Curriculum standards
Entrustable Professional Activities
LG7: Acute care
Acute care
Manage the early care of acutely unwell patients before and in the neonate period
This activity requires the ability to:
- assess seriously unwell or injured patients
- stabilise patients, and initiate appropriate investigations and management
- anticipate and recognise clinical deterioration
- reassess responses to interventions, and adjust plans accordingly
- work effectively within a team to complete tasks and coordinate efforts
- follow local processes for escalation of care, and involve appropriate additional services, including transport, subspecialists, or intensive care
- document events, interventions, and patient responses
- participate in event debriefing to review management and identify areas for improvement
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:
- recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
- anticipate the need for resuscitation at complex births
- perform advanced neonatal life support, according to the Australian and New Zealand Committee on Resuscitation guidelines, to a high level of advanced resuscitation skills
- demonstrate effective team leadership in acute resuscitation events
- demonstrate knowledge of the potential risks and complications of resuscitation
- assess, diagnose, and manage acute undifferentiated clinical presentations
- select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
- identify systematic causes of acute deterioration in health status
- manage escalations or transitions of care in a proactive and timely manner
- develop clear and concise plans of ongoing multidisciplinary treatment following acute events
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- recognise seriously unwell patients requiring immediate care
- identify antenatal factors that may require life support interventions at birth
- apply basic neonatal life support as indicated
- demonstrate effective team membership in acute resuscitation events
- explain general medical principles of caring for patients with undifferentiated and undiagnosed conditions
- identify potential causes of current or anticipated 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
- assess perioperative and periprocedural patients
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
- use closed-loop and clear communication with other healthcare team members during resuscitation
- facilitate and lead debriefs following resuscitations
- facilitate early communication with patients and healthcare team members to allow shared decision making
- negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
- 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
- demonstrate principles of counselling parents in the case of an imminent extremely preterm birth
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’ understanding of their diseases 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:
- maintain up-to-date certification in advanced neonatal life support
- use clinical information technology systems for conducting prospective and retrospective clinical audits
- 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 supervision skills and teaching specifically in neonatal resuscitation to a multidisciplinary team
- 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:
- provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
- coordinate and supervise junior colleagues from the emergency department, obstetrics, and wards
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- select studies based on optimal trial design, freedom from bias, and precision of measurement
- evaluate the value of treatments in terms of relative and absolute benefits, cost, potential patient harm, and feasibility
- evaluate the applicability of the results of clinical studies to the circumstances of individual patients, especially those with multiple comorbidities
- specify research evidence to the needs of individual patients
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
- recognise 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 will:
- negotiate health care decisions in a culturally safe way by considering variation in family structures, cultures, religion, or belief systems
- integrate culturally safe 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 nursing, midwifery, obstetrics, and other subspecialty inpatient units
- manage the transition of acute medical patients through their neonatal journeys
- lead a team by providing engagement while maintaining a focus on outcomes
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 obstetric 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:
- explain the systems for the escalation of care for deteriorating patients
- explain the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes