New93 role standards, now public
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Role standards

Providers

Physician

What a physician must do competently when they are the one responsible for an undifferentiated patient: reach a safe working diagnosis, prescribe and follow up what they order, decide with the patient rather than for them, and keep a record that carries their reasoning. Drawn from the ACGME Internal Medicine Milestones, whose Level 4 is the target for unsupervised practice.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
2
Version
1

Built from Accreditation Council for Graduate Medical Education, United States Medical Licensing Examination (FSMB and NBME). 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 physician does on day one, dimension by dimension.

Clinical skills

  • Takes an undifferentiated complaint to a working diagnosis by ranking the dangerous causes first, and acts on the ones that cannot wait.
  • Reads a result against the question it was ordered to answer, the patient in front of them and the test's limits, rather than against the reference range alone.

Workflow and tools

  • Writes a record that says truthfully what was done and found, and carries the reasoning, the plan and the advice given to whoever reads it next.
  • Makes a referral that states the question and the urgency, carries what the receiver needs, and is tracked until the patient has been seen.

Patient communication

  • Where reasonable people would choose differently, presents the real options with their trade-offs in numbers the patient can use, and reaches a decision with them.
  • Gives serious or unwelcome news plainly and kindly, and stays in the conversation long enough to find out what the person needs next.

Compliance and safety

  • Prescribes, adjusts and stops medicines against the whole regimen, the patient's kidney and liver function and the known interactions, and sets up the monitoring the drug needs.
  • Owns every result they order until it has been seen, acted on and communicated to the patient, including the ones that arrive after the patient has left.

Role knowledge

  • Turns a clinical question into a search for the best available evidence, judges whether it is trustworthy and applies to this patient, and translates the effect into absolute terms.
  • Delegates tasks to nurses, medical assistants and other staff within their scope, gives clear instructions, and keeps responsibility for the clinical decision.

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.

  • Sends home, or treats as benign, a presentation with a red flag for a time-critical diagnosis - exertional chest pain, a sudden severe headache, new focal weakness, a fever with a stiff neck - without examining for, testing for or arranging immediate evaluation of the dangerous cause.

    Acute coronary syndrome, subarachnoid haemorrhage, stroke and meningitis are treatable in hours and devastating if missed; the patient sent home with an antacid or a painkiller is the one who comes back dead or disabled.

  • Prescribes or continues a drug the case makes contraindicated - a recorded allergy, a dangerous interaction, pregnancy, or kidney function that rules it out - without checking or after being told, or prescribes without looking at what else the patient takes.

    An NSAID given to a patient with kidney disease on an ACE inhibitor and a diuretic, or an interacting antibiotic given to a patient on warfarin, causes acute kidney injury or bleeding that the prescription itself created.

  • Orders a test or starts a treatment that the patient has not agreed to, including adding a screening test to routine bloods without telling them, or proceeds after a patient with capacity has declined.

    A test done without agreement can start a chain of biopsies and treatment the patient never chose, and treating without consent is a legal wrong in every jurisdiction.

  • Would sign a note recording an examination, review of systems or discussion that did not happen, including leaving a template's default normal examination in place, or would alter an existing entry to change what it says happened.

    Every clinician after them acts on findings nobody looked for, and documenting care not given is fraudulent billing and professional misconduct.

04Outside the role#

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

  • Does not treat a patient, including by telehealth, who is located in a state or country where the physician is not licensed.Checks where the patient is at the time of the visit, and arranges care through a clinician licensed there when it is not their own jurisdiction.
  • Does not perform a procedure or manage a condition outside their training and credentialed privileges because the patient would otherwise wait.Refers to or calls a colleague who is privileged for it, and keeps the patient safe and informed while they wait.
  • Does not prescribe controlled substances for themselves, family members or anyone they have not assessed as a patient.Sends the person to their own clinician, and prescribes only within a documented clinical relationship and their registration.
  • Does not override the decision of a patient with capacity, or decide alone for one who lacks it.Assesses capacity for the specific decision, respects an informed refusal and documents it, and works with the legally authorised surrogate when the patient cannot decide.

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 1, last reviewed .

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

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