Curriculum standards
Entrustable Professional Activities
LG6: Acute illness clinical assessment and management
Acute Illness clinical assessment and management
Assess and manage the early care of acutely unwell children
This activity requires the ability to:
- recognise and manage patients with an acute illness
- assess the severity of illness, and initiate appropriate management
- recognise clinical deterioration, and respond by following the local process for escalation of care
- manage multiple acutely unwell patients simultaneously
- liaise with transport services and medical teams to ensure patients are managed in the most appropriate setting, if required
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- effectively assess, diagnose, and manage acute undifferentiated clinical presentations, as listed in the acute illness knowledge guide
- select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
- systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
- recognise immediate life-threatening conditions and critically unwell children, and respond appropriately
- manage escalations or transitions of care in a proactive and timely manner
- optimise medical management before surgical interventions
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate an understanding of general medical principles of caring for children with undifferentiated and undiagnosed conditions
- recognise seriously unwell children requiring immediate care
- identify potential causes of current deterioration, and comply with escalation protocols
- facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
- document information to outline the rationale for clinical decisions and action plans
Communication
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
- facilitate early communication with patients, families, and team members to allow shared decision making
- negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
- employ communication strategies appropriate for younger patients or those with cognitive difficulties
- explain situations to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
- determine the level of health literacy of individual patients, and their level of understanding of agreed care decisions
- develop clear and effective discharge summaries for patients, general practitioners, community health providers, or specialist teams, with recommendations for ongoing care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate communication skills to sufficiently support the function of multidisciplinary teams
- determine patients’, family members’, whānau, and/or carers’ understanding of the diseases, if possible, and what they perceive as the most desirable goals of care
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- use clinical information technology systems for conducting prospective and retrospective clinical audits
- evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
- analyse adverse incidents and sentinel events to identify system failures and contributing factors
- identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
- coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- evaluate the quality of processes through well-designed audits
- recognise the risks and benefits of operative interventions
- raise appropriate issues for review at morbidity and mortality meetings
- evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure
Teaching and learning
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- demonstrate effective supervision skills and teaching methods that are adapted to the context of the training
- encourage questioning among junior colleagues and students in response to unanswered clinical questions
- seek guidance and feedback from healthcare teams to reflect on encounters and improve future patients’ care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- mentor and train others to enhance team effectiveness
- provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
- coordinate and supervise junior colleagues from the emergency department and wards
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee may:
- select studies based on optimal trial design, freedom from bias, and precision of measurement
- specify research evidence to the needs of individual patients
- evaluate the value of treatments in terms of relative and absolute benefits, cost, feasibility, and potential patient harm
- evaluate the applicability of the results of clinical studies to the circumstances of individual patients, especially those with multiple comorbidities
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate efficient searching of literature databases to retrieve evidence
- use information from credible sources to aid in decision making
- refer to evidence-based clinical guidelines and protocols on acutely unwell patients
- demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice
Cultural safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee may:
- negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems
- integrate culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori into patients’ management
- consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- practise cultural safety appropriate for the community serviced
- proactively identify barriers to healthcare access
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- develop management plans based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
- advise patients of their rights to refuse medical therapy, including life-sustaining treatment
- consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
- facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
- demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- communicate medical management plans as part of multidisciplinary plans
- establish, where possible, patients’ wishes and preferences about care
- contribute to building a productive culture within teams
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- recognise the need for escalations of care, and escalate to appropriate staff or services
- integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making
- reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
- use care pathways effectively, including identifying reasons for variations in care
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- involve additional staff to assist in a timely fashion when required
- recognise personal limitations and seek help in an appropriate way when required
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
- manage the transition of acute medical patients through their hospital journeys
- lead a team by providing engagement while maintaining a focus on patients’ outcomes and dispositions
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- collaborate with and engage other team members, based on their roles and skills
- ensure appropriate multidisciplinary assessment and management
- encourage an environment of openness and respect to lead effective teams
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
- prioritise patients’ care based on need, and consider available resources
- collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- demonstrate an understanding of the systems for the escalation of care for deteriorating patients
- demonstrate an understanding of the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes