Curriculum standards

About this resource

The new Advanced Training in Respiratory Medicine (Adult Medicine) curriculum consists of curriculum standards and learning, teaching, and assessment (LTA) programs.

This resource outlines the curriculum standards for Advanced Training in Respiratory Medicine (Adult Medicine) for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Respiratory Medicine (Adult Medicine) LTA programs.

The new curriculum was approved by the College Education Committee in May 2024. Please refer to the College website for details on its implementation.

Download the curriculum standards PDF

LG1: Competencies

Competencies outline the expected professional behaviours, values and practices that trainees need to achieve by the end of training.

Competencies are grouped by the 10 domains of the professional practice framework.

Competencies will be common across training programs.

Medical expertise

Professional standard. Physicians apply knowledge and skills informed by best available current evidence in the delivery of high-quality, safe practice to facilitate agreed health outcomes for individual patients and populations.

Knowledge. Apply knowledge of the scientific basis of health and disease to the diagnosis and management of patients.

Synthesis. Gather relevant data via age- and context- appropriate means to develop reasonable differential diagnoses, recognising and considering interactions and impacts of comorbidities.

Diagnosis and management. Develop diagnostic and management plans that integrate an understanding of individual patient circumstances, including psychosocial factors and specific vulnerabilities, epidemiology, and population health factors in partnership with patients, families, or carers, and in collaboration with the health care team.

Communication

Professional standard. Physicians collate information, and share this information clearly, accurately, respectfully, responsibly, empathetically and in a manner that is understandable.

Physicians share information responsibly with patients, families, carers, colleagues, community groups, the public, and other stakeholders to facilitate optimal health outcomes.

Effective communication. Use a range of effective and appropriate verbal, nonverbal, written and other communication techniques, including active listening.

Communication with patients, families, and carers. Use collaborative, effective, and empathetic communication with patients, families, and carers.

Communication with professionals and professional bodies. Use collaborative, respectful, and empathetic clinical communication with colleagues, other health professionals, professional bodies, and agencies.

Written communication. Document and share information about patients to optimise patient care and safety.

Privacy and confidentiality. Maintain appropriate privacy and confidentiality, and share information responsibly.

Quality and safety

Professional standard. Physicians practice in a safe, high quality manner within the limits of their expertise.

Physicians regularly review and evaluate their own practice alongside peers and best practice standards and conduct continuous improvement activities.

Patient safety. Demonstrate a safety focus and continuous improvement approach to own practice and health systems.

Harm prevention and management. Identify and report risks, adverse events, and errors to improve healthcare systems.

Quality improvement. Participate in quality improvement activities to improve quality of care and safety of the work environment.

Patient engagement. Enable patients to contribute to the safety of their care.

Teaching and learning

Professional standard. Physicians demonstrate a lifelong commitment to excellence in practice through continuous learning and evaluating evidence.

Physicians foster the learning of others in their profession through a commitment to mentoring, supervising, and teaching.¹

Lifelong learning. Undertake effective self-education and continuing professional development.

Self-evaluation. Evaluate and reflect on gaps in own knowledge and skills to inform self-directed learning.

Supervision. Provide supervision for junior colleagues and/or team members.

Teaching. Apply appropriate educational techniques to facilitate the learning of colleagues and other health professionals.

Patient education. Apply appropriate educational techniques to promote understanding of health and disease amongst patients and populations.

References

1. Adapted from Richardson D, Oswald A, Chan M-K, Lang ES, Harvey BJ. Scholar. In: Frank JR, Snell L, Sherbino J, editors. The Draft CanMEDS 2015 Physician Competency Framework – Series IV. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2015 March.

Research

Professional standard. Physicians support creation, dissemination and translation of knowledge and practices applicable to health. They do this by engaging with and critically appraising research and applying it in policy and practice to improve the health outcomes of patients and populations.

Evidence-based practice. Critically analyse relevant literature and refer to evidence-based clinical guidelines and apply these in daily practice.

Research. Apply research methodology to add to the body of medical knowledge and improve practice and health outcomes.

Cultural safety*

Professional standard: Physicians engage in iterative and critical self-reflection of their own cultural identity, power, biases, prejudices and practising behaviours. Together with the requirement of understanding the cultural rights of the community they serve; this brings awareness and accountability for the impact of the physician’s own culture on decision-making and healthcare delivery. It also allows for an adaptive practice where power is shared between patients, family, whānau and/or community and the physician, to improve health outcomes.

Physicians recognise the patient and population’s rights for culturally safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making. This shift in the physician’s perspective fosters collaborative and engaged therapeutic relationships, allows for strength-based (or mana-enhanced) decisions, and sharing of power with the recipient of the care; optimising health care outcomes.

Physicians critically analyse their environment to understand how colonialism, systemic racism, social determinants of health and other sources of inequity have and continue to underpin the healthcare context. Consequently, physicians then can recognise their interfacing with, and contribution to, the environment in which they work to advocate for safe, more equitable and decolonised services and create an inclusive and safe workplace for all colleagues and team members of all cultural backgrounds.

Critical reflection. Engage in iterative and critical self-reflection and demonstrate cultural safety in the context of their own cultural identity, power, biases, prejudices and practising behaviours.

Allyship. Recognise the patient and population’s rights to culturally-safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making.

Inclusive communication. Apply culturally-safe communication, acknowledging the sharing of power, and cultural and human rights to enable patients, families and whānau to engage in appropriate patient care decisions.

Culturally-safe environment. Contributes to a culturally-safe learning and practice environment for patients and team members. Respect patients may feel unsafe in the healthcare environment.

*The RACP has adopted the Medical Council of New Zealand’s definition of cultural safety: Cultural safety can be defined as:²

the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.
the commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided.
the awareness that cultural safety encompasses a critical consciousness where health professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities.

References

2. Curtis et al. “Why cultural safety rather than cultural competency is required to achieve health equity”. International Journal for Equity in Health (2019) 18:174

Ethics and professional behaviour

Professional standard. Physicians’ practice is founded upon ethics, and physicians always treat patients and their families, communities and populations in a caring and respectful manner.

Physicians demonstrate their commitment and accountability to the health and wellbeing of individual patients, communities, populations and society through ethical practice.

Physicians demonstrate high standards of personal behaviour.

Beliefs and attitudes. Reflect critically on personal beliefs and attitudes, including how these may impact on patient care.

Honesty and openness. Act honestly, including reporting accurately, and acknowledging their own errors.

Patient welfare. Prioritise patients’ welfare and community benefit above self-interest.

Accountability. Be personally and socially accountable.

Personal limits. Practise within their own limits and according to ethical principles and professional guidelines.

Self-care. Implement strategies to maintain personal health and wellbeing.

Respect for peers. Recognise and respect the personal and professional integrity, roles, and contribution of peers.

Interaction with professionals. Interact equitably, collaboratively, and respectfully with other health professionals.

Respect and sensitivity. Respect patients, maintain appropriate relationships, and behave equitably.

Privacy and confidentiality. Protect and uphold patients’ rights to privacy and confidentiality.

Compassion and empathy. Demonstrate a caring attitude towards patients and endeavour to understand patients’ values and beliefs.

Health needs. Understand and address patients’, families’, carers’, and colleagues’ physical and emotional health needs.

Medical and health ethics and law. Practise according to current community and professional ethical standards and legal requirements.

Judgement and decision making

Professional standard. Physicians collect and interpret information, and evaluate and synthesise evidence, to make the best possible decisions in their practice.

Physicians negotiate, implement, and review their decisions and recommendations with patients, their families and carers, and other healthcare professionals.

Diagnostic reasoning. Apply sound diagnostic reasoning to clinical problems to make logical and safe clinical decisions.

Resource allocation. Apply judicious and cost-effective use of health resources to their practice.

Task delegation. Apply good judgement and decision making to the delegation of tasks.

Limits of practice. Recognise their own scope of practice and consult others when required.

Shared decision making. Contribute effectively to team-based decision-making processes.

Leadership, management, and teamwork

Professional standard. Physicians recognise, respect, and aim to develop the skills of others, and engage collaboratively to achieve optimal outcomes for patients and populations.

Physicians contribute to and make decisions about policy, protocols, and resource allocation at personal, professional, organisational, and societal levels.

Physicians work effectively in diverse multidisciplinary teams and promote a safe, productive, and respectful work environment that is free from discrimination, bullying, and harassment.

Managing others. Lead teams, including setting directions, resolving conflicts, and managing individuals.

Wellbeing. Consider and work to ensure the health and safety of colleagues and other health professionals.

Leadership. Act as a role model and leader in professional practice.

Teamwork. Negotiate responsibilities within the healthcare team and function as an effective team member.

Health policy, systems, and advocacy

Professional standard. Physicians apply their knowledge of the nature and attributes of local, national, and global health systems to their own practices. They identify, evaluate, and influence health determinants through local, national, and international policy.

Physicians deliver and advocate for the best health outcomes for all patients and populations.

Health needs. Respond to the health needs of the local community and the broader health needs of the people of Australia and Aotearoa New Zealand.

Prevention and promotion. Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients and their social support networks.

Equity and access. Work with patients and social support networks to address determinants of health that affect them and their access to needed health services or resources.

Stakeholder engagement. Involve communities and patient groups in decisions that affect them to identify priority problems and solutions.

Advocacy. Advocate for prevention, promotion, equity, and access to support patient and population health needs within and outside the clinical environment.

Resource allocation. Understand the factors influencing resource allocation, promote efficiencies, and advocate to reduce inequities.

Sustainability. Manage the use of healthcare resources responsibly in everyday practice.

Entrustable Professional Activities

Entrustable Professional Activities (EPAs) outline the essential work tasks trainees need to be able to perform in the workplace.

LG2: Team leadership

Learning Goal 2

Team leadership

Lead a team of health professionals

This activity requires the ability to:

prioritise workload
manage multiple concurrent tasks
articulate individual responsibilities, expertise, and accountability of team members
understand the range of team members’ skills, expertise, and roles
acquire and apply leadership techniques in daily practice
collaborate with and motivate team members
encourage and adopt insights from team members
act as a role model.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information with other disciplines to develop optimal, goal-centred plans for patients
use evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

demonstrate adequate knowledge of health care issues by interpreting complex information
assess the spectrum of problems to be addressed
apply medical knowledge to assess the impact and clinical outcomes of management decisions
provide coordinated and quality health care for populations or patients as a member of a multidisciplinary team

Communication

confident
Ready to perform without supervision

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

The trainee will:

provide support and motivate patients or populations and health professionals by effective communication
demonstrate a transparent, consultative style by engaging patients, families, carers, relevant professionals, and/or the public in shared decision making
work with patients, families, carers, and other health professionals to resolve conflict that may arise when planning and aligning goals
demonstrate rapport with people at all levels by tailoring messages to different stakeholders
recognise the cognitive, mental and social impact of illness on patients and their family members and carers and demonstrate appropriate empathy in all aspects of communication.

direction
Requires some supervision

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

The trainee may:

communicate adequately with colleagues
communicate adequately with patients, families, carers, and/or the public
respect the roles of team members

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify opportunities to improve care by participating in surveillance and monitoring of adverse events and ‘near misses’
identify and participate in activities within systems to reduce errors, improve patient and population safety, and cost-effectiveness
place safety and quality of care first in all decision making

direction
Requires some supervision

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

The trainee may:

participate in audits and other activities that affect the quality and safety of patients’ care
participate in interdisciplinary collaboration to provide effective health services and operational change
use information resources and electronic medical record technology where available

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly self-evaluate personal professional practice, and implement changes based on the results
actively seek feedback from supervisors and colleagues on their own performance
identify personal gaps in skills and knowledge, and engage in self-directed learning
maintain current knowledge of new technologies, health care priorities and changes of patients’ expectations
teach competently by imparting professional knowledge
manage and monitor learner progress, providing regular assessment and feedback

direction
Requires some supervision

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

The trainee may:

accept feedback constructively, and change behaviour in response
recognise the limits of personal expertise, and involve other health professionals as needed
demonstrate basic skills in facilitating colleagues’ learning

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate culturally competent relationships with professional colleagues and patients
demonstrate respect for diversity and difference
take steps to minimise unconscious bias, including the impact of gender, religion, cultural beliefs, and socioeconomic background on decision making

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of cultural diversity and unconscious bias
work effectively and respectfully with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
encourage open discussion of ethical and clinical concerns
respect differences of multidisciplinary team members
understand the ethics of resource allocation by aligning optimal patients and organisational care
effectively consult with stakeholders, achieving a balance of alternative views
acknowledge personal conflicts of interest and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment and bullying

direction
Requires some supervision

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

The trainee may:

support ethical principles in clinical decision making
maintain standards of medical practice by recognising the health interests of patients or populations as primary responsibilities
respect the roles and expertise of other health professionals
work effectively as a member of a team
promote team values of honesty, discipline, and commitment to continuous improvement
demonstrate understanding of the negative impact of workplace conflict

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate health services and clarify expectations to support systematic, transparent decision making
make decisions when faced with multiple and conflicting perspectives
ensure medical input to organisational decision making
adopt a systematic approach to analysing information from a variety of specialties to make decisions that benefit health care delivery

direction
Requires some supervision

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

The trainee may:

monitor services and provide appropriate advice
review new health care interventions and resources
interpret appropriate data and evidence for decision making

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

combine team members' skills and expertise in delivering patient care and/or population advice
develop and lead effective multidisciplinary teams by developing and implementing strategies to motivate others
build effective relationships with multidisciplinary team members to achieve optimal outcomes
ensure all members of the team are accountable for their individual practice
empower self and promote culture among colleagues to maintain psychological wellbeing, efficient workload management and distribution, and healthy work-life balance
identify struggling junior medical officers, and take appropriate steps to resolve issues and escalate as appropriate

direction
Requires some supervision

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

The trainee may:

understand the range of personal and other team members’ skills, expertise, and roles
acknowledge and respect the contribution of all health professionals involved in patients’ care
participate effectively and appropriately in multidisciplinary teams
seek out and respect the perspectives of multidisciplinary team members when making decisions

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

engage in appropriate consultation with stakeholders on the delivery of health care
advocate for the resources and support for health care teams to achieve organisational priorities
remove self-interest from solutions to health advocacy issues
influence the development of organisational policies and procedures to optimise health outcomes
identify the determinants of health of the population, and mitigate barriers to access to care

direction
Requires some supervision

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

The trainee may:

communicate with stakeholders within the organisation about health care delivery
understand methods used to allocate resources to provide high-quality care
promote the development and use of organisational policies and procedures

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

provide work-based teaching in a variety of settings
teach professional skills
create a safe and supportive learning environment
plan, deliver, and provide work-based assessments
encourage learners to be self-directed and identify learning experiences
supervise learners in day-to-day work, and provide feedback
support learners to prepare for assessments.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

combine high-quality care with high-quality teaching
explain the rationale underpinning a structured approach to decision making
consider the patient-centric view during consultations
consider the population health effect when giving advice
encourage the learner to consider the rationale and appropriateness of investigation and management options

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

establish rapport and demonstrate respect for junior colleagues, medical students, and other health professionals
communicate effectively when teaching, assessing, and appraising learners
actively encourage a collaborative and safe learning environment with learners and other health professionals
encourage learners to tailor communication as appropriate for different patients, such as younger or older people, and different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication
listen and convey information clearly and considerately in a culturally safe way

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

support learners to deliver quality care while maintaining their own wellbeing
apply lessons learned about patient safety by identifying and discussing risks with learners
assess learners’ competence, and provide timely feedback to minimise risks to care
maintain the safety of patients and organisations involved with education, and appropriately identify and action concerns

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate knowledge of the principles, processes, and skills of supervision
provide direct guidance to learners in day-to-day work
work with learners to identify professional development and learning opportunities based on their individual learning needs
offer feedback and role modelling
participate in teaching and supervision professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching by developing goals and strategies to improve
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in the supervision of learners
apply a standardised approach to teaching, assessment, and feedback without considering individual learners’ needs
implement teaching and learning activities that are misaligned to learning goals
adopt a teaching style that discourages learner self-directedness

Research

confident
Ready to perform without supervision

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

The trainee will:

clarify junior colleagues’ research project goals and requirements, and provide feedback regarding the merits or challenges of proposed research
monitor the progress of learners’ research projects regularly, and may review research projects prior to submission
support learners to find forums to present research projects
encourage and guide learners to seek out relevant research to support practice

direction
Requires some supervision

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

The trainee may:

guide learners with respect to the choice of research projects
ensure that the research projects planned are feasible and of suitable standards

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

role model a culturally safe approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural competence
encourage learners to consider culturally safe care of Aboriginal and Torres Strait Islander and Māori peoples into patients’ management
consider cultural, ethical, and religious values and beliefs in teaching and learning

direction
Requires some supervision

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

The trainee may:

function effectively and respectfully when working with and teaching with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

apply principles of ethical practice to teaching scenarios
act as a role model to promote professional responsibility and ethics among learners
respond appropriately to learners seeking professional guidance

direction
Requires some supervision

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

The trainee may:

demonstrate professional values, including commitment to high-quality clinical standards, compassion, empathy, and respect
provide learners with feedback to improve their experiences

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

prioritise workloads and manage learners with different levels of professional knowledge or experience
link theory and practice when explaining professional decisions
promote joint problem solving
support a learning environment that allows for independent decision making
use sound and evidence-based judgement during assessments and when giving feedback to learners
escalate concerns about learners appropriately

direction
Requires some supervision

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

The trainee may:

provide general advice and support to learners
use health data logically and effectively to investigate difficult diagnostic problems

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

maintain personal and learners’ effective performance and continuing professional development
maintain professional, clinical, research, and/or administrative responsibilities while teaching
create an inclusive environment whereby learners feel part of the team
help shape organisational culture to prioritise quality and work safety through openness, honesty, shared learning, and continued improvement

direction
Requires some supervision

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

The trainee may:

demonstrate the principles and practice of professionalism and leadership in health care
participate in mentor programs, career advice, and general counselling

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

advocate for suitable resources to provide quality supervision and maintain training standards
explain the value of health data in the care of patients or populations
support innovation in teaching and training

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify and report actual and potential (‘near miss’) errors
conduct and evaluate system improvement activities
adhere to best practice guidelines
audit clinical guidelines and outcomes
contribute to the development of policies and protocols designed to protect patients and enhance health care
monitor one’s own practice and develop individual improvement plans.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use population health outcomes to identify opportunities for improvement in delivering appropriate care
regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

contribute to processes on identified opportunities for improvement
recognise the importance of prevention and early detection in clinical practice
use local guidelines to assist patient care decision making

Communication

confident
Ready to perform without supervision

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

The trainee will:

support patients to have access to, and use, easy-to-understand, high-quality information about health care
support patients to share decision making about their own health care, to the extent they choose
assist patients’ access to their health information, as well as complaint and feedback systems
discuss with patients any safety and quality concerns they have relating to their care
implement the organisation’s open disclosure policy

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of the evidence for consumer engagement and its contribution to quality improvement in health care
apply knowledge of how health literacy might affect the way patients or populations gain access to, understand, and use health information

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
participate in organisational quality and safety activities, including morbidity and mortality reviews, clinical incident reviews, root cause analyses, and corrective and preventive action plans
participate in systems for surveillance and monitoring of adverse events and ‘near misses’, including reporting such events
ensure that identified opportunities for improvement are raised and reported appropriately
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve health care

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of a systematic approach to improving the quality and safety of health care

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

translate quality improvement approaches and methods into practice
participate in professional training in quality and safety to ensure a contemporary approach to safety system strategies
supervise and manage the performance of junior colleagues in the delivery of high-quality, safe care

direction
Requires some supervision

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

The trainee may:

work within organisational quality and safety systems for the delivery of clinical care
use opportunities to learn about safety and quality theory and systems

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure that any protocol for human research is approved by a human research ethics committee, in accordance with the national statement on ethical conduct in human research

direction
Requires some supervision

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

The trainee may:

understand that patients' participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

undertake professional development opportunities that address the impact of cultural bias on health outcomes

direction
Requires some supervision

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

The trainee may:

communicate in a manner that is appropriate to patients’ language and cultural needs

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

align improvement goals with the priorities of the organisation
contribute to developing an organisational culture that enables and prioritises patients’ safety and health care quality

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use decision-making support tools, such as guidelines, protocols, pathways, and reminders
analyse and evaluate current care processes to improve health care

direction
Requires some supervision

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

The trainee may:

access information and advice from other health practitioners to identify, evaluate, and improve patients’ care management

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort involving all key health professionals
support multidisciplinary team activities to lower patients' risk of harm, and promote interdisciplinary programs of education
actively involve clinical pharmacists in the medication-use process

direction
Requires some supervision

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

The trainee may:

demonstrate attitudes of respect and cooperation among members of different professional teams
partner with clinicians and managers to ensure patients receive appropriate care and information on their care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in the development, implementation, evaluation, and monitoring of governance processes
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving care are actively encouraged
measure, analyse, and report a set of specialty-specific process of care and outcome clinical indicators, and a set of generic safety indicators
take part in the design and implementation of the organisational systems for:
- defining the scope of clinical practice
- performance monitoring and management
- clinical, and safety and quality education and training

direction
Requires some supervision

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

The trainee may:

maintain a dialogue with service managers about issues that affect patient care
contribute to relevant organisational policies and procedures
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

identify and access sources of relevant information about patients
obtain patient histories
examine patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with patients, families, and/or carers
generate a management plan
present findings to other health professionals.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit an accurate, organised, and problem-focused medical history considering physical, psychosocial, and risk factors
perform a full physical examination to establish the nature and extent of problems
synthesise and interpret findings from the history and examination to devise the most likely provisional diagnoses via reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal set of circumstances into account

direction
Requires some supervision

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

The trainee may:

take patient-centred histories, considering psychosocial factors
perform accurate physical examinations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct the clinical encounter and diagnostic categories
develop appropriate management plans

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients and their family or carers to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care

direction
Requires some supervision

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

The trainee may:

anticipate, read, and respond to verbal and nonverbal cues
demonstrate active listening skills
communicate patients’ situations to colleagues, including senior clinicians

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
ensure patients are informed of the material risks associated with any part of proposed management plans

direction
Requires some supervision

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

The trainee may:

perform hand hygiene, and take infection control precautions at appropriate moments
take precaution against assaults from confused or agitated patients, ensuring appropriate care of patients
document history and physical examination findings, and synthesise with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
regularly reflect upon and self-evaluate professional development
obtain informed consent before involving patients in teaching activities
turn clinical activities into an opportunity to teach, appropriate to the setting

direction
Requires some supervision

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

The trainee may:

deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

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

The trainee will:

search for, find, compile, analyse, interpret, and evaluate information relevant to the research subject

direction
Requires some supervision

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

The trainee may:

refer to guidelines and medical literature to assist in clinical assessments when required
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

use plain-language patient education materials, and demonstrate cultural and linguistical sensitivity
demonstrate effective and culturally competent communication and care for Aboriginal and Torres Strait Islander and Māori peoples, and members of other cultural groups
use a professional interpreter, health advocate, or a family or community member to assist in communication with patients, and understand the potential limitations of each
acknowledge patients’ beliefs and values, and how these might impact on health

direction
Requires some supervision

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

The trainee may:

display respect for patients’ cultures, and attentiveness to social determinants of health
display an understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
appropriately access interpretive or culturally focused services

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
hold information about patients in confidence, unless the release of information is required by law or public interest
assess patients’ capacity for decision making, involving proxy decision makers appropriately

direction
Requires some supervision

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

The trainee may:

demonstrate professional conduct, honesty, and integrity
consider patients’ decision-making capacity
identify patients’ preferences regarding management and the role of families in decision making
not advance personal interest or professional agendas at the expense of patient or social welfare

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
use a holistic approach to health considering comorbidity, uncertainty, and risk
use the best available evidence for the most effective therapies and interventions to ensure quality care

direction
Requires some supervision

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

The trainee may:

demonstrate clinical reasoning by gathering focused information relevant to patients’ care
recognise personal limitations, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work effectively as a member of multidisciplinary teams to achieve the best health outcome for patients
demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources

direction
Requires some supervision

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

The trainee may:

identify and navigate components of the healthcare system relevant to patients’ care
identify and access relevant community resources to support patient care

LG6: Management of transitions in care

Learning Goal 6

Management of transitions in care

Manage the transition of patient care between health professionals, providers, and contexts

This activity requires the ability to:

manage a transition of patient care to ensure the optimal continuation of care between providers
identify the appropriate health care providers and other stakeholders with whom to share patient information
exchange pertinent, contextually appropriate, and relevant patient information
perform this activity in multiple settings (appropriate to the speciality), including inpatient, ambulatory, and critical care settings
incorporate an understanding of public and private funding, the benefits and drawbacks of both models, and local resource availability into optimal management of patients in multiple settings, including inpatient, ambulatory and critical care settings.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate an optimal transition of care for patients
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them

direction
Requires some supervision

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

The trainee may:

understand the details of patients’ conditions, illness severity, and potential emerging issues with appropriate actions
provide accurate summaries of patients’ information, with accurate identification of problems or issues

Communication

confident
Ready to perform without supervision

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

The trainee will:

write relevant and detailed medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals, when required
communicate with patients, families, and/or carers about transition of care, and engage and support these parties in decision making

direction
Requires some supervision

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

The trainee may:

communicate clearly with clinicians and other caregivers
use standardised verbal and written templates to improve the reliability of information transfer and prevent errors and omissions
communicate accurately and in a timely manner to ensure an effective transition between settings, and continuity and quality of care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify patients at risk of a poor transition of care, and mitigate this risk
use electronic tools (where available) to securely store and transfer patient information
use consent processes, including written consent if required, for the release and exchange of information
demonstrate an understanding of the medicolegal context of written communications

direction
Requires some supervision

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

The trainee may:

ensure that handover is complete, or work to mitigate risks if the handover was incomplete
ensure all outstanding results or procedures are followed up by receiving units and clinicians
keep patients’ information secure, adhering to relevant legislation regarding personal information and privacy

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate with careful consideration to health literacy, language barriers, and culture about patient preferences, and whether they are realistic and possible, respecting patient choices
recognise the timing, location, privacy, and appropriateness of sharing information with patients and their families or carers

direction
Requires some supervision

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

The trainee may:

Include relevant information regarding patients’ cultural or ethnic background in handovers, and whether an interpreter is required

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information
demonstrate an understanding of the clinical, ethical, and legal rationale for information disclosure
share information about patients’ health care in a manner consistent with privacy law and professional guidelines on confidentiality
demonstrate an understanding of the additional complexity related to some types of information, such as genetic information and blood-borne-virus status, and seek appropriate advice about disclosure of such information
interact in a collegiate and collaborative way with professional colleagues during transitions of care

direction
Requires some supervision

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

The trainee may:

maintain respect for patients, families, carers, and other health professionals, including respecting privacy and confidentiality

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patients’ care is in the most appropriate facility, setting, or provider

direction
Requires some supervision

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

The trainee may:

use a structured approach to consider and prioritise patients’ issues
recognise personal limitations, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
demonstrate an understanding of the medical governance of patient care, and the differing roles of team members
show respect for the roles and expertise of other health professionals, and work effectively as a member of professional teams
ensure that multidisciplinary teams provide the opportunity for patients’ engagement and participation when appropriate

direction
Requires some supervision

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

The trainee may:

recognise factors that impact on the transfer of care, and help subsequent health professionals to understand the issues to continue care
work to overcome the potential barriers to continuity of care, appreciating the role of handover in overcoming these barriers

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

contribute to processes for managing risks, and identify strategies for improvement in transition of care
engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital discharge

direction
Requires some supervision

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

The trainee may:

factor transport issues and costs to patients into arrangements for transferring patients to other settings

LG7: Acute care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

assess seriously unwell or injured patients, and initiate management
recognise clinical deterioration, and respond by following the local process for escalation of care
recognise and manage acutely unwell patients who require resuscitation
lead the resuscitation team initially, and involve other necessary services
liaise with transport services and medical teams
perform this activity primarily in inpatient settings.

Professional practice framework domain

Medical expertise

confident
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
perform advanced life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
demonstrate knowledge of potential risks and complications of resuscitation
effectively assess, diagnose, and manage acute undifferentiated clinical presentations
select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
manage escalations or transitions of care in a proactive and timely manner
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
provide clear and effective discharge summaries with recommendations for ongoing care
optimise medical management before, during, and after operations

direction
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
apply basic life support as indicated
understand general medical principles of caring for patients with undifferentiated and undiagnosed conditions
identify potential causes of current 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

confident
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 health care team members during resuscitation
facilitate early communication with patients, families, carers, and health care team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain the situation to patients in a sensitive and supportive manner, avoiding jargon, and confirming their understanding
determine individual patients’ level of health literacy and understanding of agreed care decisions

direction
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
if possible, determine patients’ understanding of their diseases and what they perceive as the most desirable goals of care

Quality and safety

confident
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 life support
use clinical information technology systems for conducting prospective and retrospective clinical audits
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
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
document treatment given without consent in an emergency according to local guidelines

direction
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

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective supervision skills and teaching methods which are adapted to the context of the training
encourage questioning among junior colleagues and students in response to unanswered clinical questions
seek guidance and feedback from health care teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

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

The trainee may:

mentor and train others to enhance team effectiveness
provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
coordinate and supervise junior colleagues from the emergency department and wards

Research

confident
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

direction
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
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
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 appropriate way by considering variation in family structures, cultures, religion, or belief systems
integrate culturally appropriate care of Aboriginal and Torres Strait Islander and Māori peoples into patients’ management
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams

direction
Requires some supervision

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

The trainee may:

practise cultural competency appropriate for the community served
proactively identify barriers to access to health care

Ethics and professional behaviour

confident
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 that are 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

direction
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

confident
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 escalation of care, escalating to appropriate staff or services
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and causes 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

direction
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

confident
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 the emergency department, intensive care, and other subspecialty inpatient units
manage the transition of acute medical patients through their hospital journey
lead a team by providing engagement while maintaining a focus on outcomes

direction
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 assessments and management
encourage an environment of openness and respect to lead effective teams

Health policy, systems, and advocacy

confident
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 health care resources
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

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

The trainee may:

understand the systems for the escalation of care for deteriorating patients
understand the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes

LG8: Longitudinal care

Learning Goal 8

Longitudinal care

Manage and coordinate the longitudinal care of patients with chronic illness, disability, and/or long-term health issues

This activity requires the ability to:

develop management plans and goals in consultation with patients, families, and/or carers
manage chronic and advanced conditions, complications, disabilities, and comorbidities
collaborate with other health care providers
ensure continuity of care
facilitate patients’ and/or families’ and/or carers’ self-management and self-monitoring
engage with the broader health policy context.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

regularly assess and review care plans for patients with chronic conditions and disabilities based on short- and long-term clinical and quality of life goals
provide documentation on patients' presentation, management, and progress, including key points of diagnosis and decision making to inform coordination of care
ensure patients contribute to their needs assessments and care planning
monitor treatment outcomes, effectiveness, and adverse events

direction
Requires some supervision

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

The trainee may:

assess patients’ knowledge, beliefs, concerns, and daily behaviours related to their chronic condition and/or disability and its management
contribute to medical record entries on the history, examination, and management plan in a way that is accurate and sufficient as a member of multidisciplinary teams

Communication

confident
Ready to perform without supervision

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

The trainee will:

enable patients to more meaningfully engage in management plans by enhancing health literacy and encouraging positive health related behaviours
encourage patients’ access to self-monitoring devices and assistive technologies
communicate with multidisciplinary team members, and involve patients in that dialogue

direction
Requires some supervision

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

The trainee may:

provide healthy lifestyle advice and information to patients on the importance of self-management
work in partnership with patients to develop and refine management plans

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use innovative models of chronic disease care using telehealth and digitally integrated support services
review medicine use, and ensure patients understand safe medication administration to prevent errors
support patients’ self-management by balancing between minimising risk and helping patients to become more independent
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living

direction
Requires some supervision

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

The trainee may:

participate in continuous quality improvement processes and clinical audits on chronic disease management
identify activities that may improve patients’ quality of life

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

prepare reviews of literature on patients' encounters to present at journal club meetings
search for and critically appraise evidence to resolve clinical areas of uncertainty

direction
Requires some supervision

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

The trainee may:

search literature using Problem / Intervention / Comparison / Outcome (PICO) format
recognise appropriate use of review articles

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

share information about patients’ health care, consistent with privacy laws and confidentiality and professional guidelines
use consent processes for the release and exchange of health information
assess patients’ decision-making capacity, and appropriately identify and use alternative decision makers

direction
Requires some supervision

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

The trainee may:

share information between relevant service providers
acknowledge and respect the contribution of health professionals involved in patients’ care

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients’ needs in terms of both internal resources and external support on a long-term health care journey

direction
Requires some supervision

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

The trainee may:

recognise personal limitations, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through involvement in all stages of the patients’ care journey
use a multidisciplinary approach across services to manage patients with chronic diseases and disabilities
develop collaborative relationships with patients, families, carers, and a range of health professionals

direction
Requires some supervision

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

The trainee may:

participate in multidisciplinary care for patients with chronic diseases and disabilities, including organisational and community care on a continuing basis, appropriate to patients’ context

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use health screening for early intervention and chronic diseases management
assess alternative models of health care delivery to patients with chronic diseases and disabilities
participate in government initiatives for chronic diseases management to reduce hospital admissions and improve patients’ quality of life
help patients access initiatives and services for patients with chronic diseases and disabilities

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of government initiatives and services available for patients with chronic diseases and disabilities, and display knowledge of how to access them

LG9: Communication with patients

Learning Goal 9

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

select a suitable context and include family and/or carers and other team members
adopt a patient-centred perspective, including adjusting for cognition and disabilities
select and use appropriate modalities and communication strategies
structure conversations intentionally
negotiate a mutually agreed management plan
verify patient, family, or carer understanding of information conveyed
develop and implement a plan for ensuring actions occur
ensure the conversation is documented.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options

direction
Requires some supervision

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

The trainee may:

apply knowledge of the scientific basis of health and disease to the management of patients
demonstrate an understanding of the clinical problem being discussed
formulate management plans in partnership with patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

use an appropriate communication strategy and modalities for communication, such as emails, face-to-face, or phone calls
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients to share their thoughts or explain their management plan in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
treat children and young people respectfully, and listen to their views
recognise the role of family or carers and, when appropriate, encourage patients to involve their family or carers in decisions about their care

direction
Requires some supervision

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

The trainee may:

select appropriate modes of communication
engage patients in discussions, avoiding the use of jargon
check patients’ understanding of information
adapt communication style in response to patients’ age, developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors
collaborate with patient liaison officers as required

Quality and safety

confident
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 their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand before asking for their consent
consider capacity for decision making and consent, including young people or patients with cognitive disability
recognise and take precautions where patients may be vulnerable, such as issues of child protection, self-harm, or elder abuse
participate in processes to manage patient complaints

direction
Requires some supervision

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

The trainee may:

inform patients of the material risks associated with proposed management plans
treat information about patients as confidential

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

discuss the aetiology of diseases and explain the purpose, nature, and extent of the assessments to be conducted
obtain informed consent or other valid authority before involving patients in teaching

direction
Requires some supervision

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

The trainee may:

respond appropriately to information sourced by patients, and to patients’ knowledge regarding their condition

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of New Zealand
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain an informed consent or other valid authority before involving patients in research

direction
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
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally competent communication with Aboriginal and Torres Strait Islander and Māori peoples
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

identify when to use interpreters
allow enough time for communication across linguistic and cultural barriers

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use this information wisely when they make decisions
encourage and support patients, and, when relevant, their families or carers, in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
prioritise honesty, patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions

direction
Requires some supervision

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

The trainee may:

respect the preferences of patients
communicate appropriately, consistent with the context, and respect patients’ needs and preferences
maximise patient autonomy, and support their decision making
avoid sexual, intimate, and/or financial relationships with patients
demonstrate a caring attitude towards patients
respect patients, including protecting their rights to privacy and confidentiality
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours, or the illness itself
use social media ethically and according to legal obligations to protect patients’ confidentiality and privacy

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with team members involved in patients’ care, and with patients, families and carers
discuss medical assessments, treatment plans, and investigations with patients and primary care teams, working collaboratively with all
discuss patient care needs with health care team members to align them with the appropriate resources
facilitate an environment where all team members feel they can contribute and their opinion is valued
communicate accurately and succinctly, and motivate others on the health care team

direction
Requires some supervision

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

The trainee may:

answer questions from team members
summarise, clarify, and communicate responsibilities of health care team members
keep health care team members focused on patient outcomes

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other services, such as community health centres and consumer organisations, to help patients navigate the healthcare system

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG10: Prescribing

Learning Goal 10

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

take and interpret medication histories
choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, comorbidities, potential drug interactions, risks, and benefits
communicate with patients, families, and/or carers about the benefits and risks of proposed therapies
provide instructions on medication administration effects and side effects
monitor medicines for efficacy and safety
review medicines and interactions, and cease where appropriate
collaborate with pharmacists.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ conditions requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patient preference prior to prescribing a new medication
plan for follow up and monitoring
consider individualised prescribing and education regarding device / method to optimise drug delivery based on patient factors

direction
Requires some supervision

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

The trainee may:

be aware of potential side-effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
select medicines for common conditions appropriately, safely, and accurately
demonstrate an understanding of the rationale, risks, benefits, side effects, contraindications, dosage, and drug interactions
identify and manage adverse events

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
write clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken, including use of spacers and review of inhaler technique
ensure patients’ understanding by repeating back pertinent information, such as when to return for monitoring, and whether therapy continues after this single prescription
identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients, families, or carers
explain the benefits and burdens of therapies, considering patients’ individual circumstances
write clearly legible scripts or charts using generic names of the required medication in full, including mg / kg / dose information and all legally required information
seek further advice from experienced clinicians or pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

review medicines regularly to reduce non‑adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
prescribe new medicines only when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records
use national real-time prescription monitoring services as required when prescribing drugs of dependence

direction
Requires some supervision

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

The trainee may:

check the dose before prescribing
monitor side effects of medicines prescribed
identify medication errors, and institute appropriate measures
use electronic prescribing systems safely
rationalise medicines to avoid polypharmacy

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use continuously updated software for computers and electronic prescribing programs
ensure patients understand management plans, including addressing adherence issues
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines

direction
Requires some supervision

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

The trainee may:

undertake continuing professional development to maintain currency with prescribing guidelines
reflect on prescribing, and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to ensure any new medicine improves patient-oriented outcomes more than older medicines, and not just more than placebo
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

direction
Requires some supervision

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

The trainee may:

make therapeutic decisions according to the best evidence
recognise where evidence is limited, compromised, or subject to bias or conflict of interest

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

explore patients’ understanding of and preferences for non-pharmacological and pharmacological management
offer patients effective choices based on their expectations of treatment, health beliefs, and cost
interpret and explain information to patients at the appropriate level of their health literacy
anticipate queries to help enhance the likelihood of medicines being taken as advised
ensure appropriate information is available at all steps of the medicine management pathway

direction
Requires some supervision

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

The trainee may:

appreciate patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of pharmacological and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients about:
- action of medications
- administration advice
- cessation plans
- indications
- potential side effects
make prescribing decisions based on good safety data when the benefits outweigh the risks involved
demonstrate understanding of the ethical implications of pharmaceutical industry-funded research and marketing

direction
Requires some supervision

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

The trainee may:

consider the efficacy of medicines in treating illnesses, including the relative merits of different non-pharmacological and pharmacological approaches
follow regulatory and legal requirements and limitations regarding prescribing
follow organisational policies regarding pharmaceutical representative visits and drug marketing

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use a systematic approach to select treatment options
use medicines safely and effectively to get the best possible results
choose suitable medicines only if medicines are considered necessary and of benefit to patients
prescribe medicines appropriately to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost to them
evaluate new medicines in relation to their possible efficacy and safety profile for individual patients

direction
Requires some supervision

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

The trainee may:

recognise personal limitations, and seek help in an appropriate way when required
consider the following factors for all medicines:
- contraindications
- cost to patients, families, and the community
- funding and regulatory considerations
- generic versus brand medicines
- interactions
- risk-benefit analysis

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

interact with medical, pharmacy, and nursing staff to ensure safe and effective medicine use

direction
Requires some supervision

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

The trainee may:

work collaboratively with pharmacists
participate in medication safety and morbidity and mortality meetings

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

choose medicines in relation to comparative efficacy, safety, and cost-effectiveness against medicines already on the market
prescribe for individual patients, considering history, current medicines, allergies, and preferences, ensuring that resources are used wisely for the benefit of patients

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy

LG11: Procedures

Learning Goal 11

Procedures

Plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

select appropriate procedures in partnership with patients, their families, or carers
obtain informed consent
set up the equipment, maintaining an aseptic field
perform procedures
manage unexpected events and complications during and after procedures
provide aftercare for patients
communicate aftercare protocols and instructions to patients and medical and nursing staff
maintain logbook of procedures, and participate in continuing education
perform open disclosure and reporting of incidents when required
interpret the results and outcomes of procedures, including imaging and reports, and communicate these to patients and referring doctors.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by assessing patient-specific factors, risks, benefits, and alternatives
confidently and consistently perform a range of common procedures
ensure team members are aware of all allergies / adverse reactions identified, and take precautions to avoid allergies / adverse reactions during procedures
ensure patients have complied with procedure preparation
confirm the correct position / site / side / level on patients for planned procedures
recognise and effectively manage complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of diagnostic procedures
demonstrate a level of procedural proficiency in flexible bronchoscopy / intercostal catheter insertion prior to focusing on more advanced procedures (e.g., radial endobronchial ultrasound, rigid bronchoscopy, cryotherapy) or pleural procedures (tunnelled pleural catheter, thoracoscopy), and understand their role in respiratory scope of practice

direction
Requires some supervision

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

The trainee may:

assess patients and identify indications for procedures
check for allergies and adverse reactions
consider risks and complications of procedures
interpret results of common diagnostic procedures
organise and document post-procedure review of patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

accurately document procedures in clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
explain procedures clearly to patients, families and carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
counsel patients sensitively and effectively, and support them to make informed choices
address patients’, families’, or carers’ concerns relating to procedures, providing opportunities to ask questions
tailor language according to individual patients’ age and capacity to understand
communicate effectively with team members, patients, families, and carers prior to, during, and after procedures
ensure team members are confident and competent in their assigned roles

direction
Requires some supervision

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

The trainee may:

explain the process of procedures to patients without providing a broader context
help patients, families, and carers choose the procedure
communicate with members of procedural teams so all team members understand who each member is
discuss post-procedural care with patients, families, and carers
complete relevant patients’ documentation, and conduct an appropriate clinical handover

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before undertaking any procedure
set up all necessary equipment, and consistently use universal precautions and aseptic technique
confirm patients’ identification, verify the procedure, and, where appropriate, the correct position / site / side / level for the procedure
ensure that information on patients’ consent forms match procedures to be performed
identify, document, and appropriately notify of any adverse events or equipment malfunction
maintain procedural logbooks with incorporation of procedure details, outcomes, and adverse events
engage in regular self-audit processes, and implement quality improvement changes when required

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients, families, and 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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
organise or participate in in-service training on new technology
provide specific and constructive feedback and comments to junior colleagues
initiate and conduct skills training for junior staff and other team members

direction
Requires some supervision

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

The trainee may:

participate in continued professional development
help junior colleagues develop new skills
actively seek feedback on personal technique until competent

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

consider individual patients’ cultural perceptions of health and illness, and adapt practice accordingly

direction
Requires some supervision

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

The trainee may:

respect religious, cultural, linguistic, and family values and differences

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

confidently perform common procedures
identify appropriate proxy decision makers when required
show respect for knowledge and expertise of colleagues
maximise patient autonomy in decision making

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify roles and optimal timing for diagnostic procedures
critically appraise information from assessment and evaluation of risk / benefit to prioritise patients on waiting lists
make clinical judgements and decisions based on the available evidence
select the most appropriate and cost-effective diagnostic procedures
adapt procedures in response to assessments of risks to individual patients
select appropriate investigations on the samples obtained in diagnostic procedures

direction
Requires some supervision

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

The trainee may:

prioritise which patients receive procedures first (if there is a waiting list)
assess personal skill levels, and seek help with procedures when appropriate
use tools and guidelines to support decision making
recommend suboptimal procedures for patients

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

explain critical steps, anticipated events, and equipment requirements to teams on planned procedures
provide staff with clear aftercare instructions, and explain how to recognise possible complications
identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
coordinate efforts, encourage others, and accept responsibility for work done

direction
Requires some supervision

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

The trainee may:

ensure all relevant team members are aware that a procedure is occurring
discuss patients’ management plans for recovery with colleagues

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss serious incidents at appropriate clinical review meetings
initiate local improvement strategies in response to serious incidents
use resources efficiently when performing procedures

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with organisational guidelines and policies

For each procedure/investigation, trainees should be able to perform the components of the procedure indicated below. Please select a procedure/investigation from the dropdown to see its component.

These procedures may be considered within scope of practice in Respiratory Medicine, however additional training and demonstration of competence is suggested: Mandatory, Desired, Optional (depending on exposure). Procedural competence includes procedure set up.

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Optional

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

Select and evaluate the anticipated value of the procedure

Obtain informed consent

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide after-care for patients

Interpret results

Communicate with patients and other health care providers

Maintenance of procedural logbook and continuing education

LG12: Investigations

Learning Goal 12

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

select, plan, and arrange evidence-based clinically appropriate investigations
prioritise patients receiving investigations (if there is a waiting list)
evaluate the anticipated value of the investigation
work in partnership with patients and their families or carers to facilitate choices that are right for them
provide aftercare for patients (if needed)
interpret the results and outcomes of investigations
communicate the outcome of investigations to patients and referring doctors.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations and frame them as an adjunct to comprehensive clinical assessments
assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
develop plans for investigations, identifying their roles and timing
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
understand the significance of abnormal test results, and act on these
consider patient factors and comorbidities
consider age-specific reference ranges

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain to patients the potential benefits, risks, costs, burdens, and side effects of each option, including the option to have no investigations
use clear and simple language, and check that patients understand the terms used and agree to proceed with proposed investigations
identify patients’ concerns and expectations, providing adequate explanations on the rationale for individual test ordering
confirm whether patients have understood the information they have been given and the need for more information before deciding
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 carers
give information that patients may find distressing in a considerate way

direction
Requires some supervision

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

The trainee may:

discuss the indications, risks, benefits, and complications 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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from a proposed investigation, focusing on patients’ individual situations

direction
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

Teaching and learning

confident
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, evidence sources, and decision support tools
participate in clinical audits to improve test ordering strategies for diagnoses and screening
undertake continuing professional development to maintain currency with investigation guidelines

direction
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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

understand patients’ views, preferences, and the adverse outcomes they are most concerned about in regards to any proposed investigations

direction
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

Ethics and professional behaviour

confident
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 (except for emergencies)
discuss with patients how decisions will be made once the investigation has started and the patient is not able to participate in decision making
respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
advise patients there may be additional costs, which patients may wish to clarify before proceeding
explain the expected benefits as well as the potential burdens and risks of any proposed investigation before obtaining informed consent or other valid authority
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information

direction
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, and obtaining the appropriate informed consent, including financial consent, if necessary

Judgement and decision making

confident
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

direction
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 the clinical scenario in discussion with patients
recognise personal limitations, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
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 health care team might play, and what other sources of information and support are available
ensure results are checked in a timely manner, taking responsibility for following up results

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
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, utility, safety, and cost effectiveness
consider resource utilisation through peer review of testing behaviours

LG13: Clinic management

Learning Goal 13

Clinic management

Manage an outpatient clinic

This activity requires the ability to:

manage medical procedures and treatments
manage clinic services
oversee quality improvement activities
communicate with patients, their families, and/or carers
liaise with other health professionals and team members
demonstrate problem-solving skills
responsibly use public resources.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

effectively identify and address current clinical concerns, as well as longer-term clinical objectives, as appropriate to patients’ context
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
create an accurate and appropriately prioritised problem list in the clinical notes or as part of an ambulatory care review
update documentation in a time frame appropriate to the clinical situation of patients
know when to refer patients on for specialist review in another specialty, or to another member of the multidisciplinary team

direction
Requires some supervision

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

The trainee may:

demonstrate an understanding of the importance of prevention, early detection, health maintenance, and chronic condition management

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system to improve access to care by collaboration with other services, such as community health centres and consumer organisations
link patients to specific community-based health programs and group education programs

direction
Requires some supervision

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

The trainee may:

wherever practical, meet patients’ specific language and communication needs
facilitate appropriate use of interpreter services and translated materials

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

practice health care that maximises patient safety
adopt a systematic approach to the review and improvement of professional practice in the outpatient clinic setting
identify aspects of service provision that may be a risk to patients’ safety
ensure that patients are informed about fees and charges

direction
Requires some supervision

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

The trainee may:

take reasonable steps to address issues if patients’ safety may be compromised
understand a systematic approach to improving the quality and safety of health care
participate in organisational quality and safety activities, including clinical incident reviews

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

evaluate their own professional practice
demonstrate learning behaviour and skills in educating junior colleagues
contribute to the generation of knowledge
maintain professional continuing education standards

direction
Requires some supervision

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

The trainee may:

recognise the limits of personal expertise, and involve other professionals as needed to contribute to patients’ care
use information technology appropriately as a resource for modern medical practice

Research

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before involving patients in research
inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation before obtaining consent

direction
Requires some supervision

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

The trainee may:

allow patients to make informed and voluntary decisions to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community, and how to shape service to those people
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement and health outcomes

direction
Requires some supervision

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

The trainee may:

acknowledge the social, economic, cultural, and behavioural factors influencing health, both at individual and population levels

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

identify and respect the boundaries that define professional and therapeutic relationships
respect the roles and expertise of other health professionals
comply with the legal requirements of preparing and managing documentation
demonstrate awareness of financial and other conflicts of interest

direction
Requires some supervision

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

The trainee may:

understand the responsibility to protect and advance the health and wellbeing of individuals and communities
maintain the confidentiality of documentation, and store clinical notes appropriately
ensure that the use of social media is consistent with ethical and legal obligations

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

integrate prevention, early detection, health maintenance, and chronic condition management, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care that allows maximum benefit from the available resources

direction
Requires some supervision

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

The trainee may:

understand the appropriate use of human resources, diagnostic interventions, therapeutic modalities, and health care facilities

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

prepare for and conduct clinical encounters in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups
ensure that all important discussions with colleagues, multidisciplinary team members, and patients are appropriately documented
review discharge summaries, notes, and other communications written by junior colleagues
support colleagues who raise concerns about patients’ safety

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs within public and private settings

direction
Requires some supervision

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

The trainee may:

understand common population health screening and prevention approaches

LG14: Palliative care

Learning Goal 14

Palliative care

Manage the care of patients with severe or intractable symptoms or at the end of their lives

This activity requires the ability to:

manage severe or intractable symptoms
recognise the dying phase
support patients to plan for their advance care, and document their own wishes
manage end-of-life care plans.

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

accurately assess patients’ physical and psychological symptoms
estimate prognosis and communicate this appropriately, if requested, including the uncertainties around such estimates
develop and clearly document individualised end-of-life care plans, including patients’ preferences for treatment options, resuscitation plans, preferred place of care, and preferred place of death
provide holistic symptom management, and incorporate multidisciplinary care focusing on psychological and physical distress, according to patients’ wishes
avoid unnecessary investigations or treatments, ensuring physical and psychosocial support
review the goals of care and treatment plans with patients, families, or carers if significant changes in patients’ conditions or circumstances occur
recognise and manage the terminal phase in a timely way

direction
Requires some supervision

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

The trainee may:

demonstrate an understanding of the principles of care for patients at the end of their lives
provide timely assessments and document patients’ care plans
manage physical symptoms in alignment with patients’ wishes
take steps to alleviate patients’ symptoms and distress
correctly identify patients approaching the end of life, and provide symptomatic treatment
adequately manage patients in their terminal phase

Communication

confident
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, families, or carers based on understanding, trust, empathy, and confidentiality
explore patients’ concerns across physical, spiritual, cultural, and psychological domains thoughtfully
identify opportunities to discuss end-of-life care, aligning it with patients’ values and preferences
identify proxy decision makers patients’ wish to be involved in discussions about their end-of-life care
identify and document lists of close family members or carers, and develop support plans with and 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

direction
Requires some supervision

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

The trainee may:

discuss with patients, family, 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 of situations, using plain language and avoiding medical jargon
discuss with family or carers appropriate support and bereavement care

Quality and safety

confident
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
review all deaths 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

direction
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

Teaching and learning

confident
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 and Māori peoples, and to people from other cultural backgrounds
- ethical and medicolegal issues
- relevant legislation in the state, territory, or region

direction
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

Research

confident
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 or symptom 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

direction
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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

practise culturally safe medicine based on understanding the personal, historical, and cultural influences on patients, families, and carers
develop strategies for identifying culturally appropriate decision makers, and obtain their input in discussions of patients’ end-of-life care
offer support to patients, families, and carers to include cultural or religious practices in their care

direction
Requires some supervision

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

The trainee may:

understand, 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

Ethics and professional behaviour

confident
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
ensure focus of care is on quality of life for patients before death, and 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
recognise feelings of moral distress and burnout in themselves and colleagues

direction
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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

maximise patients’ autonomy and their best interests when making treatment decisions
liaise with other relevant services, providing referrals as necessary

direction
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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

ensure care plans are communicated to all teams involved in patients’ care, including relevant community care providers
define the responsibilities and roles of team members involved in patients’ care
achieve agreement between multidisciplinary teams about patients’ treatment options
coordinate care and support to be provided in patients’ preferred place of care
effectively manage personal challenges of dealing with death and grief

direction
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

Health policy, systems, and advocacy

confident
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 and improvement of quality of life for patients with distressing symptoms
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

direction
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

Knowledge guides

Knowledge guides provide detailed guidance to trainees on the important topics and concepts trainees need to understand to become experts in their chosen specialty.

Trainees are not expected to be experts in all areas or have experience related to all items in these guides.

LG15: Scientific foundations of cardiology

Epidemiology, Pathophysiology, and Clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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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.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

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Environmental factors:
- air pollution
- effect of altitude and diving on lung disease
- occupational and environmental toxins, including silica dust and asbestos:
  - medicolegal implications of occupational dust exposure
  - methods for screening for occupational dust exposure and related disease
- smoking (tobacco and marijuana) and vaping:
  - the adverse effects on health
  - the specific effects on respiratory health
  - methods for screening for exposure to environmental tobacco smoke, including urinary / salivary cotinine
Pharmacology:
- aerosol drug delivery:
  - aerosol delivery through different interfaces, such as spacers, facemasks, high flow circuits, invasive and non-invasive positive pressure ventilation
  - mechanisms and adverse effects of aerosol treatments
  - principles of aerosol delivery to the lungs
  - principles of infection control in aerosol therapy
  - principles of pressurised metered dose inhalers, dry powder inhalers, and nebulisers
- biologics in respiratory disease
- dosing and side effects
- drug interactions and contraindications of medications
- effects of non-respiratory medications on the respiratory system
- formulations of medications
- mechanism of action
- monitoring of drug levels
- pharmacodynamics
- screening for adverse effects
Principles of statistics and epidemiology:
- basic statistics
- critical appraisal of published research and appropriate application towards clinical care
- levels of evidence and classes of recommendations
- population risk determinants of respiratory disease
Structure and function of the respiratory system:
- immunology and host defence mechanisms:
  - acquired immunity
  - antibody classes and function
  - atopy and hypersensitivity reactions
  - autoimmunity
  - cell mediated immunity
  - effects of systemic and localised immunodeficiency (e.g., GM-CSF antibody syndrome) on lung health
  - humoral immunity
  - innate immunity
  - lung microbiomeo
  - pulmonary defence mechanisms, particularly the role, makeup, and function of mucus, cilia, and cough
  - transplant immunology
  - vaccines and vaccine responses
- lung development:
  - normal development
  - surfactant physiology
  - the effects of early life lung disease on long-term health
- pulmonary physiology:
  - acid-base balance
  - alveolar gas equation
  - control of ventilatory drive
  - diffusion
  - mechanics of breathing
  - metabolic functions of the lung
  - peripheral blood flow, gas transport, and oxygen-haemoglobin dissociation
  - physiological changes and compensations under altered states
  - pulmonary blood flow, vascular resistance, and heart-lung circulatory relationships
  - ventilation and gas exchange, including ventilation perfusion relationships:
    - ageing
    - diving physiology
    - exercise
    - high altitude physiology
    - pregnancy
- the normal and abnormal structural components of the respiratory system:
  - alveoli (including type 2, Clara, and goblet cells)
  - chemoreceptors
  - chest wall
  - interstitium
  - lower airway segments (1-19)
  - mediastinal lymph node stations
  - pulmonary vasculature
  - respiratory control centres
  - respiratory muscles
  - smooth muscle and receptors
  - upper airway anatomy

Investigations

Blood gas analysis, including interpretation of arterial, venous, and capillary samples
Capnography, including exhaled and transcutaneous samples
Lung function tests:
- bronchial provocation testing, including direct and indirect methods
- bronchodilator response
- calculations of shunt fraction
- cardiopulmonary exercise testing
- diffusion assessment
- forced oscillometry testing
- fraction of exhaled nitric oxide
- high altitude simulation tests
- lung volume assessment techniques
- respiratory muscle testing, including maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressures, supine spirometry, and cough peak flow
- six-minute walk test
- spirometry, including office / bedside testing
Oximetry, including continuous / overnight studies
Oesophageal manometry and pH monitoring
Positive airway pressure device downloads
Polysomnography:
- address the benefits and limitations of different levels of polysomnography testing
Radiological investigations:
- chest x-ray
- contrast swallow tests
- CT scan of the chest
- fluoroscopy
- magnetic resonance imaging of the chest
- scintigraphy / nuclear medicine tests:
  - PET with / without integrated CT
  - ventilation / perfusion scans
- ultrasonography:
  - doppler ultrasound imaging and flow studies
  - thoracic and pleural ultrasound
  - trans-thoracic echocardiography
Radiological, serological, cytological, histological, and ancillary testing for primary lung disease and systemic disorders with pulmonary overlap:
- allergy and delayed hypersensitivity tests
- cilia studies:
  - cilial function testing
  - electron microscopy for cilial ultrastructure
  - nasal nitric oxide testing
- sweat test and genotyping for cystic fibrosis
Technical aspects of lung function testing:
- clinical interpretation of test results, and appreciation of clinically meaningful change
- clinical versus research role of the above investigations
- margins of error, and operator-dependant and patient-related factors and their implications
- methods of performing tests
- reference values and their limitations

Procedures

Bronchoscopy:
- anatomy:
  - airway anatomy
  - normal anatomical variants of airways
  - visual appearance of upper and lower airway pathology (e.g., subglottic lesions, tumours)
- applications and use of single-use / disposable bronchoscopes
- investigations:
  - assessment and quantification of dynamic airway collapse
  - collateral ventilation assessment
  - cytology and/or microbiology from brushings
  - cytology and/or microbiology from fine needle aspiration and transbronchial core needle biopsies
  - cytology and/or microbiology from washings / bronchoalveolar lavage fluid
  - histology and/or microbiology from cryobiopsy
  - histology and/or microbiology from forceps bronchial and transbronchial biopsies
- management of intra- and postoperative complications
- techniques:
  - anaesthesia, airway protection, and ventilation strategies for bronchoscopic procedures
  - methods of introduction of bronchoscopes, including nasal intubation, oral intubation with mouth / bite guard, laryngeal mask airway (LMA), endotracheal tube (ETT), and direct tracheostomy approaches
  - navigational techniques, such as bronchial branch tracing (Kurimoto technique), electromagnetic navigation, robotic navigation, navigational software, fluoroscopy, cone beam CT
  - rigid and flexible bronchoscopy, including single-use instrumentation, and linear and radial endobronchial ultrasound
- the processes for sterilisation and maintenance of bronchoscopic equipment
- therapeutic techniques:
  - advanced therapeutic modalities, such as APC, cryotherapy, and Nd-YAG laser
  - bronchoscopic drug delivery
  - endobronchial lung volume reduction
  - foreign body removal
  - large airway debulking or stent placement
  - management of persistent air leak
  - therapeutics under investigation, including thermal vapour and microwave ablation
Pleural:
- diagnostic and therapeutic indications for pleural procedures
- normal and abnormal anatomy of the pleura
- physiology and biochemistry of pleural fluid
- procedure techniques:
  - anaesthesia (local, regional, and general approaches)
  - closed pleural biopsy (Abrams and image-guided techniques)
  - indwelling tunnelled pleural catheter insertion and removal
  - large bore intercostal catheter insertion
  - needle thoracentesis
  - small bore intercostal catheter insertion
  - thoracoscopy
  - underwater seal drainage systems, including digital ambulatory systems
- risks and benefits of each of the diagnostic / therapeutic interventions
- sedation, topical anaesthesia, and analgesia
- selection and assessment of patients for procedural intervention
- therapeutic interventions:
  - pleural fluid drainage
  - pleural infection management using intrapleural fibrinolytic, plus mucolytic therapy, saline irrigation, and basic knowledge of surgical options
  - pleurodesis (slurry and poudrage)
  - pneumothorax management
  - advanced management of persistent air leak, including talc insufflation, blood patch pleurodesis, endobronchial interventions, and basic knowledge of surgical options
- utility of ultrasonography in assessment and management of pleural disorders

The following issues apply to all knowledge guides

Advanced certification or training (generally beyond scope of advanced training) for advanced procedural interventions, including:
- advanced bronchoscopic therapeutic interventions
- endobronchial lung volume reduction
- indwelling tunnelled pleural catheter insertion and removal
- large airway management
- navigational techniques
- radial endobronchial ultrasound
Engage in preventive and adjunctive care for patients with respiratory disease, including a focus on smoking cessation, vaccinations, and pulmonary rehabilitation
Incorporate principles of entrustable professional activities into clinical management of respiratory disease
Patient care considerations for specific patient groups and those with culturally diverse backgrounds, including:
- Aboriginal and Torres Strait Islander background, ethnic minorities, religious ideologies (e.g., Jehovah’s Witness), refugees, overseas travellers, low socioeconomic background, non-English speaking background
- adolescent, elderly, pregnant, and peripartum states
Procedural competence for respiratory interventions:
- flexible bronchoscopy
- intercostal catheter insertion
- linear endobronchial ultrasound
- thoracic and pleural ultrasound
Recognise the inter-relationship and impact of comorbidities and respiratory conditions on each other, with respect to clinical presentation, diagnostics, management, prognostics and impact of illness

LG16: Acute respiratory care

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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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.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

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.

View

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.

View

Presentations

Abnormal chest radiology (including chest x-ray or CT scan)
Chest pain
Chest tightness
Cough
Dyspnoea
Fatigue
Fever
Haemoptysis
Hypercapnia
Night sweats
Orthopnoea
Respiratory failure, including hypoxaemia
Sleep disruption
Snoring
Somnolence
Sputum production
Stertor
Stridor
Symptoms related to occupational or environmental exposure
Tachypnoea
Weight loss
Wheeze

Conditions

Airways disorders

Acute exacerbation of obstructive airways disease, including:
- allergic bronchopulmonary aspergillosis
- asthma
- bronchiectasis (cystic fibrosis and non-cystic fibrosis related), bronchiolitis
- chronic obstructive pulmonary disease

Diffuse parenchymal lung disorders

Acute exacerbation of obstructive airways disease, including:
- Acute eosinophilic pneumonia
- Acute exacerbation of connective tissue disease-related and other interstitial lung disease
- Acute exacerbation of idiopathic pulmonary fibrosis
- Acute hypersensitivity pneumonitis
- Acute interstitial pneumonia
- Acute pulmonary oedema
- Acute rejection post lung transplantation
- Acute respiratory distress syndrome
- Drug-induced pneumonitis
- Organising pneumonia
- Radiation pneumonitis

Large airways disorders

Acute / Subacute or critical upper airway obstruction, including:
- foreign body aspiration
- malignant central airway obstruction
- subglottic stenosis
- tracheal stenosis
- tracheo- and broncho-oesophageal fistula

Pleural disorders

Chylothorax
Empyema
Haemothorax
Persistent air leak, including bronchopleural fistula formation
Pleural effusions
Pneumothorax

Pulmonary infections

Aspiration pneumonitis
Community or healthcare-acquired pneumonia
Fungal infections, including aspergillus, cryptococcus, and pneumocystis jirovecii
Infections in patients who are immunocompromised
Infections in patients with underlying structural lung disease and airways disease
Infections related to inserted devices
Non-tuberculous mycobacterial infections
Parapneumonic effusions, pleural infections, and empyema
Respiratory viral infections, including influenza and SARS-CoV-2
Tuberculosis with pulmonary and extrapulmonary manifestations

Pulmonary vascular disorders

Acute or massive haemoptysis
Acute right ventricular failure secondary to lung disease / pulmonary arterial hypertension
Diffuse alveolar haemorrhage
Pulmonary arterial hypertension
Pulmonary embolism
Pulmonary vasculitis

Respiratory failure

Acute and acute-on-chronic hypercapnic respiratory failure in chronic respiratory conditions, including:
- airways diseases
- kyphoscoliosis
- neuromuscular diseases
- obesity hypoventilation
Acute hypercapnic respiratory failure secondary to exacerbation of airways diseases, especially chronic obstructive pulmonary disease
Acute hypoxaemic respiratory failure
Acute pulmonary oedema
Drug-induced or over-sedation related respiratory failure
Post-extubation respiratory failure

Thoracic malignancy and mediastinal disorders

Complications relating to thoracic malignancies
Large airway obstruction or endobronchial disease with associated symptoms
Mediastinal mass effect
Superior vena cava obstruction

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Conditions

Diffuse parenchymal lung disorders

Alveolar proteinosis
Barotrauma
High altitude and diving-related lung injury, including drowning
Post-haematopoietic bone marrow transplant syndromes:
- engraftment syndrome
- graft versus host disease
Traumatic lung injury, including contusions
Vaping and inhalation-related acute lung injury

Pulmonary infections

Parasitic lung infections, including:
- hydatid
- strongyloides
Pulmonary infections endemic only to certain geographical locations in Australia, New Zealand, or globally:
- burkholderia mellioid
- histoplasmosis
- strongyloidiasis
- toxoplasmosis

Thoracic malignancy and mediastinal disorder

Extra-pulmonary complications of thoracic malignancy, including:
- oesophageal obstruction
- pericardial tamponade
- spinal cord compression

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Airways disorders

Apply knowledge of epidemiology and pathophysiology of airways disease in the appropriate diagnosis and personalised management for patients

Diffuse parenchymal lung disorders

Apply knowledge of epidemiological factors, diagnostic sensitivity / specificity of investigations (serology, bronchoscopic, and surgical specimens), and pathophysiology of autoantibody syndromes (e.g., MDA-5, Jo-1), in determining appropriate diagnosis and treatment options for undifferentiated or new presentations of acute interstitial pneumonia

Pleural disorders

Apply epidemiology and pathophysiology in determining appropriate diagnosis, requirement for intervention, and management options for undifferentiated unilateral and bilateral pleural effusion

Pulmonary infections

Apply local epidemiology of prevalence of microbes and drug susceptibility patterns in aiding appropriate diagnosis and management avenues
- apply local epidemiology and risk factors for diagnosis of legionella infections
- empirical antimicrobial choice in treatment of latent tuberculous infection or culture-negative tuberculosis
Apply knowledge of timings of opportunistic infections and radiological patterns in guiding appropriate diagnosis and management, especially if empiric therapy is utilised
- empirical antimicrobial choice in treatment of suspected fungal disease in post-HSCT lung infections

Respiratory failure

Apply knowledge of epidemiology and various pathophysiological mechanisms contributing towards respiratory failure in determining appropriate positive airway pressures, additional non-invasive ventilation settings, and adjunct treatment modalities (e.g., cough assist device)

Thoracic malignancy and mediastinal disorders

Apply epidemiological risk factors in determining asymptomatic individuals suitable for lung cancer screening with low dose chest CT scan
Apply epidemiological risk factors in determining individuals at high risk of harbouring driver or targetable mutations, and therefore most suitable for advanced testing, including molecular analysis, next generation sequencing and/or liquid biopsy

Investigations

Blood gas analysis, including interpretation of arterial, venous, capillary, exhaled, and transcutaneous samples
Capnography
Lung function tests:
- calculation of shunt fraction
- cough peak flow and sniff nasal inspiratory pressures
- gas transfer assessment
- peak flow monitoring and assessment
- plethysmography
- spirometry, including pre- and post-bronchodilator, and in erect and supine positions
Oximetry, including continuous / overnight studies
Positive airway pressure device downloads
Radiological investigations:
- chest x-ray
- CT, including pulmonary angiogram and high-resolution protocols
- right heart catheterisation and haemodynamic measurements (basic knowledge and interpretation)
- scintigraphy / nuclear medicine tests (e.g., PET and ventilation / perfusion scans)
- ultrasonography
  - doppler ultrasound imaging and flow studies
  - thoracic and pleural ultrasound
  - trans-thoracic echocardiography
Serological, cytological, and histological biomarkers (e.g., utility of serology, cultures, PCR techniques, and histology for diagnosis of pulmonary infections)

Procedures

Bronchoscopy, including endobronchial ultrasound (linear and radial modalities), flexible bronchoscopy (including single use), and rigid bronchoscopy:
- advanced therapeutic modalities, such as APC, cryotherapy, endoscopic lung volume reduction, and Nd-YAG laser
- bronchial brushings
- bronchoscopic drug delivery
- collateral ventilation assessment
- cryobiopsy
- cytology and microbiology from washings / bronchoalveolar lavage fluid
- differential cell counts from bronchoalveolar lavage fluid
- fine needle aspiration
- forceps endobronchial and transbronchial biopsy
- foreign body removal
- large airway debulking or stent placement
- management of persistent air leak
Pleural procedures:
- Procedure techniques:
  - ambulatory and underwater seal drainage
  - indwelling tunnelled pleural catheter
  - large bore drain insertion
  - needle thoracentesis
  - pleural ultrasound
  - small bore intercostal catheter insertion
  - thoracoscopy
- Therapeutic interventions:
  - advanced management of persistent air leak, including blood patch pleurodesis, endobronchial interventions, talc insufflation, and basic knowledge of surgical options
  - intrapleural fibrinolysis and irrigation
  - pleural fluid drainage
  - pleurodesis
  - pneumothorax management

Appreciation for multidisciplinary team management (including allied health, medical, surgical, and critical care specialties) of severe or life-threatening presentations, particularly with:
- acute interstitial pneumonias
- decompensated respiratory failure
- haemoptysis
- large airway compromise
- pneumothorax
- pulmonary emboli
- respiratory tract infections
- severe asthma
Investigation and management of undifferentiated hypercapnia with understanding of pathophysiological mechanisms, various modalities of management and positive airway pressure delivery, and subsequent monitoring methods
Investigation and management of undifferentiated hypoxaemia, with understanding of utility of various diagnostic modalities, different oxygen delivery modalities, and use of controlled oxygen therapy
Knowledge of appropriate timings and methods for investigations, as well as their diagnostic yield, in management of patients with pulmonary infections, especially those that are severe or associated with underlying lung disease or concurrent immunocompromise
Principles of mandatory reporting, contact tracing, treatment observation, and other public measures in management of communicable diseases, particularly tuberculosis
Understanding of the interplay between various acute concurrent pathologies and comorbidities in contributing towards a patient’s clinical presentation, as well as treatment implications

LG17: Chronic respiratory care

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

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.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

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.

View

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.

View

Presentations

Allergy
Chest pain
Chest tightness
Cough (acute and chronic)
Dysfunctional breathing
Dyspnoea
Fatigue
Fever
Haemoptysis
Hypercapnia
Hypoxia
Night sweats
Orthopnoea
Recurrent infections
Sleep disruption
Snoring
Somnolence
Sputum production
Stridor
Symptoms related to environment or occupation exposures
Tachypnoea
Weight loss
Wheeze

Conditions

Airways disorders

Asthma
Bronchiectasis
Bronchiolitis
Bronchitis
Chronic obstructive pulmonary disease
Cystic fibrosis
Primary ciliary dyskinesia

Diffuse parenchymal lung disorders

Granulomatous disorders (e.g., sarcoidosis)
Diffuse disorders of a known cause:
- connective tissue disease-related lung disease
- drug-induced (medications and drugs of abuse) pneumonitis
- inflammatory bowel disease-related lung disease
- inflammatory myopathy-related lung disease
- organising pneumonia
Hypersensitivity pneumonitis
Idiopathic interstitial pneumonias:
- acute interstitial pneumonia
- cryptogenic organising pneumonia
- desquamative interstitial pneumonia
- idiopathic nonspecific interstitial pneumonia
- idiopathic pulmonary fibrosis
- respiratory bronchiolitis interstitial lung disease
Interstitial pneumonia with autoimmune features

End-stage lung disease and transplantation

Chronic hypoxic and/or hypercapnic respiratory failure
Lung transplantation
Severe pulmonary hypertension with right heart failure / core pulmonale

Environmental and occupational lung disorders

Pneumoconiosis:
- asbestos-related lung disease
- coal workers’ pneumoconiosis
- farmer’s lung
- silicosis

Pulmonary infections

Latent tuberculous infection
Non-tuberculous mycobacterial infections
Recurrent infections or pathogen colonisation in persons with underlying structural lung or airways disease or underlying immunocompromise

Pulmonary vascular disorders

Pulmonary embolic disease
Pulmonary hypertension (as per WHO classification)
Pulmonary vasculitides

Smoking-related lung disorder

Lung disease related to:
- marijuana
- tobacco
- vaping

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Diffuse parenchymal lung disorders

Alpha-1 antitrypsin disease
Eosinophilic lung diseases
Lymphangioleiomyomatosis
Lymphocytic interstitial pneumonia
Pulmonary alveolar proteinosis and granulocyte-macrophage colony-stimulating factor auto-antibody disease
Pulmonary amyloidosis
Pulmonary Langerhans cell histiocytosis

Environmental and occupational lung disorders

Indoor and outdoor pollution-related lung injuries
Other exposure-related lung disease

Large airways disorders

Subglottic stenosis
Tracheal stenosis
Tracheobronchomalacia, including excessive dynamic airway collapse
Tracheo- and broncho-oesophageal fistula

Pulmonary vascular disorders

Diffuse alveolar haemorrhage syndromes
Pulmonary vascular anomalies, including arteriovenous malformations

Systemic disorders with pulmonary overlap

Chronic liver disease
Histiocytic disorders
Nonspecific airway changes, including lymphocytic bronchiolitis, lymphoid hyperplasia, and mild constrictive changes
Ovarian hyperstimulation syndrome
Telomere disorders
Trafficking and lysosomal storage disorders

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Diffuse parenchymal lung disorders

Understanding of epidemiology, knowledge of heterogeneity in clinical, radiological, and histological presentations, and appreciation of multimodality assessment and multidisciplinary discussion in appropriate diagnosis and management of interstitial pneumonias

Environmental and occupational lung disorders

Application of epidemiological risk factors in assessment and screening of persons suspected of having exposure-related or occupational lung disease

Pulmonary infections

Apply local epidemiology of prevalence of microbes and drug susceptibility patterns in aiding appropriate diagnosis and management avenues, e.g., appropriate antimicrobial treatment for latent tuberculous infections

Small airways disorders

Epidemiology of airways disorders, and causative risk factors
Pathophysiology and genetics of cystic fibrosis, including knowledge of systemic manifestations, assessments of severity, and management approaches, including use of CFTR modulators
Principles of pathophysiological mechanisms and pharmacological management of airways disorders

Investigations

Blood gas analysis, including interpretation of arterial, venous, and capillary samples
Capnography, including exhaled and transcutaneous samples
Lung function tests:
- bronchial provocation testing, including direct and indirect methods
- bronchodilator response
- calculations of shunt fraction
- cardiopulmonary exercise testing
- diffusion assessment
- forced oscillometry testing
- fraction of exhaled nitric oxide
- high altitude simulation tests
- lung volume assessment techniques
- respiratory muscle testing, including maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressures, supine spirometry, and cough peak flow
- six-minute walk test
- spirometry, including office / bedside testing
Oximetry, including continuous / overnight studies
Polysomnography:
- address the benefits and limitations of different levels of polysomnography testing
Positive airway pressure device downloads
Radiological investigations:
- chest CT scan
- chest MRI
- chest x-ray
- contrast swallow tests
- fluoroscopy
- oesophageal manometry and pH monitoring
- right heart catheterisation and haemodynamic measurements (basic knowledge and interpretation)
- scintigraphy / nuclear medicine tests, such as:
  - PET with / without integrated CT
  - ventilation / perfusion scans
- ultrasonography:
  - doppler ultrasound imaging and flow studies
  - thoracic and pleural ultrasound
  - trans-thoracic echocardiography
Serological, cytological, histological, and ancillary testing for primary lung disease and systemic disorders with pulmonary overlap

Procedures

Bronchoscopy, including endobronchial ultrasound (linear and radial modalities), flexible bronchoscopy (including single use), rigid bronchoscopy:
- advanced therapeutic modalities, such as APC, cryotherapy, and Nd-YAG laser
- bronchoscopic drug delivery
- brushings
- collateral ventilation assessment
- cryobiopsy
- cytology and microbiology from washings / bronchoalveolar lavage fluid
- fine needle aspiration
- forceps bronchial and transbronchial biopsy
- large airway debulking or stent placement
Pleural:
- Procedure techniques:
  - ambulatory and underwater seal drainage
  - indwelling tunnelled pleural catheter
  - large bore drain insertion
  - needle thoracentesis
  - small bore intercostal catheter insertion
  - thoracoscopy
- Therapeutic interventions:
  - intrapleural fibrinolysis and irrigation
  - pleural fluid drainage
  - pleurodesis

Apply knowledge of genetics and pathophysiology of cystic fibrosis, and of evidence-based and guideline recommendations in the treatment and management of and in the prescription of CFTR modulator therapy for persons with cystic fibrosis
Apply national and international evidence-based guidelines towards achieving optimal patient care
Australian / Aotearoa New Zealand and local context and resource availability for delivering inpatient and outpatient personalised care
Inter-relationships between systemic disorders, comorbidities, and pulmonary diseases and their impacts on presentation and treatment options
Provide appropriate evidence-based prescription of preventive inhaler therapy for management of chronic airways disease
Pulmonary rehabilitation:
- apply knowledge of components of a successful pulmonary rehabilitation program
- apply knowledge of evidence base supporting pulmonary rehabilitation in COPD and other lung diseases
- select patients most likely to benefit from pulmonary rehabilitation
Role of advanced care planning, multidisciplinary care, pharmacotherapy, supplemental oxygen and positive airway pressure, and transplantation in management of severe or end-stage chronic respiratory disorders
Role of chest physiotherapy techniques in management of sputum clearance
Role of community and integrated care pathways in providing integrated care of chronic respiratory disease
Role of multidisciplinary teams and various subspecialty practitioners in diagnostic and therapeutic elements of patient care
Role of shared decision making in management of chronic respiratory disorders
Role of various bronchoscopic techniques and lung biopsies in achieving diagnostic and therapeutic outcomes for undifferentiated and established diagnoses
Understand the evidence base and provide appropriate prescription of domiciliary oxygen with use of appropriate interface and delivery devices
Understand the importance of timing, forward planning, and principals of treatments for patients with respiratory disease in relation to palliative care referral. Further understand the indications and importance of patient selection of who will benefit from palliative care involvement.

LG18: Thoracic tumours, including mediastinal diseases

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

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.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

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.

View

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.

View

Presentations

Cough
Dyspnoea
Extrapulmonary complications of malignancy:
- acute neurological change
- acute spinal cord compression
- central airway obstruction
- oesophageal obstruction / tracheo-oesophageal fistula
- paraneoplastic phenomenon
- pathological fracture
- SVC obstruction
- venous thromboembolism
Haemoptysis
Incidental pulmonary nodule or mass
Pleural effusion
Weight loss
Wheeze / Stridor

Conditions

Epithelial tumours:
- adenocarcinomas
- adenomas
- adenosquamous carcinomas
- large cell carcinomas
- other epithelial tumours
- papillomas
- precursor glandular lesions
- salivary gland-type tumours
- sarcomatoid tumours
- squamous cell carcinomas
- squamous precursor lesions
Haematolymphoid tumours, (e.g., diffuse large B cell lymphoma, Langerhans cell histiocytosis)
Lung neuroendocrine neoplasms:
- neuroendocrine carcinomas
- neuroendocrine tumours
- precursor lesion
Mediastinal tumours:
- chest wall tumours (e.g., neurofibromas)
- mediastinal germ cell tumours
- mesenchymal neoplasms
- thymic carcinomas, thymic neuroendocrine tumours, and thymomas
Mesenchymal tumours specific to the lung
Metastatic pulmonary tumours
Pleural malignancy:
- mesothelioma
- metastatic disease
- primary lung malignancy
Tumours of ectopic tissues (e.g., melanoma, meningioma)

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Presentations

Extrapulmonary complications of malignancy:
- acute cord compression
- acute neurological change
- oesophageal obstruction
- paraneoplastic phenomenon, including:
  - hyponatraemia
  - neurological change (e.g., Lambert–Eaton syndrome, seizure activity)
- pathological fracture
- SVC obstruction

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Cause and classification of lung tumours according to WHO criteria
Compare and contrast investigations for staging of lung cancer, including the role of PET-CT and mediastinal lymph node sampling (EUS, EBUS and surgical techniques)
Principles of screening for lung cancer, and assess suitable patients for low dose CT screen based on evidence-base and local funding:
- incorporate the role of smoking and vaping cessation counselling, management of concurrent respiratory disease, vaccinations, and pulmonary rehabilitation in management of patients identified for screening
Role of diagnostic procedures including bronchoscopy, endobronchial ultrasound, pleural fluid cytology and thoracoscopy, surgical biopsy, as well as emerging modalities including liquid biopsy
Staging and prognosis of lung cancer, including the role of genetic factors, according to IASLC criteria

Investigations

Advanced testing for serological, cytological, and histological samples:
- basic staining, slide preparation and interpretation of cytological (e.g., EBUS) samples
- flow cytometry
- immunohistochemistry, fluorescent in situ hybridisation, PCR, and next generation sequencing techniques
- liquid biopsy
Lung function tests for peri-operative assessment
Radiological investigations:
- chest CT scan
- chest MRI
- chest x-ray
- fluoroscopy
- PET with / without integrated computer tomography
- ultrasonography

Procedures

Bronchoscopy including endobronchial ultrasound (linear and radial modalities), flexible bronchoscopy (including single use), and rigid bronchoscopy:
- advanced therapeutic modalities, such as APC, cryotherapy, and Nd-YAG laser
- bronchoscopic drug delivery
- brushings
- cryobiopsy
- cytology and microbiology from washings / bronchoalveolar lavage fluid
- fine needle aspiration
- forceps bronchial and transbronchial biopsy
- large airway debulking or stent placement
Pleural:
- Procedure techniques:
  - ambulatory and underwater seal drainage
  - anaesthesia (local, regional, and general approaches)
  - closed pleural biopsy
  - indwelling tunnelled pleural catheter
  - large bore drain insertion
  - needle thoracentesis
  - small bore intercostal catheter insertion
  - thoracoscopy
  - therapeutic interventions:
    - intrapleural fibrinolysis and irrigation
    - pleural fluid drainage
    - pleurodesis

Define performance status, clinical frailty scores, operability, and respectability, and apply appropriately towards patient care
Identify and engage community supports and services
Role of multidisciplinary care, palliative care, and psychological support for holistic management of patients with thoracic malignancy
Understand the function and have first-hand experience attending and presenting patients at lung cancer multidisciplinary team meetings
Understand the indications, benefits, risks, and diagnostic yield of various diagnostic modalities, and utilise appropriately for investigation and management of peripheral pulmonary lesions

LG19: Pleural disorders

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

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.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

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.

View

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.

View

Presentations

Chest pain / Pleurisy
Cough
Dyspnoea
Fever
Hypoxia
Pleural effusion
Pleural plaque
Pleural thickening
Pneumothorax
Tachypnoea

Conditions

Conditions with risk of pleural effusion

Predominantly exudative processes:
- benign asbestos-related pleural effusion
- chyle leak
- connective tissue disease-related pleural effusion
- infections
- malignancy - primary lung, metastatic disease, pleural mesothelioma
- oesophageal rupture
- pancreatitis
- post-pulmonary embolism with infarction
- yellow nail syndrome
Predominantly transudative processes:
- congestive cardiac failure
- hypoalbuminemia
- liver cirrhosis hypothyroidism
- renal disease (nephrotic syndrome, peritoneal dialysis)

Conditions with risk of pneumothorax

Cystic lung disease:
- Burt-Hogg-Dube syndrome
- Langerhans cell histiocytosis
- Lymphangioleiomyomatosis
- lymphocytic interstitial pneumonia
Emphysema / Bullous disease
Iatrogenic pneumothorax:
- procedure-related
- barotrauma
Interstitial lung disease
Marfan syndrome and other connective tissue disorders

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Presentations

Non-expanding / Trapped lung
Persistent air leak
Recurrent undifferentiated effusion

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Diagnostic and therapeutic indications for pleural procedures
Investigations to differentiate between transudates and exudates
Normal anatomy and physiology of the pleura and pleural space
Normal biochemistry of pleural fluid

Investigations

Assessment of severity of air-leak using analogue meters or digital drainage systems
Chest X-Ray
CT of the chest, including pleural phase CT
PET
Pleural biopsy for culture and histopathology specimens, including closed pleural biopsy, image-guided and thoracoscopic approaches
Pleural fluid analysis, including biochemistry, cultures, cytology, PCR, and investigational approaches, including liquid biopsy
Serological testing for primary pleural pathology and systemic disorders of interest
Thoracic and pleural ultrasound

Procedures

Procedure techniques:
- anaesthesia (local, regional, and general approaches)
- closed pleural biopsy (Abrams and image-guided)
- indwelling tunnelled pleural catheter insertion and removal
- large bore intercostal catheter insertion
- management of rare but life-threatening complications of pleural procedures (e.g., intercostal artery laceration and visceral injuries)
- needle thoracentesis
- small bore intercostal catheter insertion
- thoracoscopy
- underwater seal drainage systems (including digital ambulatory systems)
Therapeutic interventions:
- advanced management of persistent air leak, including blood patch pleurodesis, endobronchial interventions, and talc insufflation
- indications and knowledge of surgical options in the management of pleural infection (washout +/- decortication)
- indications and knowledge of surgical options in the management of pneumothorax
- one-way valve systems, such as Heimlich valve
- pleural fluid drainage
- pleural infection management, including intrapleural fibrinolytic plus mucolytic (tPA + DNase) therapy and saline irrigation
- pneumothorax management, including pleurodesis (talc slurry and poudrage)

Ability to identify, manage and troubleshoot chest drains
Appropriately diagnose complicated pleural effusions and empyema based on clinical, radiological, and biochemical markers, and manage with pleural interventions, including intercostal catheter insertion, irrigation, fibrinolytic +/- mucolytic therapy or surgical options, as guided by evidence base and guidelines
Demonstrate competence in thoracic / pleural ultrasound and pleural interventions prior to independently performing procedures
Incorporate knowledge of pleural fluid physiology, and benefits and drawbacks of Light’s criteria and Heffner’s rules, in classifying pleural effusions and providing differential diagnoses for aetiology
Interpret evidence-base and manage various presentations of pneumothorax, including primary spontaneous pneumothorax, secondary spontaneous pneumothorax, iatrogenic pneumothorax, persistent air-leak, and non-expanding / trapped lung
Knowledge of digital drainage systems
Risks and benefits of each of the diagnostic and therapeutic interventions
Role and limitations of pleural fluid biochemistry, cultures, and cytology in diagnosing aetiology of pleural effusions, and appropriately consider advanced testing (e.g., biopsy, PCR) for further investigations as required
Understand limitations of cytology in diagnosis of pleural mesothelioma, and incorporate evidence-base for novel biomarkers as well as knowledge of imaging and biopsy techniques in diagnosis

LG20: Respiratory failure, including sleep-disordered breathing

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

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.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

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.

View

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.

View

Presentations

Acute hypercapnia
Acute-on-chronic and chronic hypercapnia
Chest pain
Chest tightness
Dyspnoea
Hypoxaemia
Nocturnal hypoventilation
Orthopnoea
Sleep-disordered breathing
Snoring
Somnolence
Sputum production
Tachypnoea
Wheeze

Conditions

Acute pulmonary oedema and left-heart failure
Central sleep apnoea syndromes
Chest wall disorders, including kyphoscoliosis
Chronic obstructive pulmonary disease
Decompensation
High spinal cord injuries
Neuromuscular diseases, including motor neurone disease
Obesity hypoventilation syndrome
Obstructive sleep apnoea
Sedative / Drug-induced hypoventilation

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Conditions

Central disorders of ventilation:
- brainstem disease
- cerebral palsy
- congenital central alveolar hypoventilation, and other disorders of ventilatory control
- encephalitis
- hypothyroidism
- paraneoplastic phenomena
- stroke
Respiratory muscle disorders:
- cervical spine injury
- Guillain-Barré syndrome
- muscular dystrophy
- myasthenia gravis
- myotonic dystrophy
- phrenic nerve or diaphragmatic palsy
- poliomyelitis
- polymyositis
Thoracic cage disorders:
- ankylosing spondylitis
- chest trauma, flail chest
- pectus excavatum
- thoracoplasty

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
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

Pathophysiological mechanisms of hypercapnic respiratory failure, and apply these towards obtaining diagnoses, and tailoring personalised treatment options and prescriptions:
- comorbid role of left heart failure in contributing towards acute hypercapnia
- differentials for normal versus high A-a gradient in workup of undifferentiated hypercapnia
Recognise the often-multifactorial contributors towards acute hypercapnic respiratory failure, and the significant morbidity and mortality associated with this presentation

Core investigations

Blood gas analysis, including interpretation of arterial, venous, and capillary samples
Capnography, including exhaled and transcutaneous samples
Chest x-ray
CT scan, including high resolution protocols
Diagnostic sleep studies (level 1-3 sleep studies)
Fluoroscopy for diaphragmatic assessment
Lung function tests:
- cough peak flow
- gas transfer assessment
- plethysmography
- respiratory muscle testing, such as maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressures
- spirometry (erect and supine)
Oximetry, including continuous / overnight studies (level 4 sleep study)
Positive airway pressure device downloads
Relevant serological biomarkers

Investigations (understand basics for interpretation)

Electrocardiography and Holter monitoring
Lumbar puncture
Maintenance of wakefulness tests and mean sleep latency tests
MRI
Nerve conduction studies / electromyography
Pleural / Diaphragmatic ultrasound
Polysomnography, including positive airway titration studies
Relevant histological biomarkers (e.g., muscle biopsy)
Trans-thoracic echocardiogram

Appreciate novel therapies in the area of motor neurone disease and muscular dystrophies
Appreciate the circuitry for acute and chronic non-invasive ventilation (NIV), with appreciation of the role of correct mask interface and controlled leak in delivering effective therapy
Appreciate the role of multidisciplinary teams (e.g., respiratory failure service, MND team, sleep trained physicians) and additional subspecialties (e.g., neurology, palliative care) in providing comprehensive care to patients with hypercapnic respiratory failure
Be able to identify the significant factors contributing towards undifferentiated or first presentation of acute hypercapnia, and integrate all into the management approach
Differentiate the need for acute only versus chronic NIV, based on evidence base (e.g., chronic obstructive pulmonary disease, obesity hypoventilation)
Identify bulbar involvement in motor neurone disease, and approach management accordingly
Identify patients suitable for invasive ventilation, non-invasive ventilation and supportive care
Identify poor NIV tolerance or suboptimal comfort, and troubleshoot to improve patient experience and usage
Referral to sleep trained physicians for patients with complex respiratory failure and non-respiratory sleep disorders
Utilise blood gas analysis, oximetry, capnography, polysomnography, and lung function tests in determining suitability of commencing NIV for a spectrum of respiratory failure disorders

Site:	RACP Online Learning
Course:	Advanced Training Curricula
Book:	Curriculum standards

Printed by:	Guest user
Date:	Friday, 29 August 2025, 7:46 AM

Description

Advanced Training in Respiratory Medicine

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

13

14

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour