Briefing Document: The Royal College of Emergency Medicine Advanced Clinical Practitioner (Adult) Curriculum and Credentialing Framework
Executive Summary
This document provides a comprehensive overview of the Royal College of Emergency Medicine (RCEM) framework for the training, assessment, and credentialing of Adult Emergency Medicine Advanced Clinical Practitioners (EM-ACPs). The framework establishes a nationally recognised standard of competence, addressing the historical variability in the role, which remains an unprotected title in the UK (2). A credentialed EM-ACP is a senior clinician integrated into the multidisciplinary team, capable of managing the full spectrum of undifferentiated adult patients, including leading resuscitation and trauma care (1, 3).
The pathway to credentialing is a rigorous, multi-year process. It requires a minimum of three years whole-time equivalent (WTE) of supervised clinical practice in an Emergency Department, defined as 30 hours per week of direct patient contact (1, 2). Academically, practitioners must possess an independent prescribing qualification and, from 2026, a full Master's degree in Advanced Clinical Practice from a UK Higher Education Institution (1, 2).
Assessment is entirely portfolio-based, with no final examination. The curriculum is structured around 11 Specialty Learning Outcomes (SLOs) and an extensive Clinical Syllabus covering all major domains of emergency medicine (1). To credential, a trainee ACP (tACP) must provide triangulated evidence, including a minimum of 48 mandatory assessments conducted by a consultant or eligible senior doctor (1). Progress is measured using a five-point entrustment scale, which gauges the practitioner's level of independence. A newly credentialed EM-ACP is expected to function at Entrustment Level 2b for most clinical SLOs, defined as ‘Supervisor within hospital for queries, able to provide prompt direction or assistance, and trainee knows reliably when to ask for help’ (1). This signifies their role as an autonomous practitioner who understands their scope and when to escalate.
Successful implementation of this framework requires significant departmental support. This includes providing a robust training environment and allocating a named, RCEM-trained ACP Educational Supervisor to each tACP. The College recommends this supervisory role be job-planned at a minimum of 0.25 PAs (one hour) per week, per trainee (1).
1.0 Rationale for EM-ACP Credentialing
The RCEM established its credentialing process to create a consistent standard for ACPs working in UK Emergency Departments. The initiative addresses the significant variability in performance, skills, and educational underpinning associated with the unprotected title of 'Advanced Clinical Practitioner' (2).
The General Medical Council (GMC) defines credentialing as a process providing formal accreditation of competence in a defined area of practice, ensuring the individual is fit to practise in that area (2). The RCEM EM-ACP credential confirms that a practitioner has achieved a nationally recognised standard of capability specific to emergency medicine (2).
The credentialed EM-ACP is a vital member of the multidisciplinary team, trained to:
- Identify, resuscitate, and stabilise critically ill and injured patients (3).
- Establish diagnoses and differential diagnoses for the full spectrum of undifferentiated presentations (3).
- Perform key procedural skills required in emergency care (1).
- Make safe and appropriate decisions regarding patient admission and discharge (3).
This role aligns with the NHS Long Term Workforce Plan (2023), which emphasizes expanding advanced practice roles to transform service delivery and create modernised career pathways for experienced staff (3).
2.0 The EM-ACP Training and Credentialing Pathway
The path to becoming a credentialed EM-ACP is a structured programme combining academic qualifications with extensive, supervised clinical experience.
2.1 Entry Requirements
Entry into a local training pathway is determined by the employing Trust, but RCEM recommends a suitable entry point would be five years post-registration, with a minimum of three years of experience in emergency or acute care at an enhanced practice level. All practitioners must be registered with the Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC), or General Pharmaceutical Council (GPC) (1).
2.2 Academic and Professional Requirements
To be eligible to submit for credentialing, a practitioner must meet specific academic and professional standards.
Requirement | Standard |
Academic Qualification | A level 7 qualification from a UK Higher Education Institution (HEI). A Post-Graduate Diploma (PGDip) is accepted for submissions up to and including Autumn 2025; a full Master’s degree in Advanced Clinical Practice is mandatory from 2026 onwards (1, 2). |
Core Academic Content | The academic programme must cover learning outcomes related to history taking, physical assessment, clinical decision-making, and diagnostics (1, 2). |
Independent Prescribing | A recognised independent prescribing qualification is a mandatory prerequisite for submission (1). |
Life Support | Valid certification in Advanced Life Support (ALS), Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC), and Paediatric Basic Life Support is required (1). |
2.3 Clinical Experience
The curriculum mandates a significant period of immersive clinical practice to develop the required capabilities.
- Duration: A minimum of three years (WTE) working in an advanced clinical practice role within an Emergency Department (1, 2).
- Clinical Contact: This is defined as at least 30 hours per week of direct clinical contact. Non-clinical time for study, teaching, or quality improvement is additional to this (1).
- Patient Logbook: Practitioners must demonstrate sufficient breadth and volume of experience. It is expected that a tACP will have seen a minimum of 2,100 adult patients by the end of the three-year training period. The College recommends a case mix including 20% resuscitation or high-acuity patients (1).
3.0 Curriculum Framework: Structure and Content
The 2022 curriculum (second edition, April 2025) is an outcome-based framework structured around Specialty Learning Outcomes, Key Capabilities, and entrustment levels, all underpinned by a comprehensive Clinical Syllabus (1).
3.1 Specialty Learning Outcomes (SLOs)
There are 11 SLOs that define the core capabilities of a credentialed EM-ACP. They are divided into seven patient-facing 'Clinical SLOs' and four 'Supporting SLOs' which align with the four pillars of advanced practice (1).
SLO Number | Specialty Learning Outcome | Type |
SLO 1 | Care for physiologically stable adult patients presenting to acute care across the full range of complexity | Clinical |
SLO 2 | Support the clinical team by answering clinical questions and making safe decisions | Clinical |
SLO 3 | Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop | Clinical |
SLO 4 | Care for acutely injured adult patients across the full range of complexity | Clinical |
SLO 6 | Deliver key procedural skills in adults | Clinical |
SLO 7 | Deal with complex and challenging situations in the workplace | Clinical |
SLO 8 | Provide clinical leadership to the department in the context of the multi-professional team | Clinical |
SLO 9 | Support, supervise and educate | Supporting |
SLO 10 | Participate in research and managing data appropriately | Supporting |
SLO 11 | Participate in and promote activity to improve the quality and safety of patient care | Supporting |
SLO 12 | Manage, administer and lead | Clinical |
Each SLO is broken down into specific Key Capabilities (KCs), which are the fundamental building blocks used for assessment (1).
3.2 Entrustment Levels
The curriculum uses a system of entrustment to assess a tACP's progression towards independent practice. It is a judgement decision based on direct observation of performance. Within this context, a 'supervisor' is defined as a senior decision-maker, typically an experienced doctor at ST4 level or above (1).
Level | RCEM Entrustment Scale Definition |
1 | Direct supervisor observation / involvement, able to provide immediate direction/assistance |
2a | Supervisor on the ‘shop-floor’ (e.g. ED), monitoring at regular intervals |
2b | Supervisor within hospital for queries, able to provide prompt direction or assistance and tACP knows reliably when to ask for help |
3 | Supervisor ‘on call’ from home for queries, able to provide directions via phone and able to attend the bedside if required to provide direct supervision |
4 | Would be able to manage with no supervisor involvement |
At the point of credentialing, an EM-ACP is expected to have reached Level 2b for all clinical SLOs (except SLO 6) and Level 3 for the supporting SLOs (9, 10, and 11), reflecting their existing expertise in these domains from prior Master's level study (1).
3.3 Procedural Skills (SLO 6): A Tiered Approach
SLO 6 uses a distinct, tiered approach to procedural competence with varying entrustment levels (1).
Tier | Description | Required Level | Assessment Method |
Foundation | Common skills for an experienced ED practitioner (e.g., IV cannulation, suturing, catheterisation). | Level 4 | Overall sign-off by the ACP Educational Supervisor. |
Core | Skills a credentialed EM-ACP must be able to perform independently (e.g., pleural aspiration of air, manipulation of fracture, IO access). | Level 3 | Assessed by consultant-led Direct Observation of Procedural Skills (DOPS). |
Additional | Advanced skills that may not be routine for all ACPs (e.g., chest drain, procedural sedation, resuscitative thoracotomy). | Level 2b or Level 1 | Level 2b (assessed by consultant DOPS) if performed in local practice. Level 1 (assessed by consultant Case-Based Discussion) if not. |
3.4 The Clinical Syllabus
The Clinical Syllabus defines the required breadth of clinical knowledge that underpins the SLOs. It is organised by system and specialty, listing the clinical presentations and conditions an EM-ACP is expected to manage. Trainees are required to collect evidence covering every element of the syllabus, which is then formally signed off by their ACP Educational Supervisor as part of the credentialing submission (1).
4.0 The Programme of Assessment
The assessment programme is designed to ensure practitioners are competent across the breadth of the curriculum through the triangulation of evidence from multiple sources in the workplace.
4.1 Assessment Philosophy and Blueprint
Assessment is based on the presentation of a comprehensive ePortfolio, with no summative examination. The process is prescriptive, requiring a minimum number of specific assessments to provide robust evidence for credentialing (1).
The assessment blueprint for the adult credential mandates a minimum of:
- 48 mandatory consultant/senior-doctor-led assessments, broken down as:
- 20 Mini-Clinical Evaluation Exercise (MiniCEX) or Case-Based Discussion (CbD) assessments, mapped to specific clinical areas and KCs.
- 10 Core Procedural Skills DOPS.
- 11 Additional Procedural Skills assessments (DOPS or CbD).
- 3 Acute Care Assessment Tool (ACAT) assessments.
- 3 Extended Supervised Learning Event (ESLE) assessments.
- 1 Foundation Skills sign-off form.
- A further 30 additional assessments (MiniCEX/CbD) distributed across the clinical syllabus, which can be completed by a wider range of trained assessors (e.g., ST4+).
- Additional evidence for management, teaching, and quality improvement activities (1).
4.2 Key Assessment Processes
Progression is monitored through several key panel-based and supervisory processes.
- Faculty Educational Governance Statement (FEGS): A formal statement completed annually that summarises the collated views of the local training faculty regarding a tACP's progress. A minimum of three FEGS are required for submission (1).
- Educational Supervisor Report (ESR): A comprehensive annual report written by the ACP Educational Supervisor, offering a summative judgement on progress based on a review of all evidence in the portfolio. A minimum of three ESRs are required (1).
- Multi-Source Feedback (MSF): A minimum of three MSF cycles are mandated, each requiring at least 12 respondents, including two consultants (1).
4.3 Currency of Evidence
Strict timelines apply to the evidence submitted for credentialing to ensure it reflects current practice.
- All 48 mandatory consultant assessments must be completed within three years of submission.
- The final FEGS and ESR must be completed within three months of submission.
- The final MSF cycle must be completed within six months of submission (1).
5.0 Departmental and Supervisory Responsibilities
Effective delivery of the curriculum is contingent on a high-quality training environment and robust supervision.
5.1 The Training Environment
Departments are expected to provide a safe and supportive learning environment that values education, consistent with the Health Education England (HEE) Quality Framework. Trainees must have access to facilities such as online learning, private study areas, and departmental teaching programmes (1).
5.2 Supervision and Assessors
High-quality supervision is central to the training pathway.
- ACP Educational Supervisor (ACP ES): Each tACP must have a named ACP ES who is responsible for their overall educational progress. To be eligible, a supervisor must be a substantive EM Consultant or eligible Associate Specialist/Senior Specialty Doctor, be a GMC-recognised trainer, and have successfully completed the mandatory RCEM ACP supervisor training course (1, 2).
- Time Allocation: RCEM recommends that the ACP ES role is supported with 0.25 PAs (one hour) per week per tACP in their job plan (1).
- Assessors: All mandatory assessments stipulated as requiring a consultant must be completed by an individual meeting the ACP ES eligibility criteria. A range of other senior healthcare professionals can act as assessors for other assessments, provided they are trained and competent in the area being assessed (1).
References
- Royal College of Emergency Medicine. Emergency Medicine Advanced Clinical Practitioner Curriculum 2022: Adult. 2nd ed. London: Royal College of Emergency Medicine; 2025.
- Royal College of Emergency Medicine. RCEM Emergency Medicine ACP Credentialing [Internet]. London: Royal College of Emergency Medicine; 2024. Available from: https://rcem.ac.uk/acp-curriculum-2022/
- Royal College of Emergency Medicine. Advanced Clinical Practice in Emergency Medicine [Internet]. London: Royal College of Emergency Medicine; 2024. Available from: https://rcem.ac.uk/emergency-medicine-advanced-clinical-practitioner/
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