Curriculum standards

Ready to perform without supervision

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

The trainee will:

• discuss the potential benefits, risks, side effects, cost, and burden of any proposed investigation, and obtain consent before proceeding
• discuss with patients the rationale and the possibility of false negative / false positive results, as well as incidental findings
• discuss the option of no investigation, and the risk / benefit of this with patients
• use clear and simple language, and check that patients understand the terms used
• use written or visual material or other aids that are accurate and up to date to support discussions with patients
• offer patients the opportunity to ask further questions, and time to think about decisions
• identify patients’ concerns and expectations, providing adequate explanation to address these
• give information that patients may find distressing in a considerate way, using best practice techniques for breaking bad news
• incorporate appropriate LGBTQIA+ safe language, including gender affirming language
• discuss the likely timeframe during which investigations will occur, and the plan for communicating results when available
• discuss results using simple language, and explain how the results might affect future management
• include sufficient clinical information to accurately convey patient context and the reason for investigation within the investigation request
• keep relevant healthcare practitioners updated regarding planned investigations and results, including clear communication of who is responsible for reviewing these
• check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

Requires some supervision

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

The trainee may:

• discuss the benefits, complications, indications, and risks of investigations with patients before ordering investigations
• explain the results of investigations to patients
• arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate

Ready to perform without supervision

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

The trainee will:

• select appropriate investigations using a value-based care framework, such as Choosing Wisely
• identify adverse outcomes, including false positives, false negatives, and incidental findings, that may result from a proposed investigation, focusing on patients’ individual situations
• consider strategies to reduce the chance of harm, and employ these if possible / practical
• recognise iatrogenic harms that may result from diagnostic investigations
• ensure timely follow-up of investigation results, using recall / reminder systems and other tools if appropriate
• take full responsibility for reviewing the results of ordered investigations, and hand this responsibility over to a designated colleague if this is not possible

Requires some supervision

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

The trainee may:

• consider safety aspects of investigations when planning them
• seek help with interpretation of test results for less common tests or indications or unexpected results

Ready to perform without supervision

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

The trainee will:

• use appropriate guidelines, diagnostic algorithms, evidence sources, and decision support tools
• participate in clinical and epidemiological studies to improve test ordering strategies for diagnoses and screening

Requires some supervision

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

The trainee may:

• undertake professional development to maintain currency with investigation guidelines

Ready to perform without supervision

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

The trainee will:

• ensure appropriate ethics approval is obtained when undertaking investigations as part of clinical research
• obtain written consent from patients if the investigation is part of a research program

Requires some supervision

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

The trainee may:

• refer to evidence-based clinical guidelines
• consult current research on investigations

Ready to perform without supervision

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

The trainee will:

• recognise patients’ views and preferences about any proposed investigations, and the adverse outcomes they are most concerned about
• recognise principles of equity as they pertain to diagnostic decision making, and apply these appropriately to advocate for patients
• explain the impact of implicit bias on diagnostic decision making, and initiate steps to address it

Requires some supervision

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

The trainee may:

• consider patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations

Ready to perform without supervision

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

The trainee will:

• remain within the scope of the authority given by patients (with the exception of emergencies)
• clarify who will make decisions on patients’ behalf if they are unable to do so
• respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
• advise patients if there may be additional costs, which they may wish to clarify before proceeding
• obtain written informed consent when indicated, and informal informed consent at all other times, before planning investigations
• demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information

Requires some supervision

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

The trainee may:

• identify appropriate proxy decision makers when required
• choose not to investigate in situations where it is not appropriate for ethical reasons
• practise within current ethical and professional frameworks
• practise within own limits, and seek help when needed
• involve patients in decision making regarding investigations, obtaining the appropriate informed consent, including financial consent, if necessary

Ready to perform without supervision

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

The trainee will:

• evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
• adjust the investigative path depending on test results received
• consider whether patients’ conditions may get worse or better if no tests are selected
• avoid using investigations where the results are unlikely to change clinical management
• demonstrate how the range of certainty around the accuracy of diagnostic tests and the efficacy of treatments may limit their applicability in clinical practice

Requires some supervision

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

The trainee may:

• choose the most appropriate investigation for clinical scenarios in discussion with patients
• recognise personal limitations and seek help in an appropriate way when required

Ready to perform without supervision

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

The trainee will:

• consider the role other members of the healthcare team might play, and what other sources of information and support are available
• ensure clear delegation of tasks within the team, including responsibility for following up test results
• where an investigation is time critical, ensure this is understood by the team, including an expectation of timeframe and urgency of results
• liaise with other involved healthcare professionals for expert advice when indicated

Requires some supervision

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

The trainee may:

• demonstrate awareness of what parts of an investigation are provided by different doctors or health professionals

Ready to perform without supervision

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

The trainee will:

• select and justify investigations based on the likely pathological basis of disease, appropriateness, utility, safety, and cost effectiveness
• consider resource use through peer review of testing behaviours
• actively support transfer of patients across health services as required to progress further investigation and management
• support health policy and system development to improve equitable patient access to investigations
• recognise and address equity barriers that impact the diagnostic decision-making process, and legal frameworks to counter these
• be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations