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Curriculum standards

Entrustable Professional Activities

LG5: Clinical reasoning in diagnosis and management

Learning Goal 5

Clinical reasoning in diagnosis and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

  • generate hypotheses, starting from the initial presenting concern, for immunological mechanisms:
    • that may explain patients’ signs and symptoms
    • to elicit focused histories to enhance or refute the differential diagnoses in arriving at provisional diagnoses and active differential diagnoses
  • approach investigations and examinations considering the importance of:
    • likelihood ratios
    • positive and negative predictive values
    • post-test probability, such as Bayesian reasoning
    • pre-test probability
    • sensitivity
    • specificity
    • the impact of false positive and false negative results, both laboratory and clinical, on patient care
  • recognise hypothesis falsifications, which may occur through signals from clinical histories, examinations, or investigations
  • recognise common cognitive biases in trainees, other health professionals, and patients, and the influence these can have in diagnostic and management error
  • differentiate between intuitive and analytical thinking (system I and system II), and the impact of either on diagnostic and/or management error
  • discuss diagnoses, and acknowledge and contextualise uncertainty, with patients, families, and/or carers
  • demonstrate understanding of different levels, quality, and applicability of evidence, and guide patients in the process of personalised care, shared decision making, and informed consent
  • demonstrate a structured, objective, and succinct approach to clinical communication and handover in both inpatient and outpatient settings

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • elicit accurate, organised, and problem-focused medical histories, considering family, history, physical, psychosocial, and risk factors
  • perform appropriate physical examinations to inform the diagnostic process
  • demonstrate the ability to include a genogram history where required
  • distinguish signals from noise, and synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses via reasonable differential diagnoses
  • assess the severity of problems, the likelihood of complications, and clinical outcomes
  • organise relevant testing and investigations to assist with the establishment of provisional and differential diagnoses, including performing skin testing when indicated
  • develop personalised management plans based on relevant guidelines and/or evidence, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account
  • manage patients with allergy, primary immune deficiency, and disorders of immune regulation
  • manage a response to adverse events from therapeutic interventions
  • manage intravenous (IV) access, including potential complications associated with intravascular access devices

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • take patient-centred histories, considering family, history, physical, psychosocial, and risk factors
  • perform accurate physical examinations
  • recognise and correctly interpret abnormal findings
  • synthesise pertinent information to direct clinical encounters and diagnostic categories
  • develop appropriate management plans

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
  • provide information to patients and their family or carers to enable them to participate in fully informed decision making from various diagnostic, therapeutic, and management options
  • take ownership and communicate clearly, effectively, respectfully, and promptly with other health professionals / community services involved in patients’ care
  • refer to national best practice standards around the management of patients with allergy
  • provide standardised action plans, such as the Australasian Society of Clinical Immunology and Allergy anaphylaxis and/or allergic reactions management plan
  • educate patients on the potential benefits, risks, and safety plans of therapies
  • counsel parents at elevated risk of having a child with allergies on strategies to reduce the risk of their child / children developing allergic diseases
  • demonstrate the ability to record informed consent of patients or related individuals as part of care management plans

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • anticipate, read, and respond to verbal and nonverbal cues
  • demonstrate active listening skills
  • communicate patients’ situations to colleagues, including senior clinicians
  • provide clinical progress updates on patients’ care, investigations, and management to relevant clinical stakeholders in patients’ care

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate safety skills, including infection control, adverse event reporting, clinician disclosure, and effective clinical handover
  • recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
  • obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
  • ensure patients are informed of the material risks associated with any part of proposed management plans

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • perform hand hygiene, and take infection control precautions at appropriate moments
  • take precaution against assaults from confused or agitated patients, ensuring appropriate care of patients
  • document history and physical examination findings, and synthesise with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
  • regularly reflect upon and self-evaluate professional development
  • obtain informed consent before involving patients in teaching activities
  • turn clinical activities into an opportunity to teach, appropriate to the setting
  • demonstrate the ability to access and present relevant clinical patient information to peer groups

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • set unclear goals and objectives for self-learning
  • self-reflect infrequently
  • deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate development of a research question, applying specific, measurable, achievable, relevant, and time-bound (SMART) criteria
  • search for, find, compile, analyse, interpret, and evaluate information relevant to the research subject

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • refer to guidelines and medical literature to assist in clinical assessments when required
  • demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use plain-language patient education materials, and demonstrate cultural and linguistic sensitivity
  • demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
  • incorporate appropriate LGBTQIA+ safe language, including gender affirming language
  • use professional interpreters, health advocates, or family or community members to assist in communication with patients, and understand the potential limitations of each
  • acknowledge patients’ beliefs and values, and how these might impact on health

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • display respect for patients’ cultures, and attentiveness to social determinants of health
  • display an understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
  • appropriately access interpretive or culturally focused services

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • abide by the core tenets of clinical ethics, including respecting patient autonomy, advocating for justice, promoting beneficence, and discerning non-maleficence
  • demonstrate professional values, including compassion, empathy, equity, respect for diversity, integrity, honesty, and partnership to all patients
  • hold information about patients in confidence, unless the release of information is required by law or public interest
  • assess patients’ capacity for decision making, involving a proxy decision maker appropriately

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate professional conduct, honesty, and integrity
  • consider patients’ decision-making capacity
  • identify patients’ preferences regarding management and the role of families in decision making
  • not advance personal interest or professional agendas at the expense of patient or social welfare

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate clinical reasoning using knowledge, experience, and probabilistic thinking to differentiate signals from noise, and characterise and prioritise patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
  • use a holistic approach to health, considering comorbidity, uncertainty, and risk
  • use the best available evidence applying to individual patients for the most effective therapies and interventions to ensure quality care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate the ability to gather focused information relevant to patients’ care
  • recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • work effectively as a member of multidisciplinary teams to achieve the best health outcomes for patients
  • role model the behaviour expected of leaders, and demonstrate mentorship and humility
  • demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • share relevant information with members of the healthcare team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • demonstrate systems thinking, and advocate to improve clinical governance over quality and safety of patient care
  • participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
  • aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
  • recognise social determinants of health as they pertain to clinical care, and devise strategies to address them

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • identify and navigate components of the healthcare system relevant to patients’ care
  • identify and access relevant community resources to support patients’ care