A+Acute Medical TakeUK Acute Medicine Clinical Guide
Clinical evidenceNICE · Specialist guidance · UpToDate
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Practical UK induction

New to the NHS?

A complete fourteen-stage guide—from pre-employment preparation and the acute take to patient safety, referrals, practical procedures, wellbeing and long-term professional development.

01

Stage 01

Before you start

Arrive registered, connected and ready to practise safely.

Practical checklist

  • ✓Confirm GMC registration, licence to practise, right-to-work evidence, indemnity, occupational-health clearance and DBS requirements.
  • ✓Read your contract, rota, job description, exception-reporting route, study-leave process and local induction timetable.
  • ✓Complete mandatory training and arrange smartcard, ID badge, NHS email, e-prescribing and clinical-system access.
  • ✓Ask for a named clinical supervisor, educational support contact, rota coordinator and international-doctor or locally employed doctor lead.
  • ✓Request a shadowing period and identify your scope, supervision level, unfamiliar procedures and prescribing restrictions.
  • ✓Download the BNF and locate the Trust formulary, antimicrobial policy, resuscitation policy and escalation guidance.
02

Stage 02

Your first shift

Know the team, the emergency routes and how to ask for help.

Practical checklist

  • ✓Attend handover and confirm your patients, wards, bleep/device, referral role, arrest or stroke-call responsibilities and break arrangements.
  • ✓Locate the resuscitation trolley, emergency drugs, blood-gas analyser, difficult-airway equipment and major-haemorrhage activation number.
  • ✓Use structured ABCDE assessment, NEWS2 trajectory and clinical concern; start immediate treatment while calling the appropriate senior.
  • ✓Clerk clearly: presenting problem, relevant negatives, medicines/allergies, examination, differential, investigations, treatment, escalation and review plan.
  • ✓Prescribe oxygen, fluids, antimicrobials, insulin, anticoagulants and opioids using current local policy and patient-specific renal/hepatic assessment.
  • ✓Give an SBAR handover with outstanding jobs, time-critical results, ceilings of care and explicit deterioration triggers.
03

Stage 03

Your first month

Convert induction into reliable clinical habits and supported development.

Practical checklist

  • ✓Meet your supervisor, agree learning needs and record an induction review covering clinical systems, escalation, prescribing and procedures.
  • ✓Seek direct observation and feedback on clerking, handover, ward review, consent, difficult conversations and at least one practical procedure.
  • ✓Learn local referral criteria for critical care, radiology, cardiology, stroke, renal, mental health, palliative care and safeguarding.
  • ✓Review a real payslip, pension choice, rota gaps, leave balance and safe-working arrangements; raise errors promptly.
  • ✓Join teaching, morbidity and mortality meetings, audit or quality improvement, and begin a portfolio of supervised evidence.
  • ✓Arrange wellbeing support, a GP, occupational health access and peer mentoring; recognise fatigue, isolation and culture-transition stress early.
04

Stage 04

Building your NHS career

Turn everyday work into evidence, progression and professional belonging.

Practical checklist

  • ✓Maintain appraisal and revalidation evidence: scope of work, CPD, quality improvement, significant events, feedback and reflective learning.
  • ✓Map experience to your intended route—foundation equivalence, specialty training, SAS/specialist grade, MRCP or Portfolio Pathway.
  • ✓Build evidence prospectively with workplace-based assessments, teaching feedback, leadership examples, audits and supervised procedures.
  • ✓Develop a personal development plan with achievable six- and twelve-month goals and named people who can support each step.
  • ✓Understand Good medical practice, duty of candour, confidentiality, consent, professional boundaries and social-media responsibilities.
  • ✓Find professional networks, IMG/LED forums, Royal College resources and mentors; contribute your international experience to the team.
05

Stage 05

Working on the Acute Medical Take

Prioritise, assess, treat, escalate and hand over safely.

Practical checklist

  • ✓Confirm the take team, referral route, bed base, registrar and consultant cover, critical-care outreach number and expected post-take process.
  • ✓Triage by physiological risk and clinical concern—not arrival order alone—and reassess patients whose observations or oxygen requirement are worsening.
  • ✓Use a structured clerking: presenting problem, focused history, medicines/allergies, examination, differential, investigations, immediate treatment and review plan.
  • ✓Treat time-critical syndromes in parallel with investigation: sepsis, ACS, stroke, airway compromise, respiratory failure, major bleeding, seizures and metabolic emergencies.
  • ✓Make referrals question-led: identify the clinical problem, urgency, completed tests, treatment given, response and the decision or intervention requested.
  • ✓At handover name the responsible clinician, outstanding actions, result-chasing plan, escalation ceiling and exact triggers for urgent review.
06

Stage 06

Prescribing safely in the NHS

Use patient-specific checks, approved guidance and active monitoring.

Practical checklist

  • ✓Complete medicines reconciliation using more than one source where possible; document allergy, reaction type, over-the-counter and non-prescribed medicines.
  • ✓Verify indication, dose, route, timing, duration, interactions, pregnancy status and renal/hepatic adjustment using the current BNF and local formulary.
  • ✓Apply extra safeguards to insulin, anticoagulants, opioids, sedatives, concentrated electrolytes, methotrexate and other high-risk medicines.
  • ✓Prescribe oxygen to a target saturation, IV fluids with an indication and reassessment plan, and antimicrobials with source, cultures and review/stop date.
  • ✓Check monitoring requirements and response: observations, ECG, glucose, drug levels, renal function, electrolytes, blood count or liver tests as appropriate.
  • ✓At transfer or discharge reconcile changes, explain starts/stops, communicate monitoring and provide an accurate prescription and summary.
07

Stage 07

Documentation and communication

Create a clear clinical record that another professional can safely act upon.

Practical checklist

  • ✓Date, time, identify yourself and record who was present; write contemporaneously and distinguish facts, patient statements, findings and clinical opinion.
  • ✓Document assessment, relevant negatives, differential diagnosis, investigations reviewed, treatment, response, risks, escalation and planned review time.
  • ✓Record senior and specialty discussions with the clinician's name, time, advice, agreed ownership and any actions still outstanding.
  • ✓Use professional interpreters where required; document communication needs, capacity, consent and information given to the patient or representative.
  • ✓Write discharge summaries promptly with diagnoses, medicine changes, pending results, follow-up, monitoring and explicit safety-net advice.
  • ✓Correct errors transparently without obscuring the original record; use incident reporting for safety events rather than placing blame in clinical notes.
09

Stage 09

Escalation and patient safety

Recognise risk, call the right help and close the safety loop.

Practical checklist

  • ✓Use ABCDE, NEWS2 trajectory and clinical concern; a low score does not override a threatened airway, shock, seizure or rapidly changing condition.
  • ✓Know how to contact the registrar, consultant, critical-care outreach, anaesthetics, stroke team, cardiac-arrest team and clinical site manager.
  • ✓Escalate with SBAR: current threat, relevant background, objective assessment, treatment and the decision or attendance required.
  • ✓Repeat observations and investigations after intervention; document response, review time, treatment ceiling and who now owns the plan.
  • ✓Use Datix or the local incident system for harm, near misses and system risks; be factual, preserve evidence and follow duty-of-candour processes.
  • ✓Know safeguarding leads and the Freedom to Speak Up route; raise unsafe staffing, bullying, discrimination or pressure to work beyond competence.
10

Stage 10

DNACPR, treatment ceilings and end-of-life care

Separate resuscitation decisions from active, proportionate treatment.

Practical checklist

  • ✓Understand that DNACPR applies to cardiopulmonary resuscitation only; it does not mean no antibiotics, fluids, oxygen, symptom control or appropriate escalation.
  • ✓Assess reversibility, frailty, comorbidity, likely benefit/burden and the patient's values when developing a treatment-escalation or ReSPECT plan.
  • ✓Involve the patient when possible; assess capacity, respect valid advance decisions and involve the legal representative or those close to the patient appropriately.
  • ✓Document the senior decision-maker, discussion, clinical reasoning, treatments offered, treatments not appropriate and review triggers.
  • ✓Recognise dying, review non-beneficial medicines/tests, prescribe anticipatory symptom medicines and involve palliative care and community services.
  • ✓Know local procedures for verification of death, medical certification, referral to the coroner or Procurator Fiscal and bereavement support.
11

Stage 11

Common NHS referrals

Make focused referrals that communicate urgency and the question clearly.

Practical checklist

  • ✓Stabilise immediate threats before referral and contact the correct service directly for time-critical stroke, STEMI, airway, surgical or critical-care emergencies.
  • ✓State patient identifiers, location, your name/role, urgency and the specific decision, procedure, transfer or advice requested.
  • ✓Provide focused history, physiology and trend, examination, relevant comorbidity/frailty, treatment ceiling and treatment already given with response.
  • ✓Have essential investigations available, but do not delay a time-critical call for nonessential tests; explain what is pending and who will chase it.
  • ✓Record the clinician's name, time, advice, acceptance status, destination, transport needs and interim plan if transfer is delayed.
  • ✓Escalate refused or delayed referrals when clinical risk remains; use senior-to-senior discussion and retain responsibility until handover is accepted.
12

Stage 12

Practical procedures and investigations

Confirm competence, indication, consent and post-procedure safety.

Practical checklist

  • ✓Before any procedure confirm indication, alternatives, consent/capacity, allergies, anticoagulation, imaging, blood results, equipment and supervision level.
  • ✓Use the approved checklist and aseptic technique; verify patient, site and specimen labels, and involve ultrasound guidance where recommended and competent.
  • ✓Know local pathways for venepuncture, cultures, cannulation, ABG/VBG, urinary catheterisation, lumbar puncture, ascitic and pleural procedures.
  • ✓Request investigations with a focused clinical question and enough context for prioritisation; discuss urgent or complex imaging directly with radiology.
  • ✓Review, act on and document results—including tests returning after transfer or discharge—with a named owner and escalation threshold.
  • ✓After procedures document technique, findings, samples, complications, monitoring, imaging, device care and when urgent review is required.
13

Stage 13

Working patterns and wellbeing

Understand the rota and protect safe, sustainable practice.

Practical checklist

  • ✓Clarify normal days, long days, nights, weekends, ward cover, take responsibilities, breaks and handover expectations before the rota starts.
  • ✓Check rota accuracy, pay, leave, study budget, locum arrangements and safe-working or exception-reporting processes; keep your own records.
  • ✓Take protected rest and hydration where possible, plan safe travel after nights and declare fatigue when it creates a risk to patients or driving.
  • ✓Register with a GP and know occupational health, Practitioner Health, employee assistance and local psychological or peer-support services.
  • ✓Recognise burnout, sleep disruption, anxiety, low mood, isolation and culture-transition stress in yourself and colleagues; seek help early.
  • ✓Use professional networks, IMG/LED forums, mentors and supportive colleagues while maintaining boundaries and confidential spaces for reflection.
14

Stage 14

Training and career development

Build supervised evidence continuously and choose the route that fits your goals.

Practical checklist

  • ✓Meet clinical and educational supervisors early; agree a personal development plan, supervision needs and dates for formal progress reviews.
  • ✓Collect workplace-based assessments across acute presentations, handover, procedures, leadership, communication and prescribing—not only successful cases.
  • ✓Maintain CPD, reflective learning, patient/colleague feedback, significant events, quality improvement and teaching evidence for appraisal and revalidation.
  • ✓Understand available routes: formal specialty training, locally employed development posts, SAS/specialist grade and the GMC Portfolio Pathway.
  • ✓Map Royal College curriculum capabilities prospectively and store certificates, rotas, job descriptions and verified evidence with dates and supervisor details.
  • ✓Seek opportunities in audit, QI, simulation, education, research and leadership while protecting core clinical competence and examination preparation.

Trusted starting points

Official support and professional standards

Local induction and policy always come first. These national resources provide additional orientation and professional guidance.

GMCWelcome to UK Practice workshop↗GMCGood medical practice↗NHS EmployersInternational recruitment support↗BNFUK medicines information↗
Educational orientation

Confirm local policies, responsibilities, supervision and referral routes at every organisation. This guide does not replace induction, senior advice or professional judgement.