MEM-EM: Memorising Emergency Medicine: Mapping the Emergency Practitioner (EP) Curriculum to the RCEM SLOs

🗺️ Aligning Learning: Why Mapping the Emergency Practitioner (EP) Curriculum to RCEM SLOs Matters

Emergency Practitioners (EPs) require a robust and structured education. Currently, many learning resources for EPs—especially those based on previous curriculum structures—can sometimes feel disconnected from the practical competencies required in the Emergency Department (ED).

This is why a curriculum that maps the existing EP curriculum topics to the Royal College of Emergency Medicine (RCEM) Specialty Learning Outcomes (SLOs) is incredibly useful.

What are RCEM SLOs?

RCEM SLOs are the fundamental, overarching competencies. They represent the key tasks, skills, and areas of responsibility that a doctor/practitioner must be able to perform safely and independently. Examples include "Manages the critically ill patient" or "Manages complex decision-making and risk."

🧩 The Need for Re-Structuring EP Learning

1. Clarity and Relevance for the Learner

By mapping traditional EP curriculum topics (e.g., "Management of Asthma") to the RCEM SLOs, EP learners gain immediate context and clarity. Instead of simply learning a list of topics, they see how that knowledge contributes to a high-level, real-world skill.

Before: "I need to learn about asthma management."
After (SLO-Mapped): "Learning about asthma management directly contributes to my ability to meet the SLO of 'Manages undifferentiated symptoms and multi-system pathology' and 'Manages the critically ill patient' when dealing with severe exacerbations."

This makes subsequent learning feel relevant and provides a clear goal for educational activities.

2. Structuring Teaching and Content

For educators and curriculum developers, this mapping provides a powerful structure. It ensures that teaching and assessment activities are designed to progressively build the skills required for the SLO, rather than just focusing on isolated topics. This helps align teaching objectives and ensures all critical areas of competency are covered in a balanced way.

3. Preparation for Future Curriculum Updates

The greatest practical driver for this approach is future-proofing. The RCEM and related bodies have moved to an SLO-based curriculum for consultants and other ED team members (such as ED-ACPs).

If and when the national curriculum for Emergency Practitioners is updated, it is highly likely it will be structured around SLOs to ensure consistency and seamless progression across the entire ED team. Using an SLO-mapped structure now helps EP learners and educators transition smoothly and ensures they are already aligned with the language and structure of the wider ED training framework.

📝 A Useful (Non-Formal) Document

It is important to note that this SLO-mapped document is not a replacement for the official EP curriculum. It is an interpretive and organizational tool.

It serves as a powerful, practical guide to help EPs and their supervisors:

Align Learning Outcomes: Ensure that the skills learned translate directly into required competencies.
Structure Teaching: Organize educational sessions to build towards specific SLOs.
Demonstrate Progression: Help EP learners understand and track how they are progressing toward becoming competent, independent practitioners, using the same language and standards as the consultants they work alongside.

This mapping provides a common language and a clear direction, ensuring that every piece of learning is a relevant step toward becoming a highly skilled Emergency Practitioner.

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An Outline of a Proposed Curriculum for Emergency Practitioners in an NHS Emergency Department to aid in providing a structured Education and CPD program.

Executive Summary

This document outlines a proposed curriculum for the development of Emergency Practitioners (EPs) within an NHS Emergency Department (ED) setting in England. The EP role is defined as an extended, enhanced level of practice, distinct from advanced practice, focusing on the autonomous management of patients with minor injuries and illnesses, predominantly in the Minors Area and Waiting Room (1, 2). The curriculum aims to standardize training, provide a means to measure competence, and protect the professional integrity of the autonomous practitioner (1). It is important to note that the scope of practice of EPs is defined by the local department in which they work to best meet the workforce and patient needs of that department and area. Therefore, the competencies and ongoing CPD may differ between departments and local adaptation of curriculum is likely to be needed in contrast to the nationally RCEM defined training pathway defining the knowledge skills and expertise expected of ACPs.

The development pathway begins with a Trainee Emergency Practitioner (TEP) role, typically lasting 12-18 months, progressing to a qualified EP. This pathway is open to various registered healthcare professionals, including nurses, paramedics, physiotherapists, and pharmacists, with specific professional considerations and potential additional training needs identified for each group (2).

Core educational requirements include Level 6/7 academic modules in Minor Injury and Minor Illness, alongside mandatory courses in IR(ME)R, image interpretation, plastering, suturing, and resuscitation (2). Assessment is performance-based, utilising workplace-based assessment tools such as mini-CEX, Case Based Discussions (CBD), and Direct Observation of Procedures (DOPS) under the guidance of a designated Coordinating Education Supervisor (2).

The curriculum's competency framework is structured around the Royal College of Emergency Medicine's (RCEM) Specialty Learning Outcomes (SLOs), detailing the required knowledge and skills across key domains. These include comprehensive patient assessment, clinical reasoning, procedural skills, patient safety, and adherence to legal and ethical frameworks. The document provides exhaustive detail on the clinical competencies required to manage a wide range of presentations, from musculoskeletal injuries and wound management to common medical, ophthalmological, and mental health conditions seen in the urgent care setting (1, 2).

1. Introduction and Framework

1.1 Rationale for a Standardised Curriculum

It has been recognised that a standardised training programme, integrating academic learning with practical skill development (praxis), is highly beneficial for trainees (1). The methods of Nurse Practitioner (NP) training have historically varied considerably between departments. A standardised curriculum provides a robust means to measure competence and, crucially, helps to protect the professional integrity of the autonomous practitioner. In the event a practitioner's competence is questioned, this framework provides evidence of the further training undertaken to justify the use of their title (1).

1.2 Defining the Emergency Practitioner Role

The EP role is a well-established one that originated in the nursing profession (Emergency Nurse Practitioner or ENP) and has since diversified to include a range of Allied-Healthcare-Professionals (AHPs) such as paramedics, physiotherapists, and pharmacists (2).

For the purpose of this curriculum, the term Emergency Practitioner (EP) is used to encompass these multi-professional roles. The EP role is defined as an extended role working at an enhanced level of practice, rather than an advanced role. Practitioners at this level possess specific knowledge and skills in a field of expertise, allowing them to make complex decisions and manage all aspects of a patient’s care within their scope of practice (2).

Upon completion of a preceptorship period, the EP is expected to carry out unsupervised assessments and manage patients presenting to the ED, predominantly working from the Minors Area and Waiting Room, seeking senior help or guidance as required (1).

1.3 Practitioner Development Pathway

The curriculum outlines a clear development trajectory from a trainee to a qualified practitioner (2).

Practitioner Role	Description	Agenda for Change Band*
Trainee Emergency Practitioner (TEP)	A registered healthcare professional, typically with a minimum of 5 years' experience (including experience at a Band 6 level), undertaking a trainee post. The training period normally takes one year, with around six months of supernumerary status, followed by a consolidation period. The total training time to achieve independent enhanced practice is generally 18 months.	6
Emergency Practitioner (EP)	A practitioner who has completed the TEP process and is deemed competent and confident in the autonomous management of minor injury and illness presentations. The EP is expected to have a personal development plan for continued growth.	7

* Expected pay scales as outlined in the Urgent and Emergency Care – Emergency Practitioner Framework (2).

1.4 Professional and Educational Requirements

Successful implementation of this curriculum requires clear frameworks for supervision, assessment, and education (2).

Supervision and Assessment

Every TEP must have a designated supervisor, ideally an Emergency Consultant, acting as a 'Coordinating Education Supervisor' and clinical mentor (1, 2). This supervisor supports professional development through hands-on intervention, performance assessment, and constructive feedback (1). Bi-monthly one-to-one meetings are recommended as a minimum (2).

Assessment of clinical competence is achieved through validated workplace-based assessment tools (1, 2):

Direct Observation of Procedure (DOP)
Clinical Examination Exercise (CEX)
Case Based Discussion (CBD)
Multisource Feedback (MSF)

Educational Prerequisites

The development of an EP requires a combination of academic study and practical courses. The following table outlines the requirements for the TEP and EP roles (2).

Requirement	Trainee EP (TEP)	Emergency Practitioner (EP)
Academic Level	Level 6	Level 6/7
Minor Injury Module	Complete in Year 1	Yes
Minor Illness Module	Complete in Year 1	Yes
Non-Medical Prescribing	No (works to PGDs)	Desirable (works to PGDs/NMP)
IRMER Certification	Yes	Yes
Image Interpretation	Yes	Yes
Plastering / Soft Cast / Splinting	Yes (if not a pre-requisite)	Yes
Suturing & Wound Management	Yes (if not a pre-requisite)	Yes
Resuscitation Training (BLS/ILS)	Yes (level per local guidance)	Yes

Professional Considerations for Trainees

Practitioners entering the TEP role will come from diverse professional backgrounds. Additional training needs may be required depending on their prior experience (2).

Registered Professional	Potential Training Needs and Considerations
Nurse	Patient Group Direction (PGD) awareness; support with role transition to autonomous decision-making; physical assessment skills.
Paramedic	Wider PGD awareness; ED/UTC working processes; blood investigation training; phlebotomy skills; wound assessment, dressing, and closure; limb splinting and plastering; safe discharge and health promotion skills.
Physiotherapist	PGD awareness; medicines management and administration (including IV); phlebotomy and cannulation; blood investigation training; wound assessment, dressing, and closure; limb splinting and plastering; resuscitation skills.
Pharmacist	Extensive patient initial assessment and physical examination skills; ED/UTC team orientation; administration of medicines; consultation skills; cannulation and phlebotomy; wound assessment, dressing, and closure; limb splinting and plastering; resuscitation skills.

2. Core Competencies and Specialty Learning Outcomes (SLOs)

This curriculum is structured using the RCEM's Specialty Learning Outcome (SLO) framework to map the core competencies required of an EP (2).

SLO 1, 3, 4 & 5: Clinical Assessment, Therapeutics, and Patient-Centred Care

This domain covers the fundamental skills of taking a history, performing a clinical examination, initiating treatment, and ensuring care is focused on the patient, including gaining valid consent (2).

General Competencies

History Taking: Perform a full and structured history relevant to the presenting complaint, recognising red flags of significant pathology (1).
Clinical Examination: Demonstrate a safe and thorough clinical examination, interpret findings, and document them clearly and methodically (1).
The Patient as a Central Focus: Understand the importance of factors like hand dominance, occupation, and hobbies in history taking. Involve patients in their care and ensure they understand their diagnosis and management plan (1, 2).
Therapeutics and Safe Prescribing: Follow the legal framework for Patient Group Directives (PGDs) to supply and/or administer specified medicines. For those with a prescribing qualification, adhere to the NMC Standards of Proficiency for Nurse and Midwife Prescribers (1, 2).
Valid Consent: Assess patient capacity, understanding the specifics relating to children, young people, and vulnerable adults. Ensure valid consent (verbal, non-verbal, or written) is gained before any examination, investigation, or treatment (1, 2).

SLO 2 & 11: Clinical Reasoning, Patient Safety, and Quality Improvement

This domain focuses on the ability to synthesise clinical information, make sound decisions, prioritise patient safety, and contribute to quality improvement (2).

General Competencies

Decision Making and Clinical Reasoning: Interpret investigations, formulate differential diagnoses, and create safe and effective management plans. Understand personal limitations and know when to request advice or senior review (1).
Prioritisation of Patient Safety: Recognise and escalate deteriorating patients. Understand and apply risk stratification tools (e.g., PERC, Wells, CURB-65). Be aware of safeguarding concerns in children and vulnerable adults (1, 2).
Infection Control: Adhere to local and national guidance on infection prevention and control, including assessing tetanus risk and indications for antibiotics in wounds and bites (1, 2).
Guidance on Patient Selection: While flexible, EPs should generally see patients they expect to manage autonomously and discharge or refer safely. The following patient groups are not typically seen by EPs without discussion with a senior clinician (1):

Atraumatic Chest pain >30 years old
Fever <1 year old
Unscheduled return for the same issue within 72 hours
Abdominal pain >70 years old
NEWS / PEWS >5 or single parameter >3

SLO 6: Procedural Skills

EPs must be competent in a range of practical procedures essential for managing minor injuries and illnesses. All skills competencies require assessment via Direct Observation of Procedure (DOP) (1).

Local Anaesthesia:

Digital (Ring) Block
Local Infiltration

Wound Closure:

Simple interrupted suture
Mattress Suture
Skin Glue, Steri-strips, Skin link

Foreign Body Removal:

From skin, ear, nose, eye
Removal of embedded earrings
Removal of retained tampons

Reduction of Fractures/Dislocations (as part of MDT):

Digit reduction
Limb reduction (e.g., Distal Radius Fracture Reduction)

Immobilisation:

Application of soft cast (Below elbow, Thumb Spica)
Application of splints (Zimmer, Volar slab, Ulnar gutter slab)
Application of C-spine collar and triple immobilisation

Other Procedures:

Peripheral venous cannulation
Wound washout and cleaning
Application of appropriate dressings
Nasal packing / cautery
Slit lamp examination
Irrigation of chemical eye injuries

SLO 7, 8 & 12: Teamwork, Workload Management, and Leadership

This domain covers the professional behaviours required to function effectively within the ED team and contribute to departmental service delivery (2).

Time and Workload Management: Manage patient flow effectively within the Minors area, prioritising care based on clinical need (2).
Team Working and Communication: Work collaboratively with all members of the multidisciplinary team. Communicate effectively with colleagues to ensure safe patient handover and coordinated care (1, 2).
Management and NHS Structure: Participate in regular reviews as part of the Personal Development Review (PDR) process. Attend annual "NP Update Days" to maintain knowledge and skills. Contribute to future departmental plans (1, 2).

SLO 10: Ethical and Legal Frameworks

EPs must practice within a robust ethical and legal framework, upholding professional standards at all times (2).

Professional Standards: Adhere to the NMC Code of Conduct, revalidating every 3 years within their scope of practice, knowledge, and competence (1).
Legal Framework for Practice: Maintain responsibility for radiation protection under the Ionising Radiation (Medical Exposure) Regulation (IR(ME)R) (1). Understand the Mental Health Act sections relevant to the ED (1).
Confidentiality: Uphold the principles of patient confidentiality in all aspects of practice (2).

3. Detailed Clinical Competencies by Presentation

The following sections detail the specific knowledge and skills required to manage common presentations, mapped from the detailed competencies (1) to the overarching SLO framework (2).

3.1 Musculoskeletal Presentations

Practitioners must demonstrate competence in the assessment and management of a wide range of limb injuries. This includes a thorough understanding of anatomy, mechanism of injury, specific examination tests, interpretation of imaging, and appropriate management including immobilisation and referral pathways.

Area	Key Competencies (1)	RCEM Link (2)
Spine	History/exam for red flags (e.g., cauda equina), application of Canadian C-spine rules, interpretation of imaging, management of mechanical back pain, safe immobilisation.	MuP1, MuP3
Shoulder/Upper Arm	Assessment of rotator cuff injury (impingement, supraspinatus, etc.), recognition of dislocation (including posterior), and management of fractures, nerve injury, and septic arthritis.	-
Elbow	Interpretation of adult and paediatric X-rays (radiocapitellar line, fat pads, CRITOE), management of fractures, dislocations, and pulled elbow.	-
Wrist & Hand	Assessment of scaphoid injury, special tests (Finkelstein, Phalen's, Tinel's), management of fractures, dislocations, tendon injuries (flexor/extensor), nailbed injuries, and infections (paronychia, felon, flexor tenosynovitis).	-
Hip & Pelvis	Assessment for fractures, dislocations, SUFE, and Perthes disease. Recognition of red flags (fever/unwell patient).	-
Knee	Application of Ottawa rules, special tests for ligamentous/meniscal injury (McMurray's, Lachman's), management of fractures, dislocations, and inflammatory conditions.	MuP2, MuP4, MuC4
Ankle & Lower Leg	Application of Ottawa rules, special tests for Achilles tendon rupture (Simmonds/Thompson test) and ligamentous injury (anterior drawer), management of fractures and dislocations.	-
Foot	Application of Ottawa rules, assessment of gait, management of fractures and inflammatory conditions.	-
General Lower Limb	For all lower limb injuries: Assess VTE risk for patients requiring immobilisation and manage according to local guidance. Recognise and manage the "limping child" presentation as per local policy.	TP7
Falls	Comprehensive assessment of patients who have fallen.	EIP3

3.2 Skin, Wound, and Tissue Presentations

Area	Key Competencies (1)	RCEM Link (2)
Skin & Wound Management	Classify wounds, assess depth, determine risk of infection, select appropriate closure technique (sutures, glue, strips), choose appropriate dressings, assess tetanus risk.	SLO 6
Serious Rashes	Recognise serious skin conditions: Anaphylaxis, Meningococcal disease, Necrotising Fasciitis, Steven Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN).	DP1, DP2
Burns	Classify burns by depth; estimate extent (Rule of Nines, Lund-Browder); identify burns requiring specialist referral; understand immediate first aid and dressing choices; recognise non-accidental injury.	TP8
Bites & Stings	Manage cat, dog, human, and other bites; understand indications for antibiotics, antihistamines, steroids; locate guidance on specific bites (e.g., snake, bat, tick).	-
Inoculation Injury	Understand definition and management, including wound washout, tetanus/antibiotic indications, and post-exposure prophylaxis (PEP, Hep B) following local policy.	IP4
Foreign Body (Skin)	Assess need for imaging (X-ray/ultrasound), perform wound exploration under analgesia, remove FB where appropriate, and decide on closure method.	SLO 4

3.3 Head, Neck, and ENT Presentations

Area	Key Competencies (1)	RCEM Link (2)
Ear, Nose & Throat (ENT)	Assess using an otoscope; recognise red flags (e.g., mastoiditis, septal haematoma, quinsy); understand and apply Centor/FeverPAIN criteria; manage epistaxis, otitis externa/media, and tonsillitis.	EP1, EP3, EP5, EP6
Ophthalmology	Assess visual acuity (Snellen chart); perform pen torch and slit lamp examination; measure pH for chemical injury; remove corneal foreign bodies; identify red flags requiring urgent referral (e.g., penetrating injury, retinal detachment).	OptP1-5, OptP3
Maxillo-Facial	Assess for facial bone fractures; manage dental abscesses and avulsed teeth; recognise signs of deep space neck infection; be aware of NAI concerns (e.g., frenulum injury).	MaP2
Neurology (Head Injury / Headache)	Apply NICE head injury guidance for CT scans (adults and children); perform a full neurological examination; recognise red flags for headache; manage post-concussion syndrome.	TP1, NeuP2

3.4 Medical and Systemic Presentations

Area	Key Competencies (1)	RCEM Link (2)
Respiratory	Assess and manage chest wall injuries (rib fractures, pneumothorax); recognise pathologies like pneumonia, asthma, COPD, PE; apply risk scores (CURB-65, chest injury score).	CP2, ResP1, ResP2, ResP4, TP3
Cardiology	Take a structured history for chest pain; differentiate musculoskeletal pain from serious pathology (ACS, PE, pericarditis); interpret ECGs for basic abnormalities.	CP1
Abdominal	Assess and manage conditions like UTI, renal colic, gastritis, gastroenteritis, constipation. Recognise surgical emergencies requiring senior review/referral (appendicitis, bowel obstruction, testicular/ovarian torsion).	SuP1, GP1, UP1, UP4, UP5
Mental Health	Perform a Mental State Examination (MSE); assess capacity (including Gillick competence); risk stratify for self-harm/suicide; understand de-escalation, restraint, and relevant Mental Health Act sections.	CAP30

3.5 Paediatric-Specific Competencies

While many competencies apply to all ages, EPs must be skilled in recognising and managing conditions specific to children.

Area	Key Competencies (1, 2)	RCEM Link (2)
Fever	Assessment and management of fever in all age groups, recognising guidance for fever <1 year old.	IP1
Pain	Assessment and management of pain in children.	PC1-4
Atraumatic Limp	Manage the "limping child" presentation according to local policy, considering SUFE, Perthes, and septic arthritis.	MuP2
Gastrointestinal	Manage dehydration secondary to diarrhoea and vomiting.	GC3
Respiratory	Differentiate and manage upper and lower respiratory tract infections, including bronchiolitis and croup.	-
Safeguarding	Maintain a high index of suspicion for non-accidental injury (NAI) in presentations such as burns, head injuries, and frenulum tears, and follow correct safeguarding procedures.	-

4. References

JM, MD. Emergency Department NP Band 6 Competencies. An NHS Trust; 2024.
Davies S, Adkins S, Bhandwalkar V, Dawood M, Gamston J, Lawton L, et al. Urgent and Emergency Care – Emergency Practitioner Framework. Version 1. London: Health Education England; 2023.

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