F1

• Introduces themselves to patient/carer/relative stating name and role
• Communicates clearly, politely, considerately, with understanding and empathy
• Ensures sufficient time and appropriate environment for communication

F2

• Provides the necessary / desired information
• Communicates increasingly complex information
• Checks patients’ understanding of options and supports patients in interpreting information and evidence relevant to their condition
• Ensures that patients are able to express concerns and preferences, ask questions and make personal choices
• Responds to patients’ queries or concerns
• Teaches communication skills to students and colleagues

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Communication in challenging circumstances

F1

• Uses appropriate styles of communication
• Seeks/provides additional support in situations where patient’s ability to communicate may be impaired
• Breaks bad news compassionately and supportively

F2

• Manages consultation/communication in time limited environments e.g. outpatients, emergency departments
• Manages consultation/communication when English is not a patient’s first language, including the appropriate use of an interpreter
• Manages three-way consultations e.g. with an interpreter, using sign language, or with a child patient and their family/carers

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Complaints

F1

• Acts in an open and transparent way and notifies all appropriate persons including the patient when safety has (or potentially has) been compromised
• Apologises for errors and takes steps to minimise impact

F2

• Acts to prevent/mitigate and minimise distress in situations which might lead to complaint or dissatisfaction
• Deals appropriately with angry/distressed/dissatisfied patients/carers and seeks assistance as appropriate

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Patient records

F1 and F2

• Maintains accurate, legible and contemporaneous patient records and ensures that entries are signed and dated in compliance with "Standards for the structure and content of patient records Health and Social Care Information Centre / Academy of Medical Royal Colleges (AoMRC) 2013”

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Interface with other healthcare professionals

F1

• Describes the structure and importance of the wider healthcare team
• Works effectively within the healthcare team for the benefit of patient care
• Makes clear, concise and timely written and oral referrals to other healthcare professionals within the hospital
• Produces a timely, legible discharge summary that identifies principle diagnoses, key treatments/interventions, discharge medication and follow-up arrangements

F2

• Demonstrates ability to make referrals across boundaries / through networks of care (primary, secondary, tertiary)
• Writes accurate, timely, succinct and structured clinic letters and clinical summaries

F1

• Gives structured handover to ensure safe continuing care of patients.
• Makes adequate arrangements for cover e.g. handing over bleep during educational sessions.

F2

• Allocates and prioritises tasks during handover.
• Anticipates and identifies problems for the next clinical team/shift and takes pre-emptive action where required

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Interaction with colleagues

F1

• Acts as a member of the multidisciplinary professional team by supporting, respecting and being receptive to the views of other healthcare professionals
• Works effectively with others towards a common goal e.g. accepts instructions and allocation of tasks from seniors at handovers and multidisciplinary team meetings
• Contributes to multidisciplinary team (MDT) meetings e.g. by case presentation, making records

F2

• Demonstrates initiative e.g. by recognising work pressures on others, providing support and organising / allocating work to optimise effectiveness within the clinical team

F1

• Leads within allocated roles e.g. when asked to organise medical students
• Describes the organisational structures and chains of responsibility including principles of line management in medical and non-medical staff
• Demonstrates leadership during routine tasks e.g. organising and performing core procedures

F2

• Demonstrates extended leadership role within the team by making decisions and taking responsibility for managing increasingly complex situations across a greater range of clinical and non-clinical situations,
• Supervises and supports team members, e.g. supervising F1 doctors, delegating tasks appropriately, directing patient review, organising handover

F1 and F2

• Responds promptly to notification of deterioration or concern regarding a patient’s condition e.g. change in National Early Warning Score (NEWS)
• Prioritises tasks according to clinical urgency and reviews patients in a timely manner
• Recognises, manages and reports transfusion reactions, according to local and national guidelines

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Assessment of the acutely unwell patient

F1

• Recognises and promptly assesses the acutely ill, collapsed or unconscious patient using an Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach and:
  • Correctly interprets clinical and non-invasive monitoring of vital signs*
  • Informs senior colleague and requests assistance / review e.g. NEWS ≥ 5
    * Utilises normal age-related reference ranges for vital signs in infants and children

F2

• Performs rapid, focused assessment of illness severity including physiological monitoring and also considering mental health aspects
• Performs prompt, rapid, focused assessment of the patient who presents an acute risk to themselves or to others in the context of mental disorder, incapacity or incompetence

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Immediate management of the acutely unwell patient

F1

• Initiates prompt appropriate management to stabilise/prevent further deterioration in patients with common acute presentations (including mental health) and seeks timely senior help with the further management
• Delivers immediate therapy (e.g. oxygen, fluid challenge, antibiotics) to an acutely ill patient
• Identifies electrolyte imbalance and, with senior advice, delivers a safe and effective method of correction
• Records and acts on changes in physiological status, anticipating and planning appropriate action to prevent deterioration in vital signs
• Communicates with the patient, relatives and carers and ensures they are supported

F2

• Reassesses acutely ill patients to monitor efficacy of interventions, including those aimed at managing acute mental illness and maintaining patient safety and the safety of others
• Recognises when a patient should be moved to a higher level of care and seeks appropriate assistance with review and management
• Communicates with relatives/friends/carers in acute situations and offers support

F1

• Recognises acute manifestations/exacerbations/ progression and new complications of long-term conditions and their causes
• Recognises how acute illness or injury will interact with pre-existing chronic illness/disability

F2

• Performs primary review of new referrals within the hospital or outpatient clinic
• Cares for patients with long-term diseases during their in-patient stay, as outpatients and in the community
• Reviews long-term drug regime and, with senior advice, considers modifying dosage, timing and treatment.
• Assesses and manages the impact of long term mental disorder on the presentation and course of acute physical illness, and vice versa

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The frail patient

F1

• Recognises frailty
• Formulates individual patient management plan based on assessment of frailty as well as clinical need

F2

• Prescribes with an understanding of the impact of increasing age, weight loss and frailty on drug pharmacokinetics and pharmacodynamics
• Performs a comprehensive geriatric assessment (CGA) including consideration of dementia
• Describes the impact of activities of daily living on long-term conditions (e.g. impact of a notifiable condition on driving) and provides information / discusses these with the patients and carers

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Support for patients with long term conditions

F1

• Evaluates patients’ capacity to self-care, including mental health aspects
• Organises physiotherapy and occupational therapy for inpatients with long-term mobility problems

F2

• Encourages and assists patients to make realistic decisions about their care and helps them to construct and review advance/long-term care plans
• Arranges appropriate assessment for specialist rehabilitation, care home placement and respite care

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Nutrition

F1

• Describes the prevalence of nutritional disorders in patients with long-term conditions
• Routinely assesses patients’ basic nutritional requirements
• Performs basic nutritional screen including assessing growth in children

F2

• Works with other healthcare professionals to address nutritional needs and communicate these during care planning
• Recognises eating disorders, seeks senior input and refers to local specialist service
• Formulates a plan for investigation and management of weight loss or weight gain

F1

• Obtains and presents accurate patient history, utilising all relevant sources of information including carers/family, doing so in a timely manner

F2

• Obtains relevant history, including mental health and collateral history, in time limited and sometimes difficult circumstances

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Physical and mental state examination

F1

• Performs competent physical and mental state examination in a timely manner
• Presents examination, including mental state, findings succinctly and accurately
• Uses a chaperone, where appropriate

F2

• Performs focused physical/mental state examination in time limited environments e.g. outpatients/ general practice/emergency department

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Diagnosis

F1

• Formulates appropriate physical/mental health differential diagnoses, based on history, examination and immediate investigations
• Requests and interprets necessary investigations to confirm diagnosis
• Confirms initial diagnosis with more senior doctor
• Takes account of probabilities in ranking differential diagnoses

F2

• Performs primary review of new referrals within the hospital or outpatient clinic
• Reviews initial diagnoses and plans appropriate strategies for further investigation

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Clinical management

F1

• Formulates problem list and confirms management plan with more senior doctor and initiates management plan within limits of competence
• Performs an accurate cognitive assessment to screen for dementia and delirium

F2

• Refines problem lists and management plans and develops appropriate strategies for further investigation and management

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Clinical review

F1

• Undertakes regular reviews, amends differential diagnosis and expedites patient investigation and management in the light of developing symptoms and response to therapeutic interventions

F2

• Reprioritises problems and refines strategies for investigation and management and leads regular review of treatment response to oversee patients’ progress

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Discharge planning

F1

• Anticipates and ensures patients are prepared for discharge taking medical and social factors into account
• Makes early referral within the multidisciplinary team and to community agencies
• Communicates with primary care and other agencies

F2

• Anticipates clinical evolution and starts planning discharge and on-going care from the time of admission
• Liaises and communicates with the patient, family and carers and supporting teams to arrange appropriate follow up
• Recognises and records when patients are medically, including mentally, fit for discharge

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Discharge summaries

F1 and F2

• Prescribes discharge medication in a timely fashion
• Produces a clear, timely, legible discharge summary that identifies principle diagnoses, including mental health, key treatments/interventions, discharge medication and follow-up arrangements

F1

• Requests/arranges investigations which are necessary to assist diagnosis and monitor treatment and are appropriate for patients’ needs in accordance with local and national guidance
• Ensures correct identification of patients when collecting and labelling samples
• Ensures correct identification of patients when reviewing results and planning consequent management
• Minimises risk of exposing a pregnant woman to radiation

F2

• Minimises wasteful or inappropriate use of resources by helping and directing colleagues to order appropriate tests and investigations
• Explains to patients the risks, possible outcomes and implications of investigation results and obtains informed consent

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Interpretation of investigations

F1

• Seeks, interprets, records and relays/acts on results of ECG, laboratory tests, basic radiographs and other investigations and explains these effectively to patients

F2

• Increases the range and complexity of investigations which they can interpret and helps colleagues to interpret appropriate tests and investigations

F1 and F2

• Prescribes medicines, blood products and fluids correctly, accurately and unambiguously in accordance with GMC and other guidance using correct documentation to ensure that patients receive the correct drug via the correct route at the correct frequency and at the correct time
• Demonstrates understanding of responsibilities and restrictions with regard to prescribing high risk medicines including anticoagulation, insulin, chemotherapy and immunotherapy
• Performs dosage calculations accurately and verifies that the dose calculated is of the right order
• Reviews previous prescriptions and transfers/ transcribes accurately and appropriately
• Describes the potential hazards related to different routes of drug administration (e.g. oral, intramuscular, intravenous, intrathecal)
• Follows the guidance in Good Medical Practice in relation to self-prescribing and prescribing for friends and family
• Within the hospital, prescribes controlled drugs using appropriate legal framework and describes the management and prescribing of controlled drugs in the community
• Describes the importance of security issues in respect of prescriptions

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Clinically effective prescription

F1 and F2

• Prescribes and administers for common important indications including medicines required urgently in the management of medical emergencies e.g. sepsis, exacerbation of chronic obstructive pulmonary disease, pulmonary oedema, congestive cardiac failure, pain, thromboprophylaxis
• Prescribes safely for different patient groups including frail elderly, children, women of child-bearing potential, pregnant women and those with hepato-renal dysfunction
• Prescribes and administers oxygen, fluids and antimicrobials as appropriate e.g. in accordance with NICE guidance on antimicrobial and intravenous fluid therapy
• Chooses appropriate intravenous fluids as vehicles for intravenous drugs and calculates the correct volume and flow rate
• Assesses the need for fluid replacement therapy and chooses and prescribes appropriate intravenous fluids and calculates the correct volume and flow rates
• Prescribes and administers blood products safely in accordance with guidelines/protocols on safe cross matching and the use of blood and blood products

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Discussion of medication with patients

F1 and F2

• Discusses drug treatment and administration with patients/carers, including duration of treatment, unwanted effects and interactions
• Obtains an accurate drug history, including allergy, self-medication, use of complementary healthcare products and enquiry about allergic and other adverse reactions

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Guidance on prescription

F1 and F2

• Prescribes using all available support including local and national formularies, pharmacists and more experienced prescribers to ensure accurate, safe and effective error-free prescribing, whilst recognising that legal responsibility remains with the prescriber
• Prescribes according to relevant national and local guidance on antimicrobial therapy, recognising the link between antimicrobial prescribing and the development of antimicrobial resistance.

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Review of prescriptions

F1 and F2

• Reviews prescriptions regularly for effectiveness and safety taking account of patient response, adverse reactions and drug level monitoring
• Recognises and initiates action for common adverse effects of drugs and communicates these to patients, including potential effects on work and driving

Core procedures are mandated by the General Medical Council (GMC) and trainees must be signed off a competent to perform them.

Trainees may have the opportunity to perform many other procedures according to their clinical placements.

Trainees should only perform procedures independently or teach medical students core procedures when they have been sanctioned to do this by their supervisor.

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Core procedures

F1

• Performs competently the core procedures either in the workplace or on simulated patients
• For each procedure, the foundation doctor should know the indications and contraindications and be able to
  • Explain the procedure to patients, including possible complications, and gain valid informed consent
  • Prepare the required equipment, including a sterile field
  • Position the patient
  • Prescribe and/or administer appropriate analgesia in certain patients
  • Adequately prepare the skin using aseptic technique where relevant
  • Administer local anaesthetic correctly for the procedure
  • Recognise, record and be able to undertake emergency management of common complications
  • Safely dispose of equipment, including sharps
  • Document the procedure, including the labelling of samples and giving instructions for appropriate aftercare/monitoring

F2

• Maintains and improves skills in the core procedures and develops skills in more challenging circumstances e.g. reliably able to perform venous cannulation in the majority of patients including during resuscitation

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Other procedures

F1

• Performs under supervision procedures linked to a specialty placement

F2

• Teaches other healthcare workers procedures when skilled and sanctioned to do this
• Increases the range of procedures they can perform relevant to specific clinical placements

F1

• Initiates and responds to a crash call
• Functions as a competent member of the team providing immediate life support
• Is trained:
  • To initiate and perform immediate adult life support comprising cardiopulmonary resuscitation, simple airway management and safe defibrillation
  • To provide basic paediatric life support (for doctors working with infants and children)
  • To use a defibrillator
  • To adapt resuscitation in certain situations e.g. in pregnant patients

F2

• Demonstrates the initiation and performance of advanced life support including cardiopulmonary resuscitation, manual defibrillation and management of life threatening arrhythmias and is able to lead the resuscitation team where necessary
• Demonstrates understanding of the ethics of transplantation and identifies potential donors to senior medical staff

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Do not attempt cardiopulmonary resuscitation orders

F1

• Demonstrates understanding of and respect for do not attempt cardiopulmonary resuscitation (DNACPR) decisions

F2

• Discusses DNACPR with the multidisciplinary team, the patient, long-term carers (both medical and non-medical) and relatives and then records the outcome of that discussion

F1 and F2

• Explains to patients the possible effects of lifestyle, including the effects of diet, nutrition, inactivity, smoking, alcohol and substance abuse
• Recognises the impact of wider determinants of health and advises on preventative measures with reference to local and national guidelines including:
  • Smoking cessation and supportive measures
  • Appropriate alcohol intake levels or drinking cessation
  • Illicit drug use and referral to support services
  • Biohazards
  • Risks of UV and ionising radiation especially the harmful effects of sunlight
  • Lack of exercise and physical/mental activity
  • Weight management
  • Employment
  • Vaccination programmes
  • Cancer screening e.g. breast, cervical, bowel
• Recommends well man/women clinics

F1

• Contributes as a member of the multidisciplinary team to delivering high quality end of life care that is in line with the individuals’ needs and preferences
• Recognises that a patient is likely to die in the next few hours or days and:
  • Assesses whether this is reversible and, if so, whether this is in line with the patient’s wishes
  • Ensures that this is communicated clearly and with empathy to the patient (where appropriate) and those close to the patient
  • Recognises the limitation of own competence and experience to make such an assessment and seeks senior advice
  • Accesses palliative care services when desired
• Recognises that palliative care requires attention to physical, psychological, emotional, social and spiritual aspects of the patient’s experience, and those close to them. Helps patient to access this if required

F2

• Participates in discussions regarding personalised care planning including symptom management and advance care plans with patients, family and carers
• Discusses the patients’ needs and preferences regarding care in the last days of life, including preferred place of care and death, treatment escalation plans, do not attempt cardiopulmonary resuscitation (DNACPR) decisions,

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Care after death

F1/F2

• Confirms death by conducting appropriate physical examination, documenting findings in the patient record
• Behaves professionally and compassionately when confirming and pronouncing death
• Follows the law and statutory codes of practice governing completion of Medical Certificate of Cause of Death (MCCD) and cremation certificates.
• Completes MCCD when trained to do so and notes details reported on the MCCD in the patient record
• Demonstrates understanding of circumstances requiring reporting death to coroner/procurator fiscal.
• Reports death to coroner/procurator fiscal after discussion with a senior colleague
• Discusses the benefits of post mortem examination and explains the process to relatives/carers
• Completes relevant sections of cremation forms when trained to do this

F1 and F2

• Recognises and works within limits of competency
• Calls for senior help and advice in a timely manner and communicates concerns/expected response clearly.
• Uses clinical guidelines and protocols, care pathways and bundles
• Takes part in activities to maintain and develop competence e.g. seeking opportunities to do SLES and attending simulation training
• Demonstrates evidence of reflection on practice and how this has led to personal development

F1

• Delivers healthcare within clinical governance frameworks under senior/consultant direction
• Describes how the needs of the patient should not compromise personal safety or the safety of others
• Discusses the limitations of clinical pathways and seeks advice regarding deviating from these in certain individual patient circumstances
• Undertakes appropriate pre-theatre/procedure checks including World Health Organisation (WHO) safe surgery checklist
• Describes the mechanisms to report:
  • Never events
  • Critical incidents/near misses
• Shows evidence of reflection on a patient safety issue with thought about possible causes, including role of human factors and system error

F2

• Describes the mechanisms to report:
  • Device related adverse events
  • Adverse drug reactions
• to appropriate national centre and completes reports as required
• Participates in/undertakes a project related to a patient safety issue (e.g. Quality Improvement), with recommendations for improving the reliability of care and, with senior support, takes steps to institute these
• Discusses risk reduction strategies and principles of significant event analysis and contributes to the discussion/ analysis of adverse events, including potential to identify and prevent systematic error

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Causes of impaired performance, error or suboptimal patient care

F1

• Describes:
  • The risks to patients if personal performance is compromised
  • The effects of stress and fatigue on performance (personal or of others), with actions to minimise its impact, along with sources of help
  • How medications, which they may be taking, can reduce personal performance
  • Why health problems (personal or of others) must not compromise patient care or expose colleagues or patients to harm
  • The need to report personal health problems in a timely manner and awareness of the support services available
• Takes responsibility for personal health and performance, e.g. by reporting sickness absence in a timely manner and completing return to work documentation as required.
• Notifies appropriate individuals, and arranges cover where applicable, for planned or unexpected absences.
• Seeks support appropriately (e.g. GP, occupational health, support services) regarding health or emotional concerns that might impact personal performance

F2

• Describes the role of human factors in medical errors and takes steps to minimise these
• Describes ways of identifying poor performance in colleagues and how to support them

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Patient identification

F1 and F2

• Ensures patient safety by positive identification of the patient:
  • At each encounter
  • In case notes
  • When prescribing/administering drugs
  • On collecting specimens and when requesting and reviewing investigations
  • Before consent for surgery/procedures
• Uses appropriate 2 or 3 point checks (e.g.name, date of birth, hospital number, address) in accordance with local protocols and national guidance
• Crosschecks identification immediately before procedures/administration of blood products/IV drugs

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Usage of medical devices and information technology (IT) (n.b. this excludes implantable devices)

F1 and F2

• Demonstrates ability to operate common medical devices and interpret non-invasive monitoring correctly and safely after appropriate training
• Accesses and uses IT systems including local computing systems appropriately
• Demonstrates good information governance in use of electronic records

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Infection control

F1 and F2

• Demonstrates consistently high standard of practice in infection control techniques in patient contact and treatment including hand hygiene and use of personal protective equipment (PPE)
• Demonstrates safe aseptic technique and correctly disposes of sharps and clinical waste
• Demonstrates adherence to local guidelines/protocols for antibiotic prescribing
• Requests screening for any disorder which could put other patients or staff at risk by cross contamination, e.g. Clostridium.Difficile
• Takes an active role in outbreak management within healthcare settings (e.g. diarrhoea on a ward) and complies with procedures instituted by the infection control team
• Informs the competent authority of notifiable diseases
• Challenges and corrects poor practice in others who are not observing best practice in infection control
• Recognises the need for immunisations and ensures own are up to date in accordance with local/national policy
• Takes appropriate microbiological specimens in a timely fashion with safe technique
• Recognises the risks to patients from transmission of blood-borne infection

F1

• Shows evidence of involvement in quality improvement initiatives in healthcare

F2

• Contributes significantly to at least one quality improvement project including:
  • Data collection
  • Analysis and/or presentation of findings
  • Implementation of recommendations
• Makes quality improvement link to learning/professional development in e-portfolio

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Healthcare resource management

F1 and F2

• Demonstrates understanding of the organisational structure of the NHS and independent sector and their role in the wider health and social care landscape
• Describes hospital and departmental management structure
• Describes the processes of commissioning and funding, and that all healthcare professionals have a responsibility for stewardship of healthcare resources
• Describes accountability of the NHS in its context as a publicly funded body, and the need to ensure the most effective and sustainable use of finite resources
• Recognises the resource implications of personal actions and minimises unnecessary/wasteful use of resources e.g. repeat investigations, delayed discharge
• Describes cost implications of common treatments in terms of money, equipment and human resources (e.g. generic prescribing, intravenous v oral antibiotics).

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Information management

F1 and F2

• Seeks, finds, appraises and acts on information related to medical practice including primary research evidence, reviews, guidelines and care bundles
• Critically reviews research and, where appropriate, presents finding (e.g. journal club).