Acute take evidence for the Acute Medicine Portfolio Pathway means documented ACATs across a wide case mix at independent (level 4) performance, SDEC and AMU evidence, leadership documentation, and a coherent thread of reflective practice that maps your clinical decisions to curriculum outcomes. Volume matters less than breadth and quality. An ACAT that explains what was decided, why, and what the outcome was is worth several that confirm competent performance without showing reasoning.
What the acute take means for Portfolio Pathway evidence
Senior physicians use "the acute take" to describe something specific: the unselected emergency medical admissions shift where patients arrive via the emergency department, direct GP referral, or 999 and are triaged, assessed, and initially managed by the acute medical team before being admitted, discharged, or handed on. It is the defining clinical environment of Acute Internal Medicine as a specialty, and it is where the bulk of the most important Portfolio Pathway evidence must come from.
The Acute Medicine Portfolio Pathway - formally titled Acute Internal Medicine with General Internal Medicine under the GMC and JRCPTB - is assessed against a curriculum that treats the acute take as the primary evidence-generating setting. This is distinct from planned admissions, elective procedures, specialist outpatient work, or scheduled acute assessment unit lists. The acute take involves genuinely unselected patients arriving with undifferentiated presentations: the breadth, unpredictability, and high-acuity nature of those encounters is precisely what assessors look for when reading ACAT documentation.
This matters because many doctors applying for the Portfolio Pathway in Acute Medicine have done years of acute take work. The problem is rarely the clinical experience. The problem is that much of that work has not been systematically documented in the form assessors need to see. An ACAT completed in the moment, capturing specific clinical decisions and reasoning, is a different kind of evidence from a CV entry that lists "acute take lead at [Trust] 2019-2024". Both describe real experience; only one constitutes credible Portfolio Pathway evidence.
This article is about closing that gap - converting years of clinical practice into a structured evidence base that tells the same story your CV does, but in the language the JRCPTB assessors can actually assess against the Specialty Specific Guidance (SSG) framework.
What the SSG expects from acute take evidence
The Acute Internal Medicine SSG, published by JRCPTB and accessible through the GMC website, is the document that defines what your portfolio must demonstrate. Reading it in full before building your evidence is not optional; it is the first thing to do. The SSG sets out the Capabilities in Practice (CiPs) that assessors use as their framework, alongside indicative evidence volumes for the principal assessment tools.
The SSG for Acute Internal Medicine covers two overlapping evidence strands that apply equally to Portfolio Pathway applicants as they do to trainees. The Acute Internal Medicine strand covers the core capabilities of acute medical practice: assessment and management of undifferentiated acute presentations, medical emergencies, acute deterioration, high-dependency medicine, and ambulatory acute care. The General Internal Medicine strand covers the broader internal medicine competencies that an Acute Consultant must also demonstrate: outpatient general medicine, continuity of care for patients with complex multi-morbidity, specialist interface management, and internal medicine breadth across cardiology, respiratory, gastroenterology, neurology, endocrinology, renal, and rheumatology presentations.
Like Geriatric Medicine and GIM, an Acute Internal Medicine Portfolio Pathway application is assessed against two curriculum strands simultaneously. Evidence that only addresses the acute clinical management side - and neglects GIM breadth, outpatient competence, and the full domain 1 internal medicine scope - will not produce a successful outcome. The acute take is the most important single evidence source, but it is not the only one.
Within the acute take strand, the SSG specifies indicative minimums for Acute Care Assessment Tools (ACATs) and other workplace-based assessments (WBAs). Always verify the current figures in the live SSG document before submitting; these are subject to periodic review. The indicative numbers are a floor, not a target. What matters more than hitting the minimum count is that the collective case log across all ACATs demonstrates:
- Genuine breadth of acute presentations across the internal medicine spectrum
- Independent (level 4, "I could do this independently") performance throughout
- Evidence from different clinical contexts within the acute take: overnight admissions, morning post-take ward rounds, acute assessment unit, and SDEC
- Cases where clinical complexity, diagnostic uncertainty, or acuity justified consultant-level assessment
- A temporal spread across the portfolio window - not all from one three-month period
| Evidence type | Primary setting | Performance level | Notes |
|---|---|---|---|
| ACATs (Acute Care Assessment Tools) | Acute take, SDEC, AMU | Level 4 - independent | The primary acute evidence tool. Must cover broad case mix. Each ACAT should capture a single acute encounter with structured assessor feedback. |
| Mini-CEX (Mini Clinical Evaluation Exercise) | Clinical encounters in any setting | Level 4 - independent | Supplements ACATs. Useful for outpatient encounters, ward consultations, and post-take follow-up visits that do not fit the ACAT format exactly. |
| CbD (Case-based Discussion) | Post-take review, structured reflection | Level 4 - independent | Documents clinical reasoning beyond what an observed encounter can capture. Valuable where a case involved significant diagnostic complexity, diagnostic error recovery, or complex management decisions made overnight. |
| Clinical audit / QI | Acute department or AMU | Closed loop preferred | Acute medicine audits against RCP or NHS England standards for acute medical units carry more weight than generic clinical audit. See the audit article. |
| Reflective practice | Post-take shift reflection | Qualitative | Reflections written close to the relevant shift are more credible than retrospective summaries. One well-written reflection per month of acute take evidence builds a coherent thread across the portfolio. See the reflective practice guide. |
The SSG for Acute Internal Medicine also asks for evidence of post-take ward round leadership - not just the initial acute assessment, but the consultant-level decision-making that continues through the morning after a night acute take, including decisions about investigations, escalation, specialist referral, and safe discharge or continued admission. This is a distinct evidence element from the admission ACAT, and it is one that many applicants neglect to document separately.
ACATs: the primary evidence tool for the acute take
The Acute Care Assessment Tool is the JRCPTB instrument specifically designed for the acute take environment. Unlike a Mini-CEX, which can document almost any clinical encounter, the ACAT is structured around the acute medical episode: the initial presentation, assessment, differential diagnosis, investigation decisions, acute management, and escalation planning. The assessor who completes the ACAT is usually a Consultant physician who observed or supervised the encounter directly - either the admitting Consultant supervising a trainee, or (for Portfolio Pathway applicants) a senior colleague who can honestly assess consultant-level performance.
Each ACAT should ideally be completed on the day of the encounter, or within a day or two at most. The discipline of completing ACATs promptly is one of the things that distinguishes credible Portfolio Pathway evidence from retrospective reconstruction. An ACAT completed the same evening captures the actual decision that was made and why. An ACAT completed six months later about a "memorable case" is reconstruction, and it reads differently to someone assessing dozens of portfolios.
- Assessor comment: "Good history and examination. Appropriate management."
- Case type: "67-year-old with chest pain." No diagnosis documented, no complexity noted.
- Entrustment level: 4 ticked without explanation of what justified it.
- Performance descriptors: all sections marked "above expectations" without specific observations.
- No reference to what the diagnostic uncertainty was or how it was resolved.
- No documentation of who else was involved or what escalation was considered.
- The ACAT could describe any competent SHO encounter, not a consultant-level one.
- Assessor comment specific: "Dr X assessed a complex presentation of chest pain in a patient with prior LBBB. Correctly identified need for serial ECGs and troponin, actively managed the patient's anticoagulation dilemma given AF and recent GI bleed, discussed early with cardiology and made a defensible independent decision not to anticoagulate acutely. Clear documentation throughout."
- Case type: primary diagnosis, two comorbidities, one acute management dilemma identified.
- Entrustment level 4 with specific reference to what was decided independently.
- Documents where the case was discussed with cardiology and what was decided at that interface.
- Documents immediate outcome: patient stable, plan agreed, handover completed.
- Applicant self-assessment reflects on what was most difficult and why the decision made was correct.
The principle: the ACAT exists to show what you did, why, and at what level of independence. An assessor reading your portfolio should be able to reconstruct the clinical episode and understand exactly where your consultant-level reasoning applied. If they cannot, the ACAT adds volume but not weight.
Case mix across your ACAT portfolio matters significantly. Assessors will read across all ACATs together and consider whether they collectively demonstrate the breadth of acute internal medicine presentations that the SSG curriculum covers. A collection of twelve ACATs all from similar presentations - for example, predominantly respiratory or predominantly chest pain - will not demonstrate GIM breadth even if each individual ACAT is well written. The case mix should reflect the range of a real acute medical consultant's work: cardiorespiratory, abdominal, neurological, metabolic, infective, and haematological presentations, including some where the presenting complaint is non-specific and the diagnostic work involves working through genuine uncertainty.
If you have completed multiple ACATs in a short period - for example, during an intensive period of acute take cover - it is worth noting in your portfolio introduction that these ACATs span a specific time period and why. The portfolio should also show ACATs spread across the evidence window; twenty ACATs from one three-month stretch and nothing from the previous two years raises questions about whether the current practice level was sustained, or whether the burst of documentation was in anticipation of a submission deadline.
SDEC evidence and how to frame it
Same Day Emergency Care (SDEC) - previously referred to as ambulatory emergency care - has become a central part of how acute medical departments operate. NHS England has mandated SDEC capacity across acute NHS Trusts, and most acute medicine departments now run a dedicated SDEC unit or equivalent stream within the acute medical services. For Portfolio Pathway applicants, SDEC presents both an opportunity and a framing challenge.
The opportunity: SDEC encounters often involve exactly the kind of acute diagnostic and management decisions that ACAT documentation is designed to capture. A patient assessed in SDEC who presented with an acute exacerbation of heart failure, where the acute physician decided to start IV furosemide, arrange same-day echocardiography, contact the heart failure nurse specialist, and set clear criteria for hospital admission versus safe same-day discharge - that is a consultant-level acute medicine encounter, and it should be documented as one.
The framing challenge: not all SDEC work is equivalent to acute take evidence. A proportion of SDEC activity involves planned return visits, low-acuity social referrals, and review appointments that do not generate the acute medicine evidence that ACATs are designed to document. Portfolio Pathway applicants who document SDEC encounters need to be selective: the cases chosen should be genuinely acute, should involve a real management decision (not just a routine review), and the documentation should make the acuity and decision complexity clear.
In the ACAT or WBA for an SDEC encounter, explicitly state: (1) why this patient presented acutely and what the clinical urgency was; (2) what investigations were ordered, why, and what they showed; (3) what the management decision was - specifically whether admission was considered, why it was averted if so, and what the safe discharge criteria were; (4) what was discussed with the referring clinician, the patient, and any specialist involved; and (5) what the outcome was within 24-48 hours if known. SDEC documentation that treats the encounter as a routine clinic visit fails to convey the acute medicine content that assessors need to see.
The NHS England guidance on SDEC is a legitimate primary source to reference when framing your SDEC evidence. Noting that your SDEC practice is aligned with the NHS England SDEC quality standards - in terms of time-to-assessment, same-day investigation and treatment decisions, and adherence to the acute clinical pathways - situates your SDEC documentation within the contemporary policy context and demonstrates engagement with the broader service improvement agenda that is itself part of the leadership and management evidence domain.
There is also an audit opportunity in SDEC that is directly relevant to the Portfolio Pathway. An audit of your unit's SDEC performance against NHS England standards - for example, the proportion of patients assessed within the SDEC target window, or a re-attendance audit identifying patients who returned to emergency care within 48 hours of SDEC discharge - is an Acute Medicine-specific audit that demonstrates engagement with quality improvement in the acute care setting. This kind of audit is more evidentially relevant than a generic clinical audit that could come from any specialty.
AMU leadership as Portfolio Pathway evidence
Acute Medical Unit (AMU) leadership is a distinct evidence element that goes beyond individual clinical encounters. The Acute Internal Medicine curriculum includes capabilities relating to organising acute medical services, leading ward rounds, supervising junior colleagues, managing patient flow, and contributing to the governance of acute medical services at departmental and Trust level. For Portfolio Pathway applicants, this strand of evidence is often under-represented even in portfolios that contain strong individual ACAT evidence.
AMU ward round leadership documentation should demonstrate that you are functioning as the consultant responsible for the ward round - not as a senior trainee. The distinction is not always obvious from an ACAT alone; it emerges from documentation of decisions about bed management, decisions about patients requiring escalation to HDU or ICU, decisions about complex discharges, decisions about specialist referral pathways, and decisions about clinical priority across a list of patients with competing acuity.
Post-take ward round documentation can be incorporated into ACATs or CbDs. A CbD focused on a post-take ward round is particularly useful because it allows the assessor to comment on a breadth of decision-making across multiple patients in a single assessment tool, rather than requiring separate documentation for each patient. A well-constructed CbD discussing a twelve-patient post-take ward round - including which patients were escalated, which were discharged, and what the clinical reasoning was across the range - gives assessors more insight into consultant-level AMU leadership than twelve separate ACATs covering twelve individual patients.
Teaching evidence from the acute setting also contributes to the leadership strand. If you routinely teach FY2s or registrars on the acute take, that teaching should be documented: the cases discussed, the teaching points made, the feedback given. The teaching evidence article explains what JRCPTB assessors look for in teaching documentation, and the acute take provides the most natural context for case-based bedside teaching that acute physicians do every day. The gap between doing the teaching and documenting it is one of the most consistently missed evidence opportunities in Acute Medicine portfolios.
Governance and safety contributions in the acute care setting - Significant Event Analysis (SEA) reports, mortality and morbidity meeting presentations, handover protocol development, deteriorating patient recognition work - all sit within the leadership and management evidence domain and draw directly from the acute take environment. An applicant who has led an SEA on an acute medicine serious incident, presented it at an M&M meeting, and driven a change in local practice has produced AMU leadership evidence that assessors will recognise as genuinely consultant-level.
Mapping acute take evidence to the four GMC domains
Every element of your acute take evidence needs to map to the GMC's four domains: Knowledge, Skills and Performance (Domain 1); Safety and Quality (Domain 2); Communication, Partnership and Teamwork (Domain 3); and Maintaining Trust (Domain 4). The JRCPTB assessment framework uses these domains as the organising structure for the assessment, and a portfolio that is strong in Domain 1 but thin in Domains 2, 3, and 4 will not produce a successful outcome.
Mapping acute take evidence across the four GMC domains
Acute Internal Medicine- ACATs demonstrating acute clinical assessment at level 4
- Case mix breadth across internal medicine spectrum
- MRCP(UK) or equivalent knowledge examination
- Acute Medicine SCE evidence
- CbDs on diagnostically complex cases
- Post-take ward round documentation
- Management of medical emergencies (including documentation of ALS/ACLS currency)
- Procedural competency logs for acute procedures (pleural aspiration, lumbar puncture, central venous access)
- Audit of acute medical unit performance against RCP or NHS England standards
- QI project in the acute take or SDEC setting
- SEA reports from acute care incidents
- Mortality and morbidity meeting presentations
- Escalation pathway documentation - demonstrating appropriate use of HDU/ICU referral
- Handover quality improvement evidence
- NEWS2 and early warning system governance contribution
- Patient feedback evidence from acute care encounters - see the patient feedback guide
- MSF from acute take colleagues - see the MSF planning guide
- Documentation of specialist interface management (cardiology, ITU, surgical teams)
- DNAR and capacity discussion documentation from acute settings
- MDT participation in acute medicine case conferences
- Teaching and supervision documentation from acute take
- Reflective practice entries from acute take encounters, including challenging cases and near-misses
- Documentation of decisions made under uncertainty and how uncertainty was managed
- Appraisal documentation covering acute take performance
- CPD records mapped to acute internal medicine curriculum areas
- Probity and professional conduct evidence - see the Domain 4 guide
- Documentation of honest assessment of personal limitations and escalation when appropriate
Domain 2 evidence from the acute take is often the least planned part of Acute Medicine portfolios. The assumption is that doing safe clinical work demonstrates safety. Assessors need something more specific: documented evidence that you have engaged with the safety and quality systems that govern acute medical care. An acute medicine consultant who has never contributed to an SEA, never audited acute care performance against published standards, and never participated in mortality review meetings has an unexplained gap in Domain 2 that no amount of ACAT volume will compensate for.
Domain 3 evidence from the acute take environment is naturally generated through clinical work - every patient contact, every specialist discussion, every handover - but it needs to be captured. MSF from colleagues on the acute take should specifically reflect teamwork and communication in the acute medicine context, not just generic professional feedback. MSF raters should include acute nursing staff, junior colleagues, specialist registrars you have consulted with, and if possible emergency department colleagues - the people who observe your acute take communication in the settings where it actually happens.
What thin documentation looks like - and how to fix it
Thin acute take documentation is one of the most consistent reasons Acute Medicine Portfolio Pathway applications receive requests for additional evidence (RAEs) rather than straightforward approval. Understanding what thinness looks like - and why it happens - is the first step to avoiding it.
The fix for most of these gaps does not require more clinical work. It requires better documentation of work you are already doing. The most common advice we give to Acute Medicine Portfolio Pathway applicants with thin documentation is to start an ACAT habit: one completed ACAT per acute take shift, completed within 24 hours, with a specific assessor who was present for at least part of the encounter. Sustained over six to twelve months, this generates enough well-documented evidence to address most of the gaps above.
Building your acute take evidence log
An evidence log is not a folder of documents - it is a deliberate strategy for capturing evidence across the portfolio window in a way that collectively demonstrates everything the SSG requires. For acute take evidence, an effective log has the following architecture:
Read the SSG in full and map your current evidence against it
Before building new evidence, audit what you already have. Download the current Acute Internal Medicine SSG from the GMC website. Work through the CiPs section by section and note which ones you have existing documented evidence for and which have gaps. This takes half a day the first time and prevents you from building more of what you already have enough of. The recent evidence rule also applies - evidence older than five years from your submission date carries less weight; note which older evidence will need refreshing.
Set a documentation rhythm for acute take shifts
Agree with two or three Consultant colleagues that they will complete an ACAT for a case they observe you managing on each acute take shift where you work together. A rhythm of one ACAT per shift, one shift per week, generates fifty to sixty ACATs per year - more than enough volume, with the quality to match if the documentation discipline is maintained. Ask assessors to be specific in their feedback from the first ACAT; generic feedback patterns tend to repeat.
Track your case mix as you go
Keep a simple spreadsheet of ACAT primary diagnoses as you accumulate them. After every ten ACATs, review the case mix: what presentations are covered, what is missing, what the patient complexity has looked like. If you have ten ACATs and eight are from cardiorespiratory presentations, the next month of documentation should deliberately capture broader internal medicine cases. This is not cherry-picking; it is actively ensuring your evidence log reflects the breadth that the SSG requires.
Build your reflective practice alongside your ACATs
For each month of acute take shifts, write one substantive reflective entry. Not a descriptive account of a case, but a reflection on a clinical decision that challenged you: what you decided, what the alternatives were, what happened, and what you would do differently or the same again. Link the reflection to a specific GMC domain and a specific curriculum outcome. See the reflective practice guide for the structure that prevents reflections from becoming case summaries.
Plan your Domain 2 evidence separately
Identify one audit or QI project per year that is directly relevant to the acute medical unit environment. If your Trust's AMU already runs regular audits against RCP or NHS England standards, join or lead one of those rather than designing a separate project. Existing audit activity that you contribute to and document is as strong as a new project you design independently. The key is documentation of your specific contribution and the outcome. See the QI evidence guide.
Assemble a pre-submission audit before you submit
Three months before your intended submission date, assemble everything you have and audit it against the SSG one more time. Ask a trusted Consultant colleague who knows the Portfolio Pathway well to review the acute take section and identify anything that reads as thin or generic. Fix gaps before submission rather than hoping they will not be noticed. The assessment process article explains what happens after submission and what the request for additional evidence process involves - understanding that process helps you assess whether your current evidence base is genuinely strong enough to submit.
If your current post has limited acute take access
Not every Acute Medicine applicant is in a post with daily access to an acute medical take rota. Non-substantive Consultants working in outpatient, rehabilitation, or subspecialty roles may have reduced or absent acute take sessions. This is a genuine constraint, and the solution is practical rather than theoretical.
The most direct route is to negotiate acute take sessions back into your job plan. Even two or three acute take shifts per month, sustained over two years, generates enough documented evidence if those shifts are consistently well-documented. The job plan flexibility article covers how to have that conversation with your clinical director - framing it as an educational and development need with a specific time-limited purpose is usually more successful than framing it as a general request for different working patterns.
Where full acute take access cannot be negotiated, SDEC and rapid access clinic sessions can partially supplement it. These are not identical to a traditional acute take evidentially, but a strong portfolio of SDEC ACATs demonstrating genuinely acute clinical decision-making is better than a thin portfolio of traditional acute take ACATs. The framing of SDEC evidence needs to make the clinical acuity and decision complexity explicit, as discussed above.
Direct applications from doctors whose acute medicine practice has been entirely overseas face particular challenges because NHS-specific evidence - ACATs completed with NHS Consultant assessors, audit against NHS standards, AMU-specific governance contributions - is genuinely difficult to produce from a non-NHS environment. The SSG notes that equivalence to NHS practice needs to be demonstrated. Doctors in this situation are generally better served by taking a UK senior grade post first - even a fixed-term or locum Consultant position - and building their acute take evidence from within the NHS, rather than attempting to assemble an equivalent case from overseas practice records. The overseas evidence article covers this in more detail.
Older acute take evidence from earlier in your career can contribute context but should not be the primary evidential base. The five-year rule means that evidence more than five years old will be scrutinised more carefully and may carry less weight with assessors who are trying to establish current competence rather than career history. If your most recent acute take evidence is from a period more than three years ago, that is a problem that requires adding recent evidence, not an explanation to include in your portfolio narrative.
The bottom line for applicants with limited current access: it is better to delay submission by six to twelve months and build adequate acute take evidence than to submit with a thin acute take section and receive a request for additional evidence that requires the same work but under the pressure of a formal RAE timeline. The deferrals and additional evidence requests article explains what that process involves, and the consistent message from doctors who have been through an RAE is that the same effort invested before submission would have been easier and less stressful than the same effort under RAE conditions.
All 18 specialisms
The acute take evidence principles in this article apply across all JRCPTB-assessed medicine specialties, not only Acute Internal Medicine. Several other specialisms overlap significantly with acute medicine evidence requirements - particularly Stroke Medicine, which has its own acute take requirements, and General Internal Medicine, which shares the JRCPTB assessment framework and the AIM curriculum spine.
Primary sources
| Source | Publisher |
|---|---|
| Portfolio Pathway: applying for the specialist register | GMC |
| Acute Internal Medicine specialty page and SSG | JRCPTB |
| General Internal Medicine specialty page and SSG | JRCPTB |
| Acute Medicine Toolkit | Royal College of Physicians |
| Same Day Emergency Care: clinical definition, workforce, and quality standards | NHS England |
| Acute Medical Unit standards and guidance | Royal College of Physicians |
| Clinical resources for acute medicine practice | Society for Acute Medicine |
| Good Medical Practice (2024) | GMC |
| National Early Warning Score 2 (NEWS2) guidance | NHS England / RCP |
Frequently asked questions
What does "the acute take" mean in the Acute Medicine Portfolio Pathway context?
The acute take refers to the unselected emergency medical admissions process - the shifts where undifferentiated patients arrive via the emergency department or direct GP referral and are triaged and managed by the acute medical team. In Acute Internal Medicine, demonstrating independent consultant-level practice across the acute take is central to the Portfolio Pathway application. Assessors expect evidence of decision-making across the breadth of acute presentations, not only the most common or most familiar conditions. The Specialty Specific Guidance for Acute Internal Medicine, published by JRCPTB, defines what that evidence should look like and in what volume.
What are ACATs and how many do I need for Acute Medicine Portfolio Pathway?
ACATs - Acute Care Assessment Tools - are the primary workplace-based assessment tool for evidencing acute take practice in medicine specialties assessed by JRCPTB. Each ACAT documents an observed or directly supervised acute clinical encounter, with structured assessor feedback across domains including history-taking, clinical assessment, investigation, management decisions, and professional practice. The Acute Internal Medicine SSG gives indicative minimums that applicants should treat as a floor, not a target. Always check the current published SSG for the specific figures; they are reviewed periodically. More important than volume is that the collective ACAT case mix demonstrates genuine breadth of acute presentations at independent (level 4) performance.
Does Same Day Emergency Care (SDEC) count as acute take evidence?
Yes, but with important caveats. SDEC sessions - in ambulatory emergency care units, acute assessment units, or equivalent settings - can produce strong acute medicine evidence. The patient presentations must be genuinely acute (not planned or routine), the clinical decision-making must be documented at an independent level, and the ACAT or other WBA must reflect consultant-level clinical reasoning rather than administrative triage. SDEC case logs that show a diverse mix of presentations, including patients where admission was actively considered and averted through well-structured ambulatory management, carry more evidential weight than logs dominated by low-acuity social referrals. Reference the NHS England SDEC standards in your documentation to situate your SDEC evidence within the contemporary service context.
What makes acute take documentation "thin" in assessors' eyes?
Thin acute take documentation typically falls into four patterns: a narrow case mix that repeats a small number of presentation types without demonstrating breadth; assessor comments that describe competent performance without specifying what made the clinical decisions consultant-level; ACATs completed retrospectively from memory rather than documented at the time of the encounter; and a mismatch between claimed entrustment level (level 4) and the complexity of the case documented. A convincing ACAT entry explains why the particular decision made in that encounter was the right one, what alternatives were considered, how the decision was communicated, and what the outcome was. Brevity is not the same as clarity.
Can I use retrospective acute take evidence for Acute Medicine Portfolio Pathway?
Retrospective evidence carries significantly less weight than contemporaneous documentation. JRCPTB assessors can distinguish between a portfolio where acute take cases were documented during or immediately after the shift and one assembled from memory months or years later. Contemporaneous ACATs with original assessor feedback, case log entries completed at the time, and reflective entries written shortly after the encounter are far more credible than retrospective summaries. Historical evidence from earlier career stages can contextualise an application - for example, demonstrating how many acute take sessions were completed before a role change - but the recent evidence rule also applies: the current SSG requires evidence of current competence, and a portfolio relying heavily on evidence older than five years faces scrutiny under the five-year rule.
What if my current post has limited access to the acute take?
This is a practical constraint for many non-substantive Consultants and Specialty Doctors in positions that are partially or fully removed from an acute take rota. The most direct solution is to negotiate a return to acute take sessions - even a few sessions per month - as part of a job plan discussion with your clinical director, which the job plan flexibility article covers in detail. Where that is not immediately possible, SDEC and rapid access clinic sessions can supplement limited traditional acute take evidence. A small number of well-documented, high-quality ACATs from genuine acute take shifts is more valuable than a large log from lower-acuity settings. Older acute take evidence from earlier in your career can supplement but should not be the primary evidential base.