Curriculum standards

About this resource

The new Advanced Training in Sleep Medicine (Paediatrics & Child Health) curriculum consists of curriculum standards and learning, teaching, and assessment (LTA) programs.

This document outlines the curriculum standards for Advanced Training in Sleep Medicine (Paediatrics & Child Health) for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Sleep Medicine (Paediatrics & Child Health) 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.

For more information or to provide feedback contact curriculum@racp.edu.au.

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 all or most 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, nonspeaking, and written 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 learning¹ and evaluating evidence.

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

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. Contribute 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 the families, communities and populations in a caring and respectful manner.

Physicians demonstrate their commitment and accountability to the health and well-being 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 patients’ 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 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 limitations 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 health care 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.

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 health care 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

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 and families or 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 activities within systems to reduce errors, improve patient and population safety, and implement cost-effective change
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 multidisciplinary 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 knowledge and skills, 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 discussions 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 to achieve 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 and 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

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 patient 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
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
remove self-interest from solutions to health advocacy issues

direction
Requires some supervision

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

The trainee may:

understand methods used to allocate resources to provide high-quality care
lead 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/or different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication

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 learnt 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 supervise professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessment 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 learner needs
implement teaching and learning activities that are misaligned to learning goals

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 projects’ goals and requirements, and provide feedback on 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 appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural competence
encourage learners to consider culturally appropriate care of Aboriginal and Torres Strait Islander and Māori peoples in 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 communicating 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 performances and continuing professional development
maintain professional, clinical, research and/or administrative responsibilities while teaching
create an inclusive environment whereby the learner feels part of the team
help to 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:

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
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, high-quality, easy-to-understand 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 organisations’ 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 action preventative action plans
participate in systems for surveillance and monitoring of adverse events and ‘near misses’, including reporting such events
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 patient 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 effectively with patients from culturally and linguistically diverse 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:

contribute to developing an organisational culture that enables and prioritises patients’ safety and 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 care 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:

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 that 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:

support the development, implementation, evaluation, and monitoring of governance processes
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:
- clinical, and safety and quality education and training
- defining the scope of clinical practice
- performance monitoring and management

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
elicit a comprehensive sleep-specific history consistent with the appropriate neuro-maturational stage of the child
perform full physical examinations to establish the nature and extent of problems
demonstrate expertise in assessing sleep presentations, both respiratory and non-respiratory, taking into consideration the developmental status of the child
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses via reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, and clinical outcomes
organise investigations appropriate for the child’s clinical presentation, and demonstrate understanding of the different investigative modalities
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account
develop skills for continuing management of children needing ongoing care, and demonstrate the ability to adapt the management plan with the child’s development
understand comorbidities that contribute to the presentation, and tailor assessments and management plans accordingly
develop management plans for children needing ongoing care / treatment with technology, such as continuous positive airway pressure (CPAP) / non-invasive ventilation (NIV), and demonstrate an understanding of the natural history of conditions

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, their family, and/or carers to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
demonstrate effective communication with the family that is child-centric, taking into consideration unique developmental scenarios

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 the 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:

set unclear goals and objectives for self-learning
self-reflect infrequently
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 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:

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 a proxy decision maker 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
consider comorbidity, uncertainty, and risk when making clinical decisions
consider the psychosocial and sociocultural context of patients and families in decision making
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
present and discuss complicated cases within a multidisciplinary team to help direct clinical management
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 available resources
advocate for policies that would enhance sleep health through childhood and adolescence

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 health 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 patients’ 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 situations
recognise clinical deterioration, and respond by following the local process for escalation of care

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:

assist patients from early adolescence to prepare for transfer to adult care at an appropriate age
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
recognise seriously unwell patients requiring immediate care

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 transitions 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 effective transitions between settings, and continuity and quality of care
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:

identify patients at risk of 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
maintain up-to-date certification in advanced life support

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
raise appropriate issues for review at morbidity and mortality meetings

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
educate adolescents and young adults about their conditions and their impacts on their lives
consider the involvement of parents or carers in the education process

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 may:

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
negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems

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 colleagues

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
recognise the need for escalation of care, and escalate to appropriate staff or services

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
recognise and work collaboratively with other health care providers, including allied health workers and psychologists

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 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
connect patients with local or online peer support groups

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
understand the systems for the escalation of care for deteriorating patients

LG7: Longitudinal care

Learning Goal 7

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 patient and/or families/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, families, and/or carers contribute to needs assessments and care planning
develop skills for continuing management of children needing ongoing care, and demonstrate the ability to adapt management plans with the child’s development
understand comorbidities that contribute to presentations, and tailor assessments and management plans accordingly
develop management plans for children needing ongoing care / treatment with technology, such as continuous positive airway pressure (CPAP) / non-invasive ventilation (NIV), and demonstrate an understanding of the natural history of conditions
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 histories, examinations, and management plans 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:

encourage patients’ self-management through education to take greater responsibility for their care, where appropriate, and support problem solving
provide graded autonomy for older children / adolescents in participating in their care
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, and motivate them to comply with agreed care 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 that impact 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 and parents of carers 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 long-term health care journeys

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 patients’ care journeys
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

LG8: Communication with patients

Learning Goal 8

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 mutually agreed management plans
verify patients, family members’, or carers 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 and their carers may have about their conditions and/or risk factors
inform patients and carers 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 their carers, and plan management in partnership with them
provide information to patients and their carers to enable them to make informed decisions about diagnostic, therapeutic, and management options
recognise when to refer patients to psychological support services

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 clinical problems 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’ and carers’ views, concerns, and preferences, promoting rapport
provide information to patients and their carers in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients and their carers to share their thoughts or explain their management plan in their own words, to verify understanding
convey information considerately and sensitively to patients and their carers, seeking clarification if unsure of how best to proceed
convey information in an age-appropriate manner (including using resources such as illustrations and videos)
treat children and young people respectfully, and listen to their views
provide graded autonomy for children / adolescents to participate in their care
recognise the role of family or carers and, when appropriate, encourage patients to involve their family or carers in decisions about their care
empower the adolescent or young adult to be responsible for their own compliance with treatment and timely medical reviews, self-care and independence

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’ understandings of information
adapt communication styles 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 and their carers 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 young people’s capacity for decision making and informed consent, taking into consideration their age and maturation
recognise and take precautions where patients may be vulnerable, such as issues of child protection or self-harm
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 assessment 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 NZ
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 and their carers to be well informed about the patient’s 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 and their carers
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:

role model excellent communication to other health professionals and students
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 patients with 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 and their carers 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

LG9: Prescribing

Learning Goal 9

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’ disorders requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patients' preference prior to prescribing a new medication
plan for follow up and monitoring
demonstrate awareness of different formulations of common medications, and consider appropriate formulation (including most appropriate routes of administration) and/or strength
recognise the impacts of age and metabolism on the absorption, distribution, and excretion of medicines

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 understanding of the rationale, risk and benefit, 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 and their parents or carers
write clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
educate patients and their parents or carers 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
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 them in patients’ medical records

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 and/or their carers understand management plans, including 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 that 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’ and their parents’ or carers’ understanding of, and preferences for, non-pharmacological and pharmacological management
offer patients and their parents or carers 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:
- how to take the medicine
- potential side effects
- what it does
- what it is for
- when it should be stopped
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 will benefit 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
work collaboratively in a multidisciplinary team for non-pharmacologic treatments for sleep disorders

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 health care 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

LG10: Investigations

Learning Goal 10

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

select, plan, and use 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

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 timings
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
demonstrate understanding of the channels in polysomnography (PSG), and be able to set up a child for PSG
score PSG for children of all ages and be able to score sleep stages, respiratory events, and other signals as per the current international / national guidelines
develop and demonstrate expertise in conducting titration sleep studies in children needing continuous positive airway pressure (CPAP) or bilevel support, and understand the longitudinal needs in relation to respiratory support
perform and interpret multiple sleep latency tests (MSLTs), and understand the clinical indication for this test
understand the role of abbreviated sleep testing, such as level 2 to 4 studies, and be able to demonstrate the role of such investigations in clinical practice
demonstrate understanding of other sleep medicine tools, such as actigraphy, sleep diaries, and paediatric sleep-related questionnaires and assessment tools

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 patients 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' and parents’ or carers’ 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
establish rapport with the child and family, and explain the nature and length of the tests to be conducted
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 proposed investigations, focusing on patients’ individual situations
ensure quality control of the investigations performed are up to current standards

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

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 and their parents or carers, where applicable, 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 and preferences about any proposed investigation and the adverse outcomes they are most concerned about

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 and their parents or carers (except for emergencies)
discuss with patients and their parents or carers 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 and parents or carers there may be additional costs, which they may wish to clarify before proceeding
explain the expected benefits, as well as the potential burdens and risks, of proposed investigations 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
practice within current ethical and professional frameworks
practice within own limits, and seek help when needed
involve patients in decision making regarding investigations, obtaining the appropriate informed consent, including financial consent, if necessary

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 investigations 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

LG11: Clinic management and procedures

Learning Goal 11

Clinic management

Manage an outpatient clinic and plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

manage medical procedures and treatments
ensure appropriate procedures are selected in partnership with patients, their families, and/or carers
obtain informed consent
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 timeframe appropriate to the clinical situation of patients
select procedures by assessing patient-specific factors, risks, benefits, and alternatives
confidently and consistently perform a range of common procedures
perform inpatient consultation of sleep problems in children who have complex syndrome or multisystem involvement, and devise management plans

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of the importance of prevention, early detection, health maintenance, and chronic condition management
assess patients and identify indications for procedures
perform a range of common procedures
check for allergies and adverse reactions
consider risks and complications of procedures

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 and their families navigate the healthcare system to improve access to care by collaboration with other services, such as community health centres and consumer organisations
link patients and their parents or carers to specific community-based health programs and group education programs
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, or carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices

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 communication and language 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

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
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

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
participate in continued professional development

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 and their parents or carers 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 serving, 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
understand institution / department protocols and ethical practices and guidelines around performing procedures
if required to perform procedures, do so in accordance with institution / department protocols and ethical practices and guidelines

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
understand institution / department protocols and ethical practices and guidelines around performing procedures
identify roles and optimal timings for diagnostic procedures
critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on a waiting list

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
prioritise which patients receive procedures first (if there is a waiting list)
assess personal skill level, and seek help with procedures when appropriate
use tools and guidelines to support 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:

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 colleagues
support colleagues who raise concerns about patients’ safety
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

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
ensure all relevant team members are aware that a procedure is occurring

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 the 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

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

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.

LG12: Scientific foundations of sleep medicine (including investigations and measurements)

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 tdescribe the underlying rationale, the indications for using one test or method over another, and the calculations required tgenerate descriptive statistics.

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 tinterpret the reported results of each investigation or procedure.

Advanced Trainees will know how texplain the investigation or procedure tpatients, families, and carers, and be able texplain 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, management, and outcomes.

View

Pathophysiology of normal and abnormal sleep

Anatomy and physiology of upper airway
- Changes of the above with age and maturity, from the neonatal period through adolescence
- Concept of the pharyngeal airway as a collapsible tube
- Dynamic behaviour of the pharynx during breathing, when awake and asleep, and the concept of critical pressure
- Effects of craniofacial structure, obesity, upper airway muscle function, and ventilatory control on upper airway patency
- Effects of nasal resistance on pharyngeal collapsibility
- Role of upper airway muscles in the control of breathing when asleep and awake
- Structure and functions of the upper airway
Physiology of sleep and breathing
- Breathing changes during sleep, and REM versus NREM sleep
- Control of breathing during sleep:
  - central and peripheral chemoreceptors, and hypoxic and hypercapnic ventilatory responses
  - central pattern generator as the basis for respiratory control
  - effect of sleep on respiratory neurons
  - neuroanatomical and neurophysiologic basis of control of breathing
  - normal expected changes with age and development, including the effects of prematurity on these systems
  - peripheral and central afferents and inputs
- Effect of sleep on breathing in respiratory and neuromuscular diseases
- Effect of sleep on other systems, including cardiovascular, gastrointestinal and neurological disease (such as decreased seizure threshold in NREM sleep in some epilepsy syndromes)
- Explain the mechanics of breathing in a child / adolescent
Sleep and circadian neurophysiology
- Anatomy and physiology of the circadian system
- Circadian, homeostatic, and ultradian processes that underpin sleep
- Circulating hormones and inflammatory cytokines’ impact on sleep-wake patterns
- Cultural, physical environmental, and social factors’ impact on sleep
- Distinctions between REM and NREM sleep
- Effects of sleep deprivation in terms of health and daytime functioning
- Impact of circadian and homeostatic systems on sleep-wake cycles and propensity daytime sleepiness
- Influence of NREM and REM sleep and sleep arousal on cardiovascular, endocrine, gastrointestinal, and respiratory physiology, and the neurohormonal and circadian factors that might underpin these effects on different biological systems, such as the understanding of why asthma is worse in sleep
- Influence of NREM and REM sleep and sleep arousal on the autonomic nervous system
- Interactions between sleep and wakefulness and the sensory nervous system, perception and cognition, the cardiovascular system, temperature regulation, and the endocrine system
- Molecular and neural basis of the circadian system
- Neuroanatomical and neurophysiological basis for arousal from sleep
- Neuroanatomical, neurobiological, and neurophysiological basis for sleep and wakefulness and for REM versus NREM sleep
- Normal sleep architecture, including the current classification of sleep stages, normal arousal patterns, and normal sleep movements
- Ontogeny of sleep and breathing irregularities in sleep
- Psychophysiology of the drowsy state
- Sleep stages
- Sleep structure and sleep architecture changes with age, from the neonatal period through adolescence

Assessment tools

Actigraphy
Computerised polysomnography (PSG) systems
Hardware and software of the computerised equipment used in a sleep service
Scoring of:
- arousals
- cardiac events
- movements
- respiratory events
- sleep
Sensor devices used measure physiological variables as part of sleep studies
Sleep diaries
Sleep monitoring equipment

Procedures / Treatments

Compliance monitoring (remotely or locally)
Mask fitting, including acclimatisation, and troubleshooting for positive airway pressure (PAP) therapy
Medication
Non-pharmacological treatment, such as cognitive behavioural therapy for insomnia (CBT-I)

Sleep measurement and investigations

Indications for sleep investigations:
- circumstances when sleep investigations are not indicated
- clinical features, mechanisms, and specific measurements of common sleep disorders
- common questionnaire measurements of sleepiness and quality of life scores, and know the limitations of these measurements
- effects of medications and comorbidities, such as psychiatric and medical conditions and lifestyle, on sleep-wake patterns, and how these factors can affect measurements of sleep propensity
- indications and use of tests for sleep propensity
- indications for investigation with type I-IV devices
- the role of (PSG) in sleep disorders that are predominantly behavioural
- what measurements are possible and appropriate for disorders listed in the International Classification of Sleep Disorders (ICSD-3)
Principles of measurement parameters:
- basic principles underlying the recordings of bioelectrical signals, such as appropriate filters, frequency, understanding of common artefacts in PSG
- measurements across the range of sleep studies, and determine adequacy of recording techniques
- measurements indicated for further evaluation in the event of a non-diagnostic sleep study
PSG recording, including normal and abnormal patterns:
- age-appropriate normal sleep stage distribution and proportions
- arousals
- infant sleep scoring versus standard paediatric sleep scoring
- periodic limb movements (PLMs)
- raw data from sleep studies, including:
  - airflow parameters
  - airway pressures
  - body position
  - chin electromyography
  - effort parameters
  - ECG
  - electroencephalogram (EEG)
  - electro-oculogram (EOG)
  - leg electromyography derivations
  - measures of CO2 (end tidal versus transcutaneous and their pros and cons)
  - oxygen saturation
- REM sleep without atonia (RSWA)
- respiratory events:
  - apnoeas – central, mixed, and obstructive
  - hypopnoeas
  - respiratory effort related arousals
- scoring criteria, and recognising how different scoring criteria may alter results and therefore interpretation of severity

The use of scoring concordance software

Appropriateness of performing sleep investigations based on clinical features
Brain CT scan
Brain MRI scan
Cephalometry
Chest x-ray
Continuous oximetry and measurements of CO2 in sleep
Diaphragmatic electromyography monitoring
Diaphragm testing (e.g. SNIFF test)
Drug-induced sleep endoscopy (DISE)
Limited channel sleep studies:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
- safety and technical limitations of studies performed in the home
Maintenance of wakefulness test (MWT)
Methods of measuring respiration during sleep
Multiple sleep latency test (MSLT)
Oesophageal pressure monitoring
PAP titration and review studies
PLMs
Questionnaire measurements for sleepiness and sleep disorders
Repeat investigations
Respiratory function tests to assess sleep breathing disorders:
- arterial blood gases (role of capillary and venous blood gas measurements)
- cardiopulmonary exercise testing, and other tests of ventilatory response
- fitness to fly / hypoxic challenge
- gas transfer
- lung volumes
- oximetry
- spirometry
- tests of respiratory muscle strength (including peak cough flow)
Sensitivity of the different measurements of respiration
Sleep investigation report
Sleep propensity tests
Upper airway imaging
Upper airway examination, including nasoendoscopy
Video and EEG during paroxysmal events at night

Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory to technical and other staff
Infection control and prevention of cross-infection
Influence of other disease processes on common measurement parameters, including:
- cardiovascular disease, such as heart failure
- chronic respiratory illness, such as cystic fibrosis
- epilepsy and its treatments, such as effect of antiepileptics on sleep EEG
- obesity
- prematurity
- respiratory muscle weakness
- stroke
Limitations and common parameters in sleep investigation
Referring (where appropriate), depending on sleep disorder (e.g., dentist, dietitian, neurologist, respiratory physician, sleep psychologist)
Teach patients, their families, health professionals, and the public about the nature and importance of normal sleep

LG13: Sleep-related breathing 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 thelp 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 tinterpret the reported results of each investigation or procedure.

Advanced Trainees will know how texplain the investigation or procedure tpatients, families, and carers, and be able texplain 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 intcare.

View

Presentations

Apnoeas / Gasping in sleep
Behavioural and learning problems
Cognitive impairment
Excessive sleepiness
Headaches
Impaired growth / failure thrive
Increased work of breathing
Mood changes
Poor concentration:
- cognitive impairment
- mood changes
Poor sleep quality
Snoring
Sudden waking with shortness of breath

Conditions

Sleep apnoea:
- central
- obstructive
- treatment – emergent central sleep apnoea, such as continuous positive airway pressure (CPAP) inducing central apnoea
Sleep hypoventilation disorders
Sleep-related hypoxemia disorders

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored tpatients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity, and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Conditions

Central sleep apnoea due high-altitude periodic breathing
Complex sleep apnoea
Congenital central alveolar hypoventilation syndrome
Late onset central hypoventilation with hypothalamic dysfunction, such as ROHHAD
Idiopathic central alveolar hypoventilation
Primary central sleep apnoea

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored tpatients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity, and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Assessment process for oxygen therapy
Association of excessive sleepiness and other daytime symptoms with sleep-disordered breathing (SDB) syndromes
At-risk populations including children / adolescents with Down syndrome, Prader-Willi syndrome, neuromuscular diseases and cerebral palsy
Central role of adenotonsillectomy in treating the majority of children with obstructive sleep apnoea (OSA), including other indications, contraindications, and predictors of postoperative compromise
Clinical diagnosis and management of OSA complicated by respiratory failure and/or right heart failure (e.g., where SDB overlaps with other diseases, such as gross obesity or neuromuscular disease)
Clinical features of OSA and the differential diagnoses of OSA symptoms
Delivery systems and use of oxygen therapy in CPAP and non-invasive positive pressure ventilation (NIPPV)
Epidemiology of SDB
Explain the effects of age, gender, obesity, and race on prevalence of SDB, and recognise lesser known associations
Indications and application of non-invasive versus invasive ventilation for hypercapnic respiratory failure
Indications and guidelines for use of oxygen therapy related sleep breathing disorders
Lifestyle implications of SDB
Other treatment options for OSA, including:
- CPAP
- lifestyle changes, such as weight loss
- oral appliances
- positional therapy
- upper airway or mandibular / maxillary surgery
Pathophysiology of SDB, including the different theories of causation of both central and OSA, and sleep hypoventilation syndromes
Physiology of ventilatory drive and gas exchange
Potential adverse effects of oxygen therapy
Public health implications of SDB, including impact on:
- cardiovascular morbidity and mortality
- cognitive performance, and emotional / psychological health
- diabetes, metabolic syndrome, obesity, and other comorbid medical conditions
Relative strengths and weaknesses of full polysomnography (PSG) versus limited sleep study systems for diagnosing and managing OSA
Role of cough assist devices and sputum clearance in patients with neuromuscular weakness
Role of high-flow nasal cannula (HFNC) therapy, especially in CPAP and bi-level positive airway pressure (BPAP) intolerant groups
Role of PSG and limited sleep studies in optimising non-invasive ventilator settings, patient-machine synchrony, and triggering and mask interface
Role of sleep studies in diagnosis, with reference techniques used for assessing relative contributions from upper airway obstruction versus ‘pump’ failure, and monitoring hypoventilation with transcutaneous CO2
Role of sleep-related hypoventilation in acute and chronic hypercapnic respiratory failure, including neuromuscular / chest wall disease, reduced central drive, and diseases that chronically increase respiratory load, such as obesity
Role of telemonitoring and remote monitoring of NIPPV in patients with hypercapnic respiratory failure
Role of tracheostomy in airway management
Role played by common contributors SDB in a clinical context
Use of NIPPV in managing both acute and chronic hypercapnic respiratory failure

Investigations

Assess and recognise typical and atypical features of sleep-disordered breathing
Distinguish between different causes of hypoventilation syndromes
Evaluate clinical investigations and circumstances formulate individual treatment strategies
Indication and limitations of oximetry in patients with SDB breathing, including importance of sampling rates and averaging time
Interpret PSG findings in patients on ventilatory support and make recommendations about treatment settings, including interpretation of pressure determination studies and instructions on how make adjustments
Interpret PSG study data, including oximetry and TcCO2
Measure oxygen saturation and arterial oxygen tension
Perform the relevant neurological, respiratory, cardiovascular, and general physical examinations
Recognise the role of multidisciplinary teams in the management of patients with hypoventilation syndrome, such as dieticians, neurologists, nurses, and physiotherapists
Recognise when patients’ symptoms are not consistent with a sleep breathing disorder
Select and interpret appropriate respiratory function tests and radiology investigations
Take a thorough sleep history from patients, as well as bed environment
Use and interpret the International Classification of Sleep Disorders (ICSD-3)

Procedures

Apply oxygen delivery systems, such as nasal prongs and masks
Assist with the management of weaning from a ventilator with NIPPV
CPAP:
- adjustment of device settings and cleaning procedures
- monitor patient progress and usage / compliance
- role of auto-titrating machines, such as automatic positive airway pressure (APAP) systems, and their limitations in paediatrics, especially in regard size of patients and tidal volumes
- selection and application of nasal and full-face masks
- trouble shooting treatment problems
- use of chin straps
- use of humidification in circuits
NIPPV:
- adjustment of device settings with an understanding of various modes and settings, including:
  - pressure control (PC)
  - spontaneous timed (ST)
  - volume assure pressure support (VAPS), such as iVAPS and AVAPS
- monitoring patient progress
- selection and application of masks
- troubleshooting treatment problems
- use of humidification circuits in NIPPV
Oral appliance therapy
PSG

Apply a multidisciplinary approach in the management of sleep-related breathing disorders
Assess the contribution of SDB respiratory failure, with particular reference nocturnal hypoventilation
Explain the public health implications of the high prevalence of SDB in a local context (hospital / local community) and on a national / international scale
Manage basic tracheostomy care, and refer for specialist assistance when indicated
Manage complications from hypercapnic respiratory failure, and/or heart failure
Manage CPAP side effects, and apply strategies timprove CPAP compliance
Manage the transition from in-hospital home care, applying knowledge of available support services and home care teams
Recognise the role of community, rehabilitation, and palliative care services in the management of patients with chronic respiratory failure
Recognise when referral another specialist is indicated
Weigh and synthesise history and examination information produce provisional and differential diagnoses, and formulate and undertake management plans

LG14: Central disorders of hypersomnolence

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

Changes to appetite or weight
Decreased energy
Difficulty concentrating
Difficulty waking up from sleep
Extreme daytime sleepiness (EDS)
Learning difficulties or behavioural problems
Memory and speech difficulties
Mood changes, such as anxiety and irritation
Paradoxical hyperactivity
School absenteeism
Sleeping more than average

Conditions

Hypersomnolence:
- hypersomnia associated with a psychiatric condition
- hypersomnia due to a medical condition
- idiopathic hypersomnia
- insufficient sleep syndrome
- narcolepsy type 1
- narcolepsy type 2

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

Synthesise

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

Manage

advocate and liaise with school authorities
involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Presentations

Disinhibited behaviours
Hallucinations

Conditions

Kleine–Levin Syndrome
Menstruation-related hypersomnia

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

Synthesise

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

Manage

advocate and liaise with school authorities
involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Behavioural and pharmacological strategies to manage EDS and the daytime consequences of sleep disorders
Clinical context in which limited channel sleep studies might be useful, including tests performed in the home
Clinical context in which multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) are indicated, and age-related limitations to these
Common causes of hypersomnia, including:
- behavioural factors
- environmental factors
- medical
- medication use
- primary sleep disorders
- psychiatric conditions
Common causes of persistent EDS in patients with treated obstructive sleep apnoea (OSA)
Contents of the International Classification of Sleep Disorders (ICSD-3)
Criteria for defining the severity of daytime sleepiness or inability to maintain wakefulness
Daytime neurocognitive consequences of abnormalities of sleep-wake regulation
Difference between fatigue, lethargy, tiredness, and sleepiness / drowsiness
Essential features of a sleep study report used in clinical decision making
Essential features of reports on tests of sleep propensity used in clinical decision making
Genetics, presentation, and treatment of narcolepsy
How disease states and medication use can affect sleep-wake regulation and EDS
Impact of drowsiness / sleepiness on school and home safety
Impact of MSLT and MWT findings on driving
Impact of sleep disorders on quality of life and behaviour
Important behavioural factors that influence subjective and objective sleepiness and neurocognitive function, such as chronic sleep restriction
Important role of actigraphy and sleep diaries as part of the evaluation
Indications for and the interpretation of common tests used in the evaluation of EDS and daytime consequences of sleep disorders
Lifestyle implications of EDS and other sleep disorders
Limitations of current available tests for assessment of EDS and daytime consequences of sleep disorders, and identify current research developments
Models of sleep deprivation and sleep disruption, and the effects on daytime function
Nature of the above tests, including details of how they are carried out
Normal neurobiology and neuropharmacology of sleep-wake regulation
Normative data for sleep architecture and tests of sleep propensity
Other medical conditions that are associated with EDS, such as myotonic dystrophy and Prader–Willi syndrome
Primary hypersomnias of central origin that are associated with EDS, including idiopathic hypersomnolence and narcolepsy
Range of limited channel sleep studies available
Recognise the actions of centrally acting pharmacological agents and their interactions with sleep
The role of questionnaires and sleepiness scales in children

Investigations

Assess severity of daytime consequences of sleep disorders
Identify EDS or inability to maintain wakefulness based on tests of sleep propensity
Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG
- electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
Interpret results of investigations regarding EDS and daytime consequences of sleep disorders in the clinical context of the patient
Perform a thorough history, examination, and sleep-specific assessment, including the use and limitations of sleepiness questionnaires with children
Perform the relevant general physical, neurological, and respiratory examinations
Synthesise patients’ symptoms and signs into comprehensive differential diagnoses, and plan further investigations if needed
Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time

Procedures

Actigraphy
MWT
MSLT
Polysomnography (PSG)
Urine drug screen

Determine optimal treatment settings from treatment sleep study parameters
Determine the requirement for further evaluation in the event of an indeterminate limited channel sleep study
Determine when MSLTs and MWTs might be appropriate
Explain and manage drug misuse and withdrawal
Explain behavioural strategies to reduce the symptoms of EDS and the daytime consequences of sleep disorders, such as sleep education and schedule modification, including the role of naps
Explain lifestyle implications of EDS and daytime consequences of sleep disorders
Explain public health and wider societal implications of the diagnosis of narcolepsy and related disorders, such as career choice and industrial safety
Generate reports for diagnostic and treatment sleep studies
Identify pathological hypersomnolence or inability to maintain wakefulness based on tests of hypersomnolence
Interpret results, and formulate management plans
Monitor the pharmacotherapies for central nervous system (CNS) disorders of hypersomnolence, including the surveillance of side effects and compliance
Prescribe pharmacotherapy for REM intrusion symptoms, such as cataplexy, in NT1 patients
Prescribe pharmacotherapy to reduce symptoms of EDS and daytime consequences of sleep disorders
Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary to patients, parents, or carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according to age
- use sleep diary information to inform treatment decisions
Recognise the limitations and clinical applicability of various types of limited channel sleep studies, including:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
Recognition of wearable devices which are now widely available in the consumer market, as well as their limitations
Surveillance of other disorders in patients with CNS disorders of hypersomnolence, such as increased risk of cardiovascular disease and appearance of obstructive sleep apnoea

LG15: Sleep-related movement 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

Circadian variation in symptoms (e.g., worse in evenings)
Effect of movement on symptoms
Grinding teeth
Headaches
Hypnic jerks
Jaw pain / Lock jaw
Leg cramps
Periodic limb movements (PLMs) in sleep
Uncomfortable sensations in legs
Urge to move legs when at rest

Conditions

Periodic limb movement disorder (PLMD)
Restless leg syndrome (RLS)
Sleep bruxism
Sleep-related leg cramps

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Presentations

Humming
Repetitive rhythmic movements, such as body rocking and head rolling

Conditions

Emerging sleep disorders, such as RLS
Propriospinal myoclonus at sleep onset (PSM)
Rhythmic movement disorder
Sleep-related hypermotor epilepsy (SHE)
Sleep-related movement disorder due to a medical disorder, medicine, or substance

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Abnormalities in sleep architecture, respiration or body movements, including PLMs
Actions of centrally acting pharmacological agents and their interactions with sleep and PLMs
Bruxism, hypnic jerks, rhythmic movement, and sleep talking
Clinical context in which limited channel sleep studies might be useful, including tests performed in the home, and the range of limited channel sleep studies available
Clinical features and differential diagnosis of RLS and PLMD
Clinical features and differential diagnosis of sleep-related movement disorders
Essential features of a sleep study report used in clinical decision making, and on tests of sleep propensity used in clinical decision making
Measurement of PLMs
Psychiatric disorders with sleep movements, behaviours, and experiences as symptoms
Range of tests available to diagnose and manage sleep movement disorders, including polysomnography (PSG)
Secondary causes and other precipitating factors that may cause RLS

Investigations

Apply an investigation plan for suspected RLS / PLMD, especially looking for secondary causes
Assess severity of daytime consequences of sleep disorders
Interpret and report on typical PSG findings in PLMD, including seizure disorders
Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG
- electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- leg sensors to measure movements
- measures of CO2
- oxygen saturation
Perform a thorough history, examination, and sleep-specific assessment
Perform the relevant general physical, neurological, and respiratory examinations
Synthesise patients’ symptoms and signs into comprehensive differential diagnoses, and plan further investigations if needed
Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time
The role of iron in the pathogenesis and treatment of movement disorders, and the interpretation and limitations of iron studies in children

Procedures

EEG
PSG
MSLT

Apply and locate sensors for monitoring sleep disorders
Determine optimal treatment settings from treatment sleep study parameters
Determine the requirement for further evaluation in the event of an indeterminate limited channel sleep study
Explain role of video PSG and home video for diagnosis to patients
Generate reports for diagnostic and treatment sleep studies
Interpret results, and formulate management plans
Manage and explain how drug misuse and withdrawal may impact on RLS / PLMD
Monitor for efficacy and side effects from RLS / PLMD pharmacotherapy
Prescribe and supervise drug management of RLS / PLMD
Recognise the limitations and clinical applicability of various types of limited channel sleep studies, including:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
Recognise when referral to another specialist is indicated
Role of non-pharmacological therapy for RLS / PLMD
Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans

LG16: Parasomnia

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

Bedwetting
Complex automatic behaviours
Confusion when waking
Daytime sleepiness
Difficulty sleeping
Episodes of incomplete awakening and limited responsiveness
Inability to move upon falling asleep or waking
Screaming / Crying when waking
Sleepwalking
Vivid dreams that cause feelings of intense fear / anxiety
Vocalisations during sleep

Conditions

Catathrenia (sleep-related groaning)
NREM disorders:
- confusional arousal
- night terrors
- sleepwalking
- somniloquy
REM disorders:
- nightmare disorder
- sleep paralysis
Sleep enuresis (bedwetting)

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Sleep-related hallucinations

Actions of pharmacological agents and their interactions with sleep that may exacerbate parasomnias
Classification of parasomnias depending on sleep state
Clinical features for NREM arousal disorders and their variants, such as confusional arousals, sleep terrors, and sleepwalking
Clinical utility of home videos
Collaborative investigations with other sub-specialties, such as neurologists, which might include video-telemetry
Compare the differences between nightmares and sleep terrors
Contents of the International Classification of Sleep Disorders (ICSD-3)
Differential diagnoses of parasomnias, including psychiatric disorders and sleep-related hypermotor epilepsy
Essential features of a sleep study report used in clinical decision making
Principles of pharmacological and non-pharmacological management of parasomnias
Review the predisposing factors that may trigger an episode of parasomnia
Spectrum of parasomnias and the basic features of confusional arousals, sleep terrors, sleepwalking, and age-specific presentation of various parasomnias in paediatric age group

Investigations

Assess severity of daytime consequences of sleep disorders
Interpret and report on typical polysomnography (PSG) findings in NREM arousal disorders and seizure disorders
Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
Interpret video and EEG during a paroxysmal event at night, and report differential diagnosis
Perform a thorough history, examination, and sleep specific assessment
Perform the relevant general physical, neurological, and respiratory examinations
Recognise features which may suggest parasomnia or seizure
Interpret video and EEG during a paroxysmal event at night, and report differential diagnosis
Perform a thorough history, examination, and sleep specific assessment
Perform the relevant general physical, neurological, and respiratory examinations
Recognise features which may suggest parasomnia or seizure
Synthesise patient symptoms and signs into a comprehensive differential diagnosis and plan further investigation if needed
Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour including bedtime routine, screen time and diet

Procedures

EEG, including full EEG
PSG

Apply and locate sensors for monitoring sleep disorders
Deliver comprehensive sleep education to patients
Explain non-pharmacological and pharmacological measures for management of NREM parasomnias
Explain role of video PSG and home video for diagnosis to patients
Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory to technical and other staff
Prescribe and monitor drug management
Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary to patients and carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according to age
- use sleep diary information to inform treatment decisions
Recognise when referral to another specialist is indicated, such as a psychologist, neurologists or nephrologist / urologist (in cases of nocturnal enuresis)
Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans

LG17: Insomnia

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

‘Curtain calls’ / Bedtime resistance
Behavioural problems
Daytime sleepiness
Difficulty concentrating
Difficulty falling asleep, staying asleep, or waking too early at night
Fatigue
Learning difficulties
Mood changes
Separation anxiety
Sleep association

Conditions

Insomnia:
- insomnia associated with drug and alcohol use
- insomnia due to irregular sleep schedules
- insomnia due to underlying psychiatric disorders, such as depression or anxiety
- nocturnal feeding / drinking disorder
- sleep-onset association disorder

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate and developmentally-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Conditions

Chronic insomnia
Insomnia due to underlying physical conditions, such as neurological or respiratory conditions (e.g., autism spectrum disorder)
Psychophysiological insomnia

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

Synthesise

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

Manage

involve multidisciplinary teams
prescribe therapies tailored to patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate and developmentally-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Developmental types of insomnia, including behavioural insomnia of childhood limit-setting type, and behavioural insomnia of childhood sleep-onset association type
Different types of insomnia and their clinical features
How circadian factors, such as shift work and advanced and delayed sleep, may produce apparent insomnia symptoms
How other medical and psychiatric illness may produce symptoms of insomnia
How other sleep disorders, such as sleep apnoea and restless leg syndrome, may produce symptoms of insomnia
Increased prevalence of insomnia in children / adolescents with neuro-disabilities
Indications and limitations of assessment tools for insomnia, including actigraphy, sleep diaries, and polysomnography (PSG)
Interaction, overlap, and interrelationship of psychiatric disorders with sleep disorders
Non-pharmacological treatment options for insomnia
Pharmacological treatment options for insomnia
Relevant sections in the International Classification of Sleep Disorders (ICSD-3)
The theory underlying management strategies for insomnia

Investigations

Ask about medications, including OTC medications and recreational drug use
Perform the relevant general physical, neurological, and respiratory examinations
Psychiatric assessments, with a focus on mood disorders
Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time

Procedures

Actigraphy (when available / appropriate)
Sleep diaries
Use of validated screening questionnaires

Ability to tailor treatment strategies according to patient age and developmental stage, and in the context of the family environment and dynamics
Asses the role of online delivered cognitive behavioural therapy for insomnia (CBT-I), especially when access to psychologists is limited
Deliver comprehensive sleep education to patients, including the important of sleep hygiene
Evaluate behavioural therapies, clinical circumstances, and pharmacological treatments to formulate individual treatment strategies
Explain and manage drug misuse and withdrawal
Explain the implementation of treatment strategies for insomnia, including behavioural measures and sleep education, such as bedtime restriction, cognitive behavioural therapy, relaxation therapies, and stimulus control
Prescribe and monitor pharmacological treatments for insomnia
Recognise when referral to another specialist is indicated, particularly specialist sleep psychologists and psychiatrists
Techniques used for management of behavioural / developmental aspects of night-wakings
Weigh and synthesise history and examination information to produce provisional and differential diagnoses, and formulate and undertake management plans

LG18: Circadian disorders of the sleep-wake cycle

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 thelp 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 tinterpret the reported results of each investigation or procedure.

Advanced Trainees will know how texplain the investigation or procedure patients, families, and carers, and be able texplain 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 intcare.

View

Presentations

Abnormal or no regular sleep pattern
Chronic sleep disturbances
Difficulty falling asleep
Difficulty waking
Excessive daytime sleepiness
Insomnia symptoms
Mood changes, such as depression and irritability
Reduced concentration
Reduced performance at school and/or social spheres
Waking up excessively early

Conditions

Adolescent sleep phase disorder
Delayed and advanced sleep-wake phase disorders
Irregular sleep-wake rhythm disorder

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

Synthesise

conduct an appropriate examination
consider the impact of illness and disease on patients and their quality of life when developing a management plan
establish a differential diagnosis
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
plan and arrange appropriate investigations
recognise the clinical presentation
take a comprehensive clinical history, including psychosocial assessment in relevant groups (such as adolescents)

Manage

involve multidisciplinary teams
prescribe therapies tailored patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Conditions

Circadian rhythm disorders that are part of an underlying developmental or neurogenetic condition, such as Angelman syndrome and Smith–Magenis syndrome
Jet lag
Non-24-hour sleep-wake rhythm disorder
Shift work disorder
Sleep disorders in the severely visually impaired

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

Synthesise

conduct an appropriate examination
consider the impact of illness and disease on patients and their quality of life when developing a management plan
establish a differential diagnosis
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
plan and arrange appropriate investigations
recognise the clinical presentation
take a comprehensive clinical history, including psychosocial assessment in relevant groups (such as adolescents)

Manage

involve multidisciplinary teams
prescribe therapies tailored patients’ needs and conditions
provide evidence-based management
recognise potential complications of disease and its management, and initiate preventative strategies

Consider other factors

consider age-appropriate treatment options based on maturity and mental understanding
identify individual and social factors and the impact of these on diagnosis and management

Actions of pharmacological agents and their interactions with sleep
Circadian effects on sleep duration and timing
Clinical features, evaluation, and management associated with jet lag and shift work-related circadian rhythm disorders, and how they may produce apparent insomnia symptoms
Clinical features, evaluation, and management of delayed and advanced sleep phase syndrome
Contents of the International Classification of Sleep Disorders (ICSD -3)
Effect of physical impairments, such as blindness, on circadian disorders
Normal sleep and circadian physiology, including variation by age
Principles of pharmacological management of sleep disorders
Underlying neurological disorders and their effect on circadian disorders

Investigations

Assess severity of daytime consequences of sleep disorders
Interpret subjective and objective measures of circadian rhythm
Perform a thorough history, examination, and sleep-specific assessment
Perform the relevant general physical, neurological, and respiratory examinations
Recognise the indications for actigraphy in the clinical context:
- explain carrying out actigraphy patients and carers
- interpret actigraphy results, applying knowledge of normal sleep duration and timing
- use actigraphy information tinform treatment decisions
Synthesise patients’ symptoms and signs intcomprehensive differential diagnoses, and plan further investigations if needed
Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time

Procedures

Actigraphy (when available)
Physiologic circadian phase markers, such as core body temperature monitoring and saliva or urine melatonin level monitoring
Polysomnography (PSG)
Sleep diary

Apply and locate sensors for monitoring sleep disorders
Consideration of lifestyle modifications
Deliver comprehensive sleep education patients
Explain and manage drug misuse and withdrawal
Explain role (if any) of video PSG and home video for diagnosis patients
Explain sensors, filters, gain, sampling times (frequencies), and linearity of the equipment used in the sleep laboratory technical and other staff
Explain strategies for rapid adjustment new schedules or time zones
Explain the concept of ‘social jet lag’ patients and families, and the importance of a regular sleep schedule
Explain the management of altered sleep phase, such as:
- bedtime scheduling
- light therapy
- lifestyle changes, including:
  - engaging in external activities
  - leaving the bedroom / house
  - morning sunlight
  - regular meals
- melatonin administration
Prescribe and give advice about use of pharmacotherapy, in particular melatonin and melatonin agonists
Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary patients and carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according age
- use sleep diary information inform treatment decisions
Recognise when referral another specialist is indicated
Understand the impact of delayed sleep phase in adolescence on daytime functioning, including school attendance, and the complex interaction / overlap in presentation with mental health disorders and/or school refusal

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 Sleep Medicine (Paediatrics & Child Health)

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

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

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy