Finding the Balance
in Advanced Practice





16th November 2021
Author: Helen Lees
Editor: Rasheed K M, Reviewer: Diego Olmo-Ferrer
Next Review date 15/11/2022





Advanced Clinical Practitioners bridge the gap between Nurses & Allied Health Professionals and Medical Teams.


The balance between the demands of Advanced Clinical Practice and the constant need to learn & update requires educational strategies aimed to answer the question:

So how do we create an equilibrium between Knowledge and skills to create safe & autonomous practice underpinned by the four pillars of advanced practice?





Weekly Teaching Sessions

Two hours of Consultant supervised, ACP led, teaching sessions following a monthly topic which is applied to ACP’s and Trainees of all grades. Sessions are recorded & shared on the intranet with the wider Team.


Core & Specialty sessions

Fellow ACPs & guest speakers undertake teaching to ensure up-to-date knowledge and clinical practice focussing on various aspects like:

Anatomy & Physiology

Literature Reviews

Guideline & Practice Reviews

Specialty Teaching by Consultants and Specialist practitioners.


Case reviews and discussions

ACPs present unusual and challenging cases which are then discussed within the group allowing any learning to be applied to more common cases. These are supplemented by a Departmental teaching WhatsApp Group facilitated by one of the Consultants.


Simulation

To enhance learning and achieve RCEM competencies that are rarely seen in practice. The use of anatomical mannequins allows the practice of procedures applicable to the area of clinical practice. Formal simulation sessions are supplemented with FLASH (in-situ sim sessions) & Inter-Professional Learning sessions.


Departmental Simulation Sessions

Inter-professional Simulation is one of the education styles employed for better teamwork in an increasingly pressured clinical area.


FLASH

10 –15 minutes unannounced case-based in-situ simulation sessions are undertaken in different areas of the department.


Inter-Professional Learning

Multimodal sessions involving representatives from each grade across the ED Team. By crossing the clinical divide ACPs are able to not only learn but also support others by translating different perspectives and priorities.


Journal Club

Journal Clubs support evidence-based care and the exploration of existing and new concepts.


ACP journal clubs

Run-on a monthly basis. Individual ACPs choose and review papers on a rotational basis. Subjects follow the education plan for weekly teaching. Again these are recorded and stored on the intranet for asynchronous learning or future review of discussions.


Departmental Journal clubs

ACPs are also involved within the regular Inter-Professional Journal club in the department.


Regional Journal Club

Facilitated by Emergency Medicine Trainees within the East of England Deanery.


Accreditation Processes

With no specific registration or recording of the role by governing bodies, accreditation processes aim to provide evidence that ACPs are working at a higher level than their initial registration may suggest.


Royal College of Emergency Medicine

For ACPs working in emergency care settings, RCEM has developed a specific curriculum that allows the ACP to credential with the College. The curriculum is based on that for ST3 level Emergency Medicine trainees prior to 2021 (the medical curriculum has recently been updated). Details can be found at: https://rcem.ac.uk/wp-content/uploads/2021/10/EC_ACP_Curriculum_2017


Local Processes

For those working outside the ED, or in Departments that do not use the RCEM curriculum, many Trusts have developed their own processes. Some are skills-based whereas others are based on the development of leadership, research, and educational roles besides clinical knowledge and skills.


Other Activities

As ACPs our role is diverse, drawing on education, research, leadership & clinical skills, as such we are expected to undertake activities to assist in the safe provision of care in our areas of practice.


Any of the following activities should also be viewed as learning opportunities:

Audit & Research

Clinical Governance

Morbidity & Mortality Reviews

Evidence & guideline Reviews

Quality Improvement Projects


Professional development is not finite. We should accept any opportunity to extend skills, knowledge, and roles through reflection and education.