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Role standards

Providers

Resident physician

What a resident physician must do safely when covering patients overnight under supervision: recognise who is sick, act at the bedside, get the right senior involved early and make sure they have heard, hand over what matters, and know the edge of what they have been entrusted to do alone. Drawn from the AAMC Core Entrustable Professional Activities for Entering Residency and the supervision requirements of the ACGME Common Program Requirements.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
5
Sources
3
Version
1

Built from Association of American Medical Colleges, 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 resident physician does on day one, dimension by dimension.

Clinical skills

  • Recognises the deteriorating patient from the cues, goes to the bedside, starts the first treatment and gets help before the diagnosis is certain.
  • Builds a prioritised differential for a problem on call that puts the dangerous causes first, and can explain why.

Workflow and tools

  • Gives and receives a structured handoff that leads with who is sick, carries if-then plans and pending results, and transfers responsibility explicitly.
  • Documents on-call events truthfully and promptly, including what they found, what they did, who they told and the plan.

Patient communication

  • Obtains consent for common tests and procedures only when they can explain them, from a patient with capacity or the right surrogate, as a conversation rather than a signature.
  • Handles a distressing conversation on call honestly, without taking on a decision or disclosure that belongs to the primary team or attending.

Compliance and safety

  • Tells the supervising senior or attending when the situation requires it, in a way that makes the concern and the request explicit, and confirms the plan and who owns it.
  • Writes and adjusts medication orders on call with the patient's allergies, kidney function, current drugs and the reason for the order in view.

Role knowledge

  • Knows what they have been entrusted to do alone at this stage of training, calls for supervision beyond it, and keeps the patient safe while it comes.
  • Turns a question from the ward into a search of a trustworthy source and knows how to judge whether the answer applies to the patient.

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.

  • Manages a patient with signs of acute deterioration - new confusion, hypotension, rising respiratory rate or oxygen need - by phone orders alone, or plans to see them after other work or when results are back, instead of going to the bedside now or calling the rapid response team.

    The first hour of sepsis, bleeding or respiratory failure is when treatment changes the outcome, and a patient not seen is a patient not treated.

  • Does not inform the supervising senior or attending, or plans to wait until the morning, when a patient needs a higher level of care, has an unexpected serious event or dies, or when the resident does not know how to manage what is happening.

    Supervision only protects the patient if the supervisor knows, and the program's rules for when to call exist because residents underestimate how sick patients are at night.

  • 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 returns.

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

  • Would obtain a signature for a procedure they cannot explain or whose material risks they cannot state, from a patient who lacks capacity, or by handing over the form without a discussion.

    A signature without understanding is not consent, and a procedure done on it is done without the patient's permission.

  • Performs a procedure, or makes a decision such as changing code status or discharging a patient, that they have not been entrusted to do without supervision, because the supervisor is busy or others have done so.

    The supervision levels exist because the complication rate of a procedure falls with supervised experience; a pneumothorax or arterial puncture during an unsupervised line is harm the rules were written to prevent.

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 without the level of supervision the program has set for them for that procedure.Calls the supervising senior, fellow or attending, and meanwhile does what is within their entrustment, such as peripheral or intraosseous access.
  • Does not change a patient's code status, withdraw treatment or make a major goals-of-care decision on their own.Stabilises and supports the patient and family, and involves the attending, who holds the decision.
  • Does not keep a patient on the ward whose needs exceed what the ward can provide, waiting for the morning team.Calls the rapid response or ICU team and the senior now, and stays with the patient until they are transferred.
  • Does not keep working when fatigue makes them unsafe, or conceal it.Tells the senior or chief and uses the program's fatigue mitigation and backup arrangements.

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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