Outcomes for graduates

Practical skills and procedures

Purpose of the practical skills and procedures

We set the standards and requirements for all stages of medical education and training in Promoting excellence: standards for medical education and training (2016) and hold a list of universities entitled to award a medical degree recognised as a UK primary medical qualification.

Our Outcomes for graduates (2018) set out what newly qualified doctors from all medical schools must know and be able to do.

The Practical skills and procedures outline the core set of practical skills and procedures, and minimum level of performance that newly qualified doctors must have when they start work for the first time so they can practise safely.

Provisions for encouraging diversity in medicine

We believe that equality, diversity and inclusion are integral to our work as a regulator. We are committed to supporting diversity in medicine.

We expect organisations to make supportive and pragmatic adjustments for learners to enable achievement of the practical skills and procedures, including where learners have long-term health conditions and disabilities, while also abiding by the Equality Act. Further detailed information can be found in our publications Welcomed and valued (2019), Promoting excellence (2016) and Promoting excellence - equality and diversity considerations (2017).

How the procedures relate to our other standards and guidance

Our Outcomes for graduates (the outcomes) set out what newly qualified doctors from all medical schools who award UK primary medical qualifications must know and be able to do. The Practical skills and procedures supplements the outcomes by defining the core diagnostic, therapeutic and practical skills and procedures newly qualified doctors must be able to perform safely and effectively, and identifying the level of supervision needed to ensure patient safety.

Promoting excellence sets out the standards and requirements for the management and delivery of undergraduate and postgraduate medical education and training. The outcomes and the Practical skills and procedures set out what we expect newly qualified doctors to be able to know and do and should be read alongside Promoting excellence.

We expect all newly qualified doctors to practise in accordance with the professional requirements set out in Medical practice and related guidance.

Responsibility for delivering the procedures

Medical schools

Medical schools must provide an education that allows newly qualified doctors to meet all the outcomes, including the practical skills and procedures specified in this list, and therefore to be fit to practise safely as a doctor when they graduate.

Local education providers

Local education providers, working with medical schools, must provide and quality manage clinical placements and learning opportunities that give medical students the opportunities to build knowledge, skills and practical experience to meet the outcomes and to safely and effectively carry out the practical skills and procedures by the time they qualify.

Medical students

Medical students are responsible for their own learning. They should refer to the outcomes and the practical skills and procedures specified in this list during their undergraduate education to understand what we expect them to be able to know and do by the time they graduate.

What must newly qualified doctors demonstrate for satisfactory completion?

Three levels of competence

Safe to practise in simulation

The newly qualified doctor is safe to practise in a simulated setting and is ready to move to direct supervision. This means that the newly qualified doctor will not have performed the procedure on a real patient during medical school, but on a simulated patient or manikin. This means that they will have some knowledge and skill in the procedure but will require direct supervision when performing the procedure on patients.

Safe to practise under direct supervision

The newly qualified doctor is ready to perform the procedure on a patient under direct supervision. This means that the newly qualified doctor will have performed the procedure on real patients during medical school under direct supervision. By direct supervision, we mean that the medical student or newly qualified doctor will have a supervisor with them observing their practice as they perform the procedure. As the newly qualified doctor's experience and skill becomes sufficient to allow them to perform the procedure safely they will move to performing the procedure under indirect supervision.

Safe to practise under indirect supervision

The newly qualified doctor is ready to perform the procedure on a patient under indirect supervision. This means that the newly qualified doctor will have performed the procedure on real patients during medical school under direct supervision at first and, as their experience and skill became sufficient to allow them to perform the procedure safely, with indirect supervision. By indirect supervision, we mean that the newly qualified doctor is able to access support to perform the procedure if they need to - for example by locating a colleague and asking for help.

Generic requirements

There are both generic requirements and specific procedure requirements for each procedure. Newly qualified doctors should comply with local and national guidelines, and employers will also typically have protocols for the safe performance of each procedure which should be followed.

Generic requirements for each procedure

The following generic requirements apply to each procedure:

  • introduce themselves
  • check the patient's identity
  • confirm that the procedure is required
  • explain the procedure to the patient (including possible complications and risks) and gain informed consent for the procedure (under direct supervision where appropriate)
  • follow universal precautions to reduce the risk of infections, including:
    • control the risk of cross infection, and take appropriate steps for personal safety
    • follow approved processes for cleaning hands before procedures or surgical operations
    • correctly use personal protective equipment (for example gloves, gowns and masks)
    • employ safe disposal of clinical waste, needles and other sharps
    • dispose of all equipment in the appropriate receptacles
  • label samples appropriately according to local guidelines
  • accurately document the procedure according to local guidelines
  • ensure confidentiality
  • interpret any results and act appropriately on them (the newly qualified doctor must recognise the need to seek advice on unexpected or unusual results); and
  • arrange appropriate aftercare/monitoring.

It's important to remember that newly qualified doctors who enter the Foundation Programme will work under educational and clinical supervision and in a multidisciplinary team. In accordance with the Foundation Programme Curriculum, they will need to demonstrate that they are refining their skills and

Assessment of patient needs

No Procedure Description Level of competence
1 Take baseline physiological observations and record appropriately Measure temperature, respiratory rate, pulse rate, blood pressure, oxygen saturations and urine output. Safe to practise under indirect supervision
2 Carry out peak expiratory flow respiratory function test Explain to a patient how to perform a peak expiratory flow, assess that it is performed adequately and interpret results. Safe to practise under indirect supervision
3 Perform direct ophthalmoscopy Perform basic ophthalmoscopy and identify common abnormalities. Safe to practise under indirect supervision
4 Perform otoscopy Perform basic otoscopy and identify common abnormalities. Safe to practise under indirect supervision

Diagnostic procedures

No Procedure Description Level of competence
5 Take blood cultures Take samples of venous blood to test for the growth of infectious organisms. Safe to practise under direct supervision
6 Carry out arterial blood gas and acid base sampling from the radial artery in adults Insert a needle into a patient's radial artery (in the wrist) to take a sample of arterial blood and interpret the results. Safe to practise under direct supervision
7 Carry out venepuncture Insert a needle into a patient's vein to take a sample of blood for testing. Make sure that blood samples are taken in the correct order, placed in the correct containers, that these are labelled correctly and sent to the laboratory promptly. Safe to practise under indirect supervision
8 Measure capillary blood glucose Measure the concentration of glucose in the patient's blood at the bedside using appropriate equipment. Record and interpret the results. Safe to practise under indirect supervision
9 Carry out a urine multi dipstick test Explain to patient how to collect a midstream urine sample. Test a sample of urine to detect abnormalities. Perform a pregnancy test where appropriate. Safe to practise under indirect supervision
10 Carry out a 3- and 12-lead electrocardiogram Set up a continuous recording of the electrical activity of the heart, ensuring that all leads are correctly placed. Safe to practise under indirect supervision
11 Take and/or instruct patients how to take a swab Use the correct technique to apply sterile swabs to the nose, throat, skin and wounds. Make sure that samples are placed in the correct containers, that these are labelled correctly and sent to the laboratory promptly and in the correct way. Safe to practise under indirect supervision for nose, throat, skin or wound swabs

Patient care

No Procedure Description Level of competence
12 Perform surgical scrubbing up Follow approved processes for cleaning hands and wearing appropriate personal protective equipment before procedures or surgical operations. Safe to practise under direct supervision
13 Set up an infusion Set up and run through an intravenous infusion. Have awareness of the different equipment and devices used. Safe to practise under direct supervision
14 Use correct techniques for moving and handling, including patients who are frail Use, or direct other team members to use, approved methods for moving, lifting and handling people or objects, in the context of clinical care, using methods that avoid injury to patients, colleagues, or oneself. Safe to practise under indirect supervision

Prescribing

No Procedure Description Level of competence
15 Instruct patients in the use of devices for inhaled medication Explain to a patient how to use an inhaler correctly, including spacers, and check that their technique is correct. Safe to practise under indirect supervision
16 Prescribe and administer oxygen Prescribe and administer oxygen safely using a delivery method appropriate for the patient's needs and monitor and adjust oxygen as needed. Safe to practise under indirect supervision
17 Prepare and administer injectable (intramuscular, subcutaneous, intravenous) drugs Prepare and administer injectable drugs and prefilled syringes. Safe to practise under direct supervision

Therapeutic procedures

No Procedure Description Level of competence
18 Carry out intravenous cannulation Insert a cannula into a patient's vein and apply an appropriate dressing. Safe to practise under direct supervision
19 Carry out safe and appropriate blood transfusion Following the correct procedures, give a transfusion of blood (including correct identification of the patient and checking blood groups). Observe the patient for possible reactions to the transfusion, and take action if they occur. Experienced in a simulated setting; further training required before direct supervision
20 Carry out male and female urinary catheterisation Insert a urethral catheter in both male and female patients. Safe to practise under direct supervision
21 Carry out wound care and basic wound closure and dressing Provide basic care of surgical or traumatic wounds and apply dressings appropriately. Safe to practise under direct supervision
22 Carry out nasogastric tube placement Pass a tube into the stomach through the nose and throat for feeding and administering drugs or draining the stomach's contents. Know how to ensure correct placement. Safe to practise in simulation
23 Use local anaesthetics Inject or topically apply a local anaesthetic. Understand maximum doses of local anaesthetic agents. Safe to practise under direct supervision