Curriculum standards

About this resource

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

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

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

Download the curriculum standards PDF

LG 1: 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, or carers, and in collaboration with the health care team.

Communication

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

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

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

Cultural safety*

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

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

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

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

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

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

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

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

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

References

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

Ethics and professional behaviour

Professional standard. Physicians’ practice is founded upon ethics, and physicians always treat patients and their families 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.

LG 2: Team leadership

Learning Goal 2

Team leadership

Contribute leadership within a team of health professionals to provide palliative care for patients

This activity requires the ability to:

prioritise workload
organise or coordinate multiple concurrent tasks
articulate and appropriately delegate individual responsibilities based on expertise and resources in the team
comprehend the range of team members’ skills, expertise, and roles, and monitor for accountability as appropriate
develop and apply leadership techniques in daily practice
collaborate with and motivate team members
promote and adopt insights from team members
act as a role model
resolve conflict

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly and respectfully with other health professionals and members of relevant multidisciplinary teams within and outside the palliative care team
prepare succinct and well-written documentation, including medical record notes, letters, symptom management plans for health professionals, and symptom management plans for children and families
apply relevant communication skills to resolve conflict between health professionals and with children and families
include children and families, as appropriate, in discussions with the multidisciplinary team
develop rapport with people at all levels by tailoring messages to different stakeholders

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

participate in surveillance and monitoring of adverse events and near misses
identify activities within systems to reduce errors, improve patient and population safety, and implement cost-effective change
place safety and quality of care first in all decision making

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

reflect regularly to self-evaluate personal professional practice, skills, and knowledge, and address gaps through self-directed learning
actively seek feedback from supervisors and colleagues on performance as a team member and team leader
maintain current knowledge of medical advances, as well as health care priorities and expectations of the child, family, and health care teams
teach competently by imparting professional knowledge
manage and monitor learner progress, providing regular assessment and feedback

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
encourage open discussion of ethical and clinical concerns
respect differences between multidisciplinary team members, and model respectful conversations when there are differing approaches and opinions
apply the ethics of resource allocation
effectively consult with stakeholders
acknowledge personal conflicts of interest and unconscious bias to ensure these do not negatively impact patient care
act collaboratively to resolve behavioural incidents and conflicts, including harassment and bullying

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

combine team members’ skills and expertise to deliver patient care and/or population advice
develop and lead effective multidisciplinary teams by developing and implementing strategies to motivate and support others
build effective relationships with and between multidisciplinary team members to achieve optimal outcomes
ensure all members of the team are accountable for their individual practice

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

explain the rationale underpinning a structured approach to patient assessment and clinical decision making
demonstrate child- and family-centered practice
articulate the rationale and reasoning for investigation and management options, and encourage and mentor learners to consider such rationales

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:

communicate clearly and respectfully when supervising and teaching other health professionals, junior colleagues, and medical students
supervise other health professionals, junior colleagues, and medical students in communication tasks
model a collaborative and safe learning environment
support learners to deliver clear, concise, and relevant information in both verbal and written communication
teach communication skills to other health professionals, junior colleagues, and medical students

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use errors and adverse events as opportunities to teach
identify and discuss risks with learners
ensure learners practice within their own limits of competence by providing appropriate supervision, assessment, and feedback
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:

apply knowledge of the principles, processes, and skills of supervision while supervising learners in day-to-day work
support learners to identify and participate in professional development and learning opportunities based on their individual learning needs
provide feedback and assessment tailored to learners’ goals and learning needs
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
establish and maintain effective mentoring through open dialogue
recognise the limits of personal educational expertise, and involve others appropriately
develop goals and strategies to enhance and improve teaching skills
self-assess personal teaching practice regularly, and address gaps through self-directed learning
seek feedback from colleagues and learners on teaching performance
participate in teaching and supervision professional development activities

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

provide guidance and support for junior colleagues’ research project goals and requirements
monitor the progress of learners’ research projects regularly
review and ensure acceptable standard of college research projects prior to submission
support learners to find forums to present research projects
encourage and guide learners to seek out relevant research to support practice

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural competence
respect and incorporate cultural, ethical, and religious values and beliefs of patients, families, and colleagues in teaching and learning

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

role model ethical and professional behaviour to learners, including:
- acknowledging own errors
- practising within limits of competence
- reflecting on the impact of own beliefs on patients’ care
- respect for colleagues and patients
incorporate teaching of relevant medical and health ethics and law into educational opportunities
provide professional guidance to learners when required

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
explain decisions by linking theory and practice when explaining professional decisions
promote shared problem solving
support learners to make independent decisions
apply objective evidence and expected standards to justify feedback and assessment decisions
escalate concerns about learners appropriately

direction
Requires some supervision

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

The trainee may:

provide general advice and support to learners
apply 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:

participate in and support continuing professional development
maintain professional, clinical, research, and/or administrative responsibilities while teaching
create an inclusive environment whereby learners feel part of the team

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

integrate public health principles into teaching and practice

LG 4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address areas requiring improvement in health care delivery in the paediatric palliative care setting

This activity requires the ability to:

identify and report actual and potential (near miss) errors
perform and evaluate system improvement activities
comply with best practice guidelines
evaluate clinical guidelines and outcomes
improve the development of policies and protocols designed to protect patients and enhance health care
monitor one’s own practice and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use medical knowledge and expertise to monitor for and mitigate potential adverse clinical outcomes
regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle factors contributing to poor health, and consider these when discussing therapeutic choices with patients and their families, whānau, and/or carers
use standardised protocols to adhere to best practice and quality health care
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

support patients to have access to information in a way that is accessible and meaningful to them
assist patients’ access to their health information, as well as complaint and feedback systems
discuss with patients any safety and quality concerns they have relating to their care
implement the organisation’s open disclosure policy

direction
Requires some supervision

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

The trainee may:

recognise the contribution of consumer engagement to quality improvement in health care
recognise how health literacy might affect the way patients or populations gain access to, understand, and use health information

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

participate in professional training in quality and safety
supervise and manage the performance of junior colleagues in the delivery of high-quality, safe care

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

align improvement goals with the priorities of the organisation and/or the community
contribute to developing a culture that enables and prioritises patients’ safety and quality of care

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort involving all key health professionals
support multidisciplinary team activities to lower patients’ risk of harm, and promote 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
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving care are actively encouraged
measure, analyse, and report a set of specialty-specific process of care and outcome clinical indicators, and a set of generic safety indicators
take part in the design and implementation of the organisational systems for:
- clinical, and safety and quality education and training
- defining the scope of clinical practice
- performance monitoring and management

direction
Requires some supervision

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

The trainee may:

communicate with service managers about issues that affect patients' care
contribute to relevant organisational policies and procedures
contribute to an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG 5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the palliative care needs of patients across different stages of life-limiting illnesses

This activity requires the ability to:

identify and access sources of relevant information about patients
locate patient histories
examine patients
synthesise findings to develop differential diagnoses
assess where patients are in their illness trajectory
formulate management plans, including physical, psychosocial, and spiritual needs
discuss findings and plans with patients
generate a symptom management plan
communicate findings with other health professionals

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, organised, and problem-focused medical histories, considering physical, psychosocial, and spiritual factors
perform focused physical examinations appropriate to patients’ ages, stages of illness, and presenting problem
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnosis and reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines and evidence, as well as patients’ stages of illness, goals of care, and any advance care planning discussions that have been conducted
plan for and anticipate future complications based on knowledge of the likely disease trajectory
develop symptom management plans for potential or current physical and emotional symptoms, both for other health professionals and for families
consult with other team members in grief and bereavement risk assessments, both before and after the death of a child
participate in team conversations about appropriate bereavement follow-up

direction
Requires some supervision

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

The trainee may:

take patient-centred histories, considering psychosocial factors
perform accurate physical examinations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct clinical encounters and diagnostic categories
seek supervisor input to develop appropriate management plans, including for symptom management

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain diagnosis, investigation, and management options using language appropriate to patients’ understanding and desire for information
address questions, misunderstandings, and concerns
explore the concerns and goals of patients and their families, whānau, and/or carers, and plan management in partnership
respond to verbal and nonverbal cues and emotions while providing medical information
include significant others in conversations when appropriate, recognising that in paediatrics this will commonly but not always be patients’ parents
communicate with other health professionals and members of relevant multidisciplinary teams as needed
document relevant and detailed medical record entries, including clinical assessments and management plans
share summaries of care and management plans with other professionals involved in a child’s care
address prognosis if required, acknowledging the limits of prognostication in paediatric palliative care

direction
Requires some supervision

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

The trainee may:

explain diagnosis, investigation, and management options using basic communication skills
seek supervisor input for complex or highly emotional conversations

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:

incorporate infection control into clinical practice
participate in effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
obtain informed consent before undertaking any investigations or providing treatment (except in emergencies)
contribute to monitoring and evaluation strategies around clinical assessment and management, including clinical audits
evaluate and explain the benefits and risks of clinical interventions based on the specific circumstances of individual patients
report and analyse adverse incidents and sentinel events to identify system failures and contributing factors
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patient outcomes

direction
Requires some supervision

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

The trainee may:

take precautions against potential assaults from patients or their families, whānau, and/or carers

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:

reflect regularly upon and self-evaluate professional development and clinical practice
seek feedback from colleagues on own clinical practice
address gaps in knowledge and skills through self-directed learning and continuing professional development
supervise junior colleagues in the provision of clinical care
use clinical encounters to educate patients and junior colleagues on relevant aspects of health and disease
obtain informed consent before involving patients in teaching activities

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 self-learning
initiate self-reflection practice
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:

apply evidence-based guidelines to clinical practice
analyse and apply relevant research literature to clinical practice
support or engage in research to build the paediatric palliative care evidence base

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

display respect for patients’ cultures, and attentiveness to social determinants of health
appropriately access interpretive or culturally focused services

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect, integrity, and honesty to all patients
maintain patient privacy and confidentiality according to legal guidelines
assess patients’ capacity for decision making, involving a proxy decision maker appropriately

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and clinical expertise to diagnose and manage patients’ problems and make logical and rational decisions
use a holistic approach to health considering comorbidity, uncertainty, and risk when formulating differential diagnoses and management plans
use the best available evidence for the most effective therapies and interventions to ensure quality care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work effectively as a team member to achieve the best health outcome for patients when working with:
- multidisciplinary teams
- subspecialty units in paediatric teams
- teams in community palliative care
identify colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety
ensure patients are referred to other teams as appropriate, either within or external to the palliative care team

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

aim to achieve optimal cost-effective patient care to allow maximum benefit from the available resources
advocate for children with paediatric palliative care needs in the health system

direction
Requires some supervision

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

The trainee may:

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

LG 6: Management of transitions in care settings

Learning Goal 6

Management of transitions in care settings

Manage transition of patient care between care settings and contexts, including hospital, home, and hospice

This activity requires the ability to:

manage the transition of patient care to ensure the optimal continuation of care between providers
identify the appropriate health care providers and other stakeholders with whom to share patient information
exchange pertinent, contextually appropriate, and relevant patient information
engage patients and their families, whānau, and/or carers in decision-making about the site of care

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate optimal transitions of care for patients
identify and manage key risks for patients during transition, including risk of death during transfer or risk of not being medically stable enough to return to a preferred location of care
anticipate and develop management plans for possible changes in patients’ conditions
understand the strengths and limitations of different care settings, and develop management plans that are appropriate for the setting chosen

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

explore preferred location of care and preferred location of death with patients and their families, whānau, and/or carers
communicate with patients and their families, whānau, and/or carers about options and plans for transitions in care settings, including the reasons and/or risks associated with such transitions
communicate and consult with other health professionals and members of the multidisciplinary team regarding transitions of care
provide handover to receiving health professionals
write comprehensive and accurate summaries of care, including transfer documentation

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify patients at risk of adverse outcomes, including death during transition of care, and mitigate this risk or conduct appropriate conversations with families and health professionals to ensure the risks are understood and incorporated into decision making
ensure appropriate infection control measures during transitions in care
analyse adverse incidents and sentinel events during transitions of care to identify system failures and contributing factors
use consent processes, including written consent if required, for the release and exchange of information

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly self-evaluate personal clinical practice around transitions of care
supervise junior colleagues in managing transitions of care
use teaching opportunities arising from transitions of care, including handover sessions
use opportunities from transitions of care to learn about and enhance the skills and resources available to support end-of-life care for children in different settings and communities

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handovers, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate in a culturally appropriate way by considering health literacy, language barriers, culture, religion, and belief systems when discussing transition of care with patients and their families, whānau, and/or carers
use culturally appropriate services to support patients in care transitions, such as Māori and Aboriginal or Torres Strait Islander peoples’ health workers or community-controlled organisations

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information during transitions of care in line with clinical, ethical, and legal requirements
maintain patient privacy and confidentiality according to legal guidelines during transitions of care
consider the additional complexity related to some types of information, including genetic information, and seek appropriate advice about disclosure of such information

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use medical expertise and knowledge of patients and their families, whānau, and/or carers’ wishes and priorities to ensure that care is provided in the most appropriate facility and setting

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

delegate appropriately during transitions of care
demonstrate understanding of the medical governance of patient care, and the differing roles of team members
respect the roles and expertise of health professionals across various institutions and settings, and collaborate with these professionals to ensure smooth transitions of care

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 7: Manage acute changes in clinical condition

Learning Goal 6

Manage acute changes in clinical condition

Manage acute clinical changes in the palliative care setting, including palliative care emergencies

This activity requires the ability to:

identify acute changes in clinical condition, including palliative care emergencies
initiate investigation and management appropriate to patients’ stage of disease, prognosis, and goals of care
follow local processes for escalation of care as appropriate
liaise with other medical teams as appropriate
ensure appropriate follow-up and documentation

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:

assess, diagnose, and manage acute clinical presentations as appropriate to patients’ stages of disease, prognosis, and goals of care
recommend investigations that are appropriate to patients’ stages of disease, prognosis, and goals of care
manage escalations or transitions of care in a proactive and timely manner
predict, plan for, recognise, and respond to palliative care emergencies, including large and potentially terminal bleeding events

direction
Requires some supervision

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

The trainee may:

formulate basic assessment and management plans for acute deterioration and palliative care emergencies
seek supervisor input to comprehensively medically manage acute deterioration and palliative care emergencies

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain diagnosis, investigation, and management options for acute events to patients and their families, whānau, and/or carers, using language appropriate to the patient and family’s understanding and desire for information
negotiate realistic treatment goals, and determine and explain expected prognoses and outcomes
address questions, misunderstandings, and concerns about patients’ conditions and management options
respond to verbal and nonverbal cues and emotions while discussing acute medical events with patients, their families, whānau, and/or carers
communicate with other health professionals, and complete appropriate documentation about acute changes in patients’ conditions and adjustments to their management plans

direction
Requires some supervision

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

The trainee may:

demonstrate communication skills to sufficiently support multidisciplinary teams, patients, their families, whānau, and/or carers
determine patients’ understanding of their disease and their preferred goals of care, where possible
acknowledge and escalate questions, misunderstandings, and concerns about patients’ conditions and management options to appropriate members of the multidisciplinary team

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

maintain up-to-date certification in basic life support
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
analyse adverse incidents and sentinel events to identify system failures and contributing factors
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes

direction
Requires some supervision

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

The trainee may:

recognise the risks and benefits of interventions
raise appropriate issues for review at morbidity and mortality meetings
evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly evaluate personal clinical practice around provision of acute care
seek feedback on own clinical practice
address gaps in knowledge and skills through self-directed learning and continuing professional development
supervise junior colleagues in managing acute and emergency events in palliative care
use teaching opportunities arising from acute and emergency events in palliative care

direction
Requires some supervision

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

The trainee may:

participate in inter- and intra-team education around acute events in palliative care to enhance team effectiveness
provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills

Research

confident
Ready to perform without supervision

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

The trainee will:

apply relevant research literature and evidence-based guidelines to clinical practice in managing acute and emergency events in palliative care
support and participate in research to build the palliative care evidence base in acute and emergency events encountered in palliative care

direction
Requires some supervision

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

The trainee may:

demonstrate efficient use of literature databases to retrieve evidence
use information from credible sources to aid in decision making
refer to evidence-based clinical guidelines and protocols on acutely unwell patients
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

negotiate health care decisions around acute or emergency events in culturally appropriate ways, by considering health literacy, language barriers, cultures, religion, and belief systems
integrate culturally appropriate care of Māori and Aboriginal and Torres Strait Islander peoples into management of acute events
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams in acute and emergency events encountered in palliative care

direction
Requires some supervision

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

The trainee may:

demonstrate recognition of, respect, and sensitivity to cultural factors in the community serviced
proactively identify barriers to access to health care

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

consider the consequences of delivering treatment that is deemed medically futile, recognising that patients and their families, whānau, and/or carers may have different views
demonstrate critical reflection on personal beliefs and attitudes, including how these may affect health care policy and patients’ care during acute events
initiate and engage in ethical discussions around decision making to facilitate patient- and family-centred care, and minimise and address moral distress in the multidisciplinary team

direction
Requires some supervision

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

The trainee may:

communicate medical management plans as part of multidisciplinary plans for patients
establish, where possible, patients’ wishes and preferences about care
contribute to building a positive, respectful, and inclusive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify the need for escalation of care, and escalate to appropriate staff or services when needed
integrate evidence into clinical decision making around management of acute events in palliative care
reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
incorporate available resources and local guidelines and contexts into decision making
acknowledge there is invariably more than one appropriate treatment plan, and justify the treatment plan chosen

direction
Requires some supervision

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

The trainee may:

involve additional staff to assist in patients’ care in a timely manner when required
recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work respectfully and effectively with colleagues during management of acute events
ensure appropriate multidisciplinary assessment and management of acute events
initiate emergent escalation of care within and between teams to effectively manage acute patient events

direction
Requires some supervision

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

The trainee may:

collaborate with and engage other team members during management of acute events, based on their roles and skills
encourage an environment of openness and respect

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available health care resources
collaborate with colleagues to develop policies and protocols for the investigation and management of common acute medical problems in palliative care

direction
Requires some supervision

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

The trainee may:

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

LG 8: Longitudinal care, including management of transitions across developmental ages and stages

Learning Goal 8

Longitudinal care, including management of transitions across developmental ages and stages

Manage and coordinate longitudinal care of patients with malignant and non-malignant conditions across developmental ages and stages

This activity requires the ability to:

describe the importance of developmental ages and stages in health care
describe the difference between chronological and developmental ages as relevant to children with serious illnesses
consider the changing needs of children with life-limiting illnesses as they grow and develop
facilitate and support transitions between teams and settings as patients11 grow and develop
collaborate with other health care providers
facilitate continuity of care
facilitate patients’ self-management and self-monitoring
engage with the broader health policy context

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

consider patients’ chronological and developmental ages during clinical assessments and formulation of management plans
regularly re-assess approaches to clinical assessment and management over time
elicit contributions of patients, families, whānau, and/or carers for needs assessments and care planning over time
consider appropriate timing of transition between services and teams, including neonatal to general paediatric teams, and paediatric to adult settings

direction
Requires some supervision

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

The trainee may:

recognise the need for transition between services and teams, and participate in transition planning

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 communication that is appropriate for the age and developmental stage of patients, recognising this may change over time
document and communicate changes in care plans as patients grow and develop
use assistive technologies for patients whose speech and language is impacted by underlying medical conditions
be curious and ask families and/or carers to interpret emotions, values, likes, and dislikes for patients who are nonverbal or have limited communication
stage conversations and processes of transition, with overlap between services where possible
conduct comprehensive verbal and written handovers when transitioning patients between settings and medical teams

direction
Requires some supervision

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

The trainee may:

actively elicit patients’ specific language and communication needs wherever possible
develop strategies to meet patients’ changing developmental needs over time
document and share insights about patients’ and families’ changing needs with relevant care providers to optimise and personalise care over time

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:

evaluate and explain the reasons and processes around transitioning between care settings and teams due to age
analyse adverse incidents and sentinel events to identify system failures and contributing factors when transitioning between care settings and teams
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes when transitioning between care settings and teams

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:

regularly evaluate personal clinical practice around assessing and managing patients at chronologically and developmentally appropriate levels
seek feedback on own clinical practice
address gaps in knowledge and skills through self-directed learning and continuing professional development
supervise junior colleagues in managing patients according to their chronological and developmental ages and stages, re-assessing as changes occur
use teaching opportunities arising from encounters incorporating age and developmental assessment

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 management of chronic diseases in children
participate in intra- and inter-team education around children’s changing developmental needs

Research

confident
Ready to perform without supervision

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

The trainee will:

apply relevant research literature and evidence-based guidelines to clinical practice in managing patients who transition between care settings and teams based on age
support and participate in research to enhance care for patients who encounter transitions in care settings and teams

direction
Requires some supervision

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

The trainee may:

efficiently search literature for evidence of best practice in developmentally appropriate care of patients with palliative care needs
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:

demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples and members of other cultural groups when considering ages and stages of development and transitions in care settings and teams
use professional interpreters, health advocates, family or community members to assist in communication with patients, and understand the potential limitations of each

direction
Requires some supervision

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

The trainee may:

provide culturally sensitive chronic disease management for children with palliative care needs
facilitate appropriate use of interpreter services and translated materials

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:

respect the roles and expertise of other health professionals, including those across other care settings and teams
use processes for the release and exchange of health information when patients are transitioning between care settings and teams

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 a stepwise process in the management of transition between care settings and teams, with appropriate handovers
recognise patients’ and their families’, whānau, and/or carers’ needs in terms of both internal resources and external support on a longitudinal health care journey involving the changing needs of a growing and developing child

direction
Requires some supervision

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

The trainee may:

recognise personal limitations in caring for patients with changing needs, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through involvement in all stages of patients’ care journeys as they grow and develop
work effectively within multidisciplinary teams across and between services to manage patients who may have changing needs as they grow and develop

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 care transitions between health care facilities and home, as 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:

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 when providing care to patients who have changing needs as they grow and develop

LG 9: Communication with patients

Learning Goal 9

Communication with patients

Communicate with patients across different stages of life-limiting illnesses

This activity requires the ability to:

enhance the setting for the conversation, and include other team members as needed
adapt conversations to the audience, including adjustment for age, cognition, development, and cultural and linguistic considerations
use language appropriate to patients’ understanding and desire for information
assess patients’ understanding prior to giving any information
respond to verbal and nonverbal cues and emotions
select and use appropriate communication modalities and strategies
plan conversations, and be ready to modify plans as needed
develop mutually agreed management plans
verify patients’ understanding of information shared
develop, summarise, document, and implement plans following communication to ensure actions occur

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:

explain diagnosis, investigation, and management options
use language appropriate to patients’ understanding and desire for information
address questions, misunderstandings, and concerns about patients’ conditions and management options
provide accessible information to patients to enable informed decisions about diagnostic, therapeutic, and management options
use medical expertise and knowledge about illnesses and trajectories to guide complicated and emotional decision making in palliative care, including prognosis, advance care planning, goals of care, symptoms, and end-of-life conversations

Communication

confident
Ready to perform without supervision

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

The trainee will:

tailor communication modalities to the circumstances, including emails, face-to-face, or phone calls
include significant others in conversations when appropriate
encourage and respond to questions from patients and other health professionals
respond to verbal and nonverbal cues and emotions during consultations and conversations with patients and other health professionals
consider patients’ capacity for decision making and consent, and involve them in their care with consideration to age, development, and personal preferences, appropriate to their family context
include family and other carers in patients’ care and, when appropriate, bridge understanding and conversations between patients and their families, whānau, and/or carers
document key conversations, and share details with patients and the wider care team
use language appropriate to patients’ understanding and desire for information
assess patients’ understanding prior to giving information

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 and developmental level, and cognitive, cultural, physical, situational, and socioeconomic factors
collaborate with patient liaison officers as required

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

discuss potential benefits and harms of management strategies, and ensure patients and their families, whānau, and/or carers understand these conversations to ensure safe and quality care
recognise and take precautions where patients may be vulnerable, including issues of child protection or self-harm
participate in processes to manage patient complaints

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:

supervise colleagues in managing communication with patients and their families, whānau, and/or carers, and with other health professionals
maximise teaching opportunities around communication skills

direction
Requires some supervision

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

The trainee may:

participate in learning opportunities to enhance communication skills
take opportunities to teach and supervise others to enhance their communication skills

Research

confident
Ready to perform without supervision

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

The trainee will:

incorporate communication strategies from guidelines and peer-reviewed literature into clinical practice
support and participate in research in adherence with ethics and governance requirements

direction
Requires some supervision

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

The trainee may:

refer to evidence-based clinical guidelines
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally competent communication with people of different backgrounds and cultures, including Māori and Aboriginal and Torres Strait Islander peoples
use qualified interpreters and members of cultural and religious communities to help meet the communication needs of patients, their families, whānau, and/or carers
provide plain-language and culturally appropriate written materials to patients

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:

demonstrate respectful professional relationships with patients and health professionals
communicate with integrity, transparency, empathy, and respect with patients and other health professionals
support patients’ rights to seek second opinions

direction
Requires some supervision

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

The trainee may:

communicate appropriately, consistent with the context, respecting patients’ needs and preferences
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 and other health professionals
collaborate with other health professionals within the palliative care team and from other care teams when formulating clinical assessments and plans
model and facilitate an environment where all team members feel they can participate in communication, contribute to conversations, and have their opinions valued

direction
Requires some supervision

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

The trainee may:

summarise, clarify, and communicate responsibilities of health care team members
participate in multidisciplinary care planning, including communication with the wider team about palliative care priorities
maintain the focus for health care team members on patient outcomes

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

communicate and collaborate with other services (such as regional or remote paediatric teams and community palliative care services) and key stakeholders (such as government organisations) to enhance care for patients and their families, whānau, and/or carers at patient and system levels

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

LG 10: Prescribing

Learning Goal 10

Prescribing

Prescribe medications tailored to patients’ needs, illness stages, prognosis, and goals of care

This activity requires the ability to:

collect and interpret medication histories, including the use of complementary and alternative therapies
choose appropriate pharmacological and/or non-pharmacological management options based on patients’ preferences, taking into consideration age, benefits, comorbidities, development, potential drug interactions, and risks
communicate with patients about the benefits and risks of different therapies
communicate instructions about medication administration
monitor medicines for efficacy and tolerability, and adjust doses or cease as appropriate
identify patients at increased risk from medications in the home, and initiate risk mitigation practices
collaborate with other health professionals, including pharmacists and nursing staff

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:

consider a range of factors prior to prescribing new medications, including:

age
allergies
illness type and trajectory
lifestyle factors
patient preference
potential drug interactions

incorporate a plan for follow-up and medication monitoring when commencing or adjusting medications
assess appropriate medications based on the clinical condition, prognosis, and goals of care of patients
formulate symptom management plans that include sufficient escalation steps to manage current or potential symptoms, detailing medications’ names, doses, intervals, and routes, using succinct and consistent language
incorporate non-pharmacological therapies into care and symptom management plans
identify complementary and alternative therapies sought out or used by families, and give advice on the risks and benefits offered by these practices
prescribe medications via appropriate routes for administration in the palliative care setting, such as subcutaneous or sublingual in the deteriorating or terminal phase of an illness, or subcutaneous or intravenous in the setting of nausea, vomiting, or bowel obstruction
prescribe anticipatory medications to ensure adequate preparation for the terminal phase of illnesses or crisis events across different care settings

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, including medication compatibility and monitoring in response to therapies
select medicines for common conditions safely and accurately
demonstrate understanding of the benefits, contraindications, dosage, interactions, rationale, risks, and side effects of prescribed medications
identify and manage adverse events

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the benefits, rationale, and risks of treatment options, making decisions in partnership with patients and their families, whānau, and/or carers based on illness stage and goals of care
seek guidance from pharmacists and other treating teams to ensure there are no contraindications for medications
tailor written instructions about symptom management and medication administration for patients, as well as other health professionals
educate patients about the expected outcomes, intended use, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects
describe how the medication should and should not be administered

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 required medications in full, including mg / kg / dose information and all legally required information
seek further advice from experienced clinicians or pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

review medicines regularly to reduce and understand reasons for non‑adherence, and monitor drug interactions, tolerability, and treatment effectiveness, adjusting and ceasing medicines as appropriate
access paediatric- and palliative care-specific drug references to ensure best prescribing practice, optimising medication efficacy and minimising risk
identify patients at increased risk from medications in the home, such as risk of misuse or diversion, and initiate risk mitigation practices, such as locked boxes for injectable medications
contribute to monitoring and evaluation strategies around prescribing, such as clinical audits
analyse adverse incidents and sentinel medication prescribing and administration events to identify system failures and contributing factors
report suspected adverse medication events to appropriate channels, and record in patients’ medical records

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly self-evaluate clinical practice around prescribing
seek feedback from colleagues and learners on their own prescribing practice
supervise junior colleagues’ prescribing, and review drafted symptom management plans
use, and model the use of, appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
train carers, where appropriate, about the indications for administration of medications and when to seek assistance

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:

apply relevant research literature and evidence-based guidelines to prescribing practice
support and participate in research to build the palliative care evidence base in prescribing

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

incorporate cultural and language considerations and factors into conversations and decisions about medication prescription
tailor medication advice to the language, education, and health literacy of individual patients
provide plain-language and culturally appropriate patient education materials

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:

reflect on the ethical implications of pharmaceutical industry-funded research and marketing

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use a systematic approach when selecting treatment options
incorporate findings from clinical and psychosocial assessments to formulate and explain choices for starting or continuing medications
choose suitable medicines only if medicines are considered necessary and will benefit patients
prescribe medicines appropriate to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest risk of potential harm to them
evaluate new medicines in relation to their possible efficacy and safety profile for individual patients

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other health professionals as appropriate, to ensure safe and effective medicine prescription and administration, including medical staff, pharmacists, and others

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:

incorporate considerations about access and availability when prescribing medications in palliative care, such as availability in the community, cost, and PBS listing status
advocate within health care organisations and to appropriate stakeholders when safety and availability of medications requires review, such as the cessation of certain medication products that are frequently used in palliative settings and are important for patient care

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

LG 11: Investigations and procedures

Learning Goal 11

Investigations and procedures

Order, undertake, review, and explain outcomes of investigations and procedures in the context of patients’ underlying illness stage, prognosis, and goals of care

This activity requires the ability to:

order or undertake investigations and procedures in partnership with patients, appropriate to the stage of illness, prognosis, and goals of care
arrange informed consent when applicable
confirm procedures are undertaken under appropriate conditions with appropriate monitoring and follow-up plans
interpret and communicate the results and outcomes of investigations and procedures, including imaging, and share these with other health professionals as appropriate
perform this activity across multiple relevant settings, such as the hospital, at home, or in a paediatric hospice

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use clinical acumen and experience when deciding whether to order and undertake procedures based on patients’ stages of illness, prognosis, and goals of care (e.g. considering the role and value of investigations versus an empirical treatment trial for changes in clinical condition)
use medical knowledge and experience to interpret and convey findings or outcomes of investigations and procedures

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain desired outcomes, potential value, and risks of both undertaking and not undertaking investigations or procedures to patients
address patients’ concerns about investigations or procedures, and provide opportunities to ask questions
tailor explanations and information about investigations and procedures to patients, including accounting for age and development, and cultural and linguistic considerations
provide written instructions and information to patients about investigations and procedures as appropriate
collaborate and communicate effectively with health professionals to achieve consensus about the appropriateness of investigations and procedures as appropriate, such as scoliosis surgery for a child with severe cerebral palsy who has deteriorating health

direction
Requires some supervision

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

The trainee may:

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

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:

communicate and collaborate with health professionals and care teams to ensure relevant people are involved in complex decision making about investigations and procedures in the palliative care setting
obtain informed consent or other valid authority before undertaking procedures
ensure clear plans for who is responsible for following up results and outcomes of investigations and procedures, particularly when working in a consultation-liaison role

direction
Requires some supervision

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

The trainee may:

provide information in a manner so patients are fully informed when consenting to any procedures
demonstrate consistent use of aseptic technique
identify patients using approved patient identifiers before any treatment or intervention is initiated

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:

self-reflect on approaches to ordering and conducting investigations and procedures in the palliative care setting
seek feedback from colleagues on their approach to investigations and procedures in the palliative care setting
supervise and mentor colleagues in decision making about the role of investigations and procedures in the palliative care setting
use teaching opportunities around ordering and interpreting investigations

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

obtain written consent from patients if the investigation is part of a research program

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:

tailor conversations and recommendations about investigations and procedures to the cultural context of patients, their families, whānau, and/or carers

direction
Requires some supervision

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

The trainee may:

respect cultural, linguistic, and religious values and differences of patients, their families, whānau and/or carers

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:

communicate and collaborate with health professionals within and external to the palliative care team in a respectful and timely manner to ensure best practice and quality care for investigations and procedures in the palliative care setting, such as imaging, pathology, and surgical departments
incorporate ethical principles in decision making about investigations and procedures in the palliative care setting, including autonomy, beneficence, justice, and non-maleficence
explain the expected benefits as well as the potential burdens and risks of proposed investigations before obtaining informed consent or other valid authority

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice
involve patients in decision making regarding investigations, obtaining the appropriate informed consent, including financial consent, if necessary

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify the optimal timing, risks, and roles for investigations and procedures based on patients’ illness stages, prognosis, and goals of care
adjust the investigative path in accordance with test results received

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consider the role other members of the health care team might play in ordering and/or conducting investigations, and avoid duplication of effort
provide other health professionals with clear information, and negotiate required follow-up for investigations and procedures
create a working environment in which concerns about the outcomes of investigations and procedures can be discussed in a safe and open manner

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss serious incidents regarding investigations and procedures at clinical review meetings
initiate local improvement strategies in response to serious incidents
use resources efficiently when performing investigations and procedures
advocate for equity of access to appropriate investigations for all patient groups, irrespective of age, gender, race, or socioeconomic status

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with organisational guidelines and policies

LG 12: End-of-life care

Learning Goal 12

End-of-life care

Plan for and manage the end-of-life and after-death care of patients

This activity requires the ability to:

diagnose the deteriorating and terminal palliative care phases
assess patients’ readiness to have conversations about the end-of-life stage
support patients to plan for end-of-life care through prognostic and advance care planning conversations
develop management plans in anticipation of the deteriorating and terminal phases of illnesses
assess patients’ and their families’, whānau, and/or carers’ preferences for location of end-of-life care, and the planning required and feasibility of these preferences
assess families’ coping and support levels, and tailor additional supports as needed in the last weeks of patients’ lives
support psychosocial assessments of families’ capacity to integrate grief into their lives, i.e. assess risk and protective factors for complicated grief after the death of a child
formulate plans for bereavement follow-up, in particular who or which organisation will do this, and when it will occur
consult families about after-death options for care
adapt one’s own reactions to death and loss

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:

incorporate medical acumen and experience in advance care planning conversations to elucidate patients' preferences for end-of-life care
use medical acumen and experience to assess patients’ stages of illness to diagnose when they may be, or are, in the last weeks of life
incorporate medical knowledge about disease processes and anticipated symptoms, along with an understanding of resources and local options, to consider and plan for the appropriate location for end-of-life care, such as home, hospice, or hospital
formulate goals of care and resuscitation plans in conjunction with patients, family members, and other health professionals as appropriate, to ensure that care is aligned with illness stage and prognosis
formulate holistic care and symptom management plans that encompass emotional, physical, psychological, and social needs
tailor management plans to the site of care, ensuring end-of-life care can be expertly managed across a variety of clinical settings, including home, hospice, and hospital
incorporate the needs of significant others in care planning for the end of life, including parents, siblings, grandparents, peers, schools, and the community
recognise and manage the terminal phase (last days of life) in a timely manner, recognising that this can be particularly challenging in non-malignant illness contexts
manage the potential risks and provide support during times of loss and grief

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

identify family preferences and communication styles to inform who should be involved in discussions about end of life
explore patients’, their families’, whānau, and/or carers’ wishes and readiness to inform about prognosis, dying, and after-death processes
provide bereaved families with written information about access to bereavement support in accordance with local and institutional guidelines and resources
collaborate and communicate with other health professionals, including community palliative care services or other treating teams, to ensure safe, quality, and timely care is provided to patients

direction
Requires some supervision

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

The trainee may:

discuss with patients the goals of care and treatment, and document these in patients’ clinical records
ensure consistent messages are given to patients about treatment options, their likelihood of success, risks, and prognosis
provide honest and clear clinical assessment summaries of situations, using plain language and avoiding medical jargon
discuss with family or carers appropriate support and bereavement care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

contribute to quality assurance and evaluation strategies around end-of-life care, including clinical audits and death reviews
participate in morbidity and mortality meetings
develop strategies to obtain feedback about the provision of end-of-life care from multidisciplinary team members and patients
review technological systems and processes that support safe and high-quality end-of-life care

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly self-evaluate personal clinical practice around end-of-life care
seek feedback from colleagues on their own clinical practice
address gaps in knowledge and skills about end-of-life care through self-directed learning and continuing professional development
supervise junior colleagues in managing end-of-life care
use teaching opportunities arising from the provision of end-of-life care
participate in education development and provision about end-of-life care for non-paediatric palliative care professionals, including adult-based community palliative care services, and generalist paediatric, nursing, and allied health teams

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

apply relevant literature and evidence-based guidelines to the provision of end-of-life care
support and participate in research to build the paediatric end-of-life care evidence base

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

practise culturally responsible end-of-life care based on understanding preferences and priorities of patients and their families, whānau, and/or carers
develop strategies for supporting culturally appropriate decision making in end-of-life care, such as obtaining input from cultural or religious community leaders
incorporate cultural and religious preferences in end-of-life and after-death care plans

direction
Requires some supervision

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

The trainee may:

understand, respect, and respond to individual preferences and needs of patients, regardless of their culture and religious beliefs
support patients with communication difficulties associated with cultural and linguistic diversity

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

identify and employ ethical principles in the provision of end-of-life care, such as autonomy, beneficence, justice, and non-maleficence
incorporate ethical and legal considerations into end-of-life care plans
identify and address moral distress and burnout when providing end-of-life care, both for self and colleagues

direction
Requires some supervision

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

The trainee may:

share information on advance care plans, treatment plans, goals of care, and patients’ treatment preferences with wider care teams
ensure patients’ dignity is preserved
respond appropriately to distress or concerns of colleagues and patients

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:

explain reasoning behind decision making in the provision of end-of-life care

direction
Requires some supervision

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

The trainee may:

define and document patients’ goals and agreed outcomes

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work effectively with health professionals from all disciplines to provide optimal end-of-life care, both within and external to the palliative care team
delegate roles and responsibilities for the provision of end-of-life care among health professionals, both within and external to the palliative care team
coordinate care and support to provide end-of-life care in patients’ and their families’, whānau, and/or carers’ preferred place of care, as feasible
coordinate and appropriately delegate bereavement care

direction
Requires some supervision

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

The trainee may:

document multidisciplinary care plans, including the terminal phase

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in developing frameworks for organisational policies and procedures about end-of-life care, such as advance care planning procedures and prescribing medications at the end of life
allocate resources according to the organisational strategic plan to support systems for effective delivery of end-of-life care
advocate for the needs of individual patients, social groups, and cultures within the community who have specific needs or inequitable access to tailored high-quality and safe end-of-life care

direction
Requires some supervision

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

The trainee may:

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

Knowledge guides

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

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

LG 13: Symptom management

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They may order initial investigations, and will be able to interpret the reported results of each investigation or procedure, including those arranged by the primary treating team.

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

Agitation
Breathlessness
Nausea / Vomiting
Pain
Secretions

Conditions

Gastrointestinal, including:
- anorexia / cachexia
- bowel obstruction, malignant
- constipation
- diarrhoea
- feeding intolerance
- hiccups
- mouth care
- mucositis
- nausea and vomiting
- xerostomia
Neurological, including:
- agitation
- delirium
- dystonia
- headaches
- increased intracranial pressure (ICP)
- irritability
- muscle spasm
- myoclonus
- seizures
Other, including:
- fatigue
- insomnia
- sweating
Pain, including:
- background
- bone, malignant
- breakthrough versus incident
- crises
- neuropathic
- nociceptive:
  - somatic
  - visceral
- nociplastic
- spinal cord compression
- total
Psychological, including:
- anxiety
- depression
- low mood
Respiratory, including:
- breathlessness
- cough
- secretions
Skin, including:
- breakdown:
  - epidermolysis bullosa
- itch
- tumour involvement and fungation
- wounds:
  - pressure ulcers

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Haemorrhage, catastrophic
Hypercalcaemia, malignant
Pain crisis
Seizure
Spinal cord compression, malignant
Superior vena cava obstruction
Terminal restlessness / delirium
Upper airways obstruction

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

Synthesise

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

Manage

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

Consider other factors

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

Pharmacology

Analgesic agents, including:
- adjuvant:
  - alpha adrenergic agonists
  - dexamethasone
  - gabapentinoids
  - ketamine
  - paracetamol
  - selective serotonin noradrenaline reuptake inhibitors
  - tricyclic antidepressants
- non-steroidal anti-inflammatory agents
- opioids:
  - fentanyl
  - hydromorphone
  - methadone
  - morphine
  - opioid rotations
  - oxycodone
Anti-emetic agents
Anti-secretory agents
Anxiolytic / Sedative agents
Bisphosphonates
Non-pharmacological symptom management options

Clinical assessment tools

Tailored to pathophysiology, prognosis, and goals of care
Symptom assessment scales for verbal and nonverbal patients:
- face, legs, activity, cry, and consolability (FLACC) scale
- numerical rating
- Wong–Baker Faces

Investigations

Blood tests
Imaging
Tailored to pathophysiology, prognosis, and goals of care

Symptom-related procedures

Pain control procedures, including:
- intrathecal analgesia
- nerve root injection
Patient-controlled analgesia
Radiotherapy
Subcutaneous infusion

Disease- or syndrome-specific procedures (understanding of the indications, benefits, and burdens of disease-related procedures, including the following)

Cardiac:
- disease
- surgery for congenital cardiac disease
- ventricular assist device insertion
Gastrointestinal:
- nasogastric insertion
- percutaneous gastrostomy
Neurological:
- baclofen pump insertion
- cerebrospinal fluid diversion
Orthopaedic
Renal:
- renal replacement therapy
Respiratory:
- non-invasive ventilation
- oxygen therapy
- tracheostomy
- video-assisted thoracic surgery (VATS) and pleurodesis in the setting of recurrent malignant pleural effusions
Surgical interventions:
- fracture fixation in the setting of osteopenia of disability
- scoliosis surgery in the setting of severe neurodisability

Clinical considerations

Anticipatory prescribing
Complex family discussions, encompassing the priorities and goals of care of patients, their families, whānau, and/or carers
Investigations and monitoring in the context of illness stage and goals of care
Options for place of care
Patients’ and their families’, whānau, and/or carers’ preferences for communication and degree of:
- information shared
- involvement in decision making
Uncertainty in prognosis and trajectory
Understanding and having treatment strategies for the psychosocial effects and psychosocial drivers of symptoms

Ethical and legal issues

Advance care planning
Capacity assessment in the young person
Disagreement between families and clinicians about treatment decisions
Disagreement within families about treatment decisions
Nutrition and hydration in the context of illness stage and goals of care
Terminal sedation
Withdrawal and/or withholding of life-sustaining treatment

Procedures

The understanding and ability to communicate the relative risks and burdens to children and families
Informed consent

Self-care in palliative care

Personal impact of dealing with incurable illness, death, and dying
Physician burnout

LG 14: Life-limiting and life-threatening conditions

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these 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

Non-malignant conditions, including but not limited to

Cardiac conditions, including:
- cardiac disease, congenital
- cardiomyopathy, acquired
- cardiomyopathy, familial
Congenital health problems, including:
- birth complications:
  - hypoxic brain injury
- genetic conditions, including:
  - trisomy 18
- prematurity-related
Dermatological conditions:
- epidermolysis bullosa
Gastrointestinal conditions, including:
- liver failure
- refractory feeding intolerance, generally associated with another presentation, including:
  - severe neurological impairment
- short gut syndrome
Immunological conditions, including:
- immunodeficiencies being considered for or treated with bone marrow transplant, including:
  - severe combined immunodeficiency (SCID)
Metabolic conditions, including:
- mucopolysaccharidoses
- Pompe disease
Neurological conditions, including:
- brain injury
- neurodegenerative disorders:
  - Batten disease
  - Duchenne muscular dystrophy
  - leukodystrophy
  - spinal muscular atrophy
- static encephalopathies:
  - severe cerebral palsy
Renal conditions, including:
- bilateral renal agenesis
- renal disease, end stage
Respiratory conditions, including:
- cystic fibrosis:
  - timing of consideration for lung transplant

Malignant conditions, including but not limited to

Brain tumours, including:
- diffuse midline glioma
- glioblastoma multiforme
Haematological malignancies, including:
- patients with haematological malignancy entering transplant with high disease or comorbidity burden, such as high-risk transplants
- relapsed / refractory leukemia / lymphoma, and high-risk leukemias
- second bone marrow transplant
Relapsed resistant solid tumours with poor prognosis

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

Synthesise

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

Manage

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

Consider other factors

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

For the above conditions

Disease- and patient-specific factors in prescribing potential therapies:
- organ dysfunction
- susceptibility to medication side effects
Epidemiology
Expected trajectory / trajectories of conditions
Intent of potential therapies, including:
- attempt at cure
- life prolongation
- symptom management
Pathophysiology

Clinical assessment tools

Symptom assessment scales for verbal and nonverbal patients, including:
- face, legs, activity, cry, and consolability (FLACC) scale
- numerical rating
- Wong–Baker faces
Tailored to pathophysiology, prognosis and goals of care

Investigations

Blood tests
Imaging
Tailored to pathophysiology, prognosis, and goals of care

Disease- or syndrome-specific procedures (understanding of the indications, benefits, and burdens of disease-related procedures, including the following)

Cardiac:
- disease
- surgery for congenital cardiac disease
- ventricular assist device insertion
Gastrointestinal:
- nasogastric insertion
- percutaneous gastrostomy
Neurological:
- baclofen pump insertion
- cerebrospinal fluid diversion
- palliative radiotherapy
Orthopaedic
Renal:
- renal replacement therapy
Respiratory:
- non-invasive ventilation
- oxygen therapy
- tracheostomy
- video-assisted thoracic surgery (VATS) and pleurodesis in the setting of recurrent malignant pleural effusions
Surgical interventions:
- fracture fixation in the setting of osteopenia of disability
- scoliosis surgery in the setting of severe neurodisability

Clinical considerations

Anticipatory prescribing
Complex family discussions, encompassing priorities and goals of care of patients, their families, whānau, and/or carers
Investigations and monitoring in the context of illness stage and goals of care
Options for place of care
Patients’ and their families’, whānau, and/or carers’ preferences for communication and degree of:
- information shared
- involvement in decision making
Uncertainty in prognosis and trajectory
Understanding and having treatment strategies for the psychosocial effects and psychosocial drivers of symptoms

Ethical and legal issues

Advance care planning
Capacity assessment in the young person
Disagreement within families about treatment decisions
Disagreement between families and clinicians about treatment decisions
Nutrition and hydration in the context of illness stage and goals of care
Withdrawal and/or withholding of life-sustaining treatment

Procedures

The understanding and ability to communicate the relative risks and burdens to children and families
Informed consent

Self-care in palliative care

Personal impact of dealing with incurable illness, death, and dying
Physician burnout

LG 15: End-of-life and after-death care

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

View

Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

View

Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

View

Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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

Agitation / Restlessness
Breathing changes, including:
- breathing pattern
- secretions
Changes in conscious state
Changes in perfusion
Changes specific to clinical conditions, including:
- terminal airway obstruction (e.g. secondary to mediastinal mass)
- terminal haemorrhage (e.g. secondary to coagulopathy)
Incontinence and changes in bowel habit
Reduced enteral intake
Seizures (e.g. Batten disease)

Children’s understanding and response to illness and grief
Existential distress, including emotional and psychological aspects of grief
Family contexts and communication styles, including:
- mutual pretence
- open versus closed awareness contexts
Grief and bereavement risk assessment and care
Spiritual needs and concerns, such as religious needs at end of life
Meaning-making and legacy creation

Anticipatory prescribing for potential ‘catastrophic events’:
- sedation for terminal bleeding
Medication administration at end of life:
- continuous subcutaneous infusions
Non-pharmacological management for symptoms at end of life, including:
- aromatherapy
- massage
Pharmacological management for symptoms at end of life:
- agitation / restlessness:
  - anti-psychotics
  - benzodiazepines
- breathlessness:
  - benzodiazepines
  - opioids
- pain:
  - adjuvant agents
  - opioids
- nausea / vomiting:
  - 5HT3 antagonists
  - dopamine antagonists
- secretion, such as anticholinergics

Cultural and/or religious considerations, including:
- rituals for washing
- timing of burial
Local services and resources to assist with finances, including:
- funeral funds
Options for location of care post-death, including:
- processes to have a child remain at home for a period post-death
- temperature regulated room in a hospice
Organ and tissue donation if available / appropriate
Physical changes that occur post-death
Role of the coroner, including reportable and reviewable deaths

Clinical considerations

Anticipatory prescribing
Complex family discussions, encompassing priorities and goals of care of patients, their families, whānau, and/or carers
Investigations and monitoring in the context of illness stage and goals of care
Options for place of care
Patients’ and their families’, whānau, and/or carers’ preferences for communication and degree of:
- information shared
- involvement in decision making
Uncertainty in prognosis and trajectory
Understanding and having treatment strategies for the psychosocial effects and psychosocial drivers of symptoms

Ethical and legal issues

Advance care planning
Capacity assessment in the young person
Coroner’s cases and the Coroners Act
Disagreement between families and clinicians about treatment decisions
Disagreement within families about treatment decisions
Terminal sedation
Verification and certification of death
Withdrawal and/or withholding of life-sustaining treatment

Self-care in palliative care

Personal impact of dealing with incurable illness, death, and dying
Physician burnout

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 Palliative Medicine (Paediatrics & Child Health)

Table of contents

About this resource

LG 1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

LG 2: 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

LG 3: 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

LG 4: 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

LG 5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG 6: Management of transitions in care settings

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork