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 potential benefits, burdens, costs, potential alternatives, risks, and side effects of each option
• obtain consent before proceeding
• discuss the rationale, and the possibility of false negative / false positive results, as well as incidental findings with patients and/or caregivers
• specifically discuss the option of no investigation, and the risks and benefits of this, with patients
• use clear and simple language, and check that patients understand the terms used
• offer patients the opportunity to ask further questions and time to think about the decision
• identify patients’ concerns and expectations, providing adequate explanations to address these
• confirm whether patients understand the information they have been given and the need for more information before making decisions
• use written or visual material or other aids that are accurate and up to date to support discussions with patients
• explain findings or possible outcomes of investigations to patients, families, and/or carers
• give information that patients may find distressing in a considerate way, using best-practice techniques for breaking of bad news
• discuss the likely timeframes during which investigations will occur, and the plan for communicating results when available
• include sufficient clinical information to accurately convey patients’ contexts and reasons for investigations within investigation requests
• discuss results using simple language, and explain how the results might affect future management
• counsel patients sensitively and effectively, and support them to make informed choices
• keep other relevant healthcare practitioners updated regarding planned investigations and results, including clear communication of who is responsible for reviewing these
• accurately document procedures in the clinical notes, including:
  • aftercare
  • aseptic technique
  • informed consent
  • medicines given
  • procedures performed
  • reasons for procedures
• address patients’, families’, and/or carers’ concerns relating to procedures, providing opportunities to ask questions
• communicate effectively with team members, patients, families, and/or carers prior to, during, and after procedures

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 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
• explain the process of procedures to patients without providing a broader context
• help patients, families, and/or carers choose procedures
• discuss postprocedural care with patients, families, and/or carers
• complete relevant documentation, and conduct appropriate clinical handovers if needed

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
• identify adverse outcomes, including false positives, false negatives, and incidental findings, that may result from proposed investigations, focusing on patients’ individual situations
• demonstrate understanding of iatrogenic harms that may result from diagnostic investigations
• consider strategies to reduce the chance of harm, and employ these if possible / practical
• identify, document, and appropriately notify of any adverse events or equipment malfunction
• ensure timely follow-up of investigation results, using recall / reminder systems and other tools if appropriate
• take full responsibility for reviewing results of any investigations ordered by trainees, 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
• provide information in a manner so that patients, families, and/or carers are fully informed when consenting to any procedures
• demonstrate an inconsistent application of aseptic technique
• identify patients using approved patients’ identifiers before any treatment or intervention is initiated
• attempt to perform a procedure in an unsafe environment

Ready to perform without supervision

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

The trainee will:

• use appropriate decision support tools, diagnostic algorithms, evidence sources, and guidelines
• participate in clinical audits 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
• participate in continued professional development

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 when undertaking investigations as part of clinical research
• provide patients with relevant information if a proposed investigation is part of a research program
• 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:

• be cognisant of patients’ views and preferences about any proposed investigations and the adverse outcomes they are most concerned about
• recognise the principles of equity as they pertain to diagnostic decision making, and apply these appropriately to advocate for patients
• recognise the impact of implicit bias on diagnostic decision making, and initiate steps to address this
• be aware of key legislation policies and how these relate to access to diagnostic services, such as Te Tiriti o Waitangi, the United Nations Declaration on the Rights of Indigenous Peoples, and the United Nations Refugee Agency’s 1951 Refugee Convention
• consider individual patients’ cultural perception of health and illness, and adapt practice accordingly

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:

• discuss with patients how decisions will be made once the investigation has started and the patient is not able to participate in decision making
• remain within the scope of the authority given by patients (except for emergencies)
• respect patients’ decisions to refuse investigations and procedures, even if their decisions may not be appropriate or evidence based
• explain the expected benefits as well as the potential burdens and risks of any proposed investigations or procedures
• advise patients if there may be additional costs, which they may wish to clarify before proceeding
• clarify who will make decisions on the patient’s behalf if they are unable to do so
• show respect for the knowledge and expertise of colleagues

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
• perform procedures when adequately supervised
• follow procedures to ensure safe practice

Ready to perform without supervision

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

The trainee will:

• evaluate the benefits, costs, and potential risks of each investigation in a clinical situation
• adjust investigative paths depending on test results received
• consider the clinical necessity and urgency of investigations
• 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 investigations for clinical scenarios in discussion with patients
• recognise personal limitations and seek help in an appropriate way when required
• assess personal skill levels, and seek help with procedures when appropriate
• use tools and guidelines to support decision making

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
• ensure results are checked in a timely manner
• identify relevant management options with colleagues
• liaise with other 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 understanding of what parts of investigations are provided by different doctors or health professionals
• ensure all relevant team members are aware that a procedure is occurring

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 regarding the pathological basis of disease, appropriateness, cost effectiveness, safety, and utility
• consider resource use through peer review of testing behaviours
• discuss serious incidents at appropriate clinical review meetings
• support health policy and system development to improve equitable patient access to investigations
• initiate local improvement strategies in response to serious incidents

Requires some supervision

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

The trainee may:

• perform relevant procedures in accordance with organisational guidelines and policies