Outcomes for graduates - Practical skills and procedures

About this supplement to Outcomes for graduates

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 2010 and the Disability Discrimination Act 1995.

Students need to be able to perform the practical skill or procedure using the specified method, but reasonable adjustments could be made to other aspects. For example, an adapted chair if the student needs to sit down while carrying out the procedure. 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 Good 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