Curriculum standards
Knowledge guides
LG15: General medicine presentations and conditions
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Abdominal distension
- Abdominal mass
- Abnormal speech and communication
- Adverse drug reaction
- Agitation, acute
- Altered bowel habit
- Altered conscious state
- Altered gait / Difficulty walking
- Altered sensation
- Anorexia / Loss of appetite
- Anuria / Oliguria
- Bleeding:
- abdominal
- rectal
- vaginal
- Cardiac murmur
- Changes to vision / Visual loss
- Confusion
- Constipation
- Cough
- Diarrhoea
- Discharge:
- nipple
- urethral
- vaginal
- Dizziness
- Dysmenorrhoea
- Dyspareunia
- Dysphagia
- Dyspnoea
- Dysuria
- Erectile dysfunction
- Facial droop
- Falls
- Fatigue / Lethargy / Malaise / Tiredness
- Fever
- Haematemesis
- Haematuria
- Haemoptysis
- Headache
- Hearing loss
- Hyperglycaemia
- Hypertension
- Hypoglycaemia
- Hypotension
- Insomnia
- Intoxication, acute
- Itch / Pruritus
- Jaundice
- Lesions:
- breast
- skin
- Loss of consciousness
- Lymphadenopathy:
- in the neck
- Malnutrition
- Medication optimisation / rationalisation
- Melaena
- Menorrhagia
- Muscle weakness:
- generalised
- specific
- Nocturia
- Oedema / Swelling:
- generalised
- joint
- lower limb
- peripheral
- Pain:
- abdominal
- acute
- chest
- chronic
- facial
- joint
- musculoskeletal
- Pallor
- Palpitations
- Polydipsia
- Psychological distress
- Psychosis
- Pyrexia of unknown origin
- Rash
- Seizure
- Sensory disturbance
- Somnolence
- Stridor
- Substance misuse
- Suicidal ideation
- Syncope
- Tinnitus
- Trauma:
- head injuries
- joint injuries
- lacerations
- soft tissue injuries
- Tremor
- Urinary retention
- Vertigo
- Vomiting
- Weakness
- Weight change:
- gain
- loss
- Wheeze
Cardiovascular conditions
- Arrythmia syndromes
- Heart disease:
- ischaemic
- rheumatic
- valvular
- Heart failure (HF):
- HF with preserved ejection fraction (HFpEF)
- HF with reduced ejection fraction (HFrEF)
- Hyperlipidaemia
- Myocarditis
- Pericarditis
- Physiological murmurs
- Supraventricular tachycardia
Dermatological conditions
- Adverse drug reaction
- Burns
- Cellulitis
- Cutaneous malignancy
- Dermatophytes
- Eczema
- Infections:
- ectoparasite
- fungal
- scabies
- viral
- Naevi
- Urticaria
Endocrinological conditions
- Addison disease
- Cushing syndrome
- Deficiency:
- vitamin D
- Diabetes:
- insipidus
- mellitus
- Hyperthyroidism
- Hypothyroidism
- Metabolic syndrome
- Obesity
- Osteoporosis
Gastrointestinal conditions
- Abdominal pain, chronic
- Coeliac disease
- Constipation, chronic
- Gastroenteritis
- Gastro-oesophageal reflux
- Hepatitis:
- viral
- Inflammatory bowel disease
- Liver disease:
- acute
- chronic
- Liver transplant
- Malignancy
- Micronutrient deficiency, such as vitamins:
- B1
- B12
- C
- D
- Pancreatic insufficiency
Genitourinary / Gynaecological conditions
- Endometriosis
- Infections:
- sexually transmitted
- urinary tract
- vulvovaginal candidiasis
- Lichen sclerosus
- Neurogenic bladder
- Renal calculi
- Testicular torsion
Haematological / Oncological conditions
- Anaemias
- Bleeding disorders:
- haemophilia
- Deficiency:
- iron
- vitamin B12
- Haemochromatosis
- Haemolysis
- Haemophagocytic lymphohistiocytosis (HLH)
- Idiopathic thrombocytopaenic purpura (ITP)
- Late effects of cancer treatment
- Leukaemias
- Lymphomas
- Neutropenia
- Solid organ tumours
- Thalassaemia
- Thrombosis
Immunological conditions
- Adverse drug reactions
- Allergy:
- allergic rhinitis
- food (immunoglobulin E-mediated)
- insect
- Primary immune deficiencies
Infectious disease conditions
- Cellulitis, and other skin and soft tissue
- Encephalitis and meningitis
- Fever in a returned traveller
- Gastroenteritis
- Infections:
- diabetic foot
- genitourinary
- joint and prosthetic joint
- ophthalmological
- respiratory tract
- Staphylococcus aureus
- urinary tract
- viral
- Infective endocarditis
- Pyrexia of unknown origin
- Septicaemia
- Toxic shock syndrome
Kidney conditions
- Acid-base and electrolyte disturbance
- Glomerulonephritis
- Hypertension
- Kidney failure:
- acute injury
- chronic
- Nephrotic syndrome
Mental health conditions
- Anxiety disorder
- Complex post-traumatic stress trauma
- Depression
- Grief and bereavement
- Medical trauma
- Needle phobia
Neurological and rehabilitation conditions
- Bell's palsy
- Central nervous system infections
- Cerebral palsy
- Encephalopathy
- Epilepsy
- Functional neurological disorder
- Guillain–Barré syndrome
- Headache:
- chronic
- tension
- Injury:
- spinal cord
- traumatic brain
- Migraine
- Motor neurone disease
- Multiple sclerosis
- Peripheral neuropathy
- Spinal cord compression
- Stroke
- Transverse myelitis
Respiratory and sleep conditions
- Asthma
- Bronchiectasis
- Lung cancer
- Lung disease:
- chronic obstructive
- interstitial
- restrictive
- Obstructive sleep apnoea
- Pleural effusion
- Pneumonia:
- community-acquired
- hospital-acquired
- Pneumothorax
- Respiratory tract infections
Rheumatological conditions
- Arthritis:
- psoriatic
- rheumatoid
- Fibromyalgia
- Gout
- Osteoarthritis
- Scleroderma
- Systemic lupus erythematosus (SLE)
- Vasculitis:
- large vessel
- small vessel
Sexual health medicine conditions
- Infections:
- human immunodeficiency virus (HIV)
- other sexually transmitted infections and their complications
- syphilis
- Pelvic pain syndromes
- Pre-conception counselling
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- for less common or more complex presentations and conditions the trainee must also seek expert opinions
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Cardiac conditions
- Congenital cardiac disease
- Long QT syndrome
Endocrinological conditions
- Congenital adrenal hyperplasia
- Rickets
- Transgender endocrine management
Gastrointestinal conditions
- Malabsorption syndromes
Haematological / Oncological conditions
- Asplenia
- Bone marrow failure
- Cancer predisposing syndromes
- Hypersplenia
- Hyposplenia
- Iron overload
- Leucocyte disorders
- Neutropenia
- Rare leukaemia
- Rare solid tumour
- Red cell structural disorders
- Sickle cell disease
Immunological conditions
- Autoimmune disorders
- Complement deficiencies
- Immunodeficiency syndromes
- Neutrophil abnormalities
Infectious diseases
- Arboviruses
- Dengue fever
- Healthcare-associated infections
- Infections:
- mycobacterial
- parasitic
- with antibiotic resistant organisms
- Japanese encephalitis
- Malaria
- Tuberculosis
- Typhoid fever
- Viruses:
- emerging
- hepatitis
Kidney conditions
- Diabetes insipidus, nephrogenic
- Haemolytic uraemic syndrome
- Interstitial nephritis
- Kidney failure, chronic
- Kidney tubular disorders
- Nephrotic syndrome
Mental health conditions
- Bipolar and related disorders
- Psychosis
- Schizophrenia
Musculoskeletal and rheumatalogical conditions
- Dermatomyositis
- Localised scleroderma
- Musculoskeletal pain, chronic
- Systemic lupus erythematosus
Neurological conditions
- Acute disseminated encephalomyelitis (ADEM)
- Autonomic dysreflexia
- Central nervous system inflammatory and immune-mediated disorders
- Central nervous system tumours
- Central venous sinus thrombosis
- Cerebellar disorders
- Charcot–Marie–Tooth disease
- Congenital myasthenic syndromes
- Duchenne muscular dystrophy
- Idiopathic intracranial hypertension
- Motor neurone disease
- Movement disorders
- Muscular dystrophy
- Myopathy
- Neurocutaneous syndromes
- Neurodegenerative disorders
- Spina bifida
- Spinal muscular atrophy
Respiratory conditions
- Cystic fibrosis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- for less common or more complex presentations and conditions the trainee must also seek expert opinions
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Aetiology, epidemiology, and natural history for general medical conditions listed in this knowledge guide
- An understanding of how the social determinants of health impact on the conditions listed in this knowledge guide
- Diagnosis, natural history, and treatment options for people with complex, multisystem, and chronic disorders
- Epidemiology and determinants of diseases in the local community
- Long-term effects of chronic substance use
- Pain management, treatment options, and referral to appropriate healthcare specialists
- Pharmacology, such as:
- medication considerations for elderly patients
- medication rationalisation
- monitoring and toxicity of immunosuppressive drugs
- pain management
- polypharmacy and drug interactions
- side effects of psychiatric medications in normal doses and in over-dosage
- Population and global health considerations, such as:
- burden of disease in population groups, nationally and globally
- disease prevention
- environmental influences on health
- global emergencies and the broad impact on populations
- health indicators and priorities locally, nationally, and globally
- immunisation health
- impact of climate change on health
- outbreak and disease control
- Primary preventative care, such as:
- antibiotic prophylaxis and stewardship
- cancer screening recommendations
- preventing hospital-acquired complications
- promoting healthy lifestyles
- sexual health screening
- vaccination
- Specific needs for an ageing population
Clinical assessment tools
- Anthropometric assessment
- Blood pressure monitoring
- Cognitive assessment tools
- Frailty measures
- Pain severity measurement
- Perioperative risk screening tools
- Screening for common problems among older patients
-
Nutritional screening tools, such as:
- Malnutrition Universal Screening Tool (MUST)
- Subjective Global Assessment (SGA)
- Visual acuity
Investigations
- Biopsy – skin
- Bone densitometry scan (DEXA)
- Cardiac investigations, such as:
- ECG
- echocardiography
- exercise testing
- Holter monitoring
- Micronutrient tests, such as:
- folate
- iron
-
vitamin:
- B12
- C
- zinc
- Non-cancer screening recommendations, such as:
- bone density
- Other pathology, such as:
-
cerebral spinal fluid:
- culture and antimicrobial sensitivity
- indications for additional testing, such as autoimmune / metabolic
- microscopy
-
genetic:
- chromosomal microarray analysis (CMA)
- whole exome sequencing (WES)
-
site swabs, from sterile and non-sterile sites:
- culture and antimicrobial sensitivity
- microscopy
-
stool:
- calprotectin
- culture
- cysts, ova, and parasites
- faecal occult blood
- malabsorption tests
- microscopy
- specific antigen, such as Helicobacter pylori
- toxin
- sweat test
-
urine:
- biochemistry
- culture and antimicrobial sensitivity
- microscopy
- toxicology screening
-
cerebral spinal fluid:
- Pathology tests, such as:
- antimicrobial, culture, and microscopy sensitivity
- biochemistry
- blood gases
- endocrinological
- genetic investigations
- haematological
- immunological and allergen testing
- inflammatory markers
- metabolic screening tests
-
polymerase chain reaction (PCR):
- bacterial
- viral
- serology
- Radiology, such as:
- CT scan
-
knowledge of indications for additional specialist radiological investigations, such as:
- barium studies
-
nuclear medicine studies, including:
- bone scan
- MAG3
- PET
- specialist x-rays
- MRI
- plain x-ray
- ultrasound
- Respiratory investigations, such as:
- bronchoalveolar lavage
- nasopharyngeal aspirate
- pulmonary function tests
- sleep studies
- Skin prick testing
Procedures (required)
- Airway stabilisation procedures
- Blood product transfusion
- Indwelling urinary catheter insertion
- Intravenous cannulation
- Puncture:*
- arterial (arterial blood gas sampling)
- lumbar
- Ventilation:
- high-flow oxygen therapy
- manual
-
non-invasive ventilation:
- bilevel positive airway pressure (BiPAP)
- continuous positive pressure ventilation (CPAP)
Procedures (optional)
- Arterial catheter insertion*
- Ascitic aspirate / paracentesis
- Aspiration:*
- bone marrow
- joint
- pleurocentesis
- Bedside ultrasound
- Biopsy:*
- liver
- skin
- Bronchoscopy
- Central venous catheter insertion
- Endoscopy
- Endotracheal intubation
- Intercostal catheter insertion
- Mechanical ventilation
- Nasogastric tube insertion
- Percutaneous long line (PICC)
- Point-of-care ultrasound (POCUS)
- Procedural sedation
* Highly recommended for trainees in rural, regional, and remote settings.
General management considerations
- Chronic pain management and awareness of the psychosocial consequences of chronic pain, such as depression and work loss
- Complexity theory and its application in the provision of holistic health care
- Consideration of appropriate secondary prevention, such as secondary stroke prevention
- Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
- Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel between rural and metropolitan areas
- Cost, implications, and scope of healthcare-related adverse outcomes
- Family violence awareness and screening
- Goals of therapy
- Informed consent
- Medication review and polypharmacy management
- Principles of trauma-informed, patient-centred care
- Role of allied health professionals in holistic care of patients and families affected by illness
- Tailoring treatment and management to the setting in which care is being provided, such as clinical resources and workforce planning
- The timing of decisions and risks for the individual patient
Management considerations specific to ageing patients
- Correlation between frailty and vulnerability
- Impacts of changing familial dynamics / roles, such as children caring for ageing or frail parents
- Role of aged care services and aged care assessment teams
- Transitions to supported accommodation
Management considerations specific to end-of-life care
- Awareness of voluntary assisted dying (VAD) legislation and implications for discussion and management of VAD as an end-of-life option
- Common problems associated with end-of-life care, such as dyspnoea, end organ failure, and pain
- Medical and social factors associated with medical futility
- Medicolegal aspects of decisions regarding advance health directives, capacity to consent, and resuscitation
- Suitability and timing of discussions regarding ceiling of care, organ donation, and resuscitation
Management considerations specific to patients with chronic illness
- Awareness and access to appropriate disability services and aids
- Difference between curative, palliative, and rehabilitative approaches to disease management
- Factors in rehabilitation and lifestyle management
- Impact of chronic disease and medication on fertility
- Impact of illness and disability on patients’ ability to care for family members
- Interplay of psychosocial factors in the morbidity of chronic disease
- Long-term implications of chronic disease on work
- Navigation of sub-specialty advice and guidelines
- Stanford model of chronic disease management
Management considerations specific to young adults
- Educational and vocational resources available to adolescents with special needs, and interaction of the physician with these services
- Issues of consent
- Transfer of responsibility from parents to patient