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Curriculum standards

Entrustable Professional Activities

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

  • identify and access sources of relevant information about patients
  • obtain patient histories
  • examine patients
  • synthesise findings to develop provisional and differential diagnoses
  • discuss findings with patients, families, and/or carers
  • generate management plans
  • present findings to other health professionals

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:

  • plan both open and directed questions to obtain relevant data
  • determine histories of presenting problems, incorporating the patients’ developmental stage, including:
    • associated symptoms
    • duration and course of the condition
    • symptom onset
  • elicit key features of histories, including:
    • behavioural
    • developmental milestones
    • family
    • growth
    • neurological
    • perinatal
    • prenatal
    • psychosocial and general medicine history, including:
      • alcohol
      • drugs
      • immunisation
    • sleep
  • adapt examination methods depending on the behavioural and cognitive state of the patient
  • perform various examination techniques, suitable to the neurodevelopmental stage of patients, to assess:
    • cognition / mental state
    • coordination and gait
    • cranial nerves
    • motor function
    • reflexes
    • sensory function
  • synthesise and interpret findings from histories, examinations, and investigations to devise the most likely provisional diagnoses via reasonable differential diagnoses
  • assess the severity of problems, the likelihood of complications, and clinical outcomes
  • plan necessary investigations within an appropriate time frame
  • review significant investigations, such as MRI and nuclear medicine electrophysiology
  • reconsider and, if necessary, revise a diagnosis when new information becomes available
  • develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account
  • obtain further details from other sources, such as home video, other family members, paediatricians, and teachers
  • identify mental health issues and refer appropriately
  • assess and manage problems of patients’ adherence to management
  • identify state / national driving regulations for neurological conditions, and provide guidance in relation to an individual’s fitness to drive
  • recognise signs of inflicted injury
  • assess patients’ level of consciousness using a tool such as the Glasgow Coma Scale, and explain the limitations of these in childhood
  • apply and interpret brain death criteria
  • assess sleep using scores such as the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and explain the limitations of these measures
  • recognise the signs of child abuse and domestic violence
  • assess patients’ capacity and competence to make informed decisions regarding treatment options

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 psychosocial 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 and/or carers to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
  • communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
  • include the child / adolescent in the process of information gathering
  • describe to the child and family and/or carers the potential negative impacts of investigations involving neuroimaging and genetic testing
  • communicate with hospital managers and, if necessary, insurers, lawyers, or other interested parties to provide successful advocacy for patients or services delivering care to patients
  • provide appropriate written reports to third parties
  • involve nursing staff to provide teaching and a link to the treating doctor

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

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, and effective clinical handover
  • 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
  • recognise and effectively deal with aggressive and violent patient behaviours through appropriate training

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

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:

  • search for, find, compile, analyse, interpret, and evaluate information relevant to the research subject
  • access information from neurogenetic databases, such as Online Mendelian Inheritance in Man (OMIM)

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 awareness 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 linguistical sensitivity
  • demonstrate effective and culturally competent communication and care for Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
  • use a professional interpreter, health advocate, or a family or community member 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
  • demonstrate awareness 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:

  • demonstrate professional values, including compassion, empathy, 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:

  • apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
  • use a holistic approach to health, considering comorbidity, risk, and uncertainty
  • use the best available evidence for the most effective therapies and interventions to ensure quality care
  • recognise how and when to access additional resources and/or to refer patients to other neurologists, neurosurgeons, rehabilitationists, or other specialist physicians

direction
Requires some supervision

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

The trainee may:

  • demonstrate clinical reasoning by gathering 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
  • demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patients’ 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:

  • 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
  • provide support with respect to education
  • identify community services for children with disabilities or other chronic neurological conditions

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 patient care