The strongest respiratory audit topics for Portfolio Pathway are measurable against a named BTS or NICE guideline, completed as a full cycle, led by you personally, and reflect current independent practice. COPD acute management, CAP severity scoring, PE anticoagulation, oxygen prescribing and NIV delivery are all well-evidenced choices with clear published standards and a high volume of patients in most NHS respiratory units.
What the respiratory medicine SSG says about audit
The GMC Specialty Specific Guidance (SSG) for Respiratory Medicine with General Internal Medicine is the document that shapes what assessors are looking for when they read your portfolio. Before choosing any audit topic, you should read the current SSG directly from the GMC's website. The guidance sets out the evidence categories expected across the four domains of Good Medical Practice, and audit sits within the quality, safety and improvement arm of Domain 2 (Safety and quality).
The SSG expects candidates to show engagement with clinical audit and quality improvement as part of their regular professional activity, not as a one-off exercise performed for the portfolio. Assessors distinguish between a doctor who audits because they genuinely improve their department's care and one who has generated a paper trail to tick a box. The difference shows in the reflection, in who else was involved, and in whether anything actually changed.
The guidance references audit alongside quality improvement projects (QIPs), significant event analyses and service development activity. Read the general audit guidance and the quality improvement article alongside this one. Audit and QIP evidence is complementary, and a portfolio with both, properly differentiated and reflected upon, is stronger than one that tries to use a QIP as a substitute for a completed audit cycle or vice versa.
The SSG for Respiratory Medicine is updated periodically. Always read the version live on the GMC's Specialty Specific Guidance page before building your evidence plan, not a summary written by a third party, including this article.
Choosing the right audit topic
A good audit topic for Portfolio Pathway has four qualities: a published standard you can audit against, a patient population large enough to give you a meaningful sample, a question you can genuinely investigate in your current post, and a finding that could plausibly drive change.
In respiratory medicine, the BTS (British Thoracic Society) and NICE together provide published guidelines covering most of the common conditions you manage daily. That is a significant advantage over specialties where guidance is sparse or contested. The audit standards are not hard to find; the challenge is choosing a topic that you can complete properly and that reflects your current scope of practice.
Avoid topics where the answer is predetermined. An audit that inevitably confirms your department already meets every target is less valuable than one that finds a gap, forces a change, and allows you to re-measure. Assessors are not looking for perfect compliance scores; they are looking for a doctor who understands what quality work looks like and who can drive improvement.
Do not choose a topic so narrow that you cannot collect a meaningful sample (fewer than 15 to 20 cases is usually too few). Do not present a data-collection exercise without a standard, an action plan, and evidence of follow-through. Do not lead with audits where your role was passive (you helped collect data on a project led by a registrar four years ago). The evidence needs to demonstrate your independent professional judgement and leadership.
You should also think about mapping. Each audit topic maps to at least one GMC domain and at least one Capabilities in Practice (CiP) area. An audit of COPD discharge care maps strongly to Domain 2 (Safety and quality) and to the respiratory medicine CiPs around chronic obstructive airways disease management. An audit of antibiotic choice for pneumonia maps to Domain 2 but also supports Domain 1 (Knowledge, skills and performance). When you write your evidence narrative, spell these links out rather than leaving assessors to infer them. Read about the CiPs framework and the four GMC domains before you write up any audit as portfolio evidence.
Ten audit ideas: standards-based projects
Each idea below is matched to a named guideline, a measurable indicator that you can collect from clinical records, and a note on why it works as Portfolio Pathway evidence. Use these as starting points, not scripts. The final audit question should be shaped by what is genuinely measurable in your department.
| # | Audit topic | Guideline standard | Why it works |
|---|---|---|---|
| 1 | Acute COPD exacerbation management ABG, bronchodilators, steroids, oxygen targets, NIV decision NICE NG115 BTS COPD |
NICE NG115 (COPD in over 16s: diagnosis and management, 2019 update). BTS/NICE COPD Quality Standard QS10. | High patient volume. Clear measurable indicators. Directly maps to respiratory CiPs. Loops easily into NIV or discharge bundle audit. |
| 2 | Acute asthma severity assessment and management PEFR recording, severity scoring, steroid and bronchodilator delivery, action plan at discharge SIGN 158 |
SIGN 158 / BTS British Guideline on the Management of Asthma (2023 revision). NICE Quality Standard QS25. | Well-defined severity categories (moderate, severe, life-threatening). Action plan documentation is a process indicator easy to collect retrospectively. |
| 3 | Community-acquired pneumonia: severity scoring and antibiotic choice CURB-65 or CRB-65 documented, antibiotic choice matched to protocol, blood cultures, urine antigen tests NICE NG138 BTS CAP |
NICE NG138 (pneumonia: antimicrobial prescribing, 2019). BTS CAP Guidelines (in use pending full update). | CAP is one of the highest-volume admissions in any medical unit. CURB-65 documentation is a concrete, auditable process indicator. |
| 4 | Pulmonary embolism: pre-test probability and anticoagulation Wells PE score or YEARS algorithm documented, CTPA versus V/Q decision, anticoagulation started, clear follow-up plan NICE NG158 |
NICE NG158 (venous thromboembolic diseases: diagnosis, management and thrombophilia testing, 2020 update). | NG158 is specific about when to use the Wells score and when d-dimer is appropriate. A clean process audit around decision-making is achievable with 20 to 30 cases. |
| 5 | Pleural effusion: safety of diagnostic pleural aspiration Ultrasound marking or real-time guidance used, diagnostic sample sent (biochemistry, LDH, cytology), documentation complete BTS Pleural |
BTS Pleural Disease Guidelines (2010, updated pleural biopsy guidance 2023). BTS recommends image guidance for all pleural procedures. | A procedure-safety audit maps to Domain 1 (knowledge and skills) and Domain 2 (safety). Strong evidence of independent procedural practice. |
| 6 | Non-invasive ventilation for type 2 respiratory failure NIV started at appropriate pH, initial settings documented, response reviewed at one hour, escalation plan clear BTS/ICS NIV |
BTS/ICS Non-invasive Ventilation Guidelines (2016, Thorax supplement). BTS Quality Standards for NIV. | NIV initiation is a core respiratory competency in the SSG. An audit of adherence to BTS initiation criteria demonstrates clinical independence at Consultant level. |
| 7 | COPD discharge bundle compliance Rescue pack prescribed, written action plan issued, early follow-up within two weeks arranged, pulmonary rehabilitation referral made, smoking cessation documented NHS CQUIN BTS COPD |
NHS England COPD discharge bundle. RCP COPD discharge bundle. BTS COPD Quality Standard QS10. | Process indicator, easy to extract from discharge summaries. High non-compliance rates in most units make this a guaranteed loop-closing opportunity. |
| 8 | Oxygen prescribing against BTS standards Oxygen written on the drug chart (not just administered), target saturation documented, delivery device and flow rate specified, prescriber identified BTS O2 2017 |
BTS Emergency Oxygen Guideline (2017, Thorax supplement). NPSA rapid response report on oxygen safety. | Oxygen prescribing safety spans Domain 1 and Domain 2. It is simple to audit, prescribing failures are common, and the standard is unambiguous. |
| 9 | IPF/ILD management against NICE guidance MDT discussion documented, FVC% trend tracked at six-month intervals, antifibrotic prescribing against NICE eligibility criteria, palliative care involvement NICE NG122 |
NICE NG122 (idiopathic pulmonary fibrosis in adults: diagnosis and management, 2017, updated 2023). | ILD/IPF management demonstrates subspecialty depth within respiratory medicine. MDT documentation is a proxy for the multidisciplinary working CiPs. |
| 10 | TB management: notification, treatment and contact tracing Public health notification completed, standard four-drug regimen initiated, monthly reviews documented, sputum cultures at two months, contact tracing initiated NICE NG33 |
NICE NG33 (tuberculosis: prevention, diagnosis, management and service organisation, 2016, updated 2019). | TB sits in the SSG as a distinct area. An audit across notification, treatment and safety monitoring maps to infection prevention, public health and safety domains simultaneously. |
These ten topics are not exhaustive. Other credible audit areas include interstitial lung disease multidisciplinary team outcomes, pulmonary rehabilitation referral rates, obstructive sleep apnoea pathway adherence against the NICE CG73 guidance, and spirometry quality standards from the BTS or ARTP. The ten above are chosen because they have a clear published standard, a broad enough patient population to generate a meaningful sample in most NHS respiratory units, and a measurable process indicator that does not require weeks of outcome follow-up.
The National Asthma and COPD Audit Programme (NACAP) publishes trust-level data that can give you a baseline before you begin your own departmental audit. NACAP data is publicly available and a useful context-setter for an audit of COPD or asthma care, particularly if your department's rates differ from the national benchmark. Cite the NACAP data as context rather than as a substitute for your own data collection.
Choosing between these topics for your evidence
If you are early in building your portfolio and need a high-volume, achievable first audit, COPD acute management (number 1) or CAP severity scoring (number 3) are the most practical. Both have large patient numbers in most respiratory units, process indicators that are straightforward to collect retrospectively from clinical records, and a clear published standard.
If you want to demonstrate procedural competence alongside quality work, the pleural aspiration audit (number 5) or the NIV audit (number 6) is a stronger choice. Both map to the procedural CiPs in the respiratory SSG and demonstrate that your quality work is tied to your own hands-on clinical practice rather than being a generic administrative exercise.
If you need to show subspecialty depth, the IPF/ILD audit (number 9) or the TB audit (number 10) signals that your scope of practice extends beyond acute respiratory admissions into the full breadth of an independent respiratory Consultant's work. These are particularly useful if assessors have previously indicated that your evidence is narrow.
Closing the loop in practice
Closing the loop means you did not just measure. You found a gap, designed an action to address it, implemented the action, and then re-measured or obtained credible evidence that the change was implemented and reviewed. Read the dedicated audit loop article for the full framework. For respiratory medicine specifically, here is what closing the loop looks like at each stage.
The most common failure point is Stage 3: the audit findings are presented, everyone agrees something should change, and then nothing happens because the change requires someone senior to update a protocol and that person is busy. You need to own the follow-through, not just the data collection. If you are in a Specialty Doctor or non-substantive Consultant post where you do not have formal authority over department protocols, the action plan should still be something you drove, presented, and monitored, even if a Consultant signed it off. Your reflection should be explicit about your role and about any barriers you encountered and how you addressed them.
A partial loop, where the re-audit happened but only showed a small improvement, is still worth submitting if you reflect honestly on what worked, what did not, and what you would do differently. Honest reflection on a partial result demonstrates more insight than a clean compliance figure with no critical commentary. The goal is not to show a perfect department; it is to show a doctor who understands quality work and who acts on what they find.
Writing the audit reflection
The reflection is the most important component of an audit evidence pack. It is where assessors see whether you genuinely learned from the process or whether the audit was a data-collection exercise with a short paragraph attached. Read the reflective practice article for the full framework. For audit specifically, the reflection needs to address five things:
What was the clinical problem and why did it matter?
State the gap you were investigating and why it matters for patient care in your department. For a COPD discharge bundle audit, this means explaining what happens when patients do not receive rescue prescriptions or early follow-up: readmission rates, avoidable deterioration, patient experience. Keep this short. One paragraph is enough.
What did the baseline data show?
State the actual compliance figure against the standard, not just the direction. If only 38% of COPD discharges had a written action plan against a standard of 100%, say so. Specificity signals that this was real data you collected, not a vague impression. Include the sample size, the time period covered, and who helped collect the data.
What did you do about it, and what was your specific role?
Describe the action, who agreed it, when it was implemented, and what you personally did to drive it. If you designed a revised discharge checklist and presented it at a governance meeting, say that. If you ran a teaching session for junior doctors, include the date and how many attended. Evidence of implementation is what separates a completed cycle from an incomplete one.
What did the re-audit show?
State the post-intervention compliance figure and compare it to the baseline. If compliance improved from 38% to 74%, say so. If it did not improve as expected, reflect honestly on why. A disappointing result with a credible analysis of the reasons demonstrates more clinical leadership insight than a flawless improvement with no critical commentary.
What did you learn and what will you do next?
Explain how the process changed your own clinical practice, your understanding of how the department works, or your approach to quality improvement in future. Link this to patient care, not just personal development. The best reflections end with a concrete next step, whether that is a repeat audit in two years, a linked quality improvement project, or an ongoing monitoring mechanism.
Packaging the audit evidence
The evidence pack is what you actually upload to your portfolio. The reflection alone is not enough. Assessors need to be able to verify the audit without relying on your word for it. The pack should be self-contained: a reader who has never seen your department should be able to understand the whole project from the documents you provide.
Label the folder clearly: "Audit 1 - COPD discharge bundle - 2024-2025 - Dr [Name]". Use a consistent naming convention across all your audit evidence. Assessors review multiple applicants and a clearly labelled, logically organised portfolio reduces the risk of good evidence being overlooked because it was buried inside an unlabelled folder of PDFs.
If your educational supervisor or a senior colleague has reviewed the audit, include their structured feedback or a brief comment from their structured report. Read the structured reports article for guidance on how to brief senior colleagues to produce useful written evidence rather than generic positive statements.
GIM and the cross-domain case
Respiratory medicine in the UK is a dual SSG application: respiratory medicine with General Internal Medicine. That means your evidence needs to cover both the respiratory-specific CiPs and the GIM CiPs. Audit is one of the areas where you can make a single piece of work serve both sides of the application, if you choose your topic wisely.
A CAP management audit covers a topic that sits at the boundary of respiratory medicine and GIM. The severity scoring, antibiotic choice, blood cultures and urine antigen testing indicators reflect GIM skills as much as respiratory expertise. Framing the reflection explicitly in terms of both the respiratory CiPs and the GIM SSG indicators makes the dual-domain coverage explicit to assessors rather than leaving them to infer it.
Similarly, an oxygen prescribing audit or a PE management audit maps cleanly to both specialties. PE is one of the most common conditions managed by both respiratory and acute medicine physicians. The NICE NG158 standard applies equally to both sides of your dual application. The same data-collection exercise, reflected upon explicitly against both the respiratory and GIM CiPs, gives you more evidential leverage from one audit than two separate, narrowly scoped projects.
Candidates applying under the Respiratory Medicine with GIM SSG who also have significant acute medicine exposure may find that some audit topics map across three SSGs rather than two. An acute COPD management audit, for example, covers respiratory, GIM and acute medicine CiPs simultaneously. If your acute take exposure is strong enough to support a separate acute medicine component, read the Acute Medicine Portfolio Pathway guide alongside the respiratory medicine guide before building your evidence plan.
Where audit sits in your full application
Audit is one component of a Portfolio Pathway application, not the whole application. Senior doctors sometimes over-invest in audit evidence at the expense of other areas the SSG expects. The full respiratory medicine application requires evidence across all four GMC domains: clinical knowledge and skills, safety and quality, communication and teamwork, and maintaining trust. Audit addresses Domain 2 strongly and Domain 1 to some degree. By itself, it does not address patient feedback, MSF, structured reports, CPD or teaching evidence.
Audit evidence that is strong but sits in an otherwise thin portfolio will not carry the application. Conversely, a thin audit section does not sink a strong portfolio, particularly if quality improvement project evidence covers similar ground. The goal is balance and currency: enough audit or QI evidence to demonstrate that quality work is a regular, ongoing part of your professional practice, not a one-off performance.
For the respiratory medicine application specifically, the evidence areas that most often need attention alongside audit are:
- Workplace-based assessments, particularly DOPS for procedural sign-off on bronchoscopy, pleural aspiration and chest drain insertion, and mini-CEX for acute presentations
- Multi-source feedback, typically from a spread of colleagues across both respiratory and GIM practice
- Structured reports from referees who can speak to your independent respiratory and acute medical practice
- Teaching evidence, particularly from formal teaching sessions delivered to respiratory and medical trainees
- Leadership and management evidence, which can include rota contributions, committee participation or governance responsibilities
- Research or publication evidence, if you have publications or presentation experience in a respiratory field
Build the audit evidence in parallel with these other categories, not in sequence. A year spent completing only audit evidence before starting anything else is a year without MSF, without structured reports, and without the reflective practice submissions that keep your portfolio current. Read the Portfolio Pathway overview for the full picture of how the evidence categories fit together, and use the SSG walkthrough to map your current evidence against each respiratory CiP before you decide where to invest next.
All eighteen specialisms
Respiratory Medicine is one of eighteen specialisms with a dedicated GMC SSG. Each specialism has its own CiPs, its own Royal College or Faculty, and its own procedural expectations. The guides below cover all eighteen currently on the Portfolio Pathway.
Where this article fits
This deep-dive is part of the respiratory medicine evidence cluster. It sits alongside the parent respiratory guide and the general audit and quality improvement articles.