Outcomes for graduates

Outcomes 1 - Professional values and behaviours

We expect newly qualified doctors to demonstrate appropriate generic personal and professional values and behaviours. They must keep to our ethical guidance and standards, Good medical practice and the explanatory guidance, which together describe what is expected of all doctors who are registered with us.

Illustrative figure of a doctor, the sections of each of the 3 outcomes is written above. This section is Outcomes 1 - professional values and behaviours, and the sections are 'professional and ethical responsibilties', 'legal responsibilities', 'patient safety and quality improvement', 'dealing with complexity and uncertainty', 'safeguarding vulnerable patients' and 'leadership and team woking'

Professional and ethical responsibilities

2 Newly qualified doctors must behave according to ethical and professional principles.

They must be able to:

  1. Demonstrate the clinical responsibilities and role of the doctor
  2. Demonstrate compassionate professional behaviour and their professional responsibilities in making sure the fundamental needs of patients are addressed
  3. Summarise the current ethical dilemmas in medical science and healthcare practice; the ethical issues that can arise in everyday clinical decision-making; and apply ethical reasoning to situations which may be encountered in the first years after graduation
  4. Maintain confidentiality and respect patients’ dignity and privacy
  5. Act with integrity, be polite, considerate, trustworthy and honest
  6. Take personal and professional responsibility for their actions
  7. Manage their time and prioritise effectively
  8. Recognise and acknowledge their own personal and professional limits and seek help from colleagues and supervisors when necessary, including when they feel that patient safety may be compromised
  9. Protect patients from any risk posed by their own health including:
    • the risks to their health and to patient safety posed by self-prescribing medication and substance misuse
    • the risks to their health and to patient safety posed by fatigue - they must apply strategies to limit the impact of fatigue on their health.

  10. Recognise the potential impact of their attitudes, values, beliefs, perceptions and personal biases (which may be unconscious) on individuals and groups and identify personal strategies to address this
  11. Demonstrate the principles of person-centred care and include patients and, where appropriate, their relatives, carers or other advocates in decisions about their healthcare needs
  12. Explain and demonstrate the importance of:
    • seeking patient consent, or the consent of the person who has parental responsibility in the case of children and young people, or seeking the views of those with lasting power of attorney or independent mental capacity advocates if appropriate
    • providing information about options for investigations, treatment and care in a way that enables patients to make decisions about their own care
    • assessing the mental capacity of a patient to make a particular decision, including when the lack of capacity is temporary, and knowing when and how to take action.
  13. Act appropriately, with an inclusive approach, towards patients and colleagues
  14. Be open and honest in their interactions with patients, colleagues and employers when things go wrong - known as the professional duty of candour
  15. Raise and escalate concerns through informal communication with colleagues and through formal clinical governance and monitoring systems about:
    • patient safety and quality of care
    • bullying, harassment and undermining
  16. Explain and demonstrate the importance of professional development and lifelong learning and demonstrate commitment to this
  17. Work effectively and appropriately as a mentor and teacher for other learners in the multi-professional team
  18. Respect patients' wishes about whether they wish to participate in the education of learners
  19. Access and analyse reliable sources of current clinical evidence and guidance and have established methods for making sure their practice is consistent with these
  20. Explain and demonstrate the importance of engagement with revalidation, including maintaining a professional development portfolio which includes evidence of reflection, achievements, learning needs and feedback from patients and colleagues
  21. Engage in their induction and orientation activities, learn from experience and feedback, and respond constructively to the outcomes of appraisals, performance reviews and assessments.

3 Newly qualified doctors must demonstrate awareness of the importance of their personal physical and mental wellbeing and incorporate compassionate self-care into their personal and professional life.

They must demonstrate awareness of the need to:

  1. Self-monitor, self-care and seek appropriate advice and support, including by being registered with a GP and engaging with them to maintain their own physical and mental health
  2. Manage the personal and emotional challenges of coping with work and workload, uncertainty and change
  3. Develop a range of coping strategies, such as reflection, debriefing, handing over to another colleague, peer support and asking for help, to recover from challenges and set-backs.

Patient safety and quality improvement

5 Newly qualified doctors must demonstrate that they can practise safely. They must participate in and promote activity to improve the quality and safety of patient care and clinical outcomes.

They must be able to:

  1. Place patients’ needs and safety at the centre of the care process
  2. Promote and maintain health and safety in all care settings and escalate concerns to colleagues where appropriate, including when providing treatment and advice remotely
  3. Recognise how errors can happen in practice and that errors should be shared openly and be able to learn from their own and others' errors to promote a culture of safety
  4. Apply measures to prevent the spread of infection, and apply the principles of infection prevention and control
  5. Describe the principles of quality assurance, quality improvement, quality planning and quality control, and in which contexts these approaches should be used to maintain and improve quality and safety
  6. Describe basic human factors principles and practice at individual, team, organisational and system levels and recognise and respond to opportunities for improvement to manage or mitigate risks
  7. Apply the principles and methods of quality improvement to improve practice (for example, plan, do, study, act or action research), including seeking ways to continually improve the use and prioritisation of resources
  8. Describe the value of national surveys and audits for measuring the quality of care.

Dealing with complexity and uncertainty

6 The nature of illness is complex and therefore the health and care of many patients is complicated and uncertain. Newly qualified doctors must be able to recognise complexity and uncertainty. And, through the process of seeking support and help from colleagues, learn to develop confidence in managing these situations and responding to change.

They must be able to:

  1. Recognise the complex medical needs, goals and priorities of patients, the factors that can affect a patient's health and wellbeing and how these interact. These include psychological and sociological considerations that can also affect patients' health
  2. Identify the need to adapt management proposals and strategies for dealing with health problems to take into consideration patients' preferences, social needs, multiple morbidities, frailty and long term physical and mental conditions
  3. Demonstrate working collaboratively with patients, their relatives, carers or other advocates, in planning their care, negotiating and sharing information appropriately and supporting patient self-care
  4. Demonstrate working collaboratively with other health and care professionals and organisations when working with patients, particularly those with multiple morbidities, frailty and long term physical and mental conditions
  5. Recognise how treatment and care can place an additional burden on patients and make decisions to reduce this burden where appropriate, particularly where patients have multiple conditions or are approaching the end of life
  6. Manage the uncertainty of diagnosis and treatment success or failure and communicate this openly and sensitively with patients, their relatives, carers or other advocates
  7. Evaluate the clinical complexities, uncertainties and emotional challenges involved in caring for patients who are approaching the end of their lives and demonstrate the relevant communication techniques and strategies that can be used with the patient, their relatives, carers or other advocates.

Safeguarding vulnerable patients

7 Newly qualified doctors must be able to recognise and identify factors factors that suggest patient vulnerability and take action in response.

They must be able to:

  1. Identify signs and symptoms of abuse or neglect and be able to safeguard children, young people, adults and older people, using appropriate systems for sharing information, recording and raising concerns, obtaining advice, making referrals and taking action
  2. Take a history that includes consideration of the patient's autonomy, views and any associated vulnerability, and reflect this in the care plan and referrals
  3. Assess the needs of and support required for children, young people and adults and older people who are the victims of domestic, sexual or other abuse
  4. Assess the needs of, and support required, for people with a learning disability
  5. Assess the needs of, and support required, for people with mental health conditions
  6. Adhere to the professional responsibilities in relation to procedures performed for non-medical reasons, such as female genital mutilation and cosmetic interventions
  7. Explain the application of health legislation that may result in the deprivation of liberty to protect the safety of individuals and society
  8. Recognise where addiction (to drugs, alcohol, smoking or other substances), poor nutrition, self neglect, environmental exposure, or financial or social deprivation are contributing to ill health. And take action by seeking advice from colleagues and making appropriate referrals
  9. Describe the principles of equality legislation in the context of patient care.

Leadership and team working

8 Newly qualified doctors must recognise the role of doctors in contributing to the management and leadership of the health service.

They must be able to:

  1. Describe the principles of how to build teams and maintain effective team work and interpersonal relationships with a clear shared purpose
  2. Undertake various team roles including, where appropriate, demonstrating leadership and the ability to accept and support leadership by others
  3. Identify the impact of their behaviour on others
  4. Describe theoretical models of leadership and management that may be applied to practice.

9 Newly qualified doctors must learn and work effectively within a multi-professional and multi-disciplinary team and across multiple care settings. This includes working face to face and through written and electronic means, and in a range of settings where patients receive care, including community, primary, secondary, mental health, specialist tertiary and social care settings and in patients’ homes.

They must be able to:

  1. Demonstrate their contribution to effective interdisciplinary team working with doctors from all care settings and specialties, and with other health and social care professionals for the provision of safe and high-quality care
  2. Work effectively with colleagues in ways that best serve the interests of patients. This includes:
    • safely passing on information using clear and appropriate spoken, written and electronic communication
    • at handover in a hospital setting and when handing over and maintaining continuity of care in primary, community and social care settings
    • when referring to colleagues for investigations or advice
    • when things go wrong, for example when errors happen
    • questioning colleagues during handover where appropriate
    • working collaboratively and supportively with colleagues to share experiences and challenges that encourage learning
    • responding appropriately to requests from colleagues to attend patients
    • applying flexibility, adaptability and a problem-solving approach to shared decision making with colleagues.
  3. Recognise and show respect for the roles and expertise of other health and social care professionals and doctors from all specialties and care settings in the context of working and learning as a multiprofessional team.