Certificate of Eligibility of

Specialist Registration (CESR)

Portfolio

Name:
GMC Number:
Contents:

Glossary

Introduction

Background

Format of CESR Application

Domain 1 – Knowledge, Skills and

Performance

Clinical Competency Frameworks

Domain 2 – Safety and Quality

Domain 3 – Communication, Partnership

and Teamwork

Domain 4 – Maintaining Trust

Glossary:
ACAT – Acute Care Assessment Tool
CbD – Case Based Discussion
CEM – College of Emergency Medicine
CESR – Certificate of Eligibility of Specialist
Registration CPD – Continuing Professional
Development

CTR – Clinical Topic Review

DOPS – Direct Observation of Procedural Skills

IAC – Initial assessment of competence (anaesthetics)
ICM – Intensive Care Medicine
MIMMS – Major Incident Medical Management and Support
Mini-CEX – Mini Clinical Evaluation
Exercise MSF – Multi Source Feedback
RCA – Root Cause Analysis
WBA’s – Work-Based Assessments (also called Work
placed based assessements (WPBA’s)
Introduction:
The Certificate of Eligibility of Specialist Registration
(CESR) is a means by which doctors who have not completed
an approved deanery training programme can be entered on
the Specialist Register. It is a competency-based process
where the trainee provides a portfolio of evidence that
demonstrates that their training, qualifications and experience
meet the requirements of the Emergency Medicine CCT
curriculum.
Successful completion of the CESR process results in entry
onto the Specialist Register and the doctor will then be able to
apply for Emergency Medicine Consultant posts in the
traditional way.
The process itself involves collation of a range of evidence
covering the four domains as set out by the GMC (covered in
more detail in the sections below). The evidence is then
reviewed by the GMC and the College of Emergency Medicine
CESR panel to ascertain whether there is sufficient evidence
for entry onto the Specialist Register.
Background:
Royal Derby Hospital Emergency Department has devised
tailor-made CESR rotations to facilitate all successful
applicants to our programme with the clinical and non- clinical
experience/skills required to apply for entry onto the Specialist
Register in Emergency Medicine and subsequent eligibility to
apply for a consultant post.
Each programme will run over approximately 4 years with each
year being loosely equivalent to traditional higher specialty
training (HST) years ST3-6, although this time frame can be
flexible to meet the individual needs of the CESR trainee. The
clinical secondments (Anaesthetics, ITU, Acute Medicine,
Paediatrics) will run in parallel with demonstration of the
required competencies. These are set out in the sections below
with clear guidance as to what is required in each domain.
The rotation will run in parallel with a specifically designed
teaching programme matching that of the FCEM curriculum.
There will also be focussed teaching on specific areas
including OSCE practice, Critical Appraisal teaching and mock
viva’s on both the CTR and management sections of the
FCEM examination. There will be opportunities for
collaborative learning and skills development with CESR-
training contemporaries across the Derbyshire region.
Each CESR trainee will be assigned a Consultant Educational
Supervisor who will provide support throughout the
programme. Once you have successfully completed the
portfolio and passed the FCEM examination your supervisor
will support your application with the GMC and CEM in respect
of entry onto the specialist register.
 Format of CESR Application

• Application checklist and form (completed

by candidate and validated by GMC prior to
CEM review)

• Structured Reports (These will be completed by

during your annual appraisal with your educational
supervisor.)

• Curriculum Vitae

• Domain 1 – Knowledge, Skills and Performance

• Domain 2 - Safety and Quality

• Domain 3 – Communication, Partnership

and Teamwork

• Domain 4 – Maintaining Trust

Domain 1 – Knowledge, Skills and
Performance

• Evidence of competencies in relevant

specialty areas:

o ACUTE MEDICINE
▪ 6/12 previous experience with
evidence (WBAs) of necessary skills
and experience OR
▪ 3/12 secondment during which all
WBA’s covering the Acute Medicine
mandatory presentations and
procedures are completed. (see page
13 for further details)

o ICM
▪ 3/12 previous experience as a trainee
with evidence (WBAs) of necessary
skills and experience AND a logbook
of the basic competencies in ICM as
set out by RCoA; OR
 ▪ 3/12 secondment during which all
WBA’s covering the mandatory
presentations and procedures must be
completed AND completion of a
logbook of basic competencies in ICM
as per RCoA. (see page 16/17)

o ANAESTHETICS:
▪ 3/12 previous experience as an
anaesthetic trainee including the
initial assessment of competence OR
▪ 3/12 secondment during which all
WBA’s covering the mandatory
presentations and procedures must be
completed AND completion of a
logbook of basic competencies in
Anaesthetics as per RCoA. (see page
14/15)

o PAEDIATRIC EM:
▪ 6/12 in previous Paediatric/ PEM
training post with WBA’s OR
▪ 3/12 secondment and WBAs for all
paediatric major and acute
presentations (see page 20/21)
• COMMON COMPETENCIES:
During your placements in EM you will need:
1. WBAs to cover the common
presentations, procedures and
competencies (or equivalent e-learning,
teaching or ACAT EM) (see pages 22-24)
2. A minimum of the following:
▪ 6 DOPS per year
▪ 12 mini CEX in 4 years
▪ 12 CbD in 4 years
▪ 6 ACAT-EM in 4 years
▪ 12 reflective cases in 4 years
▪ 2 MSF/ 360 appraisal in 4 years
3. You are encouraged to keep a logbook
of evidence (with anonymised patient
details) of a range of presentations,
diagnoses and any practical procedures
undertaken eg. chest drain insertion/ RSI

• ULTRASOUND:
Level 1 signed off + Log Book with 50+
cases OR completion of Level 1 Finishing
School.
• CPD: (evidenced via CEM eportfolio)
o Four years of records of CPD
(including a minimum of 50 CPD
points/ year)
o Evidence of regular (at least twice yearly)
appraisal with your educational
supervisor

• COURSES:
o Up-to-date certification in:
▪ ALS
▪ ATLS
▪ APLS (note that EPLS is not a
substitute for APLS)
▪ HMIMMS (not compulsory)
You need to be recommended as an instructor for
at least one of the above courses
• TEACHING AND TRAINING:
(you need to keep a record of evidence of all the
teaching you have attended and delivered)
o Completion of recognised teaching
courses (eg ALSG/ ATLS Instructor
Course) AND full Instructor Status for
one fo the above life support courses
o Training the Trainers Course
o Written feedback on teaching
delivered oEvidence of teaching at
multiple levels (including students,
juniors and peers)
o Presentations given
▪ You should aim to present at least one
trustwide meeting as well as at
regional and national forums such as
teaching/ conferences
o Evidence of providing feedback to others
(eg eportfolio tickets etc)
o Clinical and Educational Supervision
training leading to mentorship/
supervision of eg. foundation trainees
within the ED.
• RESEARCH:
o Successful completion of a CTR and CTR
Viva as part of the FCEM examination.
o Presentations of research at conference
o Publications

• EXAMS:
o You will be supported to work towards
completing the FCEM examination during
the final year of this programme. (Successful
completion of FCEM Examination will make
your application of entry onto the specialist
register a much more straightforward process)
 Annual Review of Competence Progression –Emergency Medicine

(It is expected that the trainee will work towards completion of the following over their time in EM and that progress will
be reviewed annually)

Yes Date No

Assessments (Mini CEX or CBD) by a CONSULTANT in 2 of the following 6 Major Presentations –

not to be duplicated with those covered elsewhere in the curriculum. (For full details see Section 6.1 of
ACCS Curriculum 2010) http://www.accsuk.org.uk/documents/accscurriculum2010.pdf

• CMP1 Anaphylaxis

• CMP2 Cardiorespiratory arrest

• CMP3 Major Trauma

• CMP4 Septic patient

• CMP5 Shocked patient

• CMP6 Unconscious patient

ALL 6 of these competencies should be completed across the entire
portfolio for completion of CESR Training.
Summative assessments (Mini CEX or CBD) by a consultant in each of the following 10
Acute/ Major Trauma Presentations. (Trainees should aim for 2-3 per year)

• CAP1 Abdominal Pain

• CAP6 Breathlessness

• CAP7 Chest Pain

• CAP18 Head Injury

• CAP30 Mental Health

• C3AP1a Major trauma - Chest injuries

• C3AP1b Major trauma - Abdominal trauma

• C3AP1c Major trauma – Spine

• C3AP1d Major trauma – Maxillofacial

• C3AP1e Major Trauma – Burns

Assessments by a consultant in at least 5 of the 38 Acute Presentations (see

page 24) using mini CEX, CBD or ACAT (see Section 6.2 of ACCS 2010
Curriculum for full details)
http://www.accsuk.org.uk/documents/accscurriculum2010.pdf

In addition to this a further 10 Acute Presentations covered by each of the following

assessment modalities:

• Teaching delivered

• Audit

• E-learning modules

• Reflective practice

• Additional WPBAs (including ACAT)

Practical procedures as DOPS in all of the following:

• Airway Maintenance

• Primary Survey

• Wound Care

• Fracture/Joint manipulation

• Any 1 other procedure from the list on page 27-29

At the completion of CESR Training, and across the whole portfolio,

assessments should have been completed for all 44 practical procedures
(see page 25-27)

At the completion of CESR Training, trainees should have

evidence of ALL 25 common competences (see page 28)

At the completion of CESR Training, the trainee should have

completed at least 4 MSFs – aim for 1 per year

ES name, signature & date Trainee name, signature & date

Note: Incomplete information will

 End of Placement Review of Competence Progression

Acute Medicine

Yes No

Assessments (Mini CEX or CBD) by a CONSULTANT in 2 of the following 6 Major Presentations –

not to be duplicated with those covered elsewhere in the curriculum: (For full details see Section 6.1 of
ACCS Curriculum 2010)

http://www.accsuk.org.uk/documents/accscurriculum2010.pdf

• CMP1 Anaphylaxis

• CMP2 Cardio-respiratory arrest

• CMP3 Major Trauma

• CMP4 Septic patient

• CMP5 Shocked patient

• CMP6 Unconscious patient

Formative assessments by a consultant in at least 10 of the 38 Acute Presentations (see page 24)
using mini CEX, CBD or ACAT (see Section 6.2 of ACCS 2010 Curriculum for full details)
http://www.accsuk.org.uk/documents/accscurriculum2010.pdf

8 -10 Acute Presentations covered by each of the following assessment modalities:

• Teaching delivered

• Audit

• E-learning modules

• Reflective practice

• Additional WPBAs
DOPs covering 5 of the following practical procedures, plus up to 5 additional practical
procedures from the list on page 25-27 – this should not be duplicated with procedures assessed
elsewhere in the curriculum. (See Section 7.0, ACCS Curriculum 2010 for full details)
http://www.accsuk.org.uk/documents/accscurriculum2010.pdf

Pleural tap & aspiration

Intercostal drain insertion (Seldinger)

Ascitic tap

Abdominal paracentesis
DC cardioversion

Knee aspiration

Temporary pacing (external / wire)

Lumbar puncture

ES name, signature & date Trainee name, signature & date

Note: Incomplete information will

 End of Placement Review of Competence Progression

Initial Anaesthetic Competencies

YES NO

Formative assessment of 5 Anaesthetic-CEX

• IAC A01 Preoperative assessment of a patient who is

scheduled for a routine operating list (non urgent or emergency)
• IAC A02 Manage anaesthesia for a patient who is not
intubated and is breathing spontaneously
• IAC A03 Administer Anaesthesia for laparotomy

• IAC A04 Rapid Sequence Induction

• IAC A05 Recovery of a patient from Anaesthesia

Formative assessment of 8 Specific Anaesthetic CbDs:

• IAC C01 Patient identification, operation and side of surgery

• IAC C02 Discuss how the need to minimise postoperative
nausea and vomiting influenced the conduct of the anaesthetic.

• IAC C03 Discuss airway assessment and how difficult

intubation can be predicted.
• IAC C04 Choice of muscle relaxants & induction agents

• IAC C05 Post op analgesia

• IAC C06 Post op oxygen therapy

• IAC C07 Emergency surgery - problems

Formative assessment of 6 further anaesthetic DOPS:

• IAC Basic and advanced life support

• IAC D01 Demonstrate function of anaesthetic machine

• IAC D02 Transfer and positioning of patient on operating table

• IAC D03 Demonstrate CPR on a manikin

• IAC D04 Technique of scrubbing up, gown & gloves

• IAC D05 Competencies for pain management including PCA

 • IAC D06 Demonstrate failed intubation drill on manikin
PLUS – WBPAs to confirm the Basis of Anaesthetic Practice

• A1 Pre-operative assessment - History taking

• A1 Pre-operative assessment – Clinical examination
• A1 Pre-operative assessment – Anaesthetic evaluation
• A2 Pre-medication

• A3 Induction of GA

• A4 Intra-operative care

• A5 Post-operative recovery

• B Management of the airway including in children

• Management of cardio-respiratory arrest

• Infection Control
And a minimum of one of the following modules – sedation, regional block,
emergency surgery, transfers

ES name, signature Trainee name, signature and date

Note: Incomplete information will be regarded as the relevant outcome having not been
achieved
 End of Placement Review of Competencies

Intensive Care Medicine

Trainees are advised to keep a logbook of their cases whilst working in ITU. A sample logbook as
recognised by the RCoA can be found at: http://www.accsuk.org.uk/icuhomefolder/icmlogbook.xls

Yes No

Formative assessments in 2 of the following Major Presentations (not to be duplicated from

elsewhere in the curriculum)

• CMP1 Anaphylaxis

• CMP2 Cardio-respiratory arrest

• CMP3 Major Trauma

• CMP4 Septic patient (ideally assessed in ICM)

• CMP5 Shocked patient

• CMP6 Unconscious patient

Formative assessment of 5 Acute Presentations as per page 18

Formative assessment of 13 Practical Procedures as DOPS, (Or Mini-CEX or CBD if

indicated) including:

• ICM 1 Peripheral venous cannulation

• ICM 2 Arterial cannulation

• ICM 3 ABG sampling & interpretation

• ICM 4 Central venous cannulation

• ICM 5 Connection to ventilator

• ICM 6 Safe use of drugs to facilitate mechanical ventilation

• ICM 7 Monitoring respiratory function

• ICM 8 Managing the patient fighting the ventilator

• ICM 9 Safe use of vasoactive drugs and electrolytes

• ICM 10 Fluid challenge in an acutely unwell patient (CBD)

• ICM 11 Accidental displacement ETT / tracheostomy

• Plus 2 other DOPS

 Paediatric Competencies
Trainee Name:

Summative assessment (Mini-CEX or CbD) of 3 of the 6 Major paediatric

presentations (or successfully complete APLS/EPLS):

• PMP1 - anaphylaxis
Completed at
• PMP2 - Apnoea, stridor and airway obstruction
least 3 of 6 or
• PMP3 - Cardiorespiratory arrest
APLS/EPLS
• PMP4 - Major trauma
• PMP5 - Shocked child Yes / No
• PMP6 - Unconscious child

Summative assessment (Mini-CEX or CbD) in ALL of the following acute presentations in

children:

• PAP1 - abdominal pain Completed all 4

• PAP5 - breathlessness
• PAP10 - Fever Yes / No
• PAP17 - child in pain

Formative assessment (ACAT-EM, Mini-CEX or CbD) in all of the following acute

presentations:

• PAP6 - Concerning presentations in children

Completed all 5
• PAP18 - Limb pain – non-traumatic
• PAP21 - Sore throat Yes / No
• PAP2 - Poisoning
• PAP20 - Rash

Remaining 10 acute presentations in children all sampled by successful completion of a

combination of the following:

• e-learning Completed all 10

• teaching and audit assessments
• self-reflective entries onto eportfolio Yes / No
• ACAT-EMs

Remaining Acute Conditions: PAP12 Gastro-intestinal bleeding

• PAP3 Acute life-threatening event (ALTE)
• PAP4 Blood disorders PAP13 Headache
PAP14 Neonatal presentations
• PAP7 Dehydration secondary to D&V
• PAP9 ENT PAP16 Ophthalmology
• PAP11 Floppy child PAP19 Painful limbs- traumatic

Formative assessment (DOPS) of all of the following 5 practical procedures:

• Venous access in children

Completed all 5
• Airway assessment and maintenance
• Demonstration of the safe use of paediatric Yes / No
equipment and guidelines in the resuscitation
room including the Resuscitaire.
• (Primary survey in an injured child
 • Safe sedation in children – these 2 competencies
may need to be undertaken during EM placement,
rather than whilst on paeds secondment)

Please detail any further WPAs (e.g. DOPS in addition to those specified above) – note NOT
mandatory:

Have at least 12 (in total) assessments been completed by a Yes / No

Consultant?

NB – as guidance trainees are expected to have seen 200 new cases (ward or CED) during the
post.

Clinical Supervisor (Consultant Paediatrician)

Name: Job Title:

GMC Number:

Email Address:

Signed: Date: / /

Educational Supervisor (Consultant in EM)

Name: Job Title:

GMC Number:

Email Address:

Signed: Date: / /

CESR Trainee

Name:

Signed: Date: / /
 Summary of Presentations, Procedures and Common
Competencies
Major Adult Presentations
➢ Anaphylaxis
➢ Cardio-respiratory arrest
➢ Major trauma
➢ Septic patient
➢ Shocked patient
➢ Unconscious patient

Acute Adult Presentations:

Abdominal Pain including loin pain (EM, Limb Pain & Swelling – Atraumatic (EM, AM)
AM)
Neck pain (EM)
Abdominal Swelling, Mass &
Constipation (EM, AM) Oliguric patient (EM, AM)

Acute Back Pain (EM) Pain Management (EM, AM)

Aggressive/disturbed behaviour (EM, Painful ear (EM)

AM) Blackout/Collapse (EM, AM) Palpitations (EM, AM)

Breathlessness (EM, AM) Pelvic pain (EM)

Chest Pain (EM, AM) Poisoning (EM, AM)

Rash (EM, AM)

Confusion, Acute/Delirium (EM, AM)

Cough (EM, AM) Red eye (EM)

Cyanosis (EM, AM) Suicidal ideation (EM)

Diarrhoea (EM, AM) Sore throat (EM)

Dizziness and Vertigo (EM, AM) Syncope and pre-syncope (EM, AM)

Falls (EM, AM) Traumatic limb and joint injuries

Fever (EM, AM) (EM) Vaginal bleeding (EM)

Fits / Seizure (EM, AM) Haematemesis & Ventilatory Support (EM, ICM)

Melaena (EM, AM) Headache (EM, AM) Vomiting and Nausea (EM, AM)

Head Injury (EM) Weakness and Paralysis (EM, AM)

Jaundice (EM, AM) Wound assessment and management (EM)

Practical Procedures - ADULT AM EM ICM Anaesthesia

1. Arterial cannulation

2. Peripheral venous
cannulation

3. Central venous
cannulation

4. Arterial blood gas

sampling

5. Lumbar puncture

6. Pleural tap and

aspiration

7. Intercostal drain
Seldinger

8. Intercostal drain - Open

9. Ascitic tap

10. Abdominal paracentesis

11. Airway protection

12. Basic and advanced life

support

13. DC Cardioversion

14. Knee aspiration

15. Temporary pacing

(external/ wire)

16. Reduction of
dislocation/ fracture

17. Large joint examination

18. Wound management

19. Trauma primary survey

20. Initial assessment of

the acutely unwell

21. Secondary assessment

 of the acutely unwell

22. Connection to a
mechanical ventilator

23. Safe use of drugs to

facilitate mechanical
ventilation

24. Managing the patient

fighting the ventilator

25. Monitoring Respiratory

function

Initial Assessment of Competence (IAC) - as listed below from Preoperative assessment to

Emergency surgery

26. Preoperative
assessment

27. Management of
spontaneously
breathing patient

28. Administer anaesthesia

for laparotomy

29. Demonstrate RSI

30. Recover patient from

anaesthesia

31. Demonstrates function of

anaesthetic machine

32. Transfer of patient to

operating table

33. Technique of scrubbing

up and donning gown
and gloves

34. Basic competences for

pain management

35. Patient Identification

36. Post op N&V

37. Airway assessment

38. Choice of muscle

relaxants and induction
 agents,

39. Post op analgesia

40. Post op oxygen therapy

41. Emergency surgery

42. Safe use of vasoactive

drugs and electrolytes

43. Delivers a fluid

challenge safely to an
acutely unwell patient

44. Describes actions

required for accidental
displacement of tracheal
tube or tracheostomy

45. Demonstrate CPR

resuscitation on a
manikin
 Common Competences:

• History taking
• Clinical examination
• Therapeutics and safe prescribing
• Time management and decision making
• Decision making and clinical reasoning
• The patient as central focus of care
• Prioritisation of patient safety in clinical practice
• Team working and patient safety
• Principles of quality and safety improvement
• Infection control
• Managing long term conditions and promoting patient self care

Relationships with patients and communication within a consultation

• Breaking bad news

• Complaints and medical error
• Communication with colleagues and cooperation
• Health promotion and public health
• Principles of medical ethics and confidentiality
• Valid consent
• Legal framework for practice
• Ethical research
• Evidence and guidelines
• Audit
• Teaching and training
• Personal behaviour
• Management and NHS structure
Domain 2 – Safety and Quality

• Audit:
o Involvement in at least one audit
per year over the four years
o Aim to fully complete at least one
audit cycle

• Show evidence of working to improve

patient care and safety in at least 3 of the
following:
o Audit
o Service Improvement Project
o Responding to appraisals
o Performance reviews
o Risk management
o Clinical governance procedures
o Submission of, or response to an IR1
o Risk meetings
o Mortality and morbidity meetings

29
 • Service Development:
o Examples may include:
▪ Introduction of new guidelines
▪ Develop new pathways
▪ Introduce new equipment

• Clinical Governance:
o Complaints: responses (anonymised)
o Serious Incidents:
investigations including RCA’s
and action plans

• Health and Safety:

oTrust Induction
oAnnual updates

30
Domain 3 – Communication,
Partnership and Teamwork

• Communication with patients:

o Compliments
o Thank you’s

• Management/Teamworking:
o Examples may include:
▪ Evidence of chairing meeting
▪ Leading project groups
▪ Evidence of project management

• Relations with Colleagues:

o Examples may include:
▪ Letters of appreciation
from colleagues
▪ Emails
▪ Other documentation of
good relationships

31
Domain 4 – Maintaining Trust

This domain is designed to show evidence

of acting with honesty and integrity
The majority of the evidence for this is obtained
as below:

• Evidenced from structured references

• Conflict resolution or other relevant courses

32
Appendix A: Useful Links

There are useful links on various websites including the

College of Emergency Medicine and the GMC.

Most of the requirements should be contained clearly within

the portfolio but the most useful links as an adjunct to this are
the following:

• College of Emergency Medicine website:

o Training and Exams - Work Place Based Assessment
o Training and Exams - Work Place Based Assessment
– SAS Doctors

o Training and Exams - Equivalence

• GMC website:
o Type “CESR” into search words

33
Appendix B: Case Based Discussion (CBD)

The Case-based Discussion (CbD) is a structured

interview designed to assess your professional
judgement in clinical cases

The discussion is framed around the actual case rather

than hypothetical events. Questions should be designed
to elicit evidence of competence: the discussion should
not shift into a test of knowledge.

The Consultant will aim to cover as many relevant

competences as possible in the time available. It’s
unrealistic to expect all competences to be covered in a
single CbD, but if there are too few you won’t have
sufficient evidence of progress.

34
 College of Emergency Medicine

Summative Case Based Discussion

Trainee name: CbD

GMC assessor
Assessor:
No:
Grade of assessor: Date / /
Case discussed (brief description) Presentation – please see curriculum for number

Unsuccessful

Not observed
Successful
Expected behaviours

Record keeping Records should be legible and signed. Should

be structured and include provisional and
differential diagnoses and initial investigation
& management plan. Should record results
and treatments given.

Review of investigations Undertook appropriate investigations.

Results are recorded and correctly
interpreted. Any Imaging should be
reviewed in the light of the trainees
interpretation

Diagnosis The correct diagnosis was achieved with

an appropriate differential diagnosis. Were
any important conditions omitted?

Treatment Emergency treatment was correct and

response recorded. Subsequent treatments
appropriate and comprehensive

Planning for subsequent care (in Clear plan demonstrating expected clinical
patient or discharged patients) course, recognition of and planning for
possible complications and instructions to
patient (if appropriate)

Clinical reasoning Able to integrate the history, examination and

investigative data to arrive at a logical
diagnosis and appropriate treatment plan
taking into account the patients co
morbidities and social circumstances

Patient safety issues Able to recognise effects of systems,

process, environment and staffing on
patient safety issues

35
 Overall clinical care The case records and the trainees discussion
should demonstrate that this episode of
clinical care was conducted in accordance
with good clinical practice and to a good
overall standard

Overall Successful
Unsuccessf
ul
If more than two “not observed” then
unsuccessful

Things done particularly well

Learning points

Action points

Assessor Signature: Trainee Signature:

36
 College of Emergency Medicine

Formative Case Based Discussion CbD

Trainee name:

GMC
Assessor: assessor
No:
Grade of assessor: Date / /

Case discussed (brief description) Presentation – please see curriculum for number

Demonstrates good practice

Further core Should Demonstrates

Please TICK to indicate learning Must address excellent
the standard of the address
Not observed needed learning practice
trainee’s performance in learning
points
each area points
highlighted
highlighted
below
below

Record keeping

Review of investigations

Diagnosis

Treatment

Planning for subsequent care

(in patient or discharged
patients)
Clinical reasoning

Patient safety issues

Overall clinical care

37
Things done particularly well

Learning points

Action points

Assessor Signature: Trainee Signature:

38
Appendix C: Directly Observed
Procedural Skills (DOPS)

A DOPS is a structured checklist for assessing both

the patient interaction and the ability of the doctor to
perform the procedure in question
The process is lead by the trainee
Each DOPS should represent a different procedure
unless the trainee feels they need additional
training/support with a particular area
The DOPS should be matched to the practical
procedures required by the College of Emergency
Medicine (see Appendix E)

39
 College of Emergency Medicine
Direct Observation of procedural Skills -
DOPs
Trainee name:

Assessor
Assessor: GMC No:

Grade of assessor: Date / /

Procedure observed (including indications)

Demonstrates good
practice
Further
Please TICK to indicate core Demonstrates excellent
Not Must Should
the standard of the learning practice
observed address address
trainee’s performance in needed
learning learning
each area points points
highlighted highlighted
below below

Indication for procedure

discussed with assessor

Obtaining informed consent

Appropriate preparation
including monitoring, analgesia
and sedation

Technical skills and

aseptic technique

Situation awareness and

clinical judgement

Safety, including prevention

and management of
complications

Care /investigations
immediately post procedure

40
Professionalism,
communication and
consideration for patient,
relatives and staff

Documentation in the notes

Completed task appropriately

Things done particularly well

Learning points

Action points

Assessor Signature: Trainee Signature:

41
Appendix D: Mini-Clinical
Evaluation Exercise (Mini-CEX)

A Mini-CEX is a structured assessment of an

observed clinical encounter
It is a “snapshot” designed to provide feedback on
skills essential to the provision of good patient care
The process is led by the trainee who usually
chooses the clinical encounter which should be
representative of their workload

42
 College of Emergency Medicine
Summative Mini-Clinical Evaluation Exercise - Mini-CEX
Trainee name:

Assessor
Assessor:
GMC no.

Grade of assessor: Date / /

Case discussed (brief description)

Presentation – please see curriculum for number

Descriptors of poor performance Successful uns

s

Initial approach

History and information

• History taking was not focused
gathering
• Did not recognise the critical symptoms, symptom patterns
• Failed to gather all the important information from the patient,
missing important points
• Did not engage with the patient
• Was unable to elicit the history in difficult circumstances- busy, noisy,
multiple demands
Examination
• Failed to detect /elicit and interpret important physical signs
• Did not maintain dignity and privacy

Investigation
• Was not discriminatory in the use of diagnostic tests

Clinical decision making

• Did not identify the most likely diagnosis in a given situation
and judgment
• Did not construct a comprehensive and likely differential diagnosis
• Did not correctly identify those who need admission and those who
can be safely discharged.
• Did not recognise atypical presentation
• Did not recognise the urgency of the case

43
 • Did not select the most effective treatments
• Did not make decisions in a timely fashion
• Decisions did not reflect clear understanding of underlying principles
• Did not reassess the patient
• Did not anticipate interventions and slow to respond
• Did not review effect of interventions
Communication with
Communication skills with colleagues
patient, relatives, staff
• Did not listen to other views
• Did not discuss issues with the team
• Failed to follow the lead of others when appropriate
• Rude to colleagues
• Did not give clear and timely instructions
• Inconsiderate of the rest of the team
• Was not clear in referral process- was it for opinion, advice, or
admission
Communication with patients
• Did not elicit the concerns of the patient, their understanding of their
illness and what they expect
• Did not inform and educate patients/carers
• Did not encourage patient involvement/ partnership in decision
making
• Did not respect confidentiality
• Did not protect the patient’s dignity
• Insensitive to patient’s opinions/hopes/fears
• Did not explain plan and risks in a way the patient could understand

Was slow to progress the case

Overall plan

• Did not ensure patient was in a safe monitored environment

Professionalism • Did not anticipate or recognise complications
• Did not focus sufficiently on safe practice
• Did not follow published standards guidelines or protocols
• Did not follow infection control measures
44 • Did not safely prescribe
Overall Successful

Unsuccessful (this outcome if any one criteria unsuccessful

Things done particularly well

Learning points

Action points

Assessor Signature: Trainee Signature:

45
Appendix E: Multi-Source Feedback (MSF)

The Multi-Source Feedback (MSF) tool is used to collect

colleagues’ opinions on your clinical performance and
professional behaviour.
It provides data for reflection on your performance and
self-evaluation.

Conducting the MSF

Provide respondents a letter explaining the MSF process

and giving the closing date (assistance is usually obtained
through the revalidation/workforce team – ask your
mentor for advice). Make sure your Consultant supervisor
knows which colleagues you’ve asked to take part.

Using a variety of respondents

It’s good practice to get opinions from as many different

colleagues as possible.

Using MSF feedback

Your Consultant supervisor will have access to the

anonymised results once the MSF closes.

You’ll then have a feedback interview (usually timed with

an appraisal) and an opportunity to reflect on the results.

46
 COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)

This form is completely anonymous.

Trainee name:

Grade of Date / /
assessor:
UNKNOWN 1 2 3 4 5
Performance Performance Performance Performance Exceeds Performance
Not Observed Does Not Meet Partially Meets Meets Expectations Consistently
Expectations Expectations Expectations Exceeds
Expectations

Good Clinical Care 1-5 or UK Comments

1 Medical knowledge and clinical skills
2 Problem-solving skills
3 Note-keeping – clarity; legibility and completeness
4 Emergency Care skills
Comments on this doctors clinical care

Relationships with Patients 1-5 or UK

1 Empathy and sensitivity
2 Communicates well with all patient groups
3 Treats patients and relatives with respect
4 Appreciates the pyscho-social aspects of patient care
5 Offers explanations
Comments on this doctors relationships with patients

Relationships with Colleagues 1-5 or UK

1 Is a team-player
2 Asks for others’ point of view and advice
3 Encourages discussion Empathy and sensitivity
4 Is clear and precise with instructions
5 Treats colleagues with respect
6 Communicates well (incl. non-vernal communication)
7 Is reliable
8 Can lead a team well
9 Takes responsibility
10 “I like working with this doctor”
Comments on this doctors relationships with colleagues

47
 Teaching and Training 1-5 or UK
1 Teaching is structur ed
2 Is enthusiastic about teaching
3 This doctor’s teachi ng sessions are beneficial
4 Teaching is present ed well
5 Uses varied teachin g skills
Comments on this doctors teaching and training skills

Global ratings and concerns 1-5 or UK

1 Overall how do you rate this Dr compared to other ST1
Drs

2 How would you ra te this trainees performance at this

stage of training
3 Do you have any concerns over this Drs probity or
health?
General comments

48
Appendix F: Practical Procedures

The College of Emergency Medicine provides an

extensive list of required procedures – these are
summarised and tabulated earlier in the portfolio.
These should be linked to the evidence provided in
the form of Directly Observed Procedural Skills
(DOPS)

49
Appendix G: CEM Teaching Observation Tool

Providing evidence of the type and quality of teaching

(including feedback) is a significant part of the CESR process
Feedback should be sought, wherever possible, from all
teaching provided and this evidence retained in your portfolio
Overleaf is a Teaching Observation Tool provided by the
College of Emergency Medicine which should be used as the
basis for obtaining feedback
 College of Emergency Medicine
Teaching observation tool
Trainee name:

Assessor
Assessor:
GMC no.

Grade of assessor: Consultant, SASG, ST4-6 Date / /

Learner group Setting

Number of learners Less than 5, 5-15, 16-30, more than 30

Length of session

Title of session

Brief description of session

Demonstrates good practice

Please TICK to indicate the Further core Demonstrates
standard of the trainee’s Not observed learning needed excellent practice
Must address Should address
performance in each area learning points learning points
highlighted below highlighted below

Introduction of self

Gained attention of group

Gave learning expected

learning outcomes

Key points emphasised

Good knowledge of subject

Logical sequence

Well paced

Clear concise delivery

Good use of tone/voice

Resources supported the topic

Varied the activity

Involved the group –

participation ,
Effective use of questioning

Appropriate use of teaching

methods

Appropriate use of assessment

techniques

Used mini-summaries

Encouraged questions from

group

Dealt with questions

appropriately

Summarised key points at end

Met learning outcomes

Kept to time limit

Overall performance

Things done particularly well

Learning points
Appendix H: CEM Audit Assessment Tool
Evidence of participation in audit is a required component of
the CESR process
Below is an Audit Assessment Tool provided by the College of
Emergency Medicine. This should act as the basis from which
evidence of participation in audit is recorded in your portfolio.
 College of Emergency Medicine
Audit assessment tool
Trainee name:

Assessor
Assessor:
GMC no.

Grade of assessor: Look up table – Consultant, SASG, ST4-6 Date / /

Basis of assessment LUT – presentation, report, both

Title of audit with brief description

CEM Audit? Yes/no

Demonstrates good practice

Please TICK to indicate the Further core Demonstrates
standard of the trainee’s Not observed learning needed excellent practice
Must address Should address
performance in each area learning points learning points
highlighted below highlighted below

Audit topic

Standard chosen

Audit methodology

Results and interpretation

Conclusions

Recommendations made as a result

Plan for implementation of change

Actions undertaken to implement change

Overall performance

Things done particularly well

Learning points
 Descriptors

Rating Description
Below expected standard Significant guidance required throughout audit process, inappropriate
topic or poor methodology resulting in inappropriate conclusions of
limited practical use. Inadequate consideration of future direction of
audit. No consideration of how to implement change

Expected standard of clinical audit Limited guidance required throughout audit process. Sound audit
methodology in a relevant topic, resulting in conclusions with practical
clinical importance. Plans for future direction of audit highlighted and
clear achievable plans outlined to implement change

Exemplary standard of clinical audit Audit topic related to an important clinical topic, detailed and
exhaustive methodology applied, resulting in conclusions with
significant clinical importance. Plans for future direction of audit
highlighted and evidence of action taken to implement change.