This page provides an explanation of the different levels of sign-off (levels 1, 2 and 3) for acquiring skills and competencies throughout your training. Expectations for sign-off at the different levels are described, together with an ‘anchor statement’ to summarise expectations at that level.
Both trainees and trainers should critically reveiw what’s expected at each level. For example, ‘observation’ isn’t simply ‘seeing a procedure performed once’ or ‘seeing one particular case’. There’s an implicit need to ensure appropriate knowledge and understanding, even at level 1 (previously ‘observation’).
Sometimes, it’s appropriate to sign off competencies using other methodologies (OM); please read the College’s guidance on when and how to sign off competencies using OM.
Level 1 (previously referred to as ‘observation’)
Trainees should be signed off at level 1 before moving to level 2, where the relevant clinical skill/problem will be undertaken under supervision.
To be signed off at level 1, the trainee should:
- Demonstrate a thorough understanding of the principles of the competence/clinical skill/situation, including the indication for the procedure and the common complications
- Be aware that, before undertaking any clinical skill under direct supervision, if possible they’ll have observed the procedure on a number of occasions
- Use other methodologies (OM; e.g. drills, simulation, e-learning and case-based discussion assessments) if direct experience of the procedure or clinical problem hasn’t been possible
Anchor statement, level 1
‘The trainee demonstrates detailed knowledge and understanding and is aware of common complications/issues relating to the competence/clinical skill/situation.’
Level 2 (previously referred to as ‘direct supervision’)
Trainees must be observed directly in different clinical situations before being signed off at level 2.
To be signed off at level 2, the trainee should:
- Perform the clinical skill/manage the case under supervision
- Be aware that the number of times the competence/clinical skill/situation needs to be assessed depends on the complexity of the case and individual aptitude
- Be aware that there’s therefore no limit to the number of times the procedure can be supervised and there’s no advantage in having a module signed off until there’s certainty the trainee can safely perform the procedure in a number of different clinical situations and levels of complexity
- Be able to manage any unexpected complications but know when to summon senior help
Anchor statement, level 2
‘The trainee is capable of performing the task or managing the clinical problem but with senior support.’
Level 3 (previously referred to as ‘independent practice’)
Progression to independent practice may by the most difficult for trainees. Once signed off for direct supervision, the trainee should start the process of performing procedures with less and less supervision, as agreed by their trainer.
To be signed off at level 3, the trainee should:
- Demonstrate the ability and confidence to perform the clinical skill/situation competently when senior staff aren’t immediately available, e.g. out of the hospital
- Show a willingness to move on to experiential learning with further case exposure
- Demonstrate a willingness to keep a record of the number of cases/procedures subsequently managed, including any complications and their resolution
- Remember that competency is a baseline level for safe independent practice, with further exposure and experience leading to proficiency and subsequently expertise (the latter will generally be developed post-CCT)
Anchor statement, level 3
‘The trainee can manage the majority of cases with no direct supervision or assistance, while having the insight to recognise that senior support will be needed in certain complex cases/complications.’