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:

• Mastering the Consultation: Utilising structured consultation models, such as the Calgary-Cambridge Guide, to ensure a patient-centred approach that identifies ideas, concerns, and expectations (ICE) (3). This includes proficiency in non-verbal communication, which is critical for building rapport and is often more impactful than verbal communication (4).
• Adopting Evidence-Based Clinical Practice: Grounding clinical examination and diagnostic reasoning in evidence-based resources to improve accuracy and clinical significance (5).
• Embracing Cultural Safety: Moving beyond basic cultural competency to a framework of cultural safety. This requires a paradigm shift towards critical self-reflection on one's own biases, privileges, and the inherent power imbalances in the clinician-patient relationship, allowing the patient to define what constitutes a safe clinical encounter (6, 7).
• Evidencing Progression: Systematically collecting evidence through a range of Workplace-Based Assessments (WPBAs), such as ACATs, CbDs, and Mini-CEXs, across a diverse case mix. Competence is summatively assessed through RCEM examinations and formal entrustment decisions at the end of Core, Intermediate, and Higher training stages (1).

This document provides a comprehensive synthesis of the curriculum requirements and best practices to guide EM trainees in successfully achieving SLO 1.