Guide
Entrustment is a judgement an assessor makes. A logbook is a record of what happened. The two are routinely confused, and they answer different questions.
Written by Dr Thomas Porter, emergency medicine registrar. Published 28 August 2026. Last reviewed 28 August 2026 against the 2025 Update.
An entrustment level is awarded by an assessor. It is recorded on a workplace-based assessment, typically a DOPS, submitted through the ePortfolio, and it represents someone else’s judgement about the supervision a trainee would need in future.
A procedure logbook is the trainee’s own record of what they did and how supervised they were at the time. It is a description of cases that have already happened.
The distinction matters because a trainee cannot award themselves an entrustment level. A logbook that offers the entrustment scale as a field is inviting a self-assessment that carries no weight, and it blurs a boundary the assessment system depends on.
Table 4 of the curriculum sets out the entrustment scale as follows.
The parenthesis on level 4 is worth reading twice. Even at the top of the scale, a consultant retains overall clinical responsibility.
The curriculum anticipates the obvious misreading and addresses it directly. Having set the expectation of level 3 by the end of intermediate training and level 4 by the end of higher training, it continues:
“This does not imply that the trainee would be entrusted to perform any or all procedures independently without assistance or supervision at the start of higher training. It is intended for this to be interpreted as that the trainee is entrusted to reliably recognise when a particular procedure is indicated and begin preparation to proceed while waiting for appropriate assistance to attend in order for things to proceed safely.”
A level is a statement about the supervision a trainee needs, not a licence to work alone.
The curriculum sets entrustment expectations at each threshold in training, summarised in its Figure 3. For emergency procedures, it expects level 3 by the end of intermediate training and level 4 by the end of higher training.
In ACCS the position varies by procedure. Most of the practical procedures carry an entrustment requirement of 2b at the end of ACCS, assessed by a DOPS or by simulated practice with reflection recorded, and the curriculum notes that the level for procedural skills varies within ACCS.
For point-of-care ultrasound the POCUS training progression tracker marks 2b as required for ACCS against peripheral IV access, central IV access and fascia iliaca block, and marks level 4 as required for completion of higher specialty training. This is covered in more detail in the guide to RCEM POCUS requirements.
Once a procedure has been signed off, the assessment requirement stops. The curriculum states that where an ACCS trainee has been signed off as able to perform a procedure independently, they “are not required to have any further assessment (DOPS) of that procedure, unless they or their educational supervisor think that this is required”, and that the same applies to procedures signed off during other training programmes.
The logging requirement does not stop. The same passage adds that trainees “would be expected to continue to record activity in their logbook”.
Sign-off therefore ends the assessments, not the record.
If entrustment is the assessor’s judgement, the logbook’s job is the factual one: what was done, when, and how much supervision was actually present on that occasion.
The terms commonly used for this in logbooks and spreadsheets are direct, indirect and independent. They are a logbook convention rather than a term from the curriculum, and they describe the circumstances of a single case rather than rating the trainee. Recorded per encounter, they show how practice changed over time, which is the evidence a supervisor and an ARCP panel are looking for.
LogEM records supervision this way for the same reason: it keeps the logbook a factual record, and leaves entrustment where it belongs, with the assessor on a DOPS.
Quotations are reproduced for reference with attribution. Requirements change: check the current documents on the RCEM website before relying on anything here. LogEM is an independent app and is not affiliated with or endorsed by the Royal College of Emergency Medicine.
LogEM is an independent app. It is not affiliated with or endorsed by the Royal College of Emergency Medicine.
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