Curriculum standards

Ready to perform without supervision

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

The trainee will:

• establish supportive relationships with patients, family, and/or carers based on understanding, trust, empathy, and confidentiality
• thoughtfully explore patients’ concerns and issues associated with impending death across physical, spiritual, cultural, and psychological domains
• discuss disease prognosis and end-of-life decision making with patients and carers in a sensitive and effective manner
• identify opportunities to discuss end-of-life care and to align care with patients’ values and preferences
• identify who else patients wish to be involved in discussions about their end-of-life care, including proxy decision makers or other care providers
• identify and document lists of close family members or carers, and develop support plans for them
• provide bereaved families or carers with written information about access to bereavement support
• communicate effectively and in a timely manner with other health professionals involved in patients’ care
• negotiate with patients, family members, and/or carers the non-initiation, and withdrawal of, life-sustaining therapy when appropriate
• discuss death certificates and reportable death protocols, including the medicolegal implications, with families and other health professionals as required
• 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 with patients, family, and/or carers the goals of care and treatment, and document this in patients’ clinical records
• ensure consistent messages are given to patients, families, or carers about treatment options, their likelihood of success, risks, and prognosis
• provide honest and clear clinical assessment summaries, using plain language and avoiding medical jargon
• discuss with family or carers appropriate support and bereavement care

Ready to perform without supervision

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

The trainee will:

• conduct medication chart safety audits and multidisciplinary mortality and morbidity meetings, and provide feedback to colleagues
• develop monitoring and evaluation strategies to capture feedback about the quality of care from multidisciplinary team members, patients, families, and carers
• participate in mortality reviews to determine the safety and quality of patients’ end-of-life care and how it could be improved
• review technological systems and processes that support safe and high-quality end-of-life care
• submit accurate death certificates and reportable death documentation as per local protocols

Requires some supervision

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

The trainee may:

• collect and review data on the safety and effectiveness of end-of-life care delivery
• communicate the content of discussions about prognosis and advance care planning to multidisciplinary teams
• ensure that actual care is aligned with patients’ documented wishes

Ready to perform without supervision

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

The trainee will:

• provide supervision, support, and teaching to develop the skills of junior colleagues on end-of-life care
• reflect on personal practice, and use this process to guide continuing professional development
• ensure all members of multidisciplinary teams receive education on their roles and responsibilities for managing end-of-life care
• promote education covering:
  • competencies for providing culturally responsive end-of-life care to Aboriginal and Torres Strait Islander peoples and Māori, and to people from other cultural backgrounds
  • ethical and medicolegal issues
  • relevant legislation in the state, territory, or region

Requires some supervision

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

The trainee may:

• participate in education on disease-specific symptom assessment and evidence-based symptom management
• participate in upskilling in best practice of end-of-life care management
• encourage junior colleagues to participate in multidisciplinary case reviews, mortality and morbidity meetings, and adverse event reviews

Ready to perform without supervision

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

The trainee will:

• ensure that quality end-of-life care management processes are evidence based and outcome focused
• use systematic reviews or personal reviews and appraisal of the literature as evidence for appropriate management
• support clinical trials to build the end-of-life care evidence base

Requires some supervision

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

The trainee may:

• recognise that the evidence may be insufficient to resolve uncertainty and make definitive decisions

Ready to perform without supervision

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

The trainee will:

• practise culturally responsible medicine based on understanding the personal, historical, and cultural influences on patients, families, and carers
• offer support to patients to include cultural or religious practices in their care
• develop strategies for identifying culturally appropriate decision makers, and obtain their input in discussions of patients’ end-of-life care
• promote and use available culturally appropriate guidelines for end-of-life care in specific groups, including Aboriginal and Torres Strait Islander peoples and Māori

Requires some supervision

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

The trainee may:

• be cognisant, respect, and respond to individual preferences and needs of patients, regardless of their culture and religious beliefs
• support patients, families, and carers with communication difficulties associated with cultural and linguistic diversity

Ready to perform without supervision

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

The trainee will:

• ensure all team members discuss end-of-life care with patients, and act on expressed patient preferences
• enhance the quality of life for patients before death to minimise pain and suffering caused by ineffective treatments
• recognise the complexity of ethical issues related to human life and death when considering the allocation of scarce resources
• ensure that care provided to patients is not burdensome or futile
• recognise feelings of moral distress and burnout in themselves and colleagues

Requires some supervision

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

The trainee may:

• ensure that information on advance care plans, treatment plans, goals of care, and patients’ treatment preferences is available to all involved in patients’ care
• ensure patients’ dignity is preserved
• respond appropriately to distress or concerns of colleagues, patients, families, and carers

Ready to perform without supervision

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

The trainee will:

• identify and support patients appropriate for conservative care, using advance health directives and care plans
• maximise patients’ autonomy and their best interests when making treatment decisions
• liaise with other relevant services when required, such as the coroner or legal teams
• recognise own limitations and seek help, when required, in an appropriate way

Requires some supervision

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

The trainee may:

• define and document patients’, families’ or carers’ goals and agreed outcomes
• inadequately consult with senior colleagues

Ready to perform without supervision

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

The trainee will:

• define the responsibilities and roles of team members involved in patients’ care
• achieve agreement between multidisciplinary teams about patients’ treatment options
• ensure care plans are communicated to all teams involved in patients’ care, including relevant community care providers
• co-ordinate care and collaborate with other teams to provide end-of-life care, including palliative care, psychiatry, nursing services, and community providers
• enable care and support to be provided in patients’ preferred place of care
• effectively manage personal challenges of dealing with death and grief

Requires some supervision

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

The trainee may:

• coordinate end-of-life care to minimise fragmentation of care
• document multidisciplinary care plans, including the terminal phase

Ready to perform without supervision

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

The trainee will:

• participate in developing frameworks for organisational advance care planning
• allocate resources according to the organisational strategic plan to support systems for effective delivery of end-of-life care
• advocate for the needs of individual patients, social groups, and cultures within the community who have specific palliative care needs or inequitable access to palliative care services

Requires some supervision

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

The trainee may:

• allocate scarce health care resources effectively
• support community-based service providers to build capacity for people to be cared for in their preferred place of death