Curriculum standards

About this resource

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

This document outlines the curriculum standards for Advanced Training in Community Child Health for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Community 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.

Download the curriculum standards PDF

LG1: Competencies

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

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

Competencies will be common across training programs.

Medical expertise

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

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

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

Diagnosis and management. Develop diagnostic and management plans that integrate an understanding of individual patient circumstances, including psychosocial factors and specific vulnerabilities, epidemiology, and population health factors in partnership with patients, families, whānau and/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, whānau and/or carers, colleagues, community groups, the public, and other stakeholders to facilitate optimal health outcomes.

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

Cultural safety*

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

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

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

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

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

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

Culturally safe environment. 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 their families, communities and populations in a caring and respectful manner.

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

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

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

Entrustable Professional Activities

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

LG2: Team leadership

Learning Goal 2

Team leadership

Lead and work collaboratively with a team of health professionals

This activity requires the ability to:

prioritise workload
manage multiple concurrent tasks
articulate and demonstrate understanding of individual responsibilities, expertise, and accountability of team members across various contexts
acquire and apply leadership techniques in daily practice
collaborate with teams across multiple healthcare settings
lead and conduct case conferences/multidisciplinary team meetings
be involved in care-coordination including with inter-sectoral agencies
demonstrate prioritisation and advocacy of team and self-wellbeing

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 and interpret information with other disciplines and health professionals to develop individually tailored, holistic, trauma-informed, patient-centred, goal-centred plans
promote and rationalise evidence-based care to meet the needs of patients or populations
consider and demonstrate measures to minimise clinical risk
apply clinical expertise and skills to effectively support team members

direction
Requires some supervision

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

The trainee may:

provide coordinated and quality health care for populations or patients as a member of a multidisciplinary team
critically appraise and recognise limitations of current evidence to inform clinical practice

Communication

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 transparent, supportive, and 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
establish 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 appropriately with colleagues
communicate appropriately with patients, families, carers, and/or the public
respect the roles of the various 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 systemic factors impacting patient attendance
prioritise safety and quality of care in 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 appropriately and effectively

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:

participate in high quality supervision and teaching of others
promote commitment to high quality teaching and professional development within the team and with learners that are attached to the team
reflect on, evaluate, and seek to improve professional practice, including actively seeking feedback from supervisors, colleagues, and mentors

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 seek appropriate help as needed
demonstrate basic skills in facilitating others’ 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 safe relationships with professional colleagues and patients
promote and advocate for respect for culture and diversity
identify and address barriers to healthcare including unconscious bias, discrimination, and systemic racism

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
encourage open discussion of ethical and clinical concerns
respect differences in multidisciplinary team members
effectively consult with stakeholders, achieving a balance of alternative views
acknowledge personal conflicts of interest and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment and bullying
promote and role model a high standard of ethical and professional practice
show compassion and empathy towards patients and colleagues

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
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:

make appropriate decisions when faced with multiple and conflicting perspectives
contribute effectively to shared decision making with teams and patients
contribute medical input to organisational decision making
apply judicious and cost-effective use of health resources
recognise limits of practice

direction
Requires some supervision

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

The trainee may:

consult team members or senior staff when faced with multiple or conflicting perspectives
review new healthcare interventions and resources
use a systematic approach to 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:

promote collaboration with team members in delivering patient care or population advice
apply leadership and followership skills in clinical and professional practice
ensure all members of the team are accountable for their individual practice
actively promote, and advocate for, improved wellbeing of colleagues and other health professionals
check in with, and support, colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety
role model prioritising personal health, safety and wellbeing
initiate, actively participate in, and where appropriate, lead multidisciplinary team meetings

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:

advocate for resources and support for healthcare teams to achieve improved and equitable health care
influence the development of organisational policies and procedures to optimise health outcomes

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of organisational policies and procedures
demonstrate an awareness of how to advocate for patient populations

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Demonstrate commitment to ongoing professional development and health professions education

This activity requires the ability to:

demonstrate commitment to health professions education opportunities
provide effective clinical teaching in a variety of settings, including lectures, small group tutorials and simulation, drawing from evidence-based practices
demonstrate how to conduct a learning needs analysis
teach and role model professional skills
create a safe and supportive learning environment
demonstrate and implement strategies towards enhancing educational culture within the clinical workplace
plan, deliver, and provide work-based assessments
support learner-driven education experiences
supervise learners in day-to-day work, and provide timely and constructive feedback
support learners to prepare for assessments
role model commitment to lifelong learning and continuous professional development
reflect on and evaluate own teaching and supervision skills

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
undertake teaching on the run/bedside teaching, including explaining the rationale underpinning a structured approach to clinical decision making
enable learners to observe and participate in clinical experiences with appropriate supervision, in a manner that is scaffolded and tailored towards learner’s level of training
support and facilitate students and health professionals to reflect and learn from clinical experiences
support learners’ strengths and areas for development and facilitate improvement

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
provide timely, clear, and constructive feedback to learners with suggestions on how to improve
actively encourage a collaborative and safe learning environment with learners and other health professionals
role model and teach high level communication skills
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 during teaching and supervision activities

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate commitment to own learning needs, training requirements, and professional development
develop appropriate learning plans for required learning outcomes
plan and submit assessments and reports within required time frames
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
participate in teaching and supervision of professional development activities
encourage self-directed learning
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching and supervision skills
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately
use and promote reflective practise to develop clinical skills

direction
Requires some supervision

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

The trainee may:

meet with supervisors regularly to receive feedback and support
keep records of supervision and work-based assessment
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
adopt a teaching style that is more didactic rather than encouraging learner self-directedness
promote engagement in learning within the clinical context

Research

confident
Ready to perform without supervision

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

The trainee will:

demonstrate ability to incorporate and critically analyse relevant and up to date evidence from the literature into clinical teaching
support learners and colleagues who are undertaking research projects
encourage and guide learners to seek out relevant research evidence to support practice and answer clinical questions

direction
Requires some supervision

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

The trainee may:

direct learners to review relevant literature

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 learners to seek out opportunities to develop and improve their own cultural safety
encourage learners to incorporate culturally safe care of Māori and Aboriginal and Torres Strait Islander peoples into patient management
consider, and role model, cultural, ethical, and religious values, and beliefs in approach to 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, 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
role model professional and ethical behaviours, including respect and collegiality
respond appropriately to learners seeking professional guidance
initiate regular supervision sessions within appropriate time frames

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

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 performance and continuing professional development standards
maintain professional, clinical, research, and administrative responsibilities whilst teaching
promote an inclusive environment whereby the learner feels part of the team
help shape organisational culture to prioritise quality and work safety through openness, honesty, shared learning, and continued improvement

direction
Requires some supervision

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

The trainee may:

demonstrate the principles and practice of professionalism and leadership in health care

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

Contribute to improving safety, effectiveness and experience of healthcare

This activity requires the ability to:

identify and report actual and potential (near miss) errors
conduct and evaluate quality improvement activities
adhere to best practice guidelines (e.g., approaching ADHD, medication management and follow up in ADHD, CRC guidelines)
audit clinical guidelines, clinical processes, and outcomes
contribute to the development of policies and protocols designed to protect patients and enhance healthcare
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
apply relevant theory related to quality improvement processes
use standardised protocols to adhere to best practice
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

contribute to processes on identified opportunities for improvement
recognise the importance of prevention and early detection in clinical practice
learn the theory related to the process of quality improvement and apply these to a clinically relevant context
use appropriate and evidence-based guidelines to assist patient care decision making

Communication

confident
Ready to perform without supervision

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

The trainee will:

support patients to have access to, and use, easy-to-understand, high-quality information about health care
support patients to share decision making about their own health care, to the extent they choose
assist patients’ access to their health information, as well as complaint and feedback systems
discuss with patients any safety and quality concerns they have relating to their care
implement the organisation’s open disclosure policy
demonstrate effective skills in knowledge translation and awareness of knowledge mobilisation as part of implementation science processes

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 healthcare
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, such as:
- antimicrobial stewardship
- audits
- clinical incident reviews
- corrective action and preventative action plans
- morbidity and mortality reviews
- review of clinical guidelines and protocols
- root cause analysis
participate in systems for surveillance and monitoring of adverse events and ‘near misses’, including reporting such events
ensure that identified opportunities for improvement are raised and reported appropriately
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve healthcare

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 healthcare

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
promote and role model high quality and safe clinical practice

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
demonstrate familiarity with both quantitative and qualitative research methodologies
hypothesise, interpret, critically analyse, and apply up to date evidence from research to clinical practice
participate in clinical research that aims to improve patient outcomes, where applicable

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
demonstrate commitment to improving cultural safety in own practice, teams and the health service
apply frameworks and policies related to improving healthcare for Māori and Aboriginal and Torres Strait Islander peoples

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:

align improvement goals with the priorities of the organisation
contribute to developing an organisational “no blame” culture that enables and prioritises patients’ safety and quality
speak up for the safety of patients and staff using appropriate systems

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
critically appraise published literature, including the quality, applicability to the local population and limitations of the evidence

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in all aspects of the development, implementation, evaluation, and monitoring of governance processes Health policy, systems, and advocacy
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving care are actively encouraged
take part in the design and implementation of the organisational systems for:
- defining the scope of clinical practice
- performance monitoring and management
- clinical and safety education and training

direction
Requires some supervision

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

The trainee may:

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: Assessment and management - Child maltreatment

Learning Goal 5

Assessment and management of child maltreatment

Develop competence in the identification and clinical management of situations of potential or suspected child harm/maltreatment.

This activity requires the ability to:

identify and access sources of relevant information about patients including obtaining and reconciling different accounts of information
identify child and family adversity that might lead to child maltreatment
perform a comprehensive and wholistic assessment of an infant, child or young person’s presenting concern, overall development, behaviour, learning, and emotional state, taking into account cultural, biological, psychological, and social environmental factors
appraise developmental and behavioural status of a child at any age by observation, physical examination, and neurodevelopmental assessment as part of a child maltreatment evaluation
recognise, and appropriately respond to, possible indicators of any form of child maltreatment by following local jurisdiction reporting requirements and urgent safety measures
select, organise, undertake, and interpret investigations relevant to child maltreatment
synthesise findings to develop provisional and differential diagnoses, including medical causes and contributors in the context of child maltreatment presentations
formulate an opinion about vulnerability and resilience in relation to children including safety, physical health, development, relationships, behaviour, and psychological wellbeing
formulate a defensible opinion regarding the likelihood that a child has experienced maltreatment
communicate findings with patients
communicate findings to other professionals including producing peer reviewed medicolegal report
collaborate with other health professionals and community agencies
provide recommendations and facilitate intervention designed to remove the adversity and ameliorate the impact of harm
produce comprehensive medical reports, including thorough documentation of findings and justifiable opinions for children in whom a suspicion of any form of child maltreatment has been identified

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise signs of child maltreatment, such as physical abuse, sexual abuse, neglect, emotional maltreatment, exposure to violence, and drug endangerment
identify, characterise, and document injuries in children, such as cutaneous injuries, fractures, abdominal and thoracic injuries, head injuries, and genital injuries
identify discrepancies between reported mechanism of injury and clinical findings
perform detailed and careful examinations for the detection of injury in infants, children, and adolescents including documentation of examination with the adjunct of illustrated body diagrams and photo documentation
describe normal anatomical variants and medical conditions that may be causes or contributors to presentations of suspected child maltreatment
conduct chaperoned external genital examination in consenting children and adolescents where indicated in the appropriate clinical setting (in line with RACP Guidance on genital examinations)
perform a comprehensive assessment of a child’s development, behaviour, learning, and emotions taking into account biological, psychological, comorbidity, and social environmental factors in cases of suspected child maltreatment, including normal and abnormal sexual behaviour development
arrange appropriate evidence-based investigations in cases of suspected child maltreatment
recognise and appropriately interpret findings of occult injury
recognise and appropriately interpret medical tests in cases of child maltreatment
engage in post-abuse or neglect treatment and management strategies for patients
be aware of protective and resilience factors in the child’s family and/or community, including cultural awareness
be aware of and address cumulative harm

direction
Requires some supervision

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

The trainee may:

explain the principles of primary, secondary and tertiary child protection
recognise injury types and describe simple injury mechanisms
demonstrate ability to formulate differential diagnosis for presentations of child maltreatment
demonstrate appropriate escalation for support and supervision to perform examinations in suspected child maltreatment

Communication

confident
Ready to perform without supervision

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

The trainee will:

obtain specific informed consent for forensic evaluations
perform interviews and examinations around child abuse, neglect, and family violence effectively, including identification of protective factors
ask difficult or sensitive questions, and show sensitive engagement of patients in an interview
synthesise and interpret findings from the history, examination, and investigations to devise likelihood of child maltreatment
clearly document assessment findings in patients’ medical record, including necessary forensic documentation, such as illustrations with diagrams and clinical photography
explain outcomes of assessment, diagnosis, and other relevant information to patients and their family or carers and ensure understanding
formulate defensible medicolegal opinions based on current literature and evidence
produce a peer reviewed medicolegal written report identifying injuries, mechanisms of injuries, likelihood of child maltreatment, and the specific medical needs and recommendations of the child assessed

direction
Requires some supervision

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

The trainee may:

explain the role of child maltreatment specialists, statutory child protection agencies, and police to patients in cases of suspected child maltreatment
document objective findings of injuries in children
formulate provisional forensic opinions for cases of suspected child maltreatment
appropriately report cases of suspected child maltreatment to statutory child protection agencies and identify barriers to reporting

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 limits of expertise and determine the need for child maltreatment specialist referral
identify, and respond to, all injuries in pre-mobile infants
recognise clinical presentations in which child maltreatment should be a considered differential diagnosis even in the absence of obvious injury, such as:
- vomiting in infants
- enlarging head circumference
- unexplained cardiorespiratory collapse

direction
Requires some supervision

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

The trainee may:

recognise various clinical presentations that may occur because of child maltreatment
diligently and efficiently follow local jurisdictional procedures for the notification of suspicions of child maltreatment

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 reflect upon and self-evaluate professional development
obtain informed consent before involving patients in teaching and research activities
use clinical activities as learning and teaching opportunities, appropriate to the setting and learner
use appropriate guidelines and evidence-based medicine resources
collaborate with relevant agencies to develop comprehensive and prioritised management plans utilising local resources designed to ameliorate vulnerability, with the aim of reducing the likelihood of physical harm, psychological harm, or inadequate care

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 child maltreatment guidelines
reflect on clinical assessment and report writing, 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:

analyse relevant literature and refer to evidence-based guidelines in cases of child maltreatment
conduct literature review to support medicolegal evidence, both as written reports and oral testimony
identify incidence, prevalence, risk, and protective factors of child and adolescent maltreatment

direction
Requires some supervision

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

The trainee may:

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:

reflect on the impact of intergenerational trauma, such as:
- community violence
- discrimination
- impacts of colonisation
- poverty
- the mitigation of cumulative risk on adverse childhood experiences
observe the complex interactions between the child, siblings, caregivers, support agencies, and the broader social context for protecting children and promoting child wellbeing
interpret and explain information to patients at the appropriate level of their health literacy
actively support, and effectively use, interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English, and document this in the medical record
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs

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 response to medical evaluation of child maltreatment

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 a broad interview framework with capacity to explore possibility of:
- fabrication, exaggeration, or induction by the child’s carer of medical symptoms or physical illness
- inflicted injury
- neglect of physical, emotional, psychological, nutritional, medical care, or educational needs
- psychological harm due to the actions of carers
- sexual abuse
obtain informed specific consent from patient and family to conduct general physical examinations, such as photographic recording of injuries, and specific anogenital examinations, including recording using the videocolposcope
assess patients’ capacity for decision making, including mature minor and Gillick competence, and involve parents or carers where appropriate
demonstrate awareness of complex issues related to sensitive information obtained from child maltreatment evaluations, and subsequent record keeping and information sharing

direction
Requires some supervision

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

The trainee may:

follow regulatory and legal requirements and limitations regarding reporting child maltreatment
refer to state based and national laws that impact consent for forensic medical assessment

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify discrepancies between reported mechanism of injury and findings
engage children and young people in decision making process at an appropriate developmental level
recognise child and family vulnerability for physical harm, psychological harm, or inadequate care
respond to suspicions of physical harm, psychological harm, or inadequate care
evaluate history and assessment and form an opinion about likelihood of maltreatment based on evidence collected
formulate an opinion regarding risk of, and resilience to, adverse outcomes for the subject child, such as:
- behaviour
- development
- physical health
- psychological wellbeing
- relationships
- safety
determine the need for referral to subspecialists including child protection or forensic paediatricians
consider indications for forensic medical investigations
use appropriate guidelines, evidence sources, and decision support tools
consider potential bias and gaps in the presentation of history
advocate for intervention to prevent further maltreatment

direction
Requires some supervision

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

The trainee may:

recognise personal limitations including limitations of expertise and seek help in an appropriate way when required
consider the best interests of the child and child safety in 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:

conduct appropriate reports to statutory child protection agencies in cases of suspected child maltreatment
work collaboratively for child safety with police and statutory child protection agencies
involve other professionals, specifically psychosocial allied health professionals, to investigate possibility of psychological and emotional harm
collaborate with hospital-based child protection multidisciplinary teams and other government agencies in the evaluation of various forms of suspected child maltreatment

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of mandatory reporting obligations and local reporting pathways for child maltreatment
participate in multidisciplinary child maltreatment 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:

apply understanding of the social determinants of health on child maltreatment and long term physical and mental health
apply knowledge of the impacts on health and child protection systems responses to child maltreatment from social determinants of health and bias
consider the impact of global health threats and emergencies on child maltreatment, such as:
- climate change
- natural disasters
- pandemic
promote health and wellbeing of children in special populations, such as:
- those in foster and out of home care
- children with disabilities
- household contacts of identified victims of child maltreatment
advocate for appropriate resources to assist families

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of the social determinants of health at a population level
describe the impact of child maltreatment investigations and responses on child wellbeing

LG6: Assessment and management - developmental and behavioural

Learning Goal 6

Assessment and management - developmental and behavioural

Provide comprehensive assessment and management of children who have been referred because of development and behavioural problems

This activity requires the ability to:

identify and access sources of relevant information about patients
perform a comprehensive assessment of an infant, child or young person’s health, development, behaviour, learning and emotional state, taking into account biological, psychological, cultural, and social environmental factors
provide an explanation for an infant, child or young person’s presenting concerns
be familiar with, and use, standardised screening, and assessment tools, where applicable, for developmental and mental health presentations
appraise developmental and behavioural status of a child at any age by observation, physical examination, and neurodevelopmental assessment
synthesise findings to develop provisional and differential diagnoses
use diagnostic formulations to construct an individualised, multi-modal management plan
communicate findings and recommendations with patients, other health professionals and relevant stakeholders
develop management plans and goals in consultation with patients
provide effective long-term management of developmental and behavioural conditions under a chronic disorder model
provide supportive family counselling, specific interventions, and targeted practical advice across the range of developmental and behavioural conditions
appropriately and safely prescribe and monitor the use of relevant psychotropic medication in children presenting with developmental and behavioural concerns

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:

Assessment

assess paediatric patients’ physical and psychological symptoms and signs
assess common developmental and behavioural paediatric presentations
assess common paediatric and adolescent mental health presentations
use a holistic, biopsychosocial framework with identification of sources of vulnerabilities and resilience
perform a comprehensive assessment of a child’s development, behaviour, learning and emotions, taking into account biological, psychological, comorbidity, and social environmental factors including family dynamics
apply and interpret standardised screening and assessment tools, where applicable, for developmental and mental health presentations
interpret abnormal results of screening, and outline referral and management pathways
choose evidence-based investigations or assessment tools as an adjunct to comprehensive clinical assessment
synthesise and interpret findings from the history, examination, and investigations to devise a coherent developmental-behavioural/ biopsychosocial paediatrics diagnostic formulation
form a hypothesis for what neurodevelopmental processes may be underlying symptoms
use available clinical information to establish the most likely provisional diagnoses and reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, likely prognosis, and clinical outcomes

Management

use diagnostic formulations to construct an individualised, multi-modal management plan
regularly revise short-term management plans, and modify goals as needed in consultation with patient
establish case management guidelines with clear follow-up intervals
introduce concepts of chronic disease management and long-term outcomes early in treatment
provide anticipatory guidance on key transitions, such as into primary school, into secondary school, or leaving school
consider psychotropic medication use, with clear therapeutic target, as part of an overall management plan
select appropriate pharmacological and non-pharmacological therapies considering the patient's age, comorbidities, adverse reactions, preparations and availability, and patient preference
refer and liaise with subspecialists and other health professionals, where appropriate
manage patients with common neurodevelopmental and behavioural concerns
manage patients with common mental health concerns in liaison with mental health support services

direction
Requires some supervision

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

The trainee may:

take patient-centred comprehensive histories, considering psychosocial factors
document medical, social, developmental, and sexual history
provide rationale for investigations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct the clinical encounter and diagnostic categories
perform basic aspects of assessing and managing common neurodevelopmental conditions, with support

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 and respectfully
listen actively and use a collaborative approach to management by identifying and addressing patients’ concerns, questions, expectations, and goals
establish supportive relationships with patients based on trust, understanding, empathy, and confidentiality
explain the potential benefits, risks, costs, burdens, and side effects of investigations to patients
explain outcomes of assessment, diagnosis, and other relevant information to patients
communicate the management plan with recommendations and goals for treatment to patient effectively, including in written form
clearly and concisely document assessment findings, recommendations and management plan in patients’ medical record and written reports
help patients navigate the healthcare system and improve access to care by collaboration with other services and agencies, such as child protection, community health centres, consumer organisations, funding, and intervention pathways
write comprehensive and accurate assessment and management reports and summaries of care, including discharge summaries, comprehensive clinic letters, and transfer documentation
provide clear, safe, effective, and timely handover between transitions of care
communicate with referring and receiving health services, such as local health services and primary health care provider
check quality and accuracy of reports or documentation generated by others and technologies such as artificial intelligence informed Large Language Models

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 non-verbal cues
demonstrate empathetic, compassionate, respectful, and active listening and communication skills
communicate patients’ situations to colleagues, including senior clinicians
explain helpful resources
explain specified tasks or requests for general practitioners, or other professionals, where appropriate
explain schedule and purpose of follow up clearly
explain the benefits and burdens of therapies, considering patients’ individual circumstances
seek further advice from experienced clinicians 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:

ensure patients are informed of the risks associated with any part of management plans
obtain informed consent before undertaking any investigation
ensure that patients are informed about fees and charges
identify and manage key risks for patients during transitions of care

direction
Requires some supervision

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

The trainee may:

keep patients' information secure, adhering to relevant legislation regarding personal information and privacy
identify medication errors and institute appropriate measures

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
use clinical activities as learning and teaching opportunities, appropriate to the setting and learner
provide appropriate supervision of junior staff in their clinical assessment of patients

direction
Requires some supervision

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

The trainee may:

set goals and objectives for selflearning
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:

critically analyse relevant literature and refer to evidence based guidelines
participate in clinical research and follow research protocols where appropriate
critically analyse relevant literature and refer to evidence-based guidelines

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

engage with patient and family to gather information in an atmosphere of trust and cooperation
acknowledge and reflect on patients’ beliefs and values, and how these might impact on health
recognise the impact of cultural differences on understanding and acceptance of neurodevelopmental concerns and diagnoses
recognise the role of cultural factors on developmental assessment and testing performance
recognise the role of social and cultural factors in the development of somatic symptoms
demonstrate cultural safety with implementation of appropriate and necessary supports
demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples, and members of other cultural groups
observe the complex interactions between the child, siblings, caregivers, support agencies, and the broader social context for protecting children and promoting child wellbeing
actively support, and effectively use, interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English, and document this in the medical record
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs

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
identify vulnerable or marginalized populations and respond appropriately

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
demonstrate, and advocate for, consideration of the comfort of the patient by minimising any distress and harm caused by medical assessment
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
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:

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
demonstrate professional conduct, honesty, and integrity

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:

engage patients in the decision-making process at an appropriate developmental level
identify and address risk and resilience factors impacting on infant, child, and young person’s development
advise on any proposed complementary or alternative treatments in a non-judgemental fashion
apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
review the best available evidence for the most effective therapies and interventions to ensure quality care
formulate an opinion regarding risk of, and resilience to, adverse outcomes for the subject child, include safety, physical health, development, relationships, behaviour, and psychological wellbeing
determine the need for referral to subspecialists
make appropriate decisions regarding referring or transferring patients to other services for further assessment, including regional and remote patients
use appropriate guidelines, evidence sources, and decision support tools
consider potential bias and gaps in the presentation of history

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
choose the most appropriate investigation for the clinical scenario in discussion with patients
recognise personal limitations and seek help in an appropriate way when required
assess family dynamics, including the family’s capacity to follow recommendations

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:

develop collaborative relationships with patients and a range of health professionals
work effectively as a member of multidisciplinary teams to achieve the best health outcome for patients
facilitate and coordinate interventions by other medical or non-medical professionals
collaborate with other health professionals to achieve accurate and thorough assessments of patients
manage cross referral for assessments by allied health professionals

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
ensure results are checked in a timely manner, taking responsibility for following up results

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:

educate patients about nature of developmental and behavioural problems
use local, regional, and national health services and systems appropriately
advocate for appropriate resources to assist families
aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
support systems to improve access to healthcare such as telehealth

direction
Requires some supervision

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

The trainee may:

identify and navigate components of the healthcare system relevant to patient care
identify and access relevant community resources to support patient care
identify and access relevant community resources to support patient care
factor transport issues and costs to patients into arrangements for transferring patients to other settings

LG7: Assessment and management - child population health

Learning Goal 7

Child population health

Assessment and management of patients through a child population health lens

This activity requires the ability to:

plan and implement local strategies to improve the health of all children and young people in their area, including child protection and safeguarding policies, and overseeing universal and targeted health promotion programs
apply knowledge of public health to work with other agencies to provide paediatric input for the commissioning and planning of services for all children and the wider community
contribute to the development of standards, protocols, measures and guidelines with a population perspective, such as a needs assessment including appraisals of their likely impact, ethics, cost, feasibility and acceptability
identify opportunities for advocacy, health promotion, and disease prevention in the communities that they serve, and respond appropriately
identify and make recommendations on the determinants of health of the populations, including barriers to access to care and resources, and inequalities affecting various age, gender, and cultural groups
identify and advocate as a leader for priority population or marginalized populations for improved health outcomes
address ethical issues and issues of gender, sexual orientation, age, culture, beliefs, and ethnicity in a professional manner so to influence improvement of the health and wellbeing of children, youth, and their families
critically appraise published literature including theoretical, descriptive, and interventional research, and to be able to synthesise and communicate population health information in a meaningful way to a variety of different forums

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 protective factors and resilience in at risk populations, and use them to generate management and recommendations
formulate an awareness and consideration of conditions that are more prevalent in specific populations
advocate, and reduce barriers, for infants, children, and young people whose particular life circumstances increase their vulnerability to improve support and access to services that increases overall health and wellbeing both at an individual and population level
manage complex care needs of patients with multiple comorbidities, aiming to improve day to day functioning and quality of life
advocate for conditions that promote optimal child and adolescent development across the age range
explain available outcome measures, such as the Public Health Outcomes Framework, and how they might be used to improve service delivery
describe procedures followed by local health protection teams during acute public health crises
contribute to the development of standards, protocols, measures, and guidelines with a population perspective, including a needs assessment
apply the evidence base for effective interventions in injury prevention
respond to a child population health question to generate a health needs assessment for a specific population of children, youth, or community
create, implement, and evaluate strategies for the promotion of child health, wellbeing, and optimal development at a population level
create, implement, and evaluate child population health policies that optimise child health, wellbeing, and development at a population level
understand complex interplay of intergeneration trauma and social determinates of health to prevent child maltreatment

direction
Requires some supervision

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

The trainee may:

identify children from priority populations
identify barriers to health for children, young people, their families, and the community
describe social determinants of health and their impacts
apply knowledge of how a policy, health promotion, or a health strategy will impact on the health and wellbeing of the populations they serve
define a population health question or policy that affects the health and wellbeing of children, youth, and their families
analyse data and evidence
focus on individual clinical risks, rather than a population perspective
describe health challenges within the population

Communication

confident
Ready to perform without supervision

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

The trainee will:

practise trauma-informed, and culturally safe, care for all patients
use alternative communication resources or information to decrease barriers to health and adherence to management plan
communicate with local service providers, primary care, and other community organisations in planning and management of care
present medical information effectively to the public or media about a medical or developmental issue
use written and oral communications to describe the health status and health risks of different population groups
use written and oral communications to convey the breadth of risks (financial, reputational, political) to the organisation, using a variety of media
use the principles of science communication to share information clearly, accurately, respectfully, responsibly, and empathetically
appropriately communicate research findings and data on markers of health and disease risk in the population
appropriately communicate results of epidemiological studies, including the difference between absolute and relative risk, and its relevance
tailor communication format and style to be appropriate for the audience

direction
Requires some supervision

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

The trainee may:

explore socioeconomic backgrounds with patients
refer to local service providers
present health information in a variety of forms, including written and oral
present health information to different audiences using a standardised format and language
ensure documentation is structured, formatted, and referenced appropriately

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:

engage consumers in quality improvement activities
participate in activities that contribute to the effectiveness of their health care organisations and systems, ranging from an individual clinical practice to organisations at local, regional, and national levels
lead or implement change in health care through quality improvement to evaluate existing health services and programs
plan and implement new health services and programs for a specific population
analyse and develop health policies or health promotion for a specific population

direction
Requires some supervision

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

The trainee may:

identify and define a policy issue or question that affects the health and wellbeing of children, youth, and their families
propose policy options that will affect the health and wellbeing of children, youth, and their families
influence policy-making processes related to the health and wellbeing of children, youth, and their families
ensure information privacy and security
critically appraise the quality of information

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:

develop resources to help educate families and carers, medical students, other health professionals, and community members about strategies to improve child health
demonstrate effective supervision skills and teaching methods which are adapted to the context of the training
encourage questioning among junior colleagues and students
organise and participate in in-service training on new technologies
provide specific and constructive feedback and comments to junior colleagues
regularly reflect upon, and self-evaluate, professional development
set defined objectives for teaching encounters, and solicit feedback on mutually agreed goals

direction
Requires some supervision

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

The trainee may:

provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
coordinate teaching for and supervise junior colleagues
participate in continued professional development
actively seek feedback on personal practice

Research

confident
Ready to perform without supervision

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

The trainee will:

contribute to child health research, where applicable
critically appraise retrieved evidence in order to address a clinical question
integrate critical appraisal conclusions into clinical care
disseminate the findings of a study appropriate to the audience
critically appraise levels of evidence, interventions, diagnostic tests, prognosis, and integrative literature
systematically search published and ‘grey’ literature

direction
Requires some supervision

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

The trainee may:

describe the principles of critical appraisal
apply the principles of evidence-based practice in both clinical and research settings
describe the principles of research and ethics
demonstrate efficient searching of literature databases to retrieve evidence
identify and critique information from credible sources to aid in decision making
refer to evidence-based guidelines and protocols
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 commitment to improving health of Māori and Aboriginal and Torres Strait Islander children
collaborate with families and communities to optimise child health outcomes
actively support management of patients within cultural and family context
advocate for culturally safe care
consider the values, beliefs, practices, models of health, biological factors, and unique health needs of specific population groups
show respect for knowledge and expertise of colleagues and communities
actively support, and effectively use, interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English, and document this in the medical record
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs

direction
Requires some supervision

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

The trainee may:

demonstrate cultural safety
practise cultural safety appropriate for the relevant community
proactively identify risks in the communication of public health information to different groups

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:

actively support and promote diversity and equity
facilitate, and advocate for, the safety and rights of the child, including adherence to child protection laws and policies
support and empower families and carers to provide optimal care for their child
explain the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity, and idealism
perform work that considers ethical implications, and adhere to legal requirements in managing and sharing public health information

direction
Requires some supervision

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

The trainee may:

adhere to child protection laws and policies
identify ethical principles relevant to the provision of public health information

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:

make decisions in the best interest of the patient
balance risks and benefits in communicating public health information
use the principles of decision science to formalise decision- making process

direction
Requires some supervision

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

The trainee may:

seek support to manage patients in challenging contexts
identify risks and benefits in communicating public health information

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively within teams to improve child health outcomes
advocate for quality, safe, and effective care in the best interest of the child and health priorities
develop and implement strategies for child wellbeing and optimal development at a regional and local population level
work collaboratively with other staff
lead teams, maintaining engagement and a focus on outcomes
maintain strong communication with other health and intersectoral professionals about the appropriate release of public health information
chair meetings

direction
Requires some supervision

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

The trainee may:

advocate for appropriate care for patients
collaborate with and engage other team members, based on their roles and skills
ensure appropriate multidisciplinary engagement
encourage an environment of openness and respect
attend relevant meetings regularly
use available tools, under supervision, to build skills in chairing meetings
prepare for, and conduct, meetings in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss principles of children’s rights, human rights and ‘in the best interest of the child’, and identify legislative support for these concepts
advocate for child friendly clinical and support services
interpret and apply legislation, policies, procedures, and protocols in the unique context of local populations and families, to advance their health
seek to address the determinants of health of the population, and mitigate barriers to access to care
advocate and promote child safety and rights of children
participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
demonstrate awareness of population health priorities
contribute to, or participate in, advocacy and policy activities to improve child health nationally and globally
direct families and carers to resources and health services targeted at improving child health
experience commissioning processes for children and young people’s services in their area, including the importance of public health data and surveys
explain the importance of just allocation of health care resources, balancing effectiveness, efficiency, and access with optimal patient care
apply evidence and management processes for cost-appropriate care
advise on global trends in health and emerging health risks
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
influence policy-making processes related to the health and wellbeing of children, youth, and their families

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of health promotion and prevention of disease activities, and encourage patients to seek these
link patients in with community health services
understand the role of physician leadership and advocacy in appraising population health and systems of care to improve population health outcomes
understand the role and place of different organisations within the health care system

LG8: Prescribing

Learning Goal 8

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/stage, comorbidities, potential drug interactions, risks, and benefits
communicate with patients about the benefits and risks of proposed therapies
provide instructions on medication administration effects and side effects
prescribe therapies tailored to patients’ needs, conditions and goals
initiate, titrate, and manage stimulant medications for management of ADHD
facilitate transition to long-acting stimulants and use of non-stimulant medications and their role
prescribe medications and understand their role (including indications, Rx objectives, risks, and side effects) in managing developmental and behavioural presentations, including psychotropics (eg. risperidone and aripiprazole), SSRIs (eg. fluoxetine, escitalopram, and sertraline), and melatonin
consult with experienced colleagues (paediatricians, psychiatrists) regarding medication options in complex situations and decisions around efficacy versus. risk
appropriately and safely prescribe and monitor the use of relevant psychotropic medication in children presenting with developmental and behavioural concerns
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 and/or behaviours requiring pharmacotherapy
determine clear therapeutic targets for medication use
consider non-pharmacologic therapies and the role of pharmacotherapy as part of broader management plan
consider age, comorbidities, medical history, psychosocial factors, allergies, potential drug interactions, and patient preference prior to prescribing a new medication
plan for follow-up and monitoring
manage patient expectations and concerns of psychotropic medication
monitor the administration of psychotropic medication, including:
- adjustment of dosage
- clear communication about ongoing regimen
- efficacy
- use standardised tools where available to measure baseline and post treatment response
recognise any unusual side effects and handle appropriately
maximise use of “window of opportunity” created by medication to set developmental intervention goals, such as:
- behaviour
- education
- self-esteem
- social

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, risks, benefits, side effects, contraindications, dosage, and drug interactions
identify and manage common adverse events
navigate controlled drug substances, including safe prescribing

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
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
write clear, legible, and cogent prescriptions in plain language, and include specific indications for the anticipated duration of therapy
use and provide curated and evidence-based medication information handouts to patients
describe how the medication should and should not be administered, such as any important relationships to food, time of day, and other medicines being taken
provide information to patients about:
- how to take it
- potential side effects
- what it does
- what the medicine is for
- when it should be stopped
explain details of medication regimens, including drug dose, side effects, and schedule where appropriate
ensure and support patient’s understanding of key information pertaining to medication administration, safety, and ongoing prescription plan
identify and address patients’ concerns and expectations
communicate with patients about future plans for weaning of psychotropic medication
educate patients to recognise and monitor symptoms and when to seek help

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
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 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:

prescribe medications and management in accordance with evidence, guidelines, and protocols
review medicines regularly to monitor efficacy and safety, and make necessary adjustments
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 relevant agencies, and record it in patients’ medical records

direction
Requires some supervision

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

The trainee may:

monitor side effects of medicines prescribed
identify medication errors and institute appropriate measures
use electronic prescribing systems safely
describe issues raised by 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 electronic prescribing programs
ensure patients understand management plans and 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
teach psychotropic prescribing skills to other medical staff

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to ensure any new medicine improves patient-oriented outcomes
use sources of independent information that provide accurate summaries of the available evidence on new medicines
research appropriate safety information and possibility of drug interactions
develop and document procedure for psychotropic medication trial and share this with patients and general practitioner

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
refer to guidelines and medical literature when required
recognise where evidence is limited, compromised, or subject to bias or conflict of interest
recognise the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

use a collaborative approach with families in making decisions about pharmacotherapy
make prescribing decisions based on good safety data when the benefits outweigh the risks involved
recognise the ethical implications of pharmaceutical industry-funded research and marketing
follow organisational policies regarding pharmaceutical representative visits and drug marketing
follow regulatory and legal requirements and limitations regarding prescribing
consider and address beliefs and attitudes towards psychotropic medication usage
consider possible indications for psychotropic medication trial, such as:
- degree of functional impairment
- differential diagnosis
- target symptoms
recognise the ethical concerns involving pharmaceutical companies presenting research favouring a medication directly to practitioners

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

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 patients
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
- 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
seek appropriate advice from senior colleagues if drug combinations are in use or proposed, where there are multiple behavioural target symptoms, or treatments for associated medical conditions
seek appropriate advice from senior colleagues in complex situations relating to psychotropic medication, including:
- lack of efficacy
- unexpected side effects
- multiple target symptoms
involve general practitioner in longitudinal management of psychotropic medication, where appropriate

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 healthcare 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

LG9: Longitudinal care

Learning Goal 9

Longitudinal care

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

This activity requires the ability to:

develop management plans and goals in consultation with patients
manage chronic and advanced conditions, complications, disabilities, and comorbidities, as well as impact of social determinatives of health and trauma
collaborate with other health care providers and other professionals
educate patients and families on the role of the paediatrician in providing longitudinal care and developmental surveillance
engage with the broader health policy context
provide advocacy for patients and families, within the broader network of education, health, and welfare services
ensure continuity of care and transition to adult care services
facilitate patients’ self-management and self-monitoring, where developmentally appropriate and in keeping with overall transition plans to adult services

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

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
document letters, write medical reports, or contribute to the medical record 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:

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:

work in partnership patients

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, as they progress towards adulthood
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through involvement in all stages of the patients’ care journey
use a multidisciplinary approach across services to manage patients with chronic diseases and disabilities
develop collaborative relationships with patients 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 healthcare 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
engage and advocate within health services for system change, resource allocation, and innovation
connect families to support groups

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

LG10: Communication in child-centred care

Learning Goal 10

Communication in child-centred care

Communicate effectively and professionally with patients, carers, families, health professionals, care partners, and other community members engaging with the health service

This activity requires the ability to:

communicate and build rapport with children and young people
communicate and build working relationships with families and carers
practice patient and family centred care
communicate with team members and other health professionals across different contexts and modalities
communicate with care partners, such as education, NGOs, justice systems, child safety and welfare
synthesise clinical information into accurate and safe handovers and summaries
communicate respectfully and professionally
negotiate mutually agreed plans
produce comprehensive medical reports, including thorough documentation of findings and justifiable opinions for children in whom a suspicion of any form of child maltreatment has been identified
deliver education to patients, families, and health professionals at appropriate levels of understanding

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:

communicate clearly the working diagnosis, other possible diagnoses, and rationale behind management plans to patients and other health professionals
anticipate, and be able to correct, any misunderstandings patients may have about their conditions and risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
provide timely updates to patients and health professionals when there is a change in plan or new result
define, summarise, and clarify the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
use clinical encounters to provide appropriate education to patients and carers on their health needs
synthesise clinical information into clear, accurate, safe, and professional summaries and handovers
present succinct clinical cases to colleagues, providing justification for proposed plan and raise points for discussion

direction
Requires some supervision

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

The trainee may:

explain the scientific basis of health and disease to patients
demonstrate an understanding of the clinical problem being discussed
formulate management plans in partnership with patients
present a working diagnosis to colleagues

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, phone calls, or video conferencing formats
actively support, and effectively use, interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English, and document this in the medical record
demonstrate efforts to develop rapport with, and show compassion for, patients
actively listen to and prioritise the needs and concerns of patients
communicate with patients respectfully and non-judgementally
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask difficult or sensitive questions and engage children in interviews in a sensitive manner
ask patients to share their thoughts or explain their management plan in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
treat children and young people respectfully, and listen to their views
demonstrate effective interview and examination skills in the conduct of forensic medical assessments
demonstrate ability to draw out and reconcile accounts of the situation from different individuals
communicate clearly, effectively, respectfully, and promptly with other health professionals and stake holders involved in patients’ care
recognise the role of family or carers and, when appropriate, encourage patients to involve their family or carers in decisions about their care
communicate respectfully and collaboratively in all discussions in the health care setting
use appropriate defusing and deescalation strategies for angry patients, prioritising safety of self and colleagues
generate professional and timely written documentation, correspondence and reports, and ensure appropriate recipients
communicate formally with different stakeholders
present written reports, visual depictions of data, and oral presentations

direction
Requires some supervision

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

The trainee may:

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

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:

ensure appropriate documentation of communications in the medical record or other appropriate means of record keeping
discuss with patients their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand before asking for their consent
consider young people’s capacity for decision making and consent
recognise and take precautions in communication where patients may be vulnerable, such as issues of child protection
participate in processes to manage patient complaints
engage consumers in quality improvement activities

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 the proposed management plan
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:

provide appropriate and ongoing education for patients
obtain informed consent, or other valid authority, before involving patients in teaching
demonstrate and teach effective communication strategies to junior colleagues and students
reflect on communication interactions that did not go as expected and demonstrate openness to feedback, continuous learning, and improvement

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 from authorities
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
communicate any research findings to appropriate stakeholders

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 safe communication with Māori and Aboriginal and Torres Strait Islander 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 appropriate

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use this information wisely when they make decisions
encourage and support patients in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
prioritise honesty, patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions
demonstrate strict adherence to patient confidentiality and consideration for the setting of clinical discussions with team members
seek consent from patients to communicate with other organisations involved in patients’ care
apply a broad interview framework with capacity to explore possibility of:
- fabrication, exaggeration, or induction by the child’s carer of medical symptoms or physical illness
- inflicted injury
- neglect of physical, emotional, psychological, nutritional, medical care, or educational needs
- psychological harm due to the actions of carers
- sexual abuse

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with team members involved in patients’ care, and with patients
disseminate the findings and recommendations using written reports and oral presentations
discuss medical assessments, treatment plans, and investigations with patients, transfer hospital and/or primary care teams
work collaboratively with patients, transfer hospital, and primary care teams
discuss patient care needs with healthcare team members to align them with the appropriate resources
facilitate an environment where all team members feel they can contribute and their opinion is valued
make strategies to respectfully negotiate plans in the best interest of the patient at times when there are differences in opinions between health professionals

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 healthcare team members

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, consumer organisations, support services, and child protection agencies to help patients navigate the healthcare system
effectively and safely use appropriate/approved digital technologies and systems to facilitate improved communication

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

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.

LG11: Developmental and behavioural paediatrics

Key presentations and conditions

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

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

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

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Presentations

Atypical development. Loss of, or acquisition of, developmental skills which is differentiated from neurotypical development:
- autism spectrum disorder
- neurodegenerative conditions
- response to trauma
Behavioural and social impairments
Behavioural complexity:
- aggression/irritability
- anxiety
- disruptive behaviours
- functional difficulty
- mood
- pica
- repetitive behaviours
- self-injurious behaviours
- social challenges
Child abuse and neglect
Concerns from school/learning difficulties
Crises and changes in families
Developmental disability
Developmental variance
Elimination disorders
Externalising behaviours (disruptive behaviour disorders):
- ADHD combined type
- conduct disorders
- ODD
Family dysfunction
Feeding and eating problems
Gender health
Global developmental delays - delay across several domains:
- cognitive
- language
Intellectual disability/cognitive impairments
Internalising behaviours:
- ADHD-I
- anxiety
- mood disorders
Isolated developmental impairments/delay:
- fine motor impairment
- isolated speech and language delay
Sexuality
Sleep issues
Social and language impairments:
- autism spectrum disorder
- expressive language delay
- selective mutism
Somatic symptoms such as chronic pain
Substance use
Temperamental variation

Conditions

ADHD
Autism spectrum disorder
Cerebral palsy
Communication disorders
Co-morbid mental health conditions:
- anxiety disorder
- conduct disorder
- eating disorders
- gender dysphoria
- mood disorder
- obsessive compulsive disorder
- oppositional defiance disorder
- tics/Tourette syndrome
Fetal alcohol spectrum disorder (FASD)
Global developmental delay
Intellectual disability
Motor disorders, such as developmental coordination disorder
Selective mutism
Sensory impairments:
- hearing impairment
- sensory processing disorder
- vision impairment
Specific learning disabilities
Syndromic conditions associated with developmental delay/presentations:
- Di-George syndrome
- Down syndrome
- NF1
- Sotos

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

Synthesise

recognise the clinical presentation and identification of any functional difficulties
understand the interplay and overlap of many neurodevelopmental and behavioural conditions
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical and biopsychosocial history, including relevant collateral history
conduct an appropriate examination and developmental assessment
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan
plan out intervention, surveillance, and management of a child

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams
ongoing understanding of management and monitoring and assessment of emerging conditions/conditions
conduct acute risk and safety assessment (mental health, child safety, acute illness)

Consider other factors

identify individual and psychosocial factors and the impact of these on diagnosis and management
understand the trajectory of the conditions and long-term impacts

Conditions

Acquired injuries to the central nervous system
Common genetic conditions affecting development
Congenital malformations of the nervous system
Neuromuscular disorders
Pre- and perinatal insults and exposures
Toxin exposures

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

Synthesise

recognise the clinical presentation and identification of any functional difficulties
understand the interplay and overlap of many neurodevelopmental and behavioural conditions
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical and biopsychosocial history, including relevant collateral history
conduct an appropriate examination and developmental assessment
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan
plan out intervention, surveillance, and management of a child

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams
ongoing understanding of management and monitoring and assessment of emerging conditions/conditions
conduct acute risk and safety assessment (mental health, child safety, acute illness)

Consider other factors

identify individual and psychosocial factors and the impact of these on diagnosis and management
understand the trajectory of the conditions and long-term impacts

Atypical development

Behavioural red flags with problems related to:
- delayed or disordered play
- delayed language
- difficulties with transition
- emotional dysregulation
- inconsistent motor coordination
- lack of imaginary play and facial expression
- not pointing or turning to name
- poor eye contact
- poor socialisation
- problems with social or emotional reciprocity
- repetitive or unusual behaviours
- sensory processing difficulties
Common co-morbidities
Cumulative risk for children experiencing adverse events from within a vulnerable population
Risk factors for atypical development, including:
- factors during childhood impacting on development, such as:
  - chronic disease
  - deprivation
  - family environment
  - postnatal depression and other maternal mental health concerns
  - sensory impairment
  - trauma
- perinatal factors impacting on childhood development, such as:
  - birth asphyxia
  - prematurity
- prenatal, such as:
  - adverse in-utero environment
  - chromosomal
  - substance use in pregnancy:
    - ethyl alcohol
    - smoking
  - stressful life events
The impact of developmental trauma on neurobiology as described in the work by Bruce Perry

Development

Attachment theory and the impact of disordered attachment on child development
Critical periods in development
Factors affecting development, such as:
- community provisions
- critical or sensitive periods
- family
- genetic
- health
- interplay of genetics and environment
- nutrition
- plasticity
- positive influences on outcomes:
  - health
  - nurture
  - nutrition
  - stimulation
- pre- and perinatal
Functional capacity of infants, children, and young people at different stages of development, including cognitive, emotional, and social capacities
Key developmental concepts, such as:
- attachment
- neuroplasticity
- resilience
- temperament
- theory of mind
Impact of social and individual factors on developmental trajectory and their implications for practice through an ecological framework and the biopsychosocial model of health and development
Influence of biological embedding of early life experience or experience-based brain development on subsequent health and development
The concept of developmental trajectory
Typical development:
- developmental milestones:
  - Bayley
  - Gesell
  - Griffiths
  - Sheridan
- expected variations in nature and sequence of developmental milestones
- key elements of theories of development
Stages of social and emotional development, such as:
- Erikson

Assessment tools/instruments

Adaptive function assessment:
- Adaptive Behaviour Assessment System (ABAS-3)
- Developmental and Behavioural checklist (DBC-2)
- Vinelands Adaptive Behaviour Scales
Autism specific tools, such as:
- 3di
- ADIR
- Autism Diagnostic Observation Schedule (ADOS)
- Childhood Autism Rating Scale (CARS)
Development assessment tools:
- Bayley scales of Infant Development
- Griffiths scales of Mental Development (Griffiths III)
Development screening tools, such as:
- Autism Detection in Early Childhood (ADEC)
- ASQs
- GMA
- HINE
- Learn the Signs
- MCHAT-R
- Schedule of Growing skills
- SCQ
- SNAP-IV
- symbolic play test
FASD neurocognitive assessments
Interpretation of:
- psychometric assessment tools completed by psychologists, such as:
  - non-verbal tests
  - WISC
  - WPPS
- office based vision and hearing screening, such as:
  - audiometer use
  - LEA charts
  - tympanometry
- those used by allied health professionals, such as:
  - assessment of cognition and academic skills
  - sensory profile
  - speech assessment
- use of and interpretation of growth charts
Interview tools, such as:
- Autism Diagnostic Interview-Revised (ADI-R)
Narrow based and broad-based instruments, such as:
- Achenbach Child Behaviour Checklist (CBCL)
- Conners system:
  - CBRS
  - Conners 4
  - Conners EC
- SNAP-IV
- Vanderbilt

Classification systems

Diagnostic:
- Diagnostic and Statistical Manual of Mental Disorders (DSM)
- International Classification of Disease (ICD)
Functional:
- World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF)

Interventions

Office-based physician interventions, including:
- catalytic: asking questions to encourage fresh thinking
- cathartic: facilitating the expression of emotions and fears
- confronting: challenging another’s thinking
- informative: helping others gain a better understanding
- prescriptive: providing direct management advice
- supportive: valuing contributions
Specific techniques, such as:
- behaviour management:
  - ABC model
  - emotion coaching approaches as described by Gottman and Dan Siegal
  - Functional Behavioural Assessment Framework
- brief, solution-focused approaches
- cognitive behavioural therapy
- early intervention:
  - occupational therapy
  - physiotherapy
  - psychology
  - social work supports
  - speech therapy
- motivational interviewing
- serve and return
- systemic family counselling
- trauma informed interventions

Investigations

Developmental screening blood tests
Genetic bloods, such as:
- cGH array
- Fragile X
- MECP-2
- WES
Neurological:
- EEG
- MRI
- Sensory investigations, such as:
  - hearing
  - vision

Bias involved in tools self-completed versus those completed by others
Community supports available, including local networks and agencies
Development of gender and sexuality
Developmental red flags for assessment around:
- chronic pain
- dysmorphic features
- growth differences
- neurological concerns
- regression
- risk of harm
- sleep impairments
Developmentally appropriate level of involvement of children and young people in their own care
Difference between screening and assessment tools, and the limitations of each
Effects of psychosocial factors on access to care
Ethical issues in prescribing to children, including the implications of off label prescribing
Factors that support resilience and optimal child wellbeing
Fail to attend/be brought to appointment
Family understanding of, response to, and coping with disability
Impact of the education sector on infant, child and youth development and wellbeing
Impacts, negative or therapeutic, that a child’s environment can have on their wellbeing
Importance of considering the child as an individual, with unique strengths and challenges
Importance of provision of family-centred care
Importance of teaching parents, children, and young people to understand and manage their own issues
Managing difficult to access children and young people
Neurodevelopmental comorbidities
Strategies to manage questionable, complementary or alternative practices
Temperament and its implication for health and development across childhood and adolescence

Management

Medication (pharmacological) management:
- alpha agonists, such as:
  - clonidine guanfacine
- antipsychotics, such as:
  - aripiprazole
  - risperidone
- dexamphetamine-based psychostimulants
- melatonin
- methylphenidate-based psychostimulants
- non-stimulants, such as atomoxetine
- psychotropics
- SNRIs
- SSRIs
Non-pharmacological management
Referrals and interagency collaboration
- allied health therapy
- education
- funding
- further assessment

LG12: Child safety and maltreatment

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of 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

Patterns of inflicted and accidental injury, such as:
- abdominal and thoracic injuries
- all injuries in pre-mobile infants
- burns
- fractures
- head injuries
- intra-oral bleeding and injuries
- perplexing presentations (PP) and Fabricated or Induced Illness (FII) in children
- poisonings
- skin and soft tissue injuries
- strangulation and suffocation
Child sexual abuse including understanding of:
- genital injury interpretation
- normal genital and anal anatomy, including developmental changes and variations
- normal sexual behaviours of children and young people
- sexually transmitted infections and their relationship to child sexual abuse

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

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical and biopsychosocial history
conduct an appropriate examination
identify protective factors
prepare a genogram for the understanding of family and social function, including supports and family histories of medical conditions
establish a differential diagnosis
obtain and reconcile different accounts from different sources of information ie parents, health, education and other agencies
plan and arrange appropriate investigations and consultations
document history, examination and investigation findings carefully and accurately
consider the impact of injury and disease on patients and their quality of life when developing a management plan
complete appropriate child safety referrals to statutory child protection agencies
produce peer reviewed medicolegal reports for the child protection and criminal justice system

Manage

maintain knowledge of developments in the evidence-base research around injury interpretation, and child maltreatment prevention and assessment
recommend therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams
involve interagency partners, NGOs, community, and society to promote child wellbeing
consult with other medical professionals and subspeciality experts around opinions and formulation

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Biopsychosocial risk factors
Emotional or behavioural presentation as a consequence of current or previous maltreatment and the impact of neglect over time
Health needs of children and young people in the care and protection systems, such as:
- children in out of home care
- medical, developmental and mental health conditions occurring in the population including those in gateway clinics
- management of such children long term
Intergenerational trauma:
- child maltreatment presentations, such as:
  - emotional maltreatment
  - exaggeration
  - fabrication
  - falsification
  - induction of illness or symptoms in a child
- exposure to interpersonal violence
- neglect
- special consideration of all injuries in non-ambulatory infants
- unexplained or repeated incidents of injury non-accidental injury including abdominal and thoracic injuries, burns, fractures, head injuries, skin and soft tissue injuries, intra-oral injuries, child sexual abuse
Legislative requirements
Population health significance of child maltreatment and describe primary, secondary and tertiary prevention strategies
Potential risk factors for harm to the child and their siblings within the family and environment
Protective factors and how they may help modify risk and augment management
Referral pathways and community and hospital services for vulnerable children and their families

Investigations: the role of investigations to assess for occult injury and medical causes or contributors to presentations of child maltreatment

Forensic tests on biological specimens
Imaging (radiology), such as:
- bone scan
- CT
- MRI
- radiographic skeletal survey
- ultrasound
Pathology tests, such as tests for:
- bone fragility
- bleeding disorders
- drugs
- genetic conditions
- metabolic conditions
- toxins
Subspeciality consultations and procedures (including retinal examination)
Tests for sexually transmitted infections

Physical examination

Documentation of examination findings using body diagrams and photographs
Evaluating parent-child interactions regarding emotional maltreatment
Genital examination including identification of normal genital development and anatomical variants
Identification and recognition of the signs of:
- child sexual abuse
- neglect
- physical abuse
Observe parent-child interaction
Top-to-toe examinations for the detection of injuries (including the significance of sentinel injuries in young infants and children 4 years and younger)

Reporting requirements

Professional, legal and ethical responsibilities around sharing of information regarding child safety, protection, and harm
Reporting requirements and mandatory reporting obligations

Awareness of personal reactions to childhood illness, behaviour, disability, and family situations and the impact these may have on professional practice
Child rights
Different types of maltreatment and neglect:
- educational
- emotional
- medical
- physical
- supervisory
Effects on children of being a witness, victim, or perpetrator of violence
Effective prevention for child maltreatment
Enablers and barriers to obtaining information in child maltreatment situations
Family and domestic violence
Family dysfunction including poverty and disadvantages, and impact of social determinants of health
Impact of bias
Impact of vicarious trauma on clinician wellbeing

Management of physical maltreatment:
- child vulnerability and suspected maltreatment, and impact on the long-term health and wellbeing of all children involved in the care and protection system
- forensic sample collection, including collection of biological specimens for DNA analysis
Methods involved in developing a differential diagnosis for maltreatment victims
Parent or caregiver involvement in shared decision making
Peer review processes and support
Principles of advocating for children
Principles underpinning national, state and local policies and procedures related to child protection
Role of courts involved in the criminal justice system
Role of courts responsible for child protection, family law and relevant courts of appeal
Role of the paediatric medical expert in writing medicolegal reports, contributing to case conferences and testifying in court in cases of child maltreatment

LG13: Social paediatrics

Epidemiology, pathophysiology, and clinical sciences

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

For the concepts listed, trainees should be able to describe the underlying impact on child health and wellbeing.

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

Adverse childhood experiences and early life trauma, and the long-term impact of violence, abuse, and neglect
Approach to child health that focuses on the child, in illness and health, within the context of their society, environment, school, family, and community
Aspects of cultural practices and beliefs which may affect understanding of health, interactions with healthcare and management choices
Awareness of behavioural modification techniques in children, adolescents, and young adults
Awareness of personal reactions to childhood illness, behaviour, disability, and family situations, and the impact these may have on professional practice
Challenges to the psychosocial development of children in blended families, including those from LGBTQIA+ families
Child and adolescent education access
Common social stresses on families living:
- in rural and remote areas
- in urban areas
Cultural and psychosocial needs of complex patients and their families being discharged from hospital
Effect of political and social bias and violence towards priority groups, including the impact of those factors on their health and wellbeing needs
Effect of stigmatisation and discrimination on children and families who are in some way different from their community
Health and wellbeing needs of children, families and communities across multiple cultural domains, such as:
- disability
- ethnicity
- gender
- indigenous status
- religious or spiritual belief
- sexual orientation
- socioeconomic status

Health and wellbeing of priority populations, such as:
- children in the care of child protection service, such as:
  - children in out of home care
  - gateway clinics
  - homeless youth (children/youth on the street)
  - juvenile justice
- living in regional or rural areas
- refugee, asylum seeker, and migrant families
Impact on children and families who experience adverse events, such as:
- domestic violence
- family dysfunction
- housing instability
- parental mental health issue
- parental substance use
Influence of poverty and financial insecurity on the epidemiology of developmental and behavioural disorders
Influence of religious affiliation and values on children and families
Integration of the physical, mental, and social dimensions of child health and development as well as care, prevention, and promotion of health and quality of life
Issues related to adoption
Physiological, social, and psychological factors influencing child development
Problems and benefits pertaining to child behaviour and development of multigenerational households
Prolonging life and promoting health through organised efforts of society, as well as the understanding of child’s rights
Providing a local, national, and global approach to child health within priority populations, such as the ability to understand concerns with the child’s health at an individual level as well as within the population
Socioeconomic, cultural, gender, and geographical barriers to health care and the impact this has on priority groups
Special challenges to children's development and behaviour of parenting without a partner because of choice, death, divorce or incarceration
Ways of advocating for priority populations

ACES/SD Tools/Resilience Tools
Assessment of mental health
Comprehensive psychosocial assessment with social work, when available
Developmental and behavioural tools for assessment or screening
Examination:
- growth
- holistic and attachment observation
HEAADSSS assessments
Interagency approach to clinical assessment – education, statutory bodies, NGOs, other health, and support agencies

Availability of services in outreach communities
Awareness of personal reactions to childhood illness, behaviour, disability, and family situations and the impact these may have on professional practice
Biological, physical, and psychosocial elements of infant feeding
Child rights
Community child health in context of broader community
Conditions under which people live in outreach communities
Conditions under which practitioners practise in outreach communities
Culturally informed care
Cumulative risks for children with disability, underrepresented group membership, poverty, and social isolation
Effective prevention for child maltreatment
Effects on children of being a witness, victim, or perpetrator of violence
Enablers and barriers to obtaining information in child maltreatment situations
Health needs of outreach communities
Impact of parental intellectual ability and educational attainment on child development and behaviour
Impact of psychosocial issues on parenting behaviours
Impact of vicarious trauma on clinician wellbeing
Implications of attachment difficulties, particularly for those in care or adopted
Influences of media exposure on child development and behaviour
Methods involved in developing a differential diagnosis for maltreatment victims
National, state and local public health policy and legislation affecting health and wellbeing of infants, children and young people
Parenting style and behaviour management resources available to parents
Parent or caregiver involvement in shared decision making
Peer review processes and support
Pre-school and school structures
Pre-school, school and education processes for infants, children, and young people with developmental delays/disabilities
Principles of advocating for children
Principles underpinning national, state, and local policies and procedures related to child protection
Psychosocial impacts of child health:
- bullying
- maternal-infant dyad
- social media
Range of parenting styles, taking into account psychosocial and cultural variations
Role of counsellors, social workers psychologists and other allied health professionals
Role of courts involved in the criminal justice system
Role of courts responsible for child protection, family law, and relevant courts of appeal
Role of the paediatric medical expert in writing medicolegal reports, contributing to case conferences, and testifying in court in cases of child maltreatment
The impact of bias
The importance of connection to community, and that of the land, sea, and sky
The importance of delivery of health services within individual communities
The importance of Te Tiriti o Waitangi
The importance of the United Nations Convention on the Rights of the Child
Trauma-informed care
Varying capabilities of parents and limitations of their parenting skills

LG14: Child population health

Epidemiology, pathophysiology, and clinical sciences

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

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

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, management and outcomes.

View

Child health screening and surveillance
Clinical and performance indicators
Difference between service monitoring, evaluation, and research
Epidemiology in terms of disease frequency and burden, including measures and causation
Identification of population sub-groups, according to:
- age
- disability
- ethnicity, race, culture
- gender identity and gender expression
- regional and rural settings
- sexual preference
- socioeconomic status
- those with exposure to violence, abuse and neglect
Indigenous data sovereignty and shared access to data and information at a regional level
Key demographic indicators by region, and trend
Key health statistics by region and population group, and trend
Key social and economic indicators by region, and trend
Needs of children and families from special and/or priority populations:
- Aboriginal and Torres Strait Islander peoples
- children in out-of-home care and protection systems such as:
  - children in out-of-home care
  - gateway clinics
  - homeless youth (children/youth on the street)
  - juvenile justice
- LGBTQIA+
- living in regional or rural areas
- Māori and Pacific Island peoples
- refugee, asylum seeker, and migrants
- social determinants of health
- socioeconomically disadvantaged
- those with intellectual or physical disabilities
Organisational responses to serious adverse events:
- liability issues
- mediation principles
- root cause analysis
- sources of professional advice
Qualitative and quantitative data, and its collection along with statistical analysis
Research methods, data analysis tools, and quality improvement methodology
Screening programs:
- clinical and performance indicators
- clinical audit
- disease and hazard surveillance systems
Studies and their design including ethics, impact of power, limitations, and power

Drivers of health inequity across diverse population sub-groups

Access to health care:
- ancillary services
- medications
- primary care
- rural and remote settings
- screening
- tertiary care
Determinants of wellbeing and disease in infants, children, and young people, and their implications for practice, including socioeconomic status, environment, and culture
Discrimination based on race, ethnicity, gender, gender identity, or disability
Diversity of key health challenges in different population groups
Drivers of policy and program implementation as distinct research, and distinct from research
Education and health literacy as determinants of health
Effects of migration and acculturation, values, concepts of health, and diversity across different populations
Evidence base for strengthening communities through promoting health and wellbeing of infants, children, and young people
Evidence base for the promotion of wellbeing and optimal child development
Historic, social, and economic factors differentially affecting specific population groups
Importance of consumer and stakeholder input
Intersectionality
Modifiable risk factors and strategies to address these, including:
- breast feeding
- drug and alcohol issues
- immunisation status
- injury
- obesity
Populations or settings at increased risk, including:
- Aboriginal and Torres Strait Islander, Māori, and Pacific Island peoples
- disabled
- LGBQTIA+
- lower socioeconomic status
- migrants
- rural and remote
Racism, including institutional racism
Social determinants of health
Syndemic theory:
- adverse interactions between diseases and social conditions; clustering of adversity by person, place, or time

Common research methodologies and designs, such as:
- different populations:
  - community
  - clinic
- measurements
- study types
Common statistical methods and terms, such as:
- descriptive and inferential statistics
- measures of association/effect sizes
- tests of significance/confidence intervals
- types of data
Common study problems and flaws, such as:
- measurement limitations
- statistical concerns:
  - power
  - sample size
- types of bias
Different types of research, such as:
- clinical/intervention
- descriptive
Funding models
Measures of deprivation and socioeconomic status
Methodologies for evaluating population health initiatives
Principles and methodologies for service evaluation
Principles of continuous quality improvement and clinical governance
Principles of epidemiology and biostatistics, including descriptive and comparative statistics
Research methodology and health needs assessments
Relevant cultural models of health

Awareness of global health and planetary health and impact on children
Burden of disease in population groups, nationally and globally
Child health indicators and priorities locally, nationally, and globally
Disease prevention
Environmental influences on child health
Global emergencies and the broad impact on children
Grant proposals and applications, and process of peer review of research for publication
Immunisation health
Impact on child health of climate change
Mechanisms for achieving change in legislation, policies, procedures and protocols
Outbreak and disease control
Principles and methods for service evaluation, such as:
- application of principles of equity to an evaluation of a program or health service
- differences between service monitoring, evaluation, and research
- evidence on factors that produce changes in clinical behaviour or managerial practice
- importance of consumer and stakeholder input into health service design, delivery, and evaluation
- principles of quality improvement, such as:
  - clinical audit processes
  - lean thinking methodology
  - quality cycle
  - systems thinking
Sources of health information and their quality, including for specific population sub-groups
Strategies for the promotion of child wellbeing and optimal developmental at a population health level
Structural competency

Environmental epidemiology

Exposure assessment:
- exposure versus dose
- group-level versus individual level
- objective
- subjective
Study designs and analytic tools:
- ecologic studies
- Poisson regression for modelling counts or rates of events
- spatial mapping, e.g. geographic information systems (GIS)
- special considerations for confounding, clustering
- time-series analyses

Infectious disease epidemiology

Basic and effective reproductive numbers
Case fatality ratio
Pathogenicity
Timeline of disease:
- constructing an epicurve
- incubation period
- symptomatic period
Timelines of infection:
- latent period
- period of infectiousness
Transmission probability:
- secondary attack rate
- transmission probability ratio
Use of whole genome sequencing

Screening

Measures of test performance:
- area under the curve
- negative predictive value
- positive predictive value
- receiver operating characteristic curve
- reliability
- sensitivity
- specificity

Surveillance

Analysis of surveillance data:
- advanced techniques to adjust for sampling designs
- descriptive statistics
Approaches to surveillance:
- active versus passive
- information systems
- laboratory-based surveillance
- notifiable disease reporting
- record linkage
- registries
- sentinel events
- surveys
Attributes of surveillance systems:
- acceptability
- accuracy and completeness of descriptive information
- flexibility
- predictive value
- representativeness
- sensitivity
- simplicity
- timelines
Descriptive epidemiology of health problems
Elements of a surveillance system:
- case definition
- confidentiality
- cycle of surveillance
- incentives to participation, e.g. for clinicians
- population under surveillance
Uses:
- detection of infectious disease outbreaks
- detection of patterns of chronic disease, e.g. geographic
- future projections
- health advocacy
- links to services, e.g. notifiable diseases
- monitoring and evaluation of interventions/public health programs
- research, e.g. generating research questions

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 Community 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

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: Assessment and management - Child maltreatment

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: Assessment and management - developmental and behavioural

Medical expertise

Assessment

Management

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making