drugs

• Psychological and social aspects of pain in paediatric, adult and elderly patients

3.4.4. DISASTER MEDICINE • Disaster preparedness

• Major incident planning/procedures/practice

• Disaster response

• Mass gatherings

• Specific medical topics (triage, bioterrorism, blast and crush injuries, chemical agents,

radiation injuries)

• Debriefing and mitigation

3.4.5. ENVIRONMENTAL ACCIDENTS IN ADULT AND CHILDREN • Electricity (electrical and lightning injuries)

• Flora and Fauna (injuries from exposure, bites and stings)

• High-altitude (medical problems)

• NBCR (nuclear, biological, chemical and radiological: decontamination, specific

aspects)

• Temperature (heat and cold related emergencies)

• Travel medicine

• Water (near-drowning, dysbarism and complications of diving, marine fauna)

3.4.6. FORENSIC ISSUES • Basics of relevant legislation in the country of practice

• Recognise and preserve evidence

• Provide appropriate medical documentation (including forensic and clinical

• photography, collection of biological samples, ballistics)

• Appropriate reporting and referrals (e.g. child abuse or neglect, gunshot and other

forms of penetrating wounds, elder abuse, sexual assault allegations)

• Medico legal documentation and report writing

• Appearing in Court

3.4.7. PATIENT MANAGEMENT ISSUES IN EMERGENCY MEDICINE • Emergency department organisation (administration, structure, staffing, resources)

• Management of specific populations:

o children in special circumstances including child protection

o geriatric patients

o homeless patients

o mentally incompetent adults

o psychiatric patients

3.4.8. TOXICOLOGY IN ADULTS AND CHILDREN • General principles of toxicology and management of poisoned patients

• Principles of drug interactions

• Specific aspects of poisoning

o drugs (including, acetaminophen, amphetamine, anticholinergic,

anticonvulsants, antidepressants, antihypertensive, benzodiazepine, digitalis,

monoamino oxidase inhibitors, neuroleptics)

o industrial, chemicals

o plants and mushrooms

o alcohol abuse and alcohols poisoning

• Organisation and information (e.g. poison centres, data bases)

3.4.9. PRE-HOSPITAL CARE • Emergency Medical Services organisation (administration, structure, staffing,

resources)

• Medical transport (including neonates and children, air transport)

• Paramedic training and function

• Safety at the scene

• Collaboration with other emergency services (e.g. police, fire department)

3.4.10. PSYCHO-SOCIAL PROBLEMS • Social wellbeing of specific populations (see 3.4.7)

• Patients with social issues

• Frequent attenders/visitors

• Social care following discharge

4. Curriculum Standards

4.1. Goals

a. The purpose of the curriculum is to describe the knowledge, skills and expertise together

with the learning, teaching, feedback and supervision that will be provided by this

educational programme designed to provide safe, expert emergency physicians

functioning independently at consultant level. This curriculum describes year 1 to

3training.

b. The curriculum was developed and validated in the following way:

The content of the curriculum has been derived from the previous Faculty of Emergency

Medicine document together with a review of curricula of other emergency medicine

training programmes (UK, Australasia and the USA) and of other GCPS faculties

(Medicine, Surgery, Paediatrics). Every effort has been made to ensure its relevance to

emergency medicine practice in Ghana. It has been submitted to the Faculty Board of

the GCPS.

c. The curriculum is embedded in the speciality of Emergency Medicine and this is

reflected both in the description of generic and speciality specific competencies.

Throughout the curriculum what is expected to be achieved by the end of Membership

training is indicated.

d. This curriculum assumes trainees have met the specified competencies of

Housemanship training.

4.2. Use of the curriculum by trainees The curriculum can be downloaded from the GCPS website. Trainees should access the up to date curriculum and will be expected to have a good knowledge of the curriculum. It should be used as a guide for the training programme and trainee discussions. Each trainee will engage with the curriculum by maintaining their Log Book. The curriculum can be used to develop learning objectives and reflect on learning experiences.

4.3. Content of Learning

a. The curriculum sets out the general professional and specialty specific content to be mastered. The knowledge, skills and expertise is specified. The general professional content includes a statement about standards and regulations set by the MDCG.

b. The content of the curriculum is presented in a way that identifies what the

trainee will need to know about, understand, describe, and be able to do at the

end of the educational programme.

c. For each of the content areas there is a recommendation for the type of learning

experiences and assessment methods.

4.4. Model of Learning Wherever possible the curriculum describes the appropriate model of learning, be it

work-based experiential learning, independent self-directed learning or appropriate off

the job education. How learning for knowledge, competence, performance and

independent action will be achieved is specified.

4.5. Learning Experiences

a. Recommended learning experiences are specified. These are predominantly self-

directed and work-based learning:

Learning from practice.

Learning from local and visiting faculty as well as EM specialists either by working

alongside or in specified one-to-one teaching.

Learning from formal situations such as group teaching within the department and

other teaching programmes e.g.:

Lectures and small group teaching

Case presentations and

Morbidity and mortality meetings

Journal clubs

Critical appraisal exercises

Research and audit projects

Learning opportunities outside the department include, special approved rotations,

life support courses and skills lab based teaching.

Clinical skills - use of simulation and multiprofessional training.

Participation in management meetings

Nearly all specialised training is centred in the Emergency Department. An

understanding of the care received beyond the Emergency Department is important

and is best obtained by being part of the team responsible for care both in the

Emergency Department and following the patient through to the first 12 to 24 hours of

their in-patient care. It is recognised that some areas of Emergency Medicine

practice require dedicated time outside of the Emergency Department prior to

practising such skills within it e.g. critical care and anaesthesia.

Focused personal study outside of normal working hours is essential.

b. Educational strategies that are suitable for work-based experiential learning include the

use of log books and personal audit. Trainees should participate in didactic lectures,

journal clubs, and case presentations.

4.6. Supervision and Feedback

a. The mechanisms for ensuring feedback on learning, recommended and required, are

specified. These include the components of formative assessment processes, one-to-

one teaching, clinical evaluation exercises, multi professional feedback appraisal and

mock examination.

b. The supervision of practice and the safety of doctor and patients are provided by means

of direct supervision of the trainee by local and visiting faculty, and by quality

improvement mechanisms including audit and risk management.

4.7. Curriculum Implementation, Review and Updating

It is intended that the curriculum identify the knowledge, skills and expertise

required of trainers and guide how they should deliver their training. It also

identifies the means by which feedback should be given and assessment

undertaken.

The trainee should have a clear idea of what is required, how they should

acquire the knowledge, skill and experience to become an emergency physician

and their role and responsibility.

It is the responsibility of the local and visiting faculty as well as EM specialists to

ensure that the curriculum is delivered. Trainers are responsible for the out of

department experiences of the trainees. For this to work effectively the trainee

has to develop a personal learning plan, indicating the learning objectives of that

experience; this will also assist those outside the emergency department

charged with that educational experience so that it is clear as to what is being

asked of them. Areas suitable for out of department experience are identified in

the curriculum.

Trainers must ensure that the annual formative assessment process is effective

and can use the assessment methods described in the curriculum to inform that

process.

Trainees also have responsibilities for the implementation of the curriculum.

They must optimise all of the time available to them to achieve the objectives of

the curriculum. All protected time must be department-based unless with the

prior agreement of their educational supervisor. In this situation, clear

educational goals, and personal development plans, must be set and achieved.

Trainees must use their study leave effectively, and recognise the importance of

personal study outside of normal working hours.

By having greater definition of the speciality of Emergency Medicine other

curriculum planners can use this curriculum.

The Curriculum will be reviewed and updated every four years taking into

account trainee feedback in respect of acquisition of knowledge and skills, as

well as new developments in the field of Emergency Medicine. Trainee

involvement in curriculum review will be facilitated initially by assessment results,

and later as the Faculty grows by the formation of a Curriculum Committee,

Education Committee, and the involvement of trainees in the various Faculty

committees.

Evaluation of the curriculum will be by informal feedback from trainers and

trainees and feedback from the Examination committee. The Curriculum

committee will be responsible for continuously monitoring this feedback and will

report directly to the Education and Examination committee annually.

Suggested future improvements of the Curriculum include continuous review of

the curriculum by emergency physicians who will review and suggest updates of

segments of the curriculum, give feedback from examinations, and from trainees.

In future, a Curriculum Committee of the Faculty of Emergency Medicine will be

responsible for continuous review of the curriculum and will receive feedback

from the Academic Board, Examination committee and those specialists

allocated segments of the curriculum.

5. SYLLABUS

5.1. Generic Competencies supporting Good Clinical Care

5.1.1. History and examination

Objectives

To be able to take a focused history from patients in all circumstances

To be able to clinically examine patients and detect and interpret relevant clinical signs

Knowledge

Recognise critical symptoms and symptom patterns.

Know the difference between open and closed questioning and when to utilise each type

Be aware of cultural and language differences in the description of common symptoms.

Be familiar with methods to elicit accurate histories

Recognise the relevance of clinical signs in a given clinical situation.

Incorporate clinical, social and psychological factors in the history.

Be aware of the considerable health equalities that exist between different groups.

Skills

Elicit a relevant focused history and identify and synthesise problems.

Take a history in difficult circumstances, (eg, busy noisy department with competing

demands, patients who are often abusive, aggressive, confused or unable to co-operate).

Apply knowledge of symptomatology to determine the likely differential diagnosis.

Take a history from a third party

Examine a patient whilst maintaining dignity and privacy

Elicit clinical signs effectively and be able to teach examination techniques to others.

Attitudes

Value the diversity of cultural backgrounds

Encourage the difficult historian and actively encourage and explore alternative ways of

communicating

Appreciate the importance of time and attention to detail in talking to patients

Be prepared to allow the patient to take their time

Be effective in eliciting facts whilst being empathic in approach

Assessment methods

Mini CEX

Clinical notes review

Audit of outcomes

Mini PAT

5.1.2. Documentation

Objectives

To provide clear, legible accurate and contemporaneous records of patient care where the

author of the record is clearly identified

To keep accurate and relevant medical records.

To ensure that written referrals for patients are complete and logical

To ensure all results are checked & x-rays reviewed in real time

To ensure that clinical details are clear and critical information is present in the notes.

Knowledge

Be familiar with Emergency Department notes (triage information, nursing and pre-hospital

notes, focused history, physical examination, laboratory data, differential diagnoses,

provisional treatments and management plan).

Know other sources of important patient information and how to access them (Polyclinic,

private practitioners, previous Emergency Department notes, inpatient notes).

Be familiar with acceptable standards of documentation.

Skills

Record accurately and legibly the history, examination, diagnosis and differential diagnosis.

Record a management plan that includes investigation and treatment.

Record the results of appropriate tests and any action taken.

Record in the notes advice and information given to the patient and/or patient’s family.

Sign notes, and record times and dates appropriately.

Give clinical details accurately and succinctly when requesting investigations to allow

appropriate choice of investigation and expert interpretation.

Write clear letters to family/private practitioners, or other referral letters which document

clearly the details and reason for the letter.

Document relevant times and details to provide evidence of care.

Able to supervise more junior residents to ensure documentation is accurate and adequate

Attitudes

Value the record as a means of continuity of care and contributing to good patient

management.

Value the role of family/private practitioners or the patient’s usual medical practitioner in the

on-going management of the patient.

Understand the importance of clear documentation of the patient episode and suggested

follow up as communicated to the family/private practitioner.

Understand the importance of completion of documentation in real time and the implications

of delayed recording of actions.

Optimise unavoidable handovers between junior doctors by excellent documentation.

Be conscientious to ensure that all results are checked and x-rays reviewed, and relevant

details are documented in the patient notes.

Assessment methods

Notes review.

Audits of documentation and of investigation requests.

Audit of referrals.

5.1.3. Diagnosis

Objectives

To be able to recognise those who are critically ill.

To make a diagnosis that is both likely and clinically relevant.

To construct a comprehensive and likely differential diagnosis.

Knowledge

Identify the most likely diagnosis in a given situation and the discriminatory investigations to

confirm that diagnosis.

Construct a working differential diagnosis for a given clinical scenario.

Recognise the contribution of false positive and false negative results.

Interpret the results of tests and apply the results to a given patient.

Skills

Identify those that require admission and those that can be safely discharged. This requires

integration of the history, examination, appropriate investigation and seeking more senior

advice where necessary.

Consider the relevance and likely contribution of an investigation to the management of a

patient and utilise such resources effectively, valuing clinical judgement.

In those patients presenting with cardinal symptoms e.g. chest pain, headache – ensure that

the important differential diagnoses are covered.

Recognise atypical presentations of important conditions.

Attitudes

Awareness and appreciation of the fact that common things are common.

Appreciate the value of the working diagnosis in the management of the patient as well as

the desire to make a definitive diagnosis.

Value the “rule out” as well as “rule in” investigation in assessing the likelihood of the

diagnosis.

Understand the importance of a nonspecific diagnosis of patients being discharged and

identifying clear pathways for the patient to explore if their clinical condition were to change.

Assessment methods

Notes review.

Exam MCQs.

Exam OSCEs.

Audit of outcomes.

Clinical incident reporting.

Case based discussion.

5.1.4. Decision Making

Objectives

To recognise those who are critically ill.

Initiate appropriate treatment.

To formulate a management plan including diagnostic testing, provisional diagnosis,

differential diagnosis and treatment plan.

To identify those requiring admission and those who may be safely discharged.

Knowledge

Know which conditions require immediate treatment appreciating that some presentations do

not require immediate intervention but nevertheless are appropriate to be treated in the

emergency department.

Select the most effective immediate treatment for a given diagnosis.

Evaluate the benefit of hospital based treatment versus community care for a given condition

in a particular patient.

Be familiar with local and national health care services to identify the most appropriate care

provider.

Understand the use of the clinical decision unit/observation unit and its value to patient care.

Be able to prioritise patients according to clinical need.

Be aware of local and national guidelines.

Skills

Plan future care either as an inpatient, discharged to patient’s primary care practitioner, or

followed up in a special clinic.

Consider the relevance and likely contribution of an investigation to the management of a

patient and utilise such resources effectively.

Utilise a clinical decision unit effectively to optimise patient care.

Be able to solve complex clinical problems in a timely way.

Manage uncertainty of diagnosis in the emergency setting and make appropriate decisions

based on what is best for patient with minimal risk.

Attitudes

Appreciate the requirement to complete clinical tasks in real time and the need to come to a

timely conclusion.

Be conscious of the requirement to reduce the number of handovers from junior doctor to

junior doctor without a conclusion being reached.

Make decisions based on logical evidence and avoid bias in making decisions.

Take responsibility for one’s decisions.

Know one’s own limitations.

Assessment methods

Notes review.

Exam MCQs.

Exam OSCEs.

Audit of outcomes.

Clinical incident reporting.

Case based discussion.

5.1.5. Time Management

Objectives

To treat patients effectively and efficiently by prioritising tasks using a focused history and

examination and seeking advice from senior colleagues when needed.

To ensure timely correct decision-making.

To manage one’s own time in an effective way.

Knowledge

Identify those patients who have an immediate threat to life and initiate treatment.

Prioritise those patients in whom timely intervention will make a difference.

Understand the other factors that affect prioritisation of patients other than clinical priority.

Understand the limits and importance of time and the relationship to the patient and

departmental needs.

Be aware of the principles of personal time management.

Skills

Integrate rapid assessment with immediate and lifesaving treatment in a timely way.

Seek advice from senior colleagues within the department when diagnostic doubt exists.

Manage the patient’s safe care, ensuring that patients are moving through the system safely

and effectively.

Minimise delays by using discriminatory tests only.

Attitudes

Recognise one’s own limitations.

Call for help when needed.

Be willing to re-prioritise in the face of changing departmental demands.

Work as a team to achieve good care.

Recognise the importance of good time keeping.

Help others to prioritise and recognise that other people’s priorities may not be the same as

yours.

Respect other people’s time by being prompt and completing tasks within agreed time frame.

Assessment methods

Notes review.

Complaints review.

Appraisal and setting and completion of personal objectives.

Mini PAT.

Multi Source Feedback.

5.1.6. Safe Prescribing

Objectives

Be able to prescribe emergency and continuing medications for patients in a safe and

reliable way.

Knowledge

Apply the principles of therapeutics and pharmacology to the patient who presents as an

emergency.

Be aware of common side effects of drugs and drug interactions as well as allergic reactions.

Know the legal framework in which prescribing must take place in this country.

Be familiar with local formulary and prescribing guidelines.

Know where and how to obtain further information about a particular drug and its action.

Know the implications of pregnancy, old age, childhood and other factors in the safe use of

commonly used drugs.

Skills

Complete a prescription legibly and legally.

Safely prescribe intravenous fluids for adults and children.

Safely prescribe and administer emergency drugs (including oxygen) within accepted

protocols.

Select the most appropriate method of drug administration in a given situation.

Use local and national drug formularies and other resources to safely prescribe and to

identify drug related conditions.

Work with the nursing staff in promoting the safe administration of drugs.

Attitudes

Appreciate the value of the multidisciplinary team in reducing drug errors.

Utilise information sources to provide safer prescribing habits.

Follow national and local guidance on prescribing.

Assessment methods

Audit of prescriptions.

Exam MCQs.

OSCE stations.

Short answer paper.

5.1.7. Continuity of care

Objectives

For those patients discharged without formal follow up provide clear guidance about the

predicted course of the disease and when and where to seek help.

Where patients have a primary care practitioner be the link between primary and secondary

care when such patients present as emergencies.

Knowledge

Know the lines of responsibility for patients.

Appreciate the place of primary, and secondary/tertiary care in the health care service.

Apply the principles of shared care and multidisciplinary team work to the continued care of

patients who present as emergencies.

Know how to communicate with patients’ primary care practitioners.

Know how to refer emergency patients for further care documenting date and time of

referral, grade and specialty of who you spoke to, indication for referral, and outcome of

referral process.

Skills

Evaluate the need for continued medical and nursing care.

Assess the whole needs of the patient and how they might be met within the health & social

care system.

Communicate the requirements of the patient to the whole healthcare team.

Complete appropriate letters to the referring physician or health care practitioner/institution

explaining diagnosis, treatment and follow up arrangements required.

Communicate with the referring physician or health care practitioner/institution by telephone

where appropriate.

Communicate with the in-patient teams and complete effective safe hand over.

Attitudes

Respect the patient’s autonomy and personal choice in how they live if further care is

refused.

Provide appropriate contacts for further care where necessary.

Value the right of the patient to contribute to the decision-making process.

Involve the whole multidisciplinary team in the evaluation of what is the best for the patient.

Listen to carers and family in relation to the needs of the patient.

Be an advocate for the patient with future care providers, particularly in vulnerable patients.

Assessment methods

OSCE.

Direct observation.

Discussions within teaching sessions.

Mini PAT/MSF.

Case based discussions.

5.1.8. Therapeutic interventions

Objectives

Be able to perform practical and therapeutic interventions safely and at appropriate times.

Knowledge

Know how to perform skills appropriate to the experience of the operator.

e.g.

Year 1 – fracture manipulation, basic airway management, insertion of chest drains

Year 3 – as above but in more difficult situations and in sicker patients

Know the contraindications and complications.

Skills

Perform the skills in a variety of situations dependent on the level of the operator.

Support others in performing the skills, either as assistant, supervisor or teacher.

Prepare appropriately to pre-empt predictable complications.

Prompt recognition of complications.

Recognise complications of procedures and deal with them safely.

Attitudes

Appreciate the inherent dangers and risks.

Know when to ask for help and never exceed the limit of own abilities.

Value the benefit of practice

Understand when it is appropriate to practice

Appreciate other’s need to practice and support and re-enforce good practice whilst

correcting errors and preventing unsafe practice.

Know when to perform the intervention and when to withhold (particularly around invasive

procedures).

Assessment methods

In workplace assessment- direct observation (DOPS).

Audit.

Exam MCQs.

OSCE.

Mini CEX.

5.2. Communication

5.2.1. Communicating with colleagues

Objectives

The Emergency Department should be a place of excellence for team working.

Effective communication between team members is essential for safe care.

Knowledge

Know the principles of good communication – and use of verbal and body language to

communicate.

Be aware of the importance of communication in patient care and the risks associated with

poor communication.

Know the principles of conflict resolution techniques.

Skills

Be professional at all times in dealing with others.

Utilise language and tone to convey messages in an appropriate way.

Reduce or eliminate tension in a difficult situation.

Put your own opinion across in a straight forward and succinct manner.

Listen to other views and evaluate the evidence in an open way.

Attitudes

Approach others with an open mind and be approachable.

Be willing to listen to others and to try to appreciate their point of view.

Be flexible and prepared to change opinion in the face of valid argument.

Welcome other specialty doctors to the department as valued colleagues and respect their

contribution.

Assessment methods

OSCE.

Direct observation.

Scenario teaching and assessment.

Mini PAT/MSF.

5.2.2. Communication skills when making or receiving referrals

Objectives

Develop and practice the ability to refer patients appropriately to specialists.

Have a clear understanding of what advice is being sought (e.g. asking for advice or a

second opinion is different to referring for admission).

Knowledge

Know which patients need specialist input and why.

Identify patients who can safely be discharged with follow up in the community.

Know which investigations to be completed before specialist review and which investigations

do not add value.

Ensure that important clinical information is clear, succinct and emphasised in the notes and

in the verbal handover.

Skills

Make clear and concise referrals both verbally and in writing.

Avoid inappropriate referrals to junior colleagues.

Exercise due caution is referring cases to colleagues of same grade. (Not the same as

handing over a patient at the end of duty shift).

Ensure the patient understands the management plan and need for specialist advice.

Ensure clarity as to whether one is seeking an opinion, advice, or admission.

Attitudes

Value the specialist opinion where relevant and appropriate.

Assessment methods

Review of case notes.

Mini PAT/MSF.

Case scenario testing/discussions.

5.2.3. Communicating with patients and their carers

Objectives

Be able to communicate effectively with patients and their relatives even in circumstances of

extreme stress for patients/carers and staff.

Knowledge

Elicit the concerns of the patient, their understanding of their illness and what they expect.

Understand the key place of communication in team functioning.

Inform and educate patients and carers in a way they can understand.

Skills

Use appropriate focused history and be able to listen.

Give clear information and feedback.

Establish a rapport with the patient and their families to enable the best communication to

take place.

Involve others (e.g. family and relatives) in the assessment and decision making process.

Attitudes

Approach other people with an open mind.

Listen to the patient and to their family, and value their contributions.

Be caring and empathic.

Encourage patient involvement and partnership in decision making.

Be sensitive to carers of patients with special needs, recognising that a multidisciplinary

approach is often required.

Assessment methods

OSCE.

Case based scenario discussion.

Direct observation.

Mini PAT/MSF.

Mini CEX.

5.2.4. Breaking bad news

Objectives

This is a frequent event in the Emergency Department where unexpected critical illness and

death is common. The emergency practitioner must be empathic whilst giving clear and

unambiguous information.

Knowledge

Know how to structure the interview.

Be aware of best practice in the location and setting of such an interview.

Be aware that this should be done as a team with supporting staff members present.

Be familiar with the requirements concerning the legal framework in which we work.

Work within the legal framework of the Ghana Health Service on the care of the deceased,

informing the Coroner’s Office, and requirements for death certification.

Skills

Be empathetic, clear, honest and work with other team members to ensure this task is done

well.

Use appropriate language and non-jargon to communicate clearly the condition and likely

prognosis in a given situation.

Attitudes

Respect the cultural and religious wishes of the family and patient.

Respect the team and understand individual responses to stressful situations.

Provide support and assistance for family and staff alike after difficult encounters.

Be able to show compassion and understanding whilst maintaining a professional position.

Assessment methods

OSCE.

Mini PAT/MSF.

Mini CEX.

5.2.5. Communication for effective team working

Objectives

To understand the role of colleagues and to work with them effectively.

The emergency practitioner must be able to work within a large disparate team who do not

work regularly together and who when they do meet may be under considerable stress.

Knowledge

Understand roles and responsibilities of team members.

Understand how teams work effectively and what can make them ineffective.

Understand the key place of communication in team functioning.

Know the principles of team leadership and the skills that are required.

Skills

Delegate and accept delegation.

Be aware of one’s own limitations and seek advice appropriately.

Ensure the proper handover of patients.

Use other team members effectively as team leader or as team member

Communicate under stress in a clear and supportive way.

Give clear and constructive feedback.

Attitudes

Be respectful of others skill and knowledge.

Be a positive team member.

Listen to the concerns of others including team members and be proactive in dealing with

those concerns.

Approach other people with an open mind.

Assessment methods

OSCE

Mini PAT/MSF

Mini CEX

5.3. Maintaining good medical practice

5.3.1. Lifelong learning

Objectives

To appreciate the principles of lifelong learning and how to apply them to one’s own work

life.

Knowledge

Be aware of the different styles of learning and identify own preferred style.

Know how to access information and educational resources including details of courses /

developmental opportunities.

Be aware of the requirements and recommendations for CPD from the Medical and Dental

Council Ghana (MDCG), Ghana College of Physicians and Surgeons (GCPS), Faculty of

Emergency Medicine.

Skills

Devise appropriate personal educational objectives that are achievable and relevant.

Adhere to educational agreements & reset objectives where appropriate.

Utilise appropriate resources that suit the individual learning style.

Make best use of multiple learning methods and resources.

Plan a learning strategy and identify knowledge gaps.

Have a clear process for filling those gaps.

Reflect on events and clinical cases to plan learning and self-development.

Incorporate new practices into the skills inventory.

Use emergency department shop floor experience to drive learning, seeking out answers to

clinical questions posed by the clinical workload.

Attitudes

Value learning opportunities.

Acknowledge the need to continue to develop throughout the professional career.

Welcome new ideas.

Have a positive approach to trying new learning styles and environments.

Make a personal development plan.

Be honest at appraisal.

Assessment methods

Appraisal(s)

Examination

Team educational meetings and planning

Audit and clinical outcomes

Objectives

Be able to complete audit as a way of continuously improving clinical practice and use

clinical outcomes as a way of improving practice.

Knowledge Know the principles of the audit cycle

Access and appraise the literature and other national guidelines to set an audit standard.

Be aware of good practice in writing recommendations.

Appreciate variation in practice and the reasons for variation.

Know how to apply the outcomes of audit to support and develop best practice.

Skills

Plan and complete an audit cycle.

Make recommendations based on the audit for the improvement of patient care.

Implement recommendations through action plans and project planning.

Interpret the audit findings and anticipate the impact of the audit findings on the

department.

Identify key clinical outcomes – and the standard for those outcomes for the

emergency department.

Suggest and utilise ways of measuring outcomes

Put the results of audit and clinical outcomes into the strategic planning and

business case of the department to influence the direction of the department.

Attitudes Value the place of audit in continuous improvement of patient care.

Appreciate the value of monitoring clinical outcomes in daily work.

Ensure results of audit are always used in a positive way to improve patient care and

working environment for staff.

Assessment methods Review of the audit /clinical outcomes study performed for methodology etc.

Presentation of audit to audit group.

Discussion within appraisal.

5.3.2. Critical appraisal of evidence & development of clinical guidelines

Objectives

Be able to use evidence to improve patient care.

Knowledge

Know the principles of evidence based medicine.

Be aware of national Ghanaian and international guidance on standards of practice, and

how they apply to the local department.

Know how to conduct a search of the published and grey literature.

Be aware of the limitations of current evidence in emergency care.

Know the principles of statistics and the interpretation of data.

Skills

Critically evaluate the evidence as it is presented and apply it to the local situation or

individual patient.

Apply National guidelines to local circumstances.

Apply rigorous evaluation criteria to new ideas before implementing them.

Write clinical guidelines in understandable language which reflect best evidence, are

applicable to the department, and presented in a practical form.

Attitudes

Value established guidelines as a source of expert guidance.

Be prepared to apply clear criteria for the acceptance of published evidence.

Appreciate the balance between rigorously evaluated evidence and pragmatic best available

evidence and judge when to use either.

Challenge in a positive way established practice where new possibilities exist however

difficult to apply.

Be flexible in the approach to guidelines.

Be receptive but questioning of new trends.

Assessment methods

Critical appraisal.

Journal clubs.

Audit and guideline meetings.

5.3.3. Information management

Objectives

The Emergency Physician must be able to access and manage information relevant to

patient care.

The Emergency department deals with a large number of undifferentiated patients for whom

little information is accessible at the time. In addition, the variety of presentations requires a

very broad knowledge of latest advances.

Knowledge

Know the potential sources of information about an individual patient and how to access

them (family practitioner/private practitioner, previous ED and inpatient notes).

Be aware of the resources available in a given department to support clinical decision

making and how to increase the access to those resources.

Understand the importance of population level health information in managing healthcare

systems.

Be acquainted with the principles of clinical coding and workload monitoring in the

department and their use for staff, budget and other clinical resource management.

Skills

Utilise information and communication technology to improve patient care in the clinical

setting.

Access the internet resources and electronic libraries for online decision support.

Operate simple word processing, spreadsheet and database applications in audit,

governance and service management.

Use E-mail and other electronic communications to optimise the department working.

Attitudes

Be open to new technology in supporting patient care.

Respect the role of information management in the hospital.

Value information as a tool to achieve improvements in budget and staff allocation.

Assessment methods

Observation.

Evaluation of audit and other governance activities.

Production of research and guidelines based on evidence.

Project completion.

5.3.4. Risk management

Objectives

To provide care that is effective and safe.

To reduce risk associated with emergency care.

Knowledge

Recognise high risk patients and presentations.

Know the theory of risk management and human factors in clinical risk.

Identify areas where care can be improved by the use of critical incident reporting.

Know the process of investigation of a clinical incident and understand their role in the

process.

Know the effect of other pressures on the risk of error occurring.

Know the principles and where to find further information within the existing national

framework of health and safety legislation.

Skills

Apply principles of risk management to emergency care.

Recognise high risk situations and minimise risk by appropriate involvement of the whole

team.

Identify when errors in care have occurred and minimise consequences to the patient and

their relatives.

Involve senior personnel in high risk areas to make the patient and family aware of the

problems and potential solutions.

Communicate effectively to ensure continuity of care and reduce risk.

Manage violence.

Carry out a risk assessment on a given clinical area or topic.

Attitudes

Recognise one’s own limitations.

Call for help, when needed, from more experienced staff in order to make the correct

decisions.

Avoid bias in making decisions.

Recognise adverse or critical events and act on them to prevent future events.

Continue to work after an adverse event and incorporate learning for others.

Recognise that one can be wrong and respond to the challenge of being corrected.

Be responsible and pro-active to ensure the effects of any errors are minimised and learning

is maximised and system changes are instituted.

Assessment methods

Notes review

Complaints review

Critical incident review

Project completion

Morbidity and Mortality meetings

5.3.5. Maintaining confidentiality

Objectives

Emergency physicians must communicate freely with other agencies to optimise patient care

but must respect the confidentiality of the patient.

Knowledge

Know the principles of the data protection act as applied to both clinical care and research

work.

Be familiar with professional guidance on patient confidentiality and the responsibility of the

medical practitioner.

Know the implications of the laws relating to access to Medical Records.

Skills

Communicate within the law, restricting the use of confidential information to that which is

absolutely essential.

Apply the principles of confidentiality to normal practice including the use of Information and

Communication Technology (ICT), computers, smart phones etc. and dealing with telephone

enquiries in the clinical area.

Explain the rules of confidentiality to patients and other interested parties.

Use anonymised data where possible in research and audit.

Avoid using confidential information in presentations of cases.

Protect personal information in managing and developing staff.

Attitudes

Respect the right of patients and staff to confidentiality.

Assessment methods

Direct observation

Audit of clinical paperwork and research information

5.4. Professional behaviour and probity

5.4.1. Professional behaviour and probity – professional attributes

Objectives

The emergency physician is a professional who is dedicated to the delivery of high quality

patient care in a consistent manner.

Knowledge

Understand what duties the Medical and Dental Council Ghana requires of doctors on the

Medical Register.

Know the current aspirations of the Emergency Medicine specialty and aspire to those aims.

Skills

Manage personal and interpersonal difficulties in a professional way and do not allow them

to affect patient care.

Be consistent in style and delivery regardless of personal difficulties.

Adapt to change and work with new staff and colleagues.

Be able to self-motivate even at times of stress or discomfort.

Identify one’s own limitations and work within them.

Attitudes

Non-judgemental to staff and patients.

Non-discriminatory and courteous at all times.

Sensitive to other people’s difficulties.

Be aware of the health inequalities within society.

Places the needs of patients above his or her own needs.

Values self-audit and participation in the peer review process.

Accepts the responsibility for contributing to the advancement of medical knowledge and

improvement of patient care.

Aspires to influence and develop the specialty including valuing the multi-professional team.

Value one’s own health and protect and maintain a healthy lifestyle, recognising the effect of

poor health on work.

Assessment methods

Direct Observation.

Mini PAT/MSF

Complaints monitoring

5.4.2. Career and professional development

Objectives

The emergency physician must be able to plan and develop their career and identify and

respond to challenges.

Knowledge

The design and structure of curriculum vitae when seeking employment.

Identification of key achievements in an appropriate way.

Knows where and how to seek career guidance.

Skills

Write a CV that is clear and appropriate.

Plan own career in the short and longer term.

Access advice for career development.

Identify new challenges and respond in a way that makes the most of existing skills and

offers opportunities to develop new skills.

Be able to work with others to identify own educational needs.

Attitudes

Value diversity and welcome challenges.

Acknowledge when inappropriate choices have been made.

Continue to work and develop despite setbacks such as exam failure.

Assessment methods

Appraisal

Self-assessment tools

5.5. Ethics and legal

5.5.1. Informed consent

Objectives

The emergency physician must perform interventions in a timely fashion but should seek

informed consent whenever possible.

Knowledge

Describe the principles of informed consent.

Identify procedures where written consent is mandatory.

Be aware of the consent procedure in the local environment and the GMC guidance on

informed consent.

Know the law on consent in children & incompetent adults.

Be able to define competence in an adult.

Understand the implications of consent in certain circumstances such as HIV testing.

Skills

Provide adequate clear information for patients to make informed consent particularly in high

risk procedures.

Obtain informed consent through excellent communication.

Seek to obtain verbal consent whenever possible by clear explanation of risk and benefits of

a given procedures.

Assess the competence of an adult or child to give or withhold consent.

Complete appropriate documentation of the process of gaining informed consent.

Attitudes

Value the patient’s right to refuse treatment or to be involved in planning treatment.

Assessment methods

Direct observation

OSCE

SAQ

Case discussion

Mini CEX

5.5.2. Do Not Attempt Resuscitation (DNAR) and advanced directives

Objectives

In the practice of Emergency Medicine there are occasions where it is appropriate to

discontinue active interventions. This must be carried out in a professional manner and with

empathy.

Knowledge

Know the legal responsibilities for continuing or discontinuing resuscitation.

Know the legal standing of DNAR and advanced directives.

Skills

Apply knowledge of the law regarding DNAR in practical circumstances.

Be able to support junior staff in determining the appropriate action, including members of

other specialty teams.

Discuss the possibilities of DNAR clearly and concisely with the patient and relatives, and

support them in agreeing the appropriate decision.

Allow patients / relatives time to think, and provide them with appropriate and clear

information.

Attitudes

Value the autonomy of patients.

Appreciate the contribution of relatives and other professionals in determining the

appropriate course of action.

Avoid being patriarchal or autocratic but also be clear in the information given.

Be empathic with patients and relatives facing difficult decisions.

Assessment methods

OSCE

Observed practice

Case scenario practice

Case discussions

5.5.3. The competent adult

Objectives

Patients who present to emergency departments may lack competence to decide for

themselves. The Emergency Physician must be able to assess competence.

Knowledge

Understand the Ghana Mental Health Act(s) in relation to competence, capacity and

guardianship.

Know the definition and assessment of competence in the adult and child.

Understand that competence to consent and competence to refuse may be different.

Know the legal requirements for the treatment of incompetent adults.

Know the place of common law and civil law in managing the adult patient in whom

competence cannot be proven.

Understand the legal rights of the guardian or adult with right of attorney.

Skills

Assess the competence of a child or adult in difficult circumstances.

Explain the options to the competent adult/child in a way they can understand.

Recognise the incompetent adult and work within the law in managing the patient.

Explain competence and the autonomy of a [Gillick] Competent child to parents or

guardians.

Ability to assess competence and management of the patient appropriately within national

legal framework.

Attitudes

Appreciate that the law protects patients and professionals.

Allow patients to refuse treatment when competent even if it appears irrational.

Understand and provide empathic support for parents where a competent children may act

against the parent wishes or families where competent adults do not take family advice.

Assessment methods

OSCE

Direct observation

Case scenario practice

Case discussions

5.5.4. Medico-legal issues

Objectives

The emergency physician must operate within the legal framework of the country in which

they work.

Knowledge

Understand the law as it applies to the practice of medicine.

Know the limits of the law in particular regard to mental health patients, the coroner, the

powers of the police and the relevant driving authority.

Understand the law around confidentiality and data protection.

Understand the law around consent (as above)

Know the difference between civil and criminal law as it applies to medical practice.

Skills

Work with the patient and the national legal institutions to provide the best possible care to

patients and to protect society.

Work within the law.

Interpret the law for the patient and for those who are less informed.

Attitudes

Value the legal framework - it stands to protect both the patient and the practitioner; but be

prepared to challenge unreasonable behaviour on the part of a patient or colleague

particularly when it interferes with safe and effective patient care.

Appreciate the need to balance the needs of the individual against the needs of society.

Assessment methods

OSCE

SAQ

Case based discussion

Viva section of the exam

5.6. Education

5.6.1. Developing others’ learning

Objectives

The emergency department is an excellent learning environment and will contain many

students of different levels at any one time – the practitioner must be able to facilitate others

learning whilst still delivering high quality care.

The practitioner should be able to plan, deliver and evaluate learning programmes for others.

Knowledge

Describe the principles of adult learning.

Illustrate different teaching techniques including group teaching, bedside teaching, tutorials

and role play.

Understand the place of questioning in educational encounters.

Outline the use of learning outcomes, educational objectives, lesson plans and other

teaching techniques.

Identify key topics for a given learner in an informal curriculum.

Know the curriculum for other learners or where to find it.

Know where the emergency medicine curriculum fits into the undergraduate curriculum and

into the curriculum of other specialties.

Understand the importance of timely constructive feedback.

Skills

Is able to facilitate learning in the clinical environment by encouraging questions, supervising

practice and giving feedback on performance.

Prepares multimedia learning sessions including formal lectures, tutorials, skills sessions

and simulations.

Deliver training in a one to one and group environment.

Set learning objectives or outcomes that are appropriate to the learner and the topic.

Develops educational programmes for a group of learners appropriate to their level.

Utilise existing departmental resources for teaching.

Support others in identifying their learning needs and outlining how they will meet those

needs.

Able to deliver lectures and skills stations in accordance with life support course

methodology.

Use a simulator or manikin in a teaching environment.

Evaluate a teaching programme.

Able to motivate others to learn.

Encourages a good learning environment.

Attitudes

Value the different styles of learning in the learners and adjust the teaching style.

Requests feedback on teaching from learners and observers and responds positively.

Value and develop a positive learning environment.

Assessment methods

Feedback from learners.

OSCE

Instructor courses e.g. ATLS Instructor Course

Direct observation and critique

5.6.2. Assessment and appraisal

Objectives

Emergency practitioners are required to give feedback to other staff and must do so in a

supportive and constructive way, as well as formally assessing performance of some groups.

Knowledge

Knows the principles of good feedback.

Understands the difference between summative and formative assessment.

Be aware of the difference between assessment and appraisal.

Be aware of current examination and accreditation guidance and criteria.

Be aware of different methods used in assessment of clinical competence.

Knows the place of the Faculty examinations in the development of the emergency

physician.

Skills

Identify measurable relevant criteria for assessment of a given knowledge or skills base.

Apply those criteria in an objective way during an assessment.

Give constructive feedback emphasising the positive and providing alternative strategies

where there is error or a need to change.

Contribute to the development of assessment methods that are generic, objective, reliable

and valid in the given circumstances.

Attitudes

Understand the importance of feedback in personal development.

Acknowledge the impact of negative feedback on individual.

Respect individuality in a learner and that there may be valid alternative views at work.

Ensure that appraisal is a two-way process valuing the feedback of the appraisee as well as

the appraiser.

Assessment methods

Direct observation

SAQ

Discussions and sessional tasks

6. Specialty specific competencies

6.1. Resuscitation

Generic objectives for Resuscitation

Objectives:

To be able to use a structured prioritised approach to life threatening situations.

To be able to undertake resuscitation procedures in a timely and effective manner.

Understand the pharmacology, indications, and contra indications of resuscitation

drugs.

Lead and supervise the resuscitation team.

Effectively interact with other specialties to ensure optimal care.

To be supportive of relatives and friends of the patient whilst giving clear

information.

Exercise good judgement as to when resuscitation is futile or inappropriate.

Specific paediatric objectives:

Be able to formulate a differential diagnosis by age of a patient with acute life

threatening respiratory difficulty and prioritise management

Be able to lead a resuscitation team in line with APLS/PALS guidelines

Understand the indications, pharmacology, contraindications, dose calculation and

routes of administration of drugs used in resuscitation and in the stabilization of

children in cardiac arrest or failure

Be able to obtain appropriate peripheral venous and arterial access including

intraosseous route

Understand the prognostic factors for outcome of cardiac resuscitation for children

Understand the indications and procedures for transport to a definitive facility

following stabilization

Have developed a sensitivity and understanding in the management of chronic end-

stage conditions

Understand the appropriate management of Sudden Death in Infancy and the local

management guidelines for supporting the family

Understanding the differential diagnosis of the well looking infant presenting with

apparent life threatening events (ALTE) e.g. apnoea, cyanosis, floppy baby.

6.1.1. Airway Objectives

To be able to assess, establish and maintain a patent airway, using both Basic Life Support and Advanced Life Support techniques.

To be able to assess, establish and maintain a patent airway in a child

Knowledge

Identification of the obstructed airway and its causes.

Methods of maintaining a patent airway i.e. head positioning, jaw thrust, adjuncts, suction.

Bag valve mask ventilation / Mapleson C circuit.

Oxygen delivery systems.

Indications for tracheal intubation.

Complications of tracheal intubation.

Understand the appropriate use of pharmacological agents in induction and maintenance of anaesthesia and be aware of their complications and side effects

Understand the principles of simple ventilators

Have knowledge of monitoring techniques (SpA02, ETC02)

Failed airway drill, including

LMA, needle & surgical cricothyroidotomy

Know the indications and contraindications for a surgical airway

Understand the prognostic features of the outcome of respiratory arrest

Skills / Attitudes

Skills o Airway assessment & optimising the patient’s position for airway

management. o Be able to identify the difficult or potentially difficult airway and summon

expertise. o Airway management with the use of oral/nasal airways. o Ventilation using bag valve and mask. o Appropriate choice and passage of tracheal tubes using appropriate

laryngoscope blades. o Use of gum elastic bougie/introducers. o Tracheal suction. o Manage tracheostomy tube complications o Identifying correct/incorrect placement of tube (oesophagus, right main

bronchus). o Perform needle/surgical cricothyroidotomy and percutaneous

transtracheal ventilation o Interpretation of capnograph trace. o Introduction and checking correct placement of laryngeal mask airway. o Heimlich manoeuvre

Attitudes: o Know own limitations o Appreciate the urgency of providing a patient airway, and the

importance of basic airway manoeuvres

o Always know the location of senior assistance o Be able to follow age-appropriate algorithms for obstructed airway

including choking.

Learning

Learning from practice

Learning from Trainers

Group Teaching

Personal Study

Life Support Courses

Simulation/Skills Lab

Follow through of patient/OPD Clinic

Dedicated time in another department (e.g. Paediatrics, T & O, ICU, anaesthesia)

Assessment

Observed Care

Directly Observed Procedure


Audit of Case Notes

Mock Examination

Membership Examination

6.1.2. Cardiac Arrest / Peri-arrest Objectives

To confirm cardiac arrest, establish Basic Life Support, use defibrillation safely and appropriately, and use appropriate drugs.

To be able to recognise and manage peri arrest arrhythmias.

Understand specific aspects of the management of cardiac arrest in children

Knowledge

Familiarity with the ALS and APLS algorithms and pharmacology.

Knowledge of cardiac arrests in special situations, e.g. hypothermia, trauma, overdose.

Knowledge of the outcomes of pre-hospital arrest.

Post arrest management.

Peri-arrest arrhythmias and pharmacology of drugs used.

Organ Donation

Understand the prognostic features and the outcome of respiratory arrest

Understand the causes of cardiac arrest in children.

Understand the outcomes of cardiac arrest in children

Skills / Attitudes

Skills o Perform effective B.L.S. and A.L.S. o Rhythm recognition and treatment. o Safe defibrillation. o To know when to discontinue resuscitation. o Central venous access. o External pacing o Endotracheal drug administration

Attitudes: o Team Work o Compassion o To act as the patient’s advocate when continued critical care input is

needed o Be able to take decisions in circumstances that present ethical issues

and know when to cease resuscitation. o Be able to discuss end of life decisions in a sympathetic and caring

manner with patients and their families o Be able to discuss organ donation in a sensitive manner

Learning



Group Teaching

Personal Study



Assessment

Observed Care



Audit of Case Notes

Mock Examination

Life support course assessments


6.1.3. Resuscitation of the Shocked patient Objectives

To be able to recognise the shocked patient, the likely cause and to initiate treatment.

Knowledge

Know the differential diagnosis of the shocked patient and the distinguishing features of hypovolaemic shock, distributive shock, obstructive shock and cardiogenic shock.

Patho-physiology of shock.

Role and types of monitoring

Appropriate use of inotropes and vasopressors.

The role of imaging, e.g. FAST scanning and echocardiography in the shocked patient.

To be competent in undertaking a FAST scan.

Skills / Attitudes

Skills o To be able to gain peripheral and central venous access in the shocked

patient. (Ultrasound guided). o Central access including: o Subclavian / internal jugular / femoral and CVP measurements o Arterial line insertion o Judicious use of fluids especially in the elderly and the trauma patient. o Intra-osseous and cut down techniques. o Accessing indwelling vascular lines o Recognition of the need for urgent surgical intervention.

Attitudes: o Ensure optimal team working to establish the diagnosis and commence

treatment. This will require close liaison with in-patient teams and radiology

Learning



Group Teaching

Personal Study




Dedicated time in another department (e.g. Paediatrics, T&O, ICU, Anaesthesia)

Assessment

Observed Care



Audit of Case Notes

Mock Examination


6.1.4. Patients presenting with Coma Objectives

To be able to look after the comatose patient safely and establish the diagnosis and differential diagnosis by systematic history and examination and appropriate diagnostic testing.

Knowledge

Understand the differential diagnosis of the comatose patient and be able to undertake investigation (routine blood tests/arterial blood gas/radiology) and commence treatment.

Skills / Attitudes

Skills o Apply the A, B, C, D approach to manage and stabilise the patient. o Protection of the comatose patient including log rolling and urinary

catheterisation.

Attitudes: o Respect o Compassion

Learning



Group Teaching

Personal Study





Assessment

Observed Care



Audit of Case Notes

Mock Examination


6.2. Anaesthetics and Pain Relief

6.2.1. Pain Management Objectives

To safely and effectively relieve pain, the commonest presenting complaint in the Emergency Department, in a timely way.

Knowledge

Assessment of pain including pain scoring

Understand the appropriate use of analgesics (including paracetamol, NSAIDs, opioids, ketamine, Entonox) and be aware of their complications and side effects.

Routes of administration: o Oral, IV, IM, and nasal/PR.

Monitoring

Knowledge of controlled drug policy.

Knowledge of adjuncts such as local anaesthesia, splinting, distraction.

Skills / Attitudes

Skills o Selection and safe prescribing of appropriate analgesic, dosage and route of

administration. o Appropriate monitoring. o Be able to discuss options for pain relief with the patient.

Attitudes: o To be safe o To ensure effectiveness and to seek help if pain is not relieved or is

disproportionate. o To treat the underlying cause of pain

Learning



Group Teaching

Personal Study



Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination


6.2.2. Local Anaesthetic Techniques

Objectives

To use local anaesthesia appropriately and safely.

Knowledge

Understand the appropriate use of local anaesthetic agents (lignocaine, bupivicaine and prilocaine) and be aware of complications and side effects

Anatomy of nerve blocks and physiology of nerve function.

Intravenous regional anaesthesia

Skills / Attitudes

Skills o To be able to undertake the following nerve blocks and know their contra-

indications: digital wrist (ulnar ,median,radial), femoral facial (auricular, supratrochlear, supraorbital) ankle Biers Block

o To calculate maximum dose of local anaesthetic for each patient.

Attitudes: o Give the highest consideration to patient safety and comfort. o Know own limitations and recognise when to call for help

Learning



Group Teaching

Personal Study


Assessment

Observed Care



Audit of Case Notes

Mock Examination


6.2.3. Safe Conscious Sedation Objectives

To be able to deliver safe conscious sedation to selected patients

Knowledge

Know how to implement and ensure safe sedation practice for healthcare procedures in adults (reference: http://www.rcoa.ac.uk)

Recognition of risk factors: airway, co- morbidity, and drugs/alcohol.

Drug pharmacology, selection, dosage.

Knowledge of antagonists.

Monitoring, O2 therapy, resuscitation equipment.

Safe discharge.

Skills / Attitudes

Skills o Airway assessment and management including BVM in order to deal with

complications. o Safe titration of drugs in a monitored environment. o Prompt recognition of over sedation and recognition that loss of verbal

responsiveness equates with general anaesthesia in terms of the level of patient care required.

Attitudes: o Give the highest consideration to patient safety and comfort. o Be able to take informal consent o Respect patient choice o Know own limitations and recognise when to call for help o Work with others to ensure implementation of local and national guidelines

Learning



Group Teaching

Personal Study



Assessment

Observed Care



Audit of Case Notes


6.3. Wound Management Objectives

To be able to assess a wound and its under-lying structures, provide analgesia/local anaesthesia to ensure adequate exploration, cleansing and debridement.

Decide if wound should be closed or not and select appropriate technique.

Recognise those wounds that require more senior Emergency Department staff or specialist referral.

Knowledge

Classification and description of wounds.

Closure techniques: sutures, staples, glue, adhesive strips, delayed primary closure.

Wound infections.

Wound dressings/splintage.

Special wounds: puncture, bites, amputation, degloving, foreign bodies.

Tetanus immunisation schedules.

Special patients, e.g. the immunocompromised

Role of antibiotics.

Detailed knowledge of hand, wrist and facial anatomy.

Skills / Attitudes

Skills o Local anaesthetic techniques. o Recognition of underlying structures. o Ensure thorough mechanical wound cleansing and removal of foreign bodies. o Ensure the best conditions for wound management i.e. good lighting, good

analgesia, and good equipment. o Correct closure technique. o Appropriate follow up, recognising those patients at risk of wound infection and

delayed healing. o

Attitudes: o Be meticulous in wound assessment and thorough in wound cleaning using

appropriate investigations to establish presence of foreign bodies and damage to underlying structures.

Learning



Group Teaching

Personal Study


Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination


6.4. Major Trauma Objectives

To be able to assess, resuscitate and stabilise victims of major trauma based on ATLS principles.

To identify those that need life or limb saving surgery.

To use diagnostic testing appropriately.

To be able to manage major trauma in children.

Knowledge

To understand the epidemiology of trauma.

Understand the importance of mechanisms of injury, trauma scoring and how trauma teams work.

Understand and apply the principles of Advanced Trauma Life Support / Advanced Paediatric Life Support

Skills / Attitudes

Skills o Take an ambulance service hand over. o To be able to recognise need for, and carry out, life saving procedures. o To provide adequate pain relief and splintage. o To be skilled in x-ray interpretation and the use of FAST. o To be able to examine a child in a way which localises injuries o Be aware of child protection and accident prevention issues

Attitudes: o Give the highest consideration to patient safety and comfort. o Optimal working within a team, using ATLS principles and sensitive handling of

relatives.

Learning



Group Teaching

Personal Study




Assessment

Observed Care



Audit of Case Notes



6.4.1. Head Injury Objectives

To be able to assess the head injured patient using history and examination and appropriate investigation.

To manage the head injured child

Knowledge

Knowledge of the anatomy of the scalp, skull and brain.

Physiology of cerebral perfusion and intracranial pressure.

To be able to stratify head injured patients, identify those who need CT/plain radiology, identify those who need neurosurgical referral.

Intracranial consequences of a head injury i.e. extradural, subdural, intracerebral haematoma, diffuse axonal injury, post concussion syndrome.

Plain radiology/CT appearances.

Knowledge of international guidelines such as NICE (http://www.nice.org.uk/) and SIGN (http://www.sign.ac.uk) guidelines.

Understand the NICE guidelines for head injury in children

Understand when to safely discharge children with minor head injury

Understand how to recognise signs of physical abuse and how to proceed with local child protection protocols

Skills / Attitudes

Skills o To recognise major head injury and institute an A, B, C, D approach, plus optimise

therapy to avoid secondary brain injury. o Identify those patients who will need intubation and ventilation. o Appropriate and timely involvement of neurosurgery. o Management of scalp lacerations. o To be able to safely recognise and treat for minor head injury. o Ensure the safe discharge of patients with minor head injury. o Be able to assess AVPU and Glasgow Coma Score (GCS) in children o Be able to request appropriate radiology including plain skull x rays and head CT

scanning as per national guidelines o Be able to initiate management of all children with scalp lacerations

Attitudes: o Optimise joint team working with Critical Care, Neurosurgery and the Emergency

Department for the seriously head injured patient.

Learning



Group Teaching

Personal Study




Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination



6.4.2. Chest Trauma Objectives

To be able to recognise and treat those patients who have life-threatening or potentially life-threatening chest injuries.

To manage chest injuries in children

Knowledge

Knowledge of the anatomy of the intrathoracic organs and surface anatomy of the major thoracic structures.

Knowledge of the pathophysiology of cardiothoracic injury.

To be able to identify life threatening chest trauma, i.e. tension, pneumothorax, open pneumothorax, flail chest, massive haemothorax, and cardiac tamponade.

To be able to identify those patients with a potential aortic injury, diaphragmatic rupture, pulmonary contusion, myocardial contusion, oesophageal rupture, tracheobronchial injury, rib fracture and sternal fracture and to appreciate the plain radiology and CT appearances of these injuries.

Understand importance of mechanism of injury e.g., penetrating versus blunt trauma

Understand the likely chest injuries through different age groups

Skills / Attitudes

Skills o Able to use the ATLS approach (or the approach taught on KATH AETC course). o Identify life threatening chest conditions. o To be able to undertake a needle thoracocentesis, place an intercostal chest drain,

pericardiocentesis. o Know when to call cardiothoracic surgery. o Resuscitative thoracotomy. (not in children) o To provide advice and care for those patients with isolated chest wall injuries who

are to be discharged.

Attitudes: o Optimise joint team working with Critical Care, and the Emergency Department for

the patient with severe chest injuries.

Learning



Group Teaching

Personal Study




Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination



6.4.3. Abdominal Trauma Objectives

Recognition of those patients who have sustained significant abdominal trauma by taking a thorough history, doing an examination, and performing appropriate investigation.

Knowledge

Knowledge of the structural function and surface markings of the abdominal organs.

Knowledge of the different presentation of abdominal trauma and the structures that may be damaged.

Specifically blunt splenic, hepatic, renal pancreatic trauma, hollow viscus injury, penetrating abdominal injury, urethral / bladder / testicular trauma.

Indications for CT / early surgical involvement.

Skills / Attitudes

Skills o To be able to assess and reassess the traumatic abdomen, initiate treatment and

investigation and involve appropriate specialists. o Recognise the influence of injuries elsewhere on abdominal assessment. o Be able to undertake a FAST scan or DPL. o Nasogastric tube placement

Learning



Group Teaching

Personal Study

Life Support Courses, Simulation/Skills Lab


Assessment

Observed Care


Mini-CEx/Case based discussion

Audit of Case Notes

Mock Examination



6.4.4. Spinal Injury Objectives

To be able to recognise those patients who have suffered a spinal cord, peripheral nerve or plexus injury by appropriate history, examination and investigation.

To manage the child with a spinal injury

Knowledge

Knowledge of anatomy and physiology of spinal cord, myotomes and dermatomes.

Recognition of injury to vertebrae (fracture / dislocation), cord (including spinal cord syndromes / SCIWORA) and ligaments.

Methods of appropriate imaging (plain radiology / CT / MRI). (reference NICE Guidelines http://www.nice.org.uk)

Neurogenic shock / spinal shock – recognition and treatment.

To be able to interpret plain radiology of the spine.

Understand the mechanisms and risk of spinal injury in children

Skills / Attitudes

Skills o Safe initial care of the potential spinally injured patient (spinal immobilisation). o Techniques of spinal immobilisation and log roll o Appreciate how spinal cord injury affects assessment. o Identify when CT and MRI is appropriate. o To record accurately the neurological status of the patient. o Liaise with appropriate specialist. o To safely ‘clear’ the c-spine. o Be able to manage the anxious immobilised child o Be able to examine the spine and apply the indications for being able to clinically

‘clear’ the spine in children

Attitudes o To communicate sensitively and accurately to the patient and their relatives the

nature of these injuries.

Learning



Group Teaching

Personal Study




Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination



6.4.5. Maxillo-facial Trauma Objectives

To identify those patients with maxillo-facial trauma, specifically those that may have airway threat.

To be able to characterise maxillo-facial injuries.

Knowledge

Anatomy and physiology of facial structure

Nasal fractures

Le Forte fractures

Mandibular fractures/dental fractures/ avulsed teeth/orbital fractures.

Zygomatic fractures

To be able to identify underlying structures at risk from facial lacerations, specifically parotid duct, facial nerve and lacrimal duct.

Temporo-mandibular joint (TMJ) dislocation

Tongue laceration.

Soft tissue injury and wounds to the neck.

Skills / Attitudes

Skills o To be able to recognise a threat to the airway – initiate emergency treatment and

call for help. o Assess the facio-maxillary bones and associated structures. o Identify those patients who will need inpatient or outpatient care. o To be able to manage torrential nasopharangeal bleeding o Avoidance of facial tattooing by thorough cleansing. o To ensure a good cosmetic result after facial suturing

Learning



Group Teaching

Personal Study




Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination



6.4.6. Burns Objectives

To be able to evaluate patients with burns.

To be able to commence resuscitation and refer appropriately whilst providing effective analgesia.

To manage minor burns.

To manage the child with burns

Knowledge

Know and understand the pathophysiology of burns.

To recognise the particular risks to the upper airway from heat and lower airway from inhalation injury.

To be able to assess the size and depth of a burn and calculate the fluid loss.

To recognise the importance of burns in special areas (i.e. face, joints, perineum).

Have knowledge of electrical and chemical burns (e.g. hydrofluoric acid).

Be able to calculate % burn surface area for children.

Skills / Attitudes

Skills o To recognise the burns patient who has an airway at risk and the need for early

intubation. The A, B, C, D approach. o To be able to calculate fluid replacement. o To identify those patients who need referral to a specialist centre. o To be able to manage minor burns and arrange appropriate follow up. o To be able to undertake escharatomy. o Be able to recognise possible patterns of child abuse in burn injuries and make the

appropriate referral.

Learning



Group Teaching

Personal Study





Assessment

Observed Care


Mini-CEx


Audit of Case Notes

Mock Examination


6.4.7. Generic objectives for musculoskeletal conditions

Objectives:

To be able to take an appropriate history, examination, investigation and initiate treatment

of patients presenting with musculoskeletal pathology. This includes splinting, POP and

pain relief.

Emergency Physicians should be aware of the predicted clinical course and specific

complications for these conditions.

Recognise those that need further inpatient/outpatient care, the role of physiotherapy

and those who can be discharged directly from the Emergency Department.

Detailed knowledge including plain radiology of both traumatic and atraumatic pathologies

is required (see below for specific anatomical regions).

Specific paediatric objectives

Understand the likely types of soft tissue and bony injuries for each age group

Be able to judge if these relate correctly to the stated mechanism of injury

Be aware of rheumatological, infectious, malignant and non-accidental causes of

musculoskeletal presentations

Be able to examine a child in a way which localises the injury

Understand the Salter-Harris classification of epiphyseal injuries

Understand the likely time-frame for recovery in children

6.4.7.1. Upper limb

Anatomical Region

1. Shoulder region.

Knowledge

Trauma o Fracture of the clavicle, proximal humerus, scapula, o ACJ and SCJ injuries o Dislocation of shoulder, o Rotator cuff injuries.

Non-trauma o Sub acromion bursitis o Supraspinatus tendonitis o Ruptured biceps tendon o Shoulder joint inflammation including capsulitis and impingement syndrome

Skills / Attitudes

o To be able to examine the shoulder region, identify injuries and any associated neurovascular problems.

o To be able to safely reduce a dislocated shoulder (anterior/posterior) and treat any associated conditions appropriately.

o Ensure appropriate follow up including physiotherapy. o To be thorough and to identify serious underlying pathology, e.g. pathological

fractures. o Application of broad arm sling / collar and cuff / U slab.

Anatomical Region

2. Long bones of the upper limb.

Knowledge

Trauma o Fractures of the humerus, radius and ulna. o Understand their common fracture patterns and associations /complications. o Compartment syndrome.

Skills / Attitudes

o To be able to undertake appropriate examination and determine any associated injuries and the need for urgent intervention.

o To be able to interpret plain radiology. o To be able to splint appropriately including application of above and below elbow

POP

Anatomical Region

3. Elbow.

Knowledge

Trauma o Supracondylar, radial head, olecranon, condyle fractures o Dislocated elbow and pulled elbow.

Non-trauma o Bursitis o Tendonitis.

Skills / Attitudes

Skills o Be able to examine the elbow region, identify injuries and any associated

neurovascular problems. o To be able to safely reduce a dislocated elbow / pulled elbow and treat the other

conditions appropriately. o To recognise which supracondylar fractures require urgent orthopaedic referral.

Anatomical Region

4. Wrist.

Knowledge

Trauma o Colles’ / Smith’s, scaphoid and Barton’s fractures. o Management of the “clinical scaphoid” fracture o Fractures of other carpal bones. o To be able to recognise dislocation of the carpal bones.

Non-trauma o Tenosynovitis o Carpal tunnel syndrome

Skills / Attitudes

Skills o To be able to recognise the conditions listed and safely reduce distal wrist fractures

and identify carpal dislocations. o Application of below elbow POP/short arm backslab o Arrange appropriate follow up.

Anatomical Region

5. Hand.

Knowledge

Trauma

o To be able to identify metacarpal and phalangeal fracture/ dislocations. o To be able to evaluate wounds of the hand including nail bed injuries, nerve injury,

foreign body, high pressure injection injury, amputations and crush injuries. o Hand compartment syndrome o Identify tendon injuries, Mallet finger and Boutonniere deformity.

Non-trauma o Infections: paronychia, pulp space, flexor sheath infection, deep space hand

infections.

Skills / Attitudes

Skills o Reduction of phalageal dislocation and simple phalangeal fractures o To be able to assess the neurovascular function and tendon function of the hand. o To be able to interpret x-rays. o To be able to explore wounds appropriately and refer those who need inpatient

care. o Ideally tendons should be repaired by a hand surgeon especially flexor tendons.

Learning



Group Teaching

Personal Study

Follow through of patient/OPD Clinic (e.g. Hand Clinic)

Assessment

Observed Care


Mini-CEx


Mock Examination


6.4.7.2. Lower limb and Pelvis

Anatomical Region

1. Pelvis and hip.

Knowledge

Trauma o Fractured neck of femur – types. o Dislocation of the hip – types, including dislocation of prosthetic hip (THR). o Pelvic fractures, sacral fractures, acetabular fractures, coccygeal fracture – types. o To understand management of the exsanguinating pelvic fracture including the role

of pelvic binders, external fixation, and arteriography/embolisation.

Non-trauma o The limping child o Transient synovitis o Slipped Upper Femoral Epiphysis (SUFE) o Joint inflammation and infection

Skills / Attitudes

o To be able to examine the hip, pelvis and sacroiliac joints. o Recognise those patients who need urgent specialist care. o To recognise the injury patterns and associations. o Femoral nerve block and splinting of femoral shaft fractures. o Apply a pelvic splint.

Anatomical Region

2. Long bones of lower limb

Knowledge

Trauma o Fractures of the femur, tibia and fibula o Understand their common fracture patterns and associations / complications. o Compartment syndrome.

Skills / Attitudes

o To be able to undertake appropriate examination and determine any associated injuries and the need for urgent intervention.

o To be able to interpret plain radiology. o To be able to undertake a femoral nerve block. o To be able to splint appropriately, using a Thomas or Donway splint

Anatomical Region

3. Knee.

Knowledge

Trauma o Meniscal injury, o Ligamentous injury (cruciate / collateral) o Dislocation and fracture of the patella. o Dislocation of the knee and, knowledge of associated injuries. o Tibial plateau fractures, fractured neck of fibula, supracondylar

fractures.

Non-trauma o Acute arthritis / bursitis o Quadriceps & patellar tendon rupture. o Ruptured Baker's cyst

Skills / Attitudes

Skills o To be able to examine the knee in detail. o Use plain radiography (Ottawa Knee Rules) appropriately. o To be able to reduce a patella dislocation and knee dislocation with

limb threatening vascular compromise. o Application of knee immobiliser o Arthrocentesis o Above and below knee POP.

Anatomical Region

4. Ankle.

Knowledge

Trauma o To understand the classification of ankle fractures. o To understand the grading of ligamentous injury and to recognise

dislocation of the ankle joint.

Non-trauma o Achilles tendonitis o Achilles rupture.

Skills / Attitudes

Skills o To be able to examine and assess the ankle joint and identify who

needs plain radiography (Ottawa Ankle Rules). o Recognise those patients who need urgent reduction of a dislocated

ankle, and to be able to reduce it. o Recognition of those ankle fractures that require operative intervention.

Anatomical Region

5. Foot.

Knowledge

Trauma o Talar, calcaneal, tarsal bone, metatarsal and phalangeal fractures. o Sub-talar, talar, mid-tarsal, tarso-metatarsal dislocations. o Crush injury of the foot.

Non-trauma o Plantar fasciitis and metatarsalgia. o Stress fractures. o Diabetic foot.

Skills / Attitudes

Skills o To be able to examine the foot. o Recognise those patients who need urgent intervention (reduction of

dislocations, compartment syndrome).

Learning



Group Teaching

Personal Study


Assessment

Observed Care


Mini-CEx


Mock Examination


6.4.7.3. Spinal conditions

Anatomical Region

Spine.

Knowledge

Trauma o See Spinal Injury section

Non-trauma o Myotomes/Dermatomes. o Cord syndromes, including cauda equina o Low back pain – recognition of important causes. o Ankylosing spondylitis, Rheumatoid Arthritis

Skills / Attitudes

o To be able to immobilise the spine; log roll. o Examine the spine. o Understand the indications for radiology and interpret spinal X-rays.

(reference http://www.nice.org.uk) o Recognise associated injuries (neurogenic shock / spinal cord injury). o Masking effect of spinal injury.

Learning



Group Teaching

Personal Study


Assessment

Observed Care


Mini-CEx


Mock Examination


6.5. Vascular Emergencies - Arterial Objectives

To be able to under-take a history and examination focused on the vascular system and identify those conditions that threaten life or limb.

Knowledge

The symptoms, signs, presentation, causes and treatment of peripheral ischaemia, abdominal and thoracic aortic aneurysms and aortic dissection.

Mesenteric ischaemia.

Intra-arterial drug injection

Traumatic vascular injury and associated fractures/dislocations.

Skills / Attitudes

To be able to resuscitate, use appropriate investigations (bed side, ultrasound and CT) and to ensure timely referral to appropriate specialist.

Learning



Group Teaching

Personal Study


Assessment

Observed Care



Mock Examination


6.6. Vascular Emergencies - Venous Objectives

Differential diagnosis of the painful / swollen calf.

Venous occlusion / DVT

Knowledge

Investigation and management of DVT including role of risk stratification, d-dimers and ultrasound.

Proximal vein thrombosis

Skills / Attitudes

Focused clinical examination to establish most likely diagnosis

Learning



Group Teaching

Personal Study


Dedicated time in another department

Assessment

Observed Care


Mini-CEx


Mock Examination


6.7. Abdominal conditions - Undifferentiated Abdominal Pain Objectives

To be able to take a full history and examination, elicit relevant physical signs, commence resuscitation and investigation.

Knowledge

To have knowledge of the causes of acute abdominal pain, including peptic ulcer disease, pancreatitis, (reference www.bsg.org.uk/clinical_prac/guidelines.htm) cholecystitis, cholangitis, biliary colic, bowel obstruction, diverticular disease, viscus perforation, acute appendicitis, and ischaemic colitis, Abdominal Aortic Aneurysm (AAA), hernias, renal calculi, pyelonephritis, chronic inflammatory bowel disease, volvulus and the medical and gynaecological causes of abdominal pain.

Skills / Attitudes

To have an A, B, C, D approach ensuring effective fluid resuscitation, pain relief and appropriate use of a nasogastric tube and antibiotics.

Identify those who need resuscitation and urgent surgery.

Those that require admission and those who may be safely discharged.

Investigation using plain radiology, CT, ultrasound and blood tests.

Learning



Group Teaching

Personal Study


Assessment

Observed Care



Audit of Case Notes

Mock Examination


6.7.1. Abdominal conditions - Haematemesis / melaena Objectives

To be able to undertake appropriate history and examination and initiate appropriate treatment for patients presenting with haematemesis.

Knowledge

Causes.

Indications for blood administration, central venous pressure monitoring, urgent endoscopy and surgical involvement

Specific knowledge of the management of bleeding oesophageal varices, including understanding of the appropriate use of pharmacological agents

Scoring systems/risk stratifications

Guidelines for management of non variceal/variceal haemorrhage (reference www.bsg.org.uk/clinical_prac/guidelines.htm)

Skills / Attitudes

Recognition of shock.

IV access in the shocked patient.

Coordination of teams

Learning



Group Teaching

Personal Study


Assessment

Observed Care


Mini-CEx


Mock Examination


6.7.2. Abdominal conditions - Anal Pain and Rectal Bleeding Objectives

To be able to undertake appropriate history and examination to establish diagnosis and initiate appropriate treatment with patients presenting with anal pain or rectal bleeding.

Knowledge

Know the causes of anal pain, specifically thrombosed haemorrhoids, anal fissure, anorectal abscess, pilonidal disease, rectal prolapse.

To know the causes of lower gastrointestinal bleeding

To know the causes of rectal bleeding including haemorrhoids / fistula / tumour / colitis etc.

Options for appropriate and adequate analgesia

Skills / Attitudes

Identify those patients who need admission and those who can be appropriately managed as an outpatient.

Recognition and treatment of shock.

Learning



Group Teaching

Personal Study


Assessment

Observed Care


Mock Examination


6.8. Urology Problem

1. Acute urinary retention.

Knowledge

To recognise patients with acute urinary retention, relieve symptoms and establish diagnosis.

Suprapubic catheterisation – its indications and how to do it

Skills / Attitudes

Urethral catheterisation.

Problem

2. Acute scrotal pain.

Knowledge

Knowledge of the common cause of scrotal pain, i.e. epididymo-orchitis, testicular torsion, torsion of testicular appendix, trauma, and tumour.

Understand the role of ultrasound.

Skills / Attitudes

Recognition that testicular torsion is an emergency and ensuring timely referral.

Problem

3. Other conditions

Knowledge

Priapism

Renal colic/renal calculi

Phimosis and paraphimosis

Urinary tract infections

Fracture of the penis

Haematuria

Gangrene of the scrotum

Prostatitis

Skills / Attitudes

Emergency management and appropriate referral.

Learning



Group Teaching

Personal Study

Assessment

Observed Care


Mock Examination


6.9. Sexually Transmitted Disease Objectives

Sexually transmitted disease

Knowledge

Common presentations

Common pathogens

Appropriate testing

Complications

Skills / Attitudes

Appropriate investigation and referral to specialist.

Symptomatic and sensitive handling

Learning



Group Teaching

Personal Study

Assessment

Observed Care

Mock Examination


6.10. Eye problems Objectives:

To be able to evaluate those patients presenting with red or painful eyes and those suffering sudden visual loss.

To be able to assess visual acuity and undertake ophthalmoscopy and slit lamp examination.

To understand the pharmacology of ocular drugs.

See below for specific ocular problems.

Problem

4. Red eye.

Knowledge

Conjunctivitis

Corneal abrasions

Corneal ulcers

Keratitis

Foreign bodies

Ocular burns

Scleritis

Episcleritis

Skills / Attitudes

To be able to diagnose, recognise associations.

Attempt removal of foreign bodies from the cornea and conjunctiva.

To provide immediate treatment for those patients who have suffered ocular chemical burns.

Problem

5. Sudden visual loss.

Knowledge

Retinal haemorrhage, especially in diabetics

Retinal vascular occlusions

Vitreous haemorrhage

Retinal detachment

Optic neuritis

Central causes of visual loss.

Skills / Attitudes

To be able to undertake the examination to identify these conditions and ensure prompt referral.

Problem

6. Painful eye

Knowledge

Glaucoma

Uveitis

Iritis

Skills / Attitudes

To be able to establish diagnosis and refer to ophthalmology.

Problem

7. Ocular trauma

Knowledge

To be able to recognise hyphaema, lens dislocation, orbital floor fractures and penetrating injuries of the eye.

Lacrimal duct injuries

Retinal detachment

Lid margin laceration

Skills / Attitudes

To be able to recognise these conditions and refer appropriately.

Problem

8. Other problems

Knowledge

Cellulitis (orbital, pre-orbital and endophthalmitis).

Dacrocystitis

Eyelid disorders – blepharitis

Keratitis

Cavernous sinus thrombosis

Skills / Attitudes

To be able to establish diagnosis and refer to ophthalmology.

Learning



Group Teaching

Personal Study


Assessment

Observed Care

Mock Examination


6.11. ENT conditions Objectives:

To be able to undertake appropriate history, examination and investigation of patients

presenting with ENT problems, ensuring appropriate treatment and referral.

See below for specific ENT problems.

Problem

1. Painful ear.

Knowledge

Otitis media

Otitis externa

Cholesteatoma

Perforated tympanic membrane

Mastoiditis

Foreign bodies

Skills / Attitudes

To be able to use an auroscope

Prescribe appropriately

Identify those who need ENT referral

Removal of foreign bodies.

Aural toilet / insertion of wick.

Problem

2. Epistaxis.

Knowledge

Common causes including trauma and medication

Assessment of nasal fractures.

Skills / Attitudes

To be able to undertake anterior nasal packing / use nasal tampon.

To be able to do posterior nasal packing using a Foley catheter.

Appropriate referral of nasal fractures.

Identification of septal haematoma.

Problem

3. Sore throat

Knowledge

Epiglottitis

Ludwig’s angina

Tonsillitis

Pre-tonsillar abscess

Retro-pharangeal abscess

Skills / Attitudes

To recognise these underlying pathologies and the risk to the airway and involve

appropriate specialist in a timely fashion

Indirect laryngoscopy

Problem

4. Foreign bodies

Knowledge

Foreign bodes in the nose, ear, oesophagus, pharynx and larynx.

Risks of button batteries.

Skills / Attitudes

To be able to remove foreign bodies from the ear and nose and recognise those that

need referral.

Identify those with oesophageal foreign bodies and ensure prompt referral.

Problem

5. Other problems

Knowledge

Causes of vertigo – labyrinthitis etc.

Salivary gland problems and oral pathology

Sinusitis

Facial pain – dental abscess/neuralgia

VII Nerve palsy

Laceration to ear and injury to underlying cartilage

Post tonsillectomy bleed

Skills / Attitudes

Appropriate emergency management and prompt specialist referral.

Problem

6. Traumatic ear conditions in children

Knowledge

Be aware of the possibility of abuse in cases of ear trauma

Skills / Attitudes

Be able to remove foreign bodies in the ear canal or pinna

Be able to recognise a haematoma requiring surgical drainage.

Problem

7. Earache or discharge in children

Knowledge

Understand the presentation of otitis media and glue ear and their association with

hearing loss in children

Skills / Attitudes

Be able to perform otoscopy correctly

Be able to identify otitis externa and otitis media and treat them appropriately

Recognise that language delay or attention deficit requires onward referral

Problem

8. Acute throat infections in children

Knowledge

Be aware of life-threatening airway obstruction in epiglottitis, and how to avoid it

Skills / Attitudes

Recognise the potentially life threatening nature of post-tonsillectomy bleeding

Learning



Group Teaching

Personal Study


Assessment

Observed Care

Mock Examination


7. Procedural Competencies

Practical procedural skills that should be acquired are summarised below in ABC

order and under “Other Procedures”. Additionally, there are further procedures

listed within this Curriculum and also in the Log Book. The acquisition of these

skills may depend on the case mix, and it may be that some skills are not

acquired by the end of membership training.

The competency level expected at various stages of training are described in

the Log Book.

Some skills may be acquired using simulation techniques on mannequins and

during life support courses.

It is not expected that trainees will be assessed for all the listed procedures below

but wherever the opportunity arises the trainees should seek to be observed by a

trainer and as a minimum should maintain a contemporaneous record of these

procedures in the Log Book.

7.1. CPR SKILLS • Cardio-pulmonary resuscitation procedures in a timely and effective manner

according to the current ILCOR guidelines for adults and children

• Advanced CPR skills (e.g. therapeutic hypothermia, open chest CPR)

7.2. Airway Airway protection

Oropharyngeal airway placement

Nasopharyngeal airway placement

Endotracheal intubation

Cricothyroidotomy

• Open and maintain the airway in the emergency setting (insertion of oropharyngeal

or nasopharyngeal airway)

• Endotracheal intubation

• Alternative airway techniques in the emergency setting (e.g. laryngeal mask

insertion, surgical airway)

• Difficult airway management algorithm

• Use of rapid sequence induction of anaesthesia in the emergency setting

7.3. ANALGESIA AND SEDATION SKILLS • Assessment of the level of pain and sedation

• Monitor vital signs and potential side effects during pain management

• Provide procedural sedation and analgesia including conscious sedation (including

testing of life support equipment)

• Use of appropriate local, topical and regional anaesthesia techniques

7.4. BREATHING AND VENTILATION MANAGEMENT SKILLS Pleural tap and aspiration

Intercostal drain - Seldinger

Intercostal drain - Open

Connection to a mechanical ventilator

Safe use of drugs to facilitate mechanical ventilation

Managing the patient fighting the ventilator

Monitoring respiratory function

Deliver a fluid challenge safely to an acutely unwell patient

Describe actions required for accidental displacement of tracheal tube or tracheostomy

• Assessment of breathing and ventilation

• Oxygen therapy

• Interpretation of blood gas analysis, pulse oximetry and capnography

• Bag-mask-valve ventilation

• Thoracocentesis

• Chest tube insertion, connection to under-water drainage and assessment of

functioning

• Non-invasive ventilation techniques

• Invasive ventilation techniques

7.5. CIRCULATION: CIRCULATORY SUPPORT AND CARDIAC SKILLS AND

PROCEDURES Peripheral venous cannulation

Central venous cannulation

Intra-osseous access

Venous cutdown

Arterial cannulation

Arterial blood gas sampling

Basic and advanced life support

Safe defibrillation

DC cardioversion

Temporary pacing (external/wire)

• Administration of fluids including blood and substitutes

• Monitoring of ECG and the circulation

• Defibrillation and pacing (e.g. cardioversion, transcutaneous pacing)

• Emergency pericardiocentesis

• Vascular access (peripheral venous, arterial, and central venous catheterisation,

intraosseous access)

• Emergency thoracotomy

7.6. DIAGNOSTIC PROCEDURES AND SKILLS • Interpretation of ECG

• Appropriate request and interpretation of laboratory investigations (blood chemistry,

blood gases, respiratory function testing and biological markers)

• Appropriate request and interpretation of imaging (e.g. x-rays, ultrasound, CT/MRI)

• Performance of focused assessment of sonography

7.7. ENT SKILLS AND PROCEDURES • Anterior rhinoscopy

• Insertion of nasal pack

• Inspection of oropharynx

• Otoscopy

• Removal of foreign body if airway is compromised

• Insertion and replacement of tracheostomy tube

7.8. GASTROINTESTINAL PROCEDURES • Insertion of nasogastric tube

• Gastric lavage

• Peritoneal lavage

• Abdominal hernia reduction

• Abdominal paracentesis

• Ascitic tap

• Measurement of abdominal pressure

• Balloon tamponade for oesophageal varices

• Proctoscopy

7.9. GENITOURINARY PROCEDURES • Insertion of indwelling urethral catheter

• Suprapubic cystostomy

• Testicular torsion reduction

• Evaluation of patency of urethral catheter

7.10. DECONTAMINATION AND INFECTION CONTROL SKILLS AND

PROCEDURES • Decontamination of patient and the environment

• Patient isolation and staff protection

7.11. MUSCULOSKELETAL TECHNIQUES • Large joint examination

• Aseptic joint aspiration

• Knee aspiration

• Fracture reduction

• Fracture immobilisation

• Joint-dislocation reduction

• Log roll and spine immobilisation

• Splinting (plasters, braces, slings, tapes and other bandages)

• Management of compartment syndrome

• Fasciotomy, escharotomy

7.12. NEUROLOGICAL SKILLS AND PROCEDURES • Evaluation of consciousness including the Glasgow Coma Scale

• Fundoscopy

• Lumbar puncture

• Interpretation of neuro-imaging

7.13. OBSTETRIC AND GYNAECOLOGICAL SKILLS AND PROCEDURES • Emergency delivery

• Vaginal examination using speculum

• Assessment of the sexual assault victim

7.14. OPHTHALMIC SKILLS AND PROCEDURES • Removal of foreign body from the eye

• Slit lamp

• Lateral canthotomy

7.15. TEMPERATURE CONTROL PROCEDURES • Measuring and monitoring of body temperature

• Cooling techniques (evaporative cooling, ice water or slush immersion)

• Internal cooling methods

• Warming techniques

• Monitoring heat stroke patients

• Treatment and prevention of hyper- and hypothermia

7.16. TRANSPORTATION OF THE CRITICALLY ILL PATIENT • Telecommunication and telemedicine procedures

• Preparation of the EMS vehicle

• Specific aspects of monitoring and treatment during transportation

7.17. WOUND MANAGEMENT • Abscess incision and drainage

• Aseptic techniques

• Treatment of lacerations and soft tissue injuries

• Wound irrigation and wound closure

7.18. Other procedures Trauma primary survey

Trauma secondary survey

Application of Pelvic binder

Emergency thoracotomy – indications and contraindications

Lumbar puncture

Initial assessment of the acutely unwell

Secondary assessment of the acutely unwell (i.e. after initial resuscitation and in the

intensive care unit)

8. The Training Programme for Emergency Medicine

This part of the document is based on the standards of the World Federation for Medical

Education (WFME) for Quality Assurance for Postgraduate Medical Education. The

curriculum seeks to guide learning, teaching, and experience, and it specifies standards

using two levels of attainment.

• Basic standard which is a minimum accreditation requirement to be met from the • outset. Basic standards are expressed by a “must/ shall”.

• Standard for quality development which means that the standard is in accordance

with international consensus about best practice for postgraduate medical education.

Standards for quality development are expressed by a “should”.

8.1. TRAINING PROCESS Recognised specialist training in Emergency Medicine must conform to national and

institutional regulations and must take into account the individual needs of trainees. It must

encompass integrated and updated practical, clinical and theoretical instruction.

It must be based on clinical participation and responsibilities in patient care. The trainee

must attain the core competencies described in the sections 3.1 and 3.5 of this document.

8.2. Training structure The Training Programme (TP) must be recognised at national level by the Ghana College

which has the responsibility and authority for organising, coordinating and assessing the

individual training centre. The training process must be clearly identified and supervised in

each centre by the management of the accredited institution.

8.3. Duration of training The Training duration of training of medical specialists must be sufficient to ensure training

for independent practice of the specialty after the completion of training.

The programme is set at a minimum of three years of full-time training. Training must take

place in a full-time appointment or the equivalent length for a flexible part-time appointment

according to the Ghana College regulations.

The three years will comprise 24 months in Emergency Medicine, and a selection of six

elective placements each lasting one month. The division of time between these posts is

stated in the membership curriculum (Appendix A).

8.4. Entry Requirements The selection and appointment of trainees must be in accordance with recognised selection

procedure and agreed entry requirements of the Ghana College of Physicians and

Surgeons. Entry will be competitive, based on a MCQ test, and some form of face-to-face

interview assessment. Once enrolled it is the trainee’s responsibility to ensure that the

College can communicate with him/her through effective channels.

8.5. Working conditions The working conditions and responsibilities of trainers and trainees shall be defined and

made known. The educational goals of the Training Programme and learning objectives of

trainees shall not be compromised by excessive reliance on trainees to fulfil institutional

service obligations. The overall structuring of duty hours and on-call schedules shall focus

on the needs of the patient, continuity of care, and the educational needs of the trainee.

Trainees must be in appropriately remunerated positions or should have financial

sponsorship from employers. As the Faculty expands, to ensure training and teaching of

high quality, the Ghana College must approve the maximum number of trainees per year

and/or per Training Programme for accreditation purposes. The number of training posts

must be proportionate to established criteria, including clinical/practical training opportunities

based on case mix and volume, supervisory capacity and educational resources.

8.6. TEACHING AND LEARNING METHODS The curriculum will be delivered through a variety of learning situations ranging from formal

teaching programmes to experiential learning.

Types of learning situations:

Learning with peers

Working alongside peers, discussing cases, small group teaching and examination

preparation.

Workplace based experiential learning

This is where the majority of learning takes place, with consultant- or specialist-supervised

care (review of patients, note keeping, initial management, investigation and referral), with

progressive increase in responsibility as competence and experience is gained.

Such learning can occur across the following settings:

1. The resuscitation room

2. Other trolley bound patients in the ED

3. Less severely ill and injured patients (ambulant)

4. The Observation Ward/ Clinical Decision Unit

5. Paediatric cases

6. Liaison and discussion of cases with other specialists

7. Working closely with multidisciplinary teams e.g. mental health, physiotherapy, plaster

room technicians, etc.

8. Within management teams

Simulation

Some clinical presentations are relatively infrequent but very important (i.e. anaphylaxis) and

therefore simulation may be utilised for both learning opportunities but also for the

assessment of competence. In addition simulation is excellent for learning and developing

common competences, and non-technical skills. The use of simulation allows reflection on

actual behaviours, interaction with others and safety awareness. The Advance Life Support

courses provide ample training opportunities using simulation.

Formal postgraduate teaching

Didactic lectures are given in the emergency department and will be based on the

curriculum. Trainees should also take advantage of elective rotations, as well as regional,

national and international meetings.

8.7. MANDATORY TRAINING COURSES Ethics and Medicolegal

Scientific writing

Advanced Life Support Courses

Suggested activities include:

1. A programme of regular teaching sessions to cohorts of trainees designed to cover

aspects of the curriculum.

2. Case presentations

3. M&M meetings

4. Journal clubs

5. Research and audit projects

6. Lectures and small group teaching

7. Clinical skills - use of simulation and multi-professional training.

8. Critical appraisal exercises

9. Joint specialty meetings

10. Life support courses

8.8. Independent self-directed learning 1. Reading, including the use of web-based materials

2. Maintenance of personal portfolio (self-assessment, reflective writing, personal

development plan)

3. Maintenance of log book and practical procedures

4. Audit and research projects

5. Reading journals

6. Management portfolio

RESEARCH

By the end of the three-year training, the trainee should have carried out at least one clinical

audit and one research project. The research should be ready for publishing.

8.9. SUPERVISION AND FEEDBACK SUPERVISION

The trainee will be supervised by Junior and Senior specialists throughout the training.

Each trainee will be assigned a mentor who encourage and see to the trainees progress.

APPRAISAL

Trainees will be evaluated by their peers as well as their supervisors regularly based on the

following:

General Provision of Patient Care

Medical Knowledge Base

Case Presentations

Diagnostic Planning

Procedural Skills

Disposition Practices

Practice-Based Learning and Improvement

Interpersonal and Communication Skills

Documentation Quality

Professionalism

Teaching Skills

Department and Systems Management

EXAMINATION FEEDBACK

Trainees will receive feedback during evaluations and after every examination.

8.10. EXPECTED TRAINING OUTCOMES MEMBERSHIP/FELLOWSHIP At the end of the training, it is expected that the trainee will be a good Emergency Physician

who manage all acutely ill patients in a standard fashion.

9. ASSESSMENT METHODS AND TOOLS

9.1. Introduction Trainees will have a training mentor for every placement and be under the overall

direction of the Faculty chair throughout the training programme. The Faculty chair is

responsible for implementing the curriculum.

The standard assessment methods must be formative and summative as previously

defined.

A system of workplace based training and assessment is laid out in this curriculum.

Formative assessments must be satisfactory and, in addition, those wishing to

progress from the membership training year 3 in EM would be expected to have

passed the Membership Examination at the end of year 3. All parts of the exam would

be required for progression to be a member of The College

A portfolio based on the core curriculum shall be used for assessment. In the portfolio

the trainee documents the theoretical, clinical and practical experience. The acquired

competencies must be validated by the trainers contemporaneously

9.2. Formative assessment and Documentation Purpose

The purposes of assessing trainees in the workplace include:

To provide opportunities for observation and feedback at regular intervals throughout training (a formative purpose or ‘assessment for learning’).

To identify for more detailed assessment trainees displaying delayed

development of their clinical skills.

To identify for more detailed assessment trainees displaying generic

problems that are likely to be a barrier to clinical practice.

Formative assessment is used as part of an ongoing learning or developmental

process in giving feedback and advice. It shall provide benchmarks to orient the

trainee. It must evaluate the trainee’s progress and identify the strengths and

weaknesses of that individual. The evaluation and any recommendations must be

fully shared with the trainee.

The following should be part of formative assessment:

Formal Documentation of trainee’s development and progress

Workplace based Assessment:

o Observed clinical care of unselected patients during working time.

o Observation of the trainee operating within a team.

o Mini Clinical Examination (or Direct Observation of Procedural Skills), to

assess the knowledge, procedural and practical skills and attitudes of the

trainee’s interaction with a patient.

o Case-Based Discussion, to explore clinical reasoning on a recent case.

9.2.1. Summative assessment Summative assessment is usually a test that takes place after a specified training

period with the purpose of deciding whether the trainee has reached a standard to

proceed to the next level of training or to be awarded a certificate of Completion of

Training. The methods of summative assessment shall include:

Written examinations (multiple choice questions, short answered questions, essays).

Oral and practical examinations (clinical vivas and objective structured clinical

examinations, stations to assess medical knowledge, clinical, communication and

ethical skills in short predetermined scenarios).

Evaluation of trainee’s Portfolio or Log Book.

Decide and treat

During membership training the trainee will improve core clinical knowledge and procedural

skills so that he or she can practice autonomously.

The membership trainee should learn to:

• derive and deliver a plan of care regardless of complexity in all but exceptional

circumstances

• anticipate and act when decision making may be challenging, related to the nature of

the decision-making task, person making it, the context in which it is made

By the end of membership training, the specialist must be able to derive a plan of care for

any patient presenting to the ED and deliver all key ED treatments

The membership trainee will be able to carry out Resuscitation by undertaking a rapid

history and clinical examination, applying the appropriate imaging tools and lifesaving

procedural skills. The goal is to practice at an autonomous level in all cases, and

independently lead an emergency team.

• He/she will lead resuscitation through to disposal regardless of complexity in all but

exceptional circumstances with authority

• Demonstrate ability to retain situational awareness across more than one

resuscitation and to utilise optimise resources to provide safe care

• Be aware of the potential impact on the team of resuscitation cases and can

effectively debrief and support the team after resuscitation

By the end of the membership training the specialist must be able to lead any complex

resuscitation through to disposal. He/she must be able to oversee the care for resuscitation

cases in parallel utilising resources optimally.

The Fellowship trainee will be able to work with others in a multidisciplinary team. It is

essential to deepen core clinical and medico-legal knowledge, and to maintain the standards

of medical practice. He/she will provide supervision and feedback for less experienced

clinicians. He/she will demonstrate the necessary leadership skills of authority and

assertiveness, and be good at communication with the team. He/she will improve skills at

gathering information, selecting and communicating options, and updating the team.

• Considers the department as a whole and works to build team effectiveness

• Able to provide support to the team on all clinical and medico-legal matters in the

workplace.

• Can motivate and support the team, supervise any member of the team

• Provide high level feedback on skills and behaviours.

• Can communicate expertly with patients, care- givers, colleagues outside agencies.

10. MANAGING THE CURRICULUM

The organisation of the Emergency Medicine training programme is the responsibility of the

Faculty of Emergency Medicine of the Ghana College of Surgeons.

The faculty of Emergency Medicine will coordinate local postgraduate medical training with

terms of reference as follows:

• Participate in national recruitment to residency training

• Oversee induction of trainees from primaries to membership and fellowship level

• Allocation of trainees to rotations

• Oversee the quality of training posts provided locally

• Ensure adequate provision of appropriate educational events

• Ensure trainees are moved to the latest version of the curriculum at the earliest

possible opportunity, meeting international medical standards

• Ensure curriculum implementation across training programmes

• Oversee workplace based assessment process within the training programme

• Coordinate the Annual Review of Competence Progression process for trainees

• Provide adequate and appropriate career advice

• Provide systems to identify and assist doctors with training difficulties

• Recognise the potential of specific trainees to progress into an academic career

• Educational programmes to train educational supervisors and assessors in

workplace based assessment will be delivered by Local Education and Training

Boards or their equivalent.

Oversight of the implementation of the curriculum is the responsibility of the Educational

Committee (EC) of the GCPS which consists of representatives from every Faculty. The

Educational Committee supervises and reviews all training posts, in accordance with the

faculty curriculum.

Trainees are represented at each level and are asked for curriculum feedback.

Curriculum changes will be communicated via the TSC to Chair and Training Programme

Directors of the Faculty.

The e-Log book allows the College to monitor progress of trainees ensuring proper

supervision and satisfactory progress.

INTENDED USE OF THE CURRICULUM BY TRAINERS AND TRAINEES

• The curriculum is a web-based document available from GCPS website. Access to

the e- Log book /e-portfolio is gained via the GCPS after acceptance into the

residency training program. It can also be accessed on the College website.

• The educational supervisors and trainees will be required to be up to date with the

curriculum and have a good knowledge of it.

• The curriculum.serves as a guide for the training programme and trainee discussions

as well as individual learning experiences.

• Learning centred on clinical experience alone will lead to uneven coverage of the

curriculum.

• Using the curriculum retrospectively simply as a check list as the exams

approach will helpfully identify deficiencies but will leave the trainee with very limited

time to learn of these conditions and probably little or no time to see patients with

these problems.

• Proactive use of the curriculum to confirm coverage and identify areas to be covered

ensures more thoughtful and less frenetic learning, making cases more valuable

learning experiences.

• The curriculum is also key to preparing and planning of tutorials and assessments for

Residents.

RECORDING PROGRESS IN THE GCPS RESIDENTS E-PORTFOLIO APP

On enrolling with the GCPS, trainees will be given access to the e-portfolio.

The e-portfolio allows evidence of training of Residents to be built up to inform decisions on

a trainee’s progress and provides tools to support the trainee’s education and development.

The trainee’s responsibilities are to:

Keep their e-portfolio up to date

Prepare drafts of appraisal forms

Maintain their personal development plan.

Record their reflections on learning and record their progress through the curriculum

The supervisor’s responsibilities are to:

• Use the e-portfolio/ e-Logbook evidence (assessment outcomes, reflections, and

PDPs) to inform appraisal meetings.

• Update the trainee’s progress through the curriculum

• Write end of attachment appraisals and supervisor’s reports

All appraisal meetings, personal development plans and workplace based assessments

should be recorded in the e-portfolio.

Trainees are encouraged to reflect on their learning experiences and record these in the e-

portfolio (these can be kept private or shared with the trainer).

Reflections, assessments and other e-portfolio content should be linked to the

curriculum competences in order to provide evidence towards acquisition of these

competences.

11. GLOSSARY OF ABBREVIATIONS

ABBREVIATION MEANING

EM Emergency Medicine

ED Emergency department

GCPS Ghana College of Physicians and Surgeons

MDCG Medical and Dental Council Ghana

DNAR Do Not Attempt Resuscitation

ENT Ear, Nose, and Throat

FAST (scan) Focused Assessment with Sonography in Trauma

GCS Glasgow Coma Score

ECG Electrocardiogram

MRI Magnetic Resonance Imaging

EP Emergency Physician

ILCOR International Liaison Committee on Resuscitation

Mini-CEX Mini Clinical Examination

CBD Case Based Discussion

OSCE Objective Structured Clinical Examination

MSF Multi Source Feedback

DOPS Direct Observation of Procedural Skills

TO Teaching Observation

EMS Emergency Medical Services

12. RECOMMENDED READING LIST

It is recommended that you spread out the generic curriculum reading /courses throughout

your training programme.

Try to read at least one recommended small textbook (e.g. Lecture Notes series) from the

clinical specialties during the time of the relevant clinical attachment.

Suggested textbooks:

Oxford Handbook of African Emergency Medicine

Oxford Handbook of Emergency Medicine

Lecture Notes on Emergency Medicine

Tintinalli’s Emergency Medicine

Rosen’s Emergency Medicine

Emergency Medicine Procedures, Second Edition

Wounds and Lacerations: Emergency Care and Closure (Expert Consult – Online and Print),

4e 4th (fourth) Edition by Trott MD, Alexander T. (2012)

Manual of Emergency Airway Management RM Walls

Cope’s Early Diagnosis of the Acute Abdomen (Silen, Early Diagnosis of the Acute

Abdomen)

Essential Emergency Trauma

Accident and Emergency Radiology: A Survival Guide, 3e N Raby

Practical Fracture Treatment, 5e R McRae

Bailey and Love’s Surgery

Davidson’s Principles and Practice of Medicine

Suggested web-based resources:

http://emcrit.org/

http://www.lifeinthefastlane.com/

http://www.uptodate.com

http://www.ncemi.org/

http://www.erpocketbooks.com/

http://www.sonoguide.com/introduction.html

http://www.ultrasoundpodcast.com/

Suggested Journals:

African Journal of Emergency Medicine

Annals of Emergency Medicine

Emergency Medicine Journal

Journal of Emergency Medicine

Academic Emergency Medicine

13. APPENDICES

LOG BOOK

Documents

Faculty of Emergency Medicine GCPS · 2018-11-26 · emergency medical care and within the province and expertise of almost all medical practitioners. Emergency Medicine has been