ACCIDENT AND MEDICAL PRACTISE, VOCATIONALL MEDICAL INTERIM

1/B58
Effective 17 February 2010

1.0PREAMBLE

This specification outlines the requirements for a provider to be considered for Health Workforce New Zealand funding for training in Accident and Medical Practice. The training programme will meet all requirements of the Accident and Medical Practitioners’ Association (AMPA), detailed in ‘Trainee Accreditation Handbook’.

This training leads to Fellowship of the Accident and Medical Practitioners Association (FAMPA). The Accident and Medical training programme is based on a four year clinical and academic curriculum.

The milestone year of training incorporates the Accident and Medical Care Programme which prepares registrants for the Part 1 exam (AMPEX).

The Part II Exam is a University Diploma currently run as a distance learning programme run by the University of Auckland (Goodfellow Unit). The convenor holds a FAMPA. There are AMPA representatives on the Diploma Board of Censors. Following successful completion of this programme, the Accident and Medical Practitioner will qualify to apply for vocational registration in Accident and Medical Practice. This branch of medicine is recognised by the Medical Council.

In this specification, the term ‘trainee’ means a registrar in training as defined in Section 3.1 Trainee Eligibility for HWNZ Funding.

2.0DESCRIPTION OF SERVICE

Accident and Medical Practice is defined by the Medical Council as the branch of medicine that involves the assessment and treatment, on a non-appointment basis, of patients requiring urgent attention, but does not involve the provision of continuing care or making arrangement for such care.

Training in this branch of medicine is of four years duration. Entry into the Accident & Medical Training Programme requires trainees to have a general medical registration and at least two years of medical experience in a variety of posts. Training occurs in AMPA approved clinics and emergency departments and in supervised teaching programmes.

The overall objective of training is to develop professional medical competence in Accident and Medical practice. Learning is facilitated through interactions with patients and medical and other health professionals, supervised clinical practice, attendance at a formal teaching programme, attendance at peer review meetings, and other continuing medical education activities, by teaching others, by training in research practice and methodology and by reading books and journals.

The Convenor of AMPA’s Education Committee has oversight of all trainees in the Accident and Medical Training Programme.

This Programme Convenor works with three AMPA Committees - the Board of Censors, the Education Committee, and the Professional Standards Committee. These Committees, in conjunction with the AMPA executive, are responsible for the assessment of the vocational registration status of trainees, training programmes, quality control, examinations, disciplinary action and competence reviews.

There are two formal examinations: AMPEX (Part 1) and the Diploma of Community Emergency Medicine (Part 2).

A basic trainee is a trainee who has yet to complete 1000 hours of approved clinical time with an onsite supervisor and has yet to pass AMPEX. Completion of these criteria progresses a trainee to advanced trainee status.

2.1LEARNING ENVIRONMENT

Part 1 – A & M Care Programme

Training is based on participation in a one year programme via distance learning plus a 16 hour Advanced Cardiac Life Support (ACLS) weekendand a Practical Skills weekend.

The training programme must comply with, and maintain Medical Council of New Zealand approval.

The training programme will equip trainees with the knowledge, skills and attitude necessary to provide accident and medical care independently in community clinics and also in hospital Emergency Departments (EDs) with the oversight of an emergency medicine specialist. Where a District Health Board-based trainee undertakes an Emergency Department rotation funded by HWNZ, the training must comply with the requirements of vocational training in Emergency Medicine as described in Specification 1/B4 (except sections 1.0, 2.0, 2.1.1 (Specific Requirements), 2.1.2 (Specific Requirements), 3.1, 6.0 and 6.1).

Training can be carried out in AMPA-approved Accident and Emergency clinics and AMPA-approved District Health Board facilities.

Learning takes place in a variety of settings:

  • Rural and public hospital ED departments
  • Community Accident and Medical Clinics
  • Formal teaching at the Medical School and Distance Learning
  • Weekend workshops
  • Continuing education activities
  • Peer review Groups
  • Self-directed individual study.

2.1.1 Clinical Placements

(i)General requirements

The content of training experienced in any clinical placements is in accordance with the current AMPA approved advertised Training Programmes, so that the trainee, over a period of four years, gains the clinical knowledge and experience required to pass the primary and secondary examinations.

Learning takes place in:

  • AMPA-approved Level 2 Accident and Medical Clinics
  • AMPA-approved Emergency departments in city and rural areas
  • AMPA-approved District Health Board facilities

Trainees will be released from clinical duties to attend formal learning programmes.

The focus is to:

  • Ensure that the trainee can recognise, assess and provide initial management of acute conditions to a level of competence that ensures acceptable safe practice by a trainee when they commence independent practice in an Accident and Medical Environment.
  • Prepare each trainee to successfully complete both exams leading to full vocational registration in Accident and Medical Practice.

(ii)Specific requirements for trainees

Trainees spend four years in a range of approved training posts. All trainees and their supervisors receive and agree on specific educational objectives for each individual placement. Evaluation of the placement and assessment of trainees’ progress are measured against these objectives. Trainees will spend time and placement in ED departments of hospitals and community accident and medical approved level 2 facilities.

The breakdown of these hours is as follows:

YEAR 1 (Milestone Year)

Trainee Educational Learning Hours

  • Distance learning videos (40 x 2.5 hours)100 hours
  • Advanced Cardiac Life Support weekend 16 hours
  • Practical Skills weekend 16 hours
  • Research and preparation of Clinical Case studies 50 hours
  • Programme Material – self directed study100 hours
  • Peer review groups (min 5, aver. 2 hours each) 10 hours
  • Exam preparation (self directed)100 hours
  • Attendance AMPEX exams 8 hours

Trainee Educational hoursTOTAL = 400 hours

Trainee Clinical Working Hours

Treating patients and observing teachers and supervisors and other vocationally registered team members.

Trainee Clinical Working hoursTOTAL = 400 hours

Supervisors Hours

Local Supervisor

  • Direct supervision of trainee’s clinical work of 10 hours per week

460 hours

  • Direct supervision of trainee educational time 1 hour per week

46 hours

Local SupervisorTOTAL = 506 hours

Regional supervisor

  • Direct supervision of clinical work nil
  • Direct supervision of trainee educational time of 2 hours every 3

months 8 hours

Regional SupervisorTOTAL = 8 hours

Total Supervision time per trainee is 514 hours per annum

YEAR 2

Trainee Educational Learning Hours

  • Advanced Cardiac Life Support weekend 4 hours
  • Audit activity 20 hours
  • Peer review group / Continuing Medical Education (CME)

minimum 20 hours

Trainee Clinical Working Hours

  • Clinical practice400 hours

YEAR 3

Trainee Educational Learning Hours

  • Advanced Cardiac Life Support Refresher 4 hours
  • Audit activity 20 hours
  • Peer review group / CME minimum 20 hours
  • PG Diploma of Community Emergency Medicine (DipCEM)
  • Clinical 384 hours
  • Attendance at specialist clinics 50 hours
  • Study 700 hours
  • Formal lectures 16 hours

Trainee Clinical Working Hours

Clinical time treating400 hours

YEAR 4

Trainee Educational Learning Hours

  • Advanced Cardiac Life Support Refresher 4 hours
  • Audit activity 20 hours
  • Peer review group / CME minimum 20 hours
  • PG Diploma of Community Emergency Medicine
  • Clinical 384 hours
  • Attendance at specialist clinics 112 hours
  • Study 500 hours
  • Formal lectures 16 hours

Trainee Clinical Working Hours

Clinical time treating patients400 hours

2.1.2Formal Teaching Programme

(i)General Requirements

The content of the formal teaching programme is in accordance with the current AMPA Training programme, ‘Trainee Accreditation Handbook’.

The trainee is released from clinical duties in the milestone year to attend peer review groups, workshops and seminars and formal teaching.

In addition trainees should undertake study and self-directed learning, including attendance at clinical meetings and other education activities provided by the employer for the benefit of all staff.

(ii)Specific Requirements

In the year leading up to both the primary (AMPEX) and fellowship (DipCEM) examinations, an additional period of approximately two hours per week of specific examination preparation is also required.

Primary examination preparation occurs in year 1 of training. Fellowship examination preparation occurs for examination in year 3/4 of training.

2.1.3Access to Resources

Resources for training include:-

  • Facilities for teaching in a clinical setting.
  • Facilities for meetings, case discussion and group teaching sessions.
  • Access to a library containing recognised texts and a relevant range of current journals.
  • Audiovisual resources

2.2SUPERVISION

The trainee and supervisor must meet for one hour at least six times each year. For each year the trainee and supervisor must discuss the trainee’s personal aims and objectives, and list the particular skills to be learnt. The supervisor will complete the AMPA assessment report.

A basic trainee must work with a supervisor at least 6 hours per week. A supervisor must be on site while a basic trainee is undertaking clinical work. Supervision from an offsite supervisor may be approved by AMPA.

An advanced trainee does not require supervision once they have completed the ACLS course.

In a hospital ED department supervision will be provided by a FACEM or a Senior Clinician, nominated by the national supervisory committee or AMPA Education Committee, to provide clinical supervision of a trainee.

2.3PROGRAMME CO-ORDINATION

The duties of the Education Committee in relation to the training programme are:

  • To assist with interviewing and selecting applicants.
  • To provide information regarding the content of the training programme to potential trainees.
  • To assist with training of supervisors.
  • To liaise with and advise supervisors regarding trainee progress and any concerns with individual trainees.
  • To provide an extra level of expertise to assist both trainees and supervisors in addressing areas of concern.
  • To advise AMPA of any changes to supervisors or serious concerns expressed at any level about a trainee.
  • To meet every 3 months and issue an annual report on the trainee together with a recommendation on whether to pass into the next year of training.

2.4EXPECTED OUTCOMES

The final outcome of the training is Fellowship of the Accident and Medical Practitioners Association (FAMPA).

The intermediary outcomes are:

  • Success in the Primary Examination of AMPEX, within the first or second year of training. This is required before progression to advanced trainee status.
  • Success in the Diploma of Community Emergency Medicine examination, taken in the third or fourth year of training.
  • Four full-time equivalent (FTE) years of accredited training approved by the AMPA Board of Censors.
  • Satisfactory supervisors’ reports.

3.0ELIGIBILITY

3.1TRAINEE ELIGIBILITY FOR HWNZ FUNDING

To be eligible for HWNZ funding trainees must:

  • Be accepted by AMPA into the training programme; and
  • Be a New Zealand Citizen or hold a New Zealand residency permit
  • Have been in the programme no longer than 2 FTEyears beyond the approved programme length of four years.

Medical graduates who do not meet the above criteria may be considered on a case-by-case basis.

Entry into the training programme requires:

  • Credentialing of the trainee by AMPA.

3.2PROVIDER ELIGIBILITY

All training posts must be approved by AMPA. The Regional supervisor can initiate an inspection of any training site at any time.

4.0LOCATION AND SETTING

Training takes place in AMPA Board of Censor and Education Committee-approved level 2 facilities and AMPA-approved emergency departments.

5.0ASSOCIATED LINKAGES

The provider has established linkages with:

  • The Medical Council of New Zealand
  • Level 2 clinics and Hospital Emergency departments throughout New Zealand
  • Goodfellow Unit – Auckland University
  • Accident Compensation Corporation – Close liaison over 5 years developing formal standards for Accident and Medical Clinics (NZS 8151:2001)
  • Schools of Medicine
  • Australasian College of Emergency Medicine
  • Other relevant advanced medical training programmes.
  • Other provider-based continuing education programmes.
  • Other providers of emergency medicine training.

6.0PURCHASE UNITAND REPORTING UNIT

6.1PURCHASE UNIT

  • An eligible full-time equivalent trainee, (trainees working and training for a period of 46 weeks per annum during the milestone year of training) in AMPA-approvedtraining facilities.
  • Part-time trainees - Funding will be provided on pro rata FTE basis to a minimum of 0.5 FTE.
  • Purchase Unit:
  • CTM63AM A & M Practice

6.2REPORTING UNIT

  • An eligible trainee listed in Report 1 (refer to Head of Agreement).

7.0QUALITY STANDARDS: PROGRAMME SPECIFIC

This section will be read in conjunction with Schedule 1 Part 3 of the HWNZ Head Agreement, which specifies generic quality standards for all programmes provided under the contract.

7.1LEARNING ENVIRONMENT QUALITY STANDARDS

Reports as described in Schedule 1 Part 1 of the HWNZ Head Agreement require a summary of the programme. Schedule 1 Part 3 of the HWNZ Head Agreement requires that providers have a quality plan in place for the ongoing monitoring of the training provided. The summary should refer specifically to the outcomes of this internal quality management.

1/B58, Version 1, Accident and Medical Practice, effective 17 February 2010 1