New93 role standards, now public
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Role standards

Providers

Hospitalist

What a hospitalist is expected to do competently on an inpatient service: manage the common acute conditions, move patients safely across transitions, and work inside the hospital as a system rather than around it.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
2

Built from Society of Hospital Medicine, Journal of Hospital Medicine, Society of Hospital Medicine. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent hospitalist does on day one, dimension by dimension.

Clinical skills

  • Builds and revises a differential against the evidence in front of them, and states what would change their mind.
  • Identifies the deteriorating inpatient early and escalates the level of care without waiting for certainty.

Workflow and tools

  • Writes documentation that carries the clinical reasoning, not just the findings, to whoever picks the patient up.
  • Works the record efficiently under load without copy-forward that propagates stale findings.

Patient communication

  • Presents real options with their trade-offs and elicits what matters to this patient before recommending.
  • Delivers serious news and discusses goals of care directly, without retreating into euphemism.

Compliance and safety

  • Reconciles medication at admission, transfer and discharge against an actual source, not the previous list.
  • Considers the drug chart as a cause of a new problem before adding another drug to it.

Role knowledge

  • Hands off with explicit anticipatory guidance: what may go wrong overnight and what to do about it.
  • Works as one member of a team that includes nursing, pharmacy and therapies, and defers where their expertise is better.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Answers a worsening patient by escalating treatment for the admitting label - more bronchodilators, steroids, antibiotics or ventilatory support - without considering or testing a dangerous alternative such as pulmonary embolism, pneumothorax, heart failure or drug-induced hypercapnia.

    Diagnostic momentum leaves a treatable cause of deterioration untreated while the patient receives more therapy for a condition that is not the problem.

  • Resolves an unexplained discrepancy in a high-risk medication - an anticoagulant, insulin, opioid, antiepileptic or immunosuppressant - by assumption, restarting it at the listed dose or discontinuing it, without verifying against another source and without a plan to do so.

    An opioid restarted at a dose the patient stopped months ago, or an anticoagulant dropped because one list omitted it, reaches the patient as an overdose, a withdrawal, a clot or a bleed.

  • Hands over without naming a patient they know is unstable or at risk of deteriorating, or without the time-critical pending result on that patient and what to do when it comes back.

    The night clinician cannot act on a risk nobody told them about, and the first they hear of it is the emergency.

  • Would document an examination, finding or conversation that did not happen, including carrying yesterday's examination forward as today's without examining the patient, or would alter an entry to hide what happened.

    Every clinician after them acts on a false record, and attesting to care not given is fraudulent documentation.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not perform a procedure outside their credentialed privileges, however routine it seems or however urgent the request.Arranges a privileged colleague, interventional radiology or the relevant service, and meanwhile keeps the patient safe.
  • Does not proceed with a test or treatment that a patient with capacity has refused, or pressure them until they agree.Explores the reasons, offers alternatives, documents the informed refusal, and keeps caring for the patient on the terms they accept.
  • Does not make a decision for a patient who has capacity, or substitute their own view for a surrogate's when the patient lacks it.Assesses capacity for the specific decision, works with the legally authorised surrogate on what the patient would have wanted, and involves ethics when that cannot be agreed.
  • Does not keep a patient on the ward whose monitoring or support needs exceed what the ward can safely provide.Escalates to a step-down unit or the ICU through the rapid response or critical care route, and stays with the patient's care until the transfer is complete.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 2, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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