Climate change presents an existential threat to public health and a direct challenge to the delivery of healthcare services in the UK. The NHS, which contributes 4% of the UK's carbon footprint , is responding with a world-leading commitment to become the first net-zero national health service, an ambition enshrined in the Health and Care Act (2022). For Emergency Departments (EDs), this national mandate coincides with the compounding crisis of rising demand, creating both a significant challenge and a unique opportunity.The Royal College of Emergency Medicine (RCEM) has established the GreenED initiative to guide departments in this transition. This briefing synthesises the core principles and practical guidance for implementing environmentally sustainable practices within the emergency care setting.
Key Takeaways:
• Sustainability as Quality Improvement: The core principle is that sustainable healthcare is high-quality healthcare. By improving efficiency, optimising patient pathways, and reducing waste, EDs can enhance patient care, improve staff well-being, generate cost savings, and reduce their environmental impact simultaneously.
• Leadership is Crucial: A key finding from the GreenED pilot project is that lasting change is exceptionally difficult without senior buy-in. Engaging clinical leads, senior nurses, and managers by aligning green initiatives with trust-level strategic goals (e.g., cost savings, patient experience) is essential for success.
• A Whole-Team Approach: Effective change requires the engagement of all staff, from consultants and nurses to porters, administrative staff, and managers. Establishing a multidisciplinary "Green ED" group is a foundational first step.
• The "Reduce, Reuse, Recycle" Hierarchy: The greatest environmental and financial benefits come from reducing consumption in the first place (e.g., rationalising blood tests, avoiding unnecessary cannulation). This is a more impactful strategy than reuse, which in turn is more effective than recycling.
• Actionable Framework: This document provides a practical framework covering strategic context, RCEM's official recommendations, and a detailed guide to implementation, including forming a green group, identifying carbon hotspots, and motivating an already exhausted workforce with tangible, data-driven benefits.
Achieving RCEM Specialty Learning Outcome 1: Care for Physiologically Stable Adult Patients
Executive Summary
Specialty Learning Outcome (SLO) 1, "Care for physiologically stable adult patients presenting to acute care across the full range of complexity," represents the fundamental building block of clinical practice in Emergency Medicine (EM) (1). Mastery of this SLO is essential for trainees at all levels and forms the basis for all other clinical learning outcomes. The purpose of the Royal College of Emergency Medicine (RCEM) curriculum is to train consultants capable of providing urgent and emergency care to all undifferentiated patients, a demand which is increasing annually, particularly among older patients with complex co-morbidities (2).
Achieving SLO 1 requires the development of expertise in history taking, clinical examination, decision-making, and the management of individual adult patients. This capability must be applied across the full spectrum of presentations, including physical and mental health problems, complex co-morbidities, and frailty syndromes (1).
Key strategies for developing and demonstrating competence include:
This document provides a comprehensive synthesis of the curriculum requirements and best practices to guide EM trainees in successfully achieving SLO 1.
This episode synthesizes the November 2021 Royal College of Emergency Medicine (RCEM) Best Practice Guideline on Patient Care in the Emergency Department (ED). The guideline was developed in response to key inquiries, including the Francis Report, to re-emphasise a culture where a safe, committed, compassionate, and caring service is paramount, shifting focus from purely target-based metrics. It serves as a comprehensive checklist for medical and nursing staff to benchmark, audit, and improve patient experience and quality of care.
This episode synthesizes the core standards and recommendations from the Royal College of Emergency Medicine's (RCEM) Guidelines for the Provision of Emergency Medical Services (GPEMS). It is intended for emergency medicine clinicians and highly trained professionals working within NHS Emergency Departments (EDs) in England. The guidelines establish best practices, define service delivery standards, and provide pragmatic, patient-centred recommendations to address the significant strains on Emergency Medicine Services (EMS).
🧩 The Need for Re-Structuring EP Learning
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.
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.
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.
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.
This episode 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 . 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.
The Portfolio Pathway, formerly known as the Certificate of Eligibility for Specialist Registration (CESR), represents a demanding yet flexible alternative to the conventional Certificate of Completion of Training (CCT) for achieving specialist registration in Emergency Medicine. This strategic plan serves as a comprehensive, multi-year professional roadmap. Embarking on this journey requires exceptional organization, unwavering commitment, and meticulous strategic planning from the outset. It is a significant undertaking, comparable to a marathon, not a sprint, and should be approached with the gravity it deserves.
Executive Summary
• This episode synthesizes the core principles, competencies, and philosophical underpinnings of modern Emergency Medicine (EM) consultant practice in the NHS, as defined by the Royal College of Emergency Medicine (RCEM) curriculum and key professional insights. The training and practice of EM are shaped by a persistent and significant rise in demand for services, with attendances increasing by 12.2% over a decade and 1 in 2.4 people in the UK attending an Emergency Department (ED) annually.
•The purpose of the RCEM curriculum is to train consultants capable of providing 24/7 care to all undifferentiated patients, of all ages, across the full spectrum of acute illness and injury. The consultant's role is multifaceted, extending beyond clinical care to encompass leadership of multi-disciplinary teams, strategic direction of the department, quality improvement, supervision, and administration. This comprehensive scope is defined by 12 core Specialty Learning Outcomes (SLOs) that a trainee must be entrusted to deliver by the point of CCT.
•A distinctive feature of EM practice is its unique mindset, characterized as "playing not to lose." The primary focus is on risk stratification and the exclusion of rare but life-threatening conditions, rather than simply identifying the most probable diagnosis. This practice, performed in an environment of inherent uncertainty, is grounded in the core professional virtues of Honesty, Humility, and Integrity, which enable sound decision-making and professional resilience.
This episode outlines the South West Initiative for Traumatic Intracranial Event Evaluation (SWIFTIEE), a new regional protocol for managing adult patients with minor traumatic brain injuries (MTBI) who have abnormalities on CT head imaging. The initiative aims to standardise care, improve hospital flow, and enhance patient safety by addressing ambiguities in current NICE NG232 guidance regarding the definition of 'surgically significant' and 'clinically important' radiological findings.
This episode synthesizes key strategies and resources for continuous professional development (CPD) in Emergency Medicine (EM), tailored for professionals within the Emergency Department. The core challenge addressed is managing the immense and rapidly changing volume of medical information inherent to the specialty, a task often described as daunting and prone to causing resource fatigue.
Two principal, complementary strategies are identified for building and maintaining expertise. First, the "Big Book/Little Book" approach provides a structured method for establishing a comprehensive and personalised foundational knowledge base. Second, the practice of Rapid Cycle Deliberate Practice (RCDP)—engaging in small, frequent learning activities—is presented as a sustainable and highly effective method for lifelong learning, skill retention, and professional resilience.
Effective implementation of these strategies is supported by the strategic use of technology, such as RSS feed aggregators (e.g., Feedly) and podcast managers, to streamline the flow of new information from curated sources. A critical approach to evaluating online content is essential, using tools such as the Social Media Index (SM-i). Furthermore, professionals are advised to maximise cost-effectiveness by utilising institutional resources, including NHS Athens for access to services like UpToDate, before making personal purchases. This accompanying website document provides a curated list of recommended textbooks, online resources, and mobile applications to support these learning frameworks.
A Discussion of Actionable Plans For Professional Sustainability and Performance in Emergency MedicineThe "ACEM 1000 hour exam" is the nickname for the rigorous preparation needed to pass the Australasian College for Emergency Medicine (ACEM) Fellowship exams. It refers to the substantial time commitment & high-quality study required to be successful. The Royal College of Emergency Medicine Exams are no different. Therefore, before you can contemplate preparing for fellowship exams, portfolio pathway or a career in Emergency Medicine (EM) you need to look after yourself & your family physically, mentally, emotionally and financially. This document synthesizes key strategies and insights for Emergency Medicine (EM) professionals to enhance on-shift performance, mitigate psychological challenges, and build sustainable, fulfilling careers. The demanding nature of EM necessitates a proactive, multi-faceted approach to wellbeing, which is a shared responsibility between individual clinicians and the healthcare system. Critical takeaways include the need for structured strategies to manage the predictable chaos of an ED shift, the implementation of deliberate boundary rituals to separate work and home life, and a deeper understanding of psychological phenomena such as moral injury and compassion fatigue. Systemic support, a positive organisational culture, and robust long-term career planning are equally crucial. By integrating these evidence-based tools and frameworks, clinicians can improve their daily professional experience, reduce burnout, and ensure career longevity. Further references and resources are available on the MEM-EM Website.
Welcome to the Memorising Emergency Medicine (MEM-EM) project. We are thrilled to have you join us. This podcast (& the corresponding blog post on MEM-EM) introduces you to the core educational strategies that form the foundation of our resources and our approach to helping you succeed.