Unless granted an exemption for some or all of the skills, all registrars are required to have their skills assessed, and competence confirmed, before the exit interview and achieving Fellowship. This is done by completing the Core Skills Lists (CSL).
RNZCUC identified 38 separate skills and procedures that urgent care doctors should be competent in performing. Each of the skills and procedures has an associated set of sub-skills.
Each CSL describes the required level of competence for that skill for an urgent care doctor working in an urgent care clinic or emergency department. Many include expert techniques and pathognomonic signs which are specific to certain diseases or pathological processes, aiding the doctor on the diagnosis and/or disposition of the patient.
The 38 core skills DO NOT include those taught and assessed on compulsory courses (Trauma, PALS/APLS, Communications, resuscitation).
The CSL, individually or in one booklet, are available for download.
Registrars have options for sign off. They may ask their supervisor, other urgent care Fellows or relevant specialists (e.g orthopaedic surgeon for knee examination), attend the SDAW for some skills, or in some cases a senior nurse. Some core skills can be signed off at an urgent care fracture or soft tissue clinic. If the registrar would like to attend a DHB or private clinic in radiology, ENT, Ophthalmology, plastics, or orthopaedics, then the College would offer a letter of support.
On completion, the pages should be scanned and sent to the office (firstname.lastname@example.org). Please retain the completed and signed pages.
The College recognises that not all core skills can be physically demonstrated on a patient. This is because it may not be possible to complete them in person as the condition does not occur frequently enough and/ or it is not safe to perform this skill outside an emergency department. Some skills may also be discussed rather than performed due to privacy and consent issues.
Sign-off instructions for specific cases:
- Knee arthrocentesis – It can be performed under the direct supervision of the experienced supervisor with the patient consent for the right conditions, i.e. diagnostic aspiration for gout, synovitis and others. If concerned about septic arthritis and no immediate lab to test the aspiration, don’t do it and refer the patient to the hospital.
- Male catheter – This may be required to be performed on a dummy, given the infrequent nature of catheterisation in an Urgent Care Clinic or explain to the supervisor the steps the trainee will undertake to do the procedure.
- Nailbed injuries – It may be more appropriate to discuss, rather than perform, a nailbed repair. However, this is an important skill for an urgent care doctor to acquire, so it would be expected that the registrar demonstrates it on a dummy or ‘fake’ finger or explain to the supervisor the steps the trainee will undertake to do the procedure.
- Pelvic exam may be inappropriate to do with a supervisor to be signed off unless privacy and chaperone conditions are met. If it’s inappropriate, the supervisor discusses the exam technique with the registrar after the exam is done and seeks feedback from a nurse who is present at the exam.
- Senior nurses and charge nurses can also sign off appropriate clinical skills. These include applying splints, administering inhalers and nebuliser, and ECG placement. Cast application and cast checks are also suitable for senior nurse sign-off.
Change management and exemptions from this requirement
To manage the change-over from practical skills weekend and the CSL, the tables below describe the possibilities showing whether CLS sign-off is required or not.
|1||I completed PSW.||
|2||I was required to complete PSW and haven’t done so.||
|3||I have been granted an exemption from completing PSW.||
|4||I have been granted an exemption from completing the CSL sign-off requirement.||
|5||I have been granted an exemption from completing some of the skills in CSL.||
Y (skills not granted an exemption)
*Senior registrars granted an exemption from completing the full CSL because they attended the 2018 SDAW. They have received an exemption letter, and are required to achieve sign-off of the 16 SDAW skills.