Curriculum standards

About this resource

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

LG1: Competencies

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

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

Competencies will be common across training programs.

Medical expertise

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

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

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

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

Communication

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

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

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

Cultural safety*

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

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

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

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

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

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

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

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

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

References

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

Ethics and professional behaviour

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

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

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

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

Entrustable Professional Activities

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

LG2: Team leadership

Learning Goal 2

Team leadership

Lead and/or work collaboratively with a team of health professionals

This activity requires the ability to:

prioritise workload
manage multiple concurrent tasks
articulate individual responsibilities, expertise, and accountability of team members
understand the range of team members’ skills, expertise, and roles
acquire and apply leadership techniques in daily practice
collaborate with teams across multiple health care settings
encourage and adopt insights from team members
act as a role model
conduct multidisciplinary case conferences

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 evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

provide support and motivate patients or populations and health professionals by effective communication
demonstrate a transparent, consultative style by engaging patients, families, carers, relevant professionals, and/or the public in shared decision making
demonstrate rapport with people at all levels by tailoring messages to different stakeholders

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify opportunities to improve care by participating in surveillance and monitoring of adverse events and ‘near misses’
identify activities within systems to reduce errors, improve patient and population safety, and implement cost-effective change
supervise team members in the development and conduct of clinical audits, up to implementing changes based on findings and measuring the effect of such changes
place patient and staff 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:

promote commitment to high quality teaching within the team and with learners that are attached to the team
regularly self-evaluate personal professional development practice, and implement changes based on the results
actively seek feedback from supervisors and colleagues on their own performance
identify personal gaps in skills and knowledge, and engage in self-directed learning
maintain current knowledge of new technologies, health care priorities, and changes of patients’ expectations
teach competently by imparting professional knowledge
manage and monitor learners’ progress, providing regular assessments 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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate culturally safe relationships with professional colleagues and patients
promote and advocate 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
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:

demonstrate ability to effectively manage own workload and prioritise concurrent tasks
promote a team culture of shared accountability for decisions and outcomes
encourage open discussions of ethical and clinical concerns
respect differences of multidisciplinary team members
understand the ethics of resource allocation by aligning optimal patient and organisational care
effectively consult with stakeholders, and respect alternative views
acknowledge personal conflicts of interest and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment and bullying

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate health services and clarify expectations to support systematic and transparent decision making
make decisions when faced with multiple and conflicting perspectives
contribute 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
recognise limits of practice

direction
Requires some supervision

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

The trainee may:

review new health care interventions and resources
interpret appropriate data and evidence for decision making

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

combine team members’ skills and expertise in delivering patient centred care and/or population advice
develop and lead effective multidisciplinary teams
build effective relationships with multidisciplinary team members to achieve optimal outcomes
ensure all members of the team are accountable for their individual practice
actively promote, support, and advocate for improved wellbeing of colleagues and other health professionals

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

engage in appropriate consultation with stakeholders on the delivery of health care
advocate for resources and support for health care teams to achieve organisational priorities
influence the development of organisational policies and procedures to optimise health outcomes
identify the determinants of health of the population, and mitigate barriers to access to care
lead the development and use of organisational policies and procedures

direction
Requires some supervision

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

The trainee may:

understand methods used to allocate resources to provide high quality care
demonstrate awareness of organisational policies and procedures

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Demonstrate commitment to ongoing professional development and education of other health care practitioners

This activity requires the ability to:

demonstrate commitment to health professional education opportunities
provide work-based teaching in a variety of settings
teach and role model professional skills
create a safe and supportive learning environment
plan, deliver, and provide work-based assessments
encourage learners to be self-directed and identify learning experiences
supervise learners, such as trainees and medical students, in day-to-day work, providing timely and constructive feedback
support learners to prepare for assessments
role model commitment to lifelong learning and continuous professional development reflect on and evaluate own teaching and supervision skills
reflect on and evaluate own teaching and supervision skills

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

combine high-quality care with high-quality teaching
explain the rationale underpinning a structured approach to decision making by participating in teaching on the run / bedside teaching
consider the views of patients, their family members, and/or carers during health consultations
consider the population health effect when giving advice
encourage learners to consider the rationale and appropriateness of investigations and management options
identify and support learners’ strengths and areas for development and facilitate improvement, including learners’ self-reflection

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:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in the supervision of learners
not tailor learning, assessments, and feedback to individual learners
not match teaching and learning objectives clearly to outcomes
not encourage learners to be self-directed

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide general advice and support to learners
use health data logically and effectively to investigate complex and/or uncertain diagnostic dilemmas

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

maintain and encourage effective performances and continuing professional development
maintain professional, clinical, research, and/or administrative responsibilities while teaching
help to shape organisational culture to prioritise quality and work safety through openness, honesty, shared learning, and continued improvement
create an inclusive environment in which 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
support collaboration and share resources in health professionals’ education

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify, mitigate, and report actual and potential (‘near miss’) errors
conduct and evaluate system improvement activities
adhere to best practice guidelines
use clinical audits to improve practice and outcomes
contribute to the development of policies and protocols designed to protect patients and enhance health care
monitor one’s own practice, and develop individual improvement plans
demonstrate commitment to ensuring deliverable health care is safe, timely, patient-centred, effective, efficient, and equitable

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

regularly review patients or population health outcomes to identify opportunities for improvement in delivering appropriate care
use standardised protocols / standard of care guidelines to adhere to best practice and ensure optimal outcomes where applicable
demonstrate the ability to critically analyse relevant literature, and refer to evidence-based guidelines, and apply this to daily practice
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

contribute to processes on identified opportunities for practice improvement
use local guidelines to assist patient care decision making

Communication

confident
Ready to perform without supervision

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

The trainee will:

support patients to have access to, and use, high-quality, easy-to-understand information about health care
obtain informed consent before undertaking any investigation, procedure, or therapy
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 organisations’ open disclosure policy
engage consumers in quality improvement activities

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills including infection control, adverse event reporting, and effective clinical handover during escalation and between transitions of care
participate in organisational quality and safety activities, including morbidity and mortality reviews, antimicrobial stewardship, review of clinical guidelines / action plans and protocols, root cause analysis, and clinical incident reviews
use clinical audits and registries of data on patients’ experiences and outcomes, and learn 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 an understanding of a systematic approach to improving the quality and safety of health care
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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

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
participate in clinical research that aims to improve patient outcomes, where applicable

direction
Requires some supervision

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

The trainee may:

understand that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice
present critical analysis of relevant literature at departmental journal club meetings

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
apply frameworks and policies related to improving health care for Aboriginal and Torres Strait Islander and Māori peoples

direction
Requires some supervision

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

The trainee may:

communicate in a manner that is appropriate to patients’ language and cultural needs
demonstrate commitment to improving cultural safety in your practice

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

contribute to developing an organisational culture that enables and prioritises patients’ safety and quality of care
demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients and health professionals

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
consider patients’ (including young people’s) / carers’ capacity for decision making and consent, involving a proxy decision maker appropriately

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:

support multidisciplinary team activities to minimise risk of harm, and promote multidisciplinary and interdisciplinary education programs
actively involve clinical pharmacists in the medication-use process

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

support the development, implementation, evaluation, and monitoring of governance processes
maintain a dialogue with service managers about issues that affect patient care
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement
contribute to the development of policies and protocols designed to protect patients and enhance health care (including health promotion policies and protocols), such as the development of resources and interventions to support smoking and vaping cessation for young people and carers in hospital and in the community

direction
Requires some supervision

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

The trainee may:

contribute and adhere to relevant organisational policies and procedures

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients across multiple settings

This activity requires the ability to:

identify and access sources of relevant information about patients across the range of ages, from birth to young people, in inpatient and outpatient tertiary hospitals, community settings, metropolitan and outreach, as well as telehealth methods
obtain patient histories
examine patients
synthesise findings to develop provisional and differential diagnoses
generate a management plan (including selecting, organising, undertaking, and interpreting relevant investigations)
discuss findings with patients, families and/or carers
present findings to other health professionals

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit an accurate, organised, and problem-focused medical history, considering physical, psychosocial, and risk factors
perform a full physical examination to establish the nature and extent of problems
synthesise and interpret findings from the history and examination to devise the most likely provisional diagnoses via reasonable differential diagnoses, including common and uncommon presentations, acute and chronic / complex conditions
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop evidence-based management plans, and consider the balance of benefit and harm by taking patients’ personal circumstances into account
decide on the most appropriate investigations based on available evidence, minimising unnecessary and potentially harmful investigations where possible
use the most appropriate methods to monitor chronic respiratory disease longitudinally
oversee the perioperative care of patients having surgical procedures / interventions (e.g., bronchoscopy, insertion and management of pleural drains, insertion and management of IV access)
manage patients where there are concerns for child maltreatment (in conjunction with other relevant agencies)

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and respond to patients, parents and carers’ concerns seriously, and give them adequate opportunity to ask questions
provide information to patients, family, or carers to enable them to make informed decisions from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
communicate sensitively regarding diagnoses and management plans, such as genetic family disorders
prepare timely and accurate communication in the form of letters and reports to disseminate elevant medical information to children and families, other health professionals, and other relevant agencies

direction
Requires some supervision

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

The trainee may:

anticipate, read, and respond to verbal and nonverbal cues
demonstrate active listening skills
communicate patients’ situations to colleagues, including senior clinicians
accurately and thoroughly document clinical histories, examinations, investigations, impressions, and management plans in medical records

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills including infection control, adverse event reporting, and effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
obtain informed consent before undertaking any investigation or providing treatment, except when not feasible (e.g., in some emergency / lifesaving situations)

direction
Requires some supervision

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

The trainee may:

perform hand hygiene and take infection control precautions at appropriate moments
take precautions against assaults from agitated patients, and ensure appropriate care of patients
document history and physical examination findings, and synthesise with clarity and completeness
ensure that patients are informed of the potential risks associated with any part of proposed management plans

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
regularly reflect and self-evaluate professional development

direction
Requires some supervision

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

The trainee may:

deliver teaching considering learners’ level of training
where appropriate, obtain informed consent before turning clinical activities into teaching opportunities

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

acknowledge patients’ beliefs and values, and how these might impact on health
demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander and Māori peoples, and members of other cultural groups
use health information resources that are culturally safe

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
hold information about patients in confidence, unless the release of information is required by law or public interest
assess patients (including young people’s) and/or carers’ capacity for decision making, and involve a proxy decision maker when appropriate

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and experience to identify patients’ problems, make logical and rational decisions, and act to achieve optimal patient outcomes
consider comorbidity, uncertainty, and risk when making decisions about patient care
use the best available evidence for the most appropriate 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
determine the need for referrals

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:

present and discuss complicated patients’ cases with local medical and surgical teams and other members of the multidisciplinary team to determine clinical management
work effectively as a member of multidisciplinary teams to achieve patients’ best health outcomes
demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate appropriate utilisation of local, regional, and national health services and systems
participate in health promotion, disease prevention and control, screening, and reporting of notifiable diseases
evaluate the cost versus benefit of investigations
support and utilise innovations to ensure the delivery of equitable and quality health care, such as telehealth digitally integrated support services
participate in health promotion and primary prevention activities and strategies to improve lung health in communities

direction
Requires some supervision

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

The trainee may:

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

LG6: Management of transitions from paediatric to adult care

Learning Goal 6

Management of transitions from paediatric to adult care

Manage transitions of patient care from paediatric to adult medicine

This activity requires the ability to:

assess the timing and risks in transition from paediatric to adult care
assess patient, family, and/or carer readiness for transfer to adult care
create goals of transition in care specific to patients and their care needs
develop a transition plan in collaboration with patients, family, and/or carers, and the medical team
summarise and document the clinical case for handover to the adult respiratory physician

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

assist patients from early adolescence to prepare for transfer to adult care at an appropriate age
assess patients’ health literacy and developmental readiness for the demands of the adult care setting
assess adherence to treatment and monitoring plans
outline the key components of a transitional care program and the differences between the cultures of paediatric and adult care services, including the role of the adult physician / GP
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
anticipate, prevent, and manage changes in health status at the time of transfer
adapt transition to meet individual patients’ needs (e.g., if a patient has an intellectual disability)

direction
Requires some supervision

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

The trainee may:

assess psychosocial issues that may affect health and/or access to adult health services
identify the ways in which chronic respiratory conditions may impact on patients’ lifestyles, such as contraception, pregnancy, employment, sport / leisure activities, and smoking / vaping / risk taking activities
establish plans for ongoing care that include monitoring health status and managing adherence

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 the impact of chronic respiratory disease on adolescents’ and young adults’ leisure, educational, and work activities

direction
Requires some supervision

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

The trainee may:

assess patients’ understanding of their illness and health care needs, and work with them to increase their understanding
use communication skills and strategies to help patients make informed decisions
recognise and explore the worries and concerns of adolescent and adult patients with chronic respiratory disease
identify the need to shift responsibility for decision making from parents to patients, and work with patients and their carer on planning this
communicate sensitively with adolescents and young adults
recognise when it is appropriate to communicate with patients individually versus when it is appropriate to communicate with patients and their family members and/or carers
discuss with patients the differences between paediatric and adult care, such as the involvement of the parent or carer in decisions for adult patients versus paediatric patients

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

ensure patients are informed of risks associated with any part of proposed management plans
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:

document and provide handover of patient history with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

educate adolescents and young adults about their conditions and their impacts on their lives

direction
Requires some supervision

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

The trainee may:

explain how patient education can empower young adults to take responsibility for their health

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 culturally safe health information resources to assist with the provision of health information to Aboriginal and Torres Strait Islander and Māori peoples
discuss topics including sexuality and contraception sensitively and in line with the cultural and religious beliefs of patients

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:

explain the role of GPs 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:

identify the right time to start facilitating transition by considering the needs of individual patients and their family members or carers
select the appropriate specialist to transition the patient to (e.g., GP, respiratory physician, metro versus outreach / regional)

direction
Requires some supervision

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

The trainee may:

consider whether a paediatric or adult setting may be more appropriate to conduct procedures and/or investigations in young people

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:

recognise and work collaboratively with other health care providers, including allied health workers and psychologists
ensure sufficient handover to all care providers (including primary care and community care providers), including robust notes to convey complex history and/or rationale for past decisions

direction
Requires some supervision

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

The trainee may:

recognise the importance of the multidisciplinary team in the management of young people
consider how to transition other specialties in which the patient is receiving care into adult 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:

connect patients with local or online peer support groups
contribute to the development of a written transition policy, which is a document that sets out principles, standards, and practices of how transitions are managed at the centre
advocate for resources to support efficient and more effective transitions

direction
Requires some supervision

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

The trainee may:

apply local and international guidelines around transitions in chronic respiratory disease

LG7: Acute paediatric respiratory care

Learning Goal 7

Acute paediatric respiratory care

Assess and manage the care of acutely unwell paediatric respiratory patients

This activity requires the ability to:

recognise instability and medical acuity in clinical presentations
provide assessment and initial stabilisation of airways, breathing, and circulation
elicit histories, including relevant history, and perform relevant physical examinations
select and/or interpret appropriate investigations
develop and implement management plans
liaise with paediatric intensive care or neonatal intensive care units, retrieval services, and referral centres when appropriate
safely prepare and handover acutely unwell patients at change of shift or change in patient status or location
communicate with family and carers regarding acute situations and 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:

recognise and manage typical and atypical respiratory presentations
integrate and synthesise clinical information and results of investigations to assess clinical status
initiate and manage respiratory support, including oxygen therapy, high flow, and non-invasive and invasive ventilation (with the support of ICU physicians as required)
monitor respiratory status in the acute setting, including clinical observations, oximetry, capnography, and blood gases
manage patients with central venous access devices, PICCs, gastrostomy tubes, and other in situ medical devices, in liaison with other subspecialty teams

direction
Requires some supervision

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

The trainee may:

recognise deterioration, and know how to escalate treatment
perform the sequence of resuscitation as per established protocols
use appropriate tools for monitoring acutely unwell patients
develop management plans for immediate treatment
select and use diagnostic techniques to differentiate the underlying causes and precipitating factors of respiratory disease, and to evaluate respiratory status

Communication

confident
Ready to perform without supervision

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

The trainee will:

convey information to other medical professionals involved in patients’ care, including ICU, retrieval services, and other teams (e.g., general surgery, thoracic surgery, cardiology, neurology, sleep medicine, general paediatrics)
facilitate early sensitive communication with patients and families during escalation and resuscitation to allow shared decision making
explain procedures clearly to patients, families, and carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
accurately document procedures in the clinical notes, including informed consent, indication for procedures, medicines given, aseptic technique, difficulties encountered, and aftercare
support health professionals in remote settings to manage acutely unwell patients
support multidisciplinary teams to achieve the best health outcomes for acutely unwell patients

direction
Requires some supervision

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

The trainee may:

document information to outline the rationale for clinical decisions and action plans
convey information to families about diagnosis and prognosis clearly, compassionately, and in a timely manner
demonstrate communication skills to sufficiently support the function of multidisciplinary teams

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:

consider alternative strategies if complications arise or treatment is ineffective
participate in organisational quality and safety activities, including morbidity and mortality reviews and clinical incident reviews
document treatment given without consent in an emergency according to local guidelines

direction
Requires some supervision

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

The trainee may:

review and reassess acute management plans
comply with safety requirements of the health service

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate learning behaviour and skills when educating junior colleagues, and organise education and learning opportunities for colleagues and students
regularly reflect upon and self-evaluate professional development
where appropriate, obtain informed consent before turning clinical activities into teaching opportunities

direction
Requires some supervision

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

The trainee may:

self-reflect infrequently
set unclear goals and objectives for self-learning
participate in in-service training on new technology

Research

confident
Ready to perform without supervision

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

The trainee will:

lead and/or participate in clinical research that aims to improve patient outcomes, where applicable

direction
Requires some supervision

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

The trainee may:

refer to evidence-based clinical guidelines
search for and critically appraise the evidence to resolve clinical areas of uncertainty
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:

take steps to help support Aboriginal and Torres Strait Islander and Māori peoples in a culturally safe way
negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams

direction
Requires some supervision

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

The trainee may:

understand the impact of cultural and psychosocial perspectives of the family
practice cultural competency

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

apply ethical principles to lifesaving treatments and patients’ and families’ rights to decide on care management, including withdrawal of care
engage appropriate colleagues in decision making (e.g., when withdrawing care or continuing to provide care despite patient or parent wishes)
hold information about patients in confidence, unless the release of information is required by law or public interest

direction
Requires some supervision

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

The trainee may:

establish, where possible, patients’ wishes and preferences about care
consider discrepancies between parents' or carers’ wishes and decisions around what is best for patients based on their personal comfort and life expectancy

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:

determine the setting of care appropriate for patients’ current care needs
balance risk, effectiveness, and priority of intervention in the presence of multiple comorbidities and/or other features of case complexity
reconcile conflicting advice from other specialties, and support shared clinical decisions in the presence of uncertainty
use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

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

The trainee may:

integrate best evidence and clinical expertise into decision making
participate in decisions to admit, discharge, or transfer patients from the ICU
recognise personal limitations, and seek help when required (including escalation of care)
assess personal skill levels, and seek help with procedures when appropriate

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 effectively with staff in the emergency department, paediatric, and neonatal intensive care units, and other subspecialty inpatient units in the acute care of patients, as appropriate
determine the need and timing of referrals to other physicians and surgeons
check in and support team members’ wellbeing and, where necessary, support psychological first aid and formal debriefing

direction
Requires some supervision

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

The trainee may:

present patient cases to health care teams, and understand the respiratory management plans
encourage an environment of openness and respect to lead effective teams
determine the need and timing of referrals to other specialists (including general paediatricians and relevant adult health services)

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs, balancing costs against outcomes
collaborate with emergency medicine staff, general paediatric teams, and other colleagues to develop policies and protocols for the investigation and management of common acute presentations (including acute complications of chronic respiratory conditions)
advocate for public health policies and strategies to promote lung health, such as climate change mitigation strategies and air pollution reduction policies, and education and interventions targeted at tobacco-free and nicotine-free environments

direction
Requires some supervision

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

The trainee may:

understand 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
apply knowledge of local protocols and resources

LG8: Longitudinal care of patients with chronic respiratory conditions, from birth to the adolescent and young adult

Learning Goal 8

Longitudinal care of patients with chronic respiratory conditions, from birth to the adolescent and young adult

Manage and coordinate the longitudinal care of patients with complex respiratory conditions, including transition and end-of-life care

This activity requires the ability to:

develop management plans in consultation with patients, their families, and/or carers
facilitate patients’, families’ and/or carers’ self-management and self-monitoring
demonstrate problem-solving skills to manage chronic conditions, complications, disabilities, and comorbidities
liaise with other health professionals and team members to ensure continuity of care and smooth transition of care
engage with the broader health policy context, and responsibly use public resources
manage end-of-life care plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify and address current clinical concerns as well as longer-term clinical objectives, as appropriate to patients’ contexts
collaborate with other clinicians (such as general paediatric, other subspecialty, and/or adult clinicians) to optimise the care of patients from birth through to adolescence and young adult
create accurate and appropriately prioritised problem lists in clinical notes, or as part of ambulatory care reviews
provide documentation on patients' presentations, management, and progress, including key points of diagnosis and decision making
ensure that patients, families, and/or carers contribute to their need assessments and care planning
recognise and appropriately utilise all available modalities (including health innovations) to monitor disease status, health trajectories, treatment outcomes, effectiveness, and adverse events
review care goals and treatment plans with patients, family, and/or carers in a timely manner if significant changes in patients’ conditions or circumstances occur (including consideration of end-of-life care plans)
outline the key components of a transitional care program and the differences between the cultures of paediatric and adult care services, including the role of the adult physician / GP

direction
Requires some supervision

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

The trainee may:

assess patients’ knowledge, beliefs, concerns, and daily behaviours related to their chronic condition / disability and its management
contribute to medical record entries on histories, examinations, and management plans in an accurate and sufficient manner as a member of multidisciplinary teams

Communication

confident
Ready to perform without supervision

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

The trainee will:

encourage patients’ access to self-monitoring devices and assistive technologies
communicate with multidisciplinary team members, and involve patients in that dialogue
help patients navigate the healthcare system by collaborating with other services, such as community health centres and consumer organisations, to improve access to care
link patients to specific community-based health programs and group education programs
identify opportunities to discuss end-of-life care, aligning it with patients’, families’ and/or carers’ values and preferences
identify appropriate timing of palliative care involvement

direction
Requires some supervision

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

The trainee may:

work in partnership with patients, and motivate them to comply with agreed care plans
wherever practical, meet patients’ specific language and communication needs
facilitate appropriate use of interpreter services and translated materials
recognise when it is appropriate to communicate with young people individually versus when it is appropriate to communicate with patients and their family members and/or carers
discuss appropriate support and bereavement care with family or carers

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 using innovative models of chronic disease care (e.g., telehealth and digitally integrated support services)
participate in quality improvement processes impacting on patients’ ability to undertake normal activities of daily living
practice health care that maximises patient safety
adopt a systematic approach to the review and improvement of professional practice in the outpatient clinic setting
identify aspects of service provision that may be a risk to patients’ safety
review all clinical incidents / deaths to determine the safety and quality of patients’ care (including end-of-life care where relevant) and how it could be improved
participate or support benchmarking through chronic disease registries

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines (national and international)
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery
evaluate own professional practice
role model effective clinical care
demonstrate learning behaviour and skills in educating junior colleagues
contribute to the generation of knowledge
maintain professional continuing education standards relevant to the profession
recognise and support feelings of moral distress and burnout in self and colleagues

direction
Requires some supervision

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

The trainee may:

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

prepare critical analysis of current literature on the management of chronic conditions to present at journal club meetings
search for and critically appraise the evidence to resolve clinical areas of uncertainty
obtain informed consent or other valid authority before involving patients in research
inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation before obtaining consent

direction
Requires some supervision

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

The trainee may:

search literature using Problem / Intervention / Comparison / Outcome (PICO) format
recognise appropriate use of review articles
refer to evidence-based clinical guidelines
consult current research on clinical practice, including investigations and management

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community serving and how to shape service to target the needs of the community
provide culturally sensitive chronic disease management, and practice strengths-based holistic care
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement and healthcare outcomes

direction
Requires some supervision

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

The trainee may:

practice cultural competency
identify when to use interpreters
allow enough time for communication across linguistic and cultural barriers
acknowledge the social, economic, cultural, and behavioural factors influencing health, both at individual and population levels

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients and, when relevant, their families or carers, in caring for themselves and managing their health in a respectful professional relationship
share information about patients’ health care, consistent with privacy laws and professional guidelines about confidentiality
use consent processes for the release and exchange of health information
identify and respect the boundaries that define professional and therapeutic relationships
respect the roles and expertise of other health professionals
comply with the legal requirements of preparing and managing documentation
demonstrate awareness of financial and other conflicts of interest
recognise the complexity of ethical issues related to human life and death, when considering the allocation of scarce resources

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
understand the responsibility to protect and advance the health and wellbeing of individuals and communities
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours, or the illness itself
maintain the confidentiality of documentation, and store clinical notes appropriately
ensure that the use of social media is consistent with ethical and legal obligations
respond appropriately to patients’, family members’, carers’ or colleagues’ distress or concerns

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients’ needs in terms of both internal resources and external support on long-term care journeys
integrate prevention, early detection, health maintenance, and chronic condition management, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care that allows maximum benefit from available resources

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

use a multidisciplinary approach across services to manage patients with chronic diseases and disabilities
develop collaborative relationships with patients, families, and/or carers, and a range of health professionals
coordinate whole-person care through involvement in all stages of the patients’ care journey
prepare for and conduct clinical encounters in an organised and efficient manner
work effectively as a member and/or a leader of multidisciplinary teams or other professional groups
formulate strategies to respectfully negotiate plans in the best interest of the patient at times when there are differences in opinions between health professionals
review discharge summaries, notes, and other communications written by junior colleagues
support colleagues who raise concerns about patient safety
facilitate an environment where all team members feel they can contribute and their opinion is valued
support the wellbeing of team members

direction
Requires some supervision

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

The trainee may:

participate in multidisciplinary team care for patients with chronic diseases and disabilities, including organisational and community care, on a continuing basis appropriate to patient context
attend relevant clinical meetings regularly
ensure all important discussions with colleagues, multidisciplinary team members, and patients are appropriately documented
communicate effectively with local service providers, primary care and other community organisations in planning and management of care, including referring and receiving health services

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:

assess alternative models of health care delivery to patients with chronic diseases and disabilities
participate in initiatives for chronic diseases management to reduce hospital admissions, prevent deterioration, and improve patients’ quality of life
help patients access initiatives and services for patients with chronic diseases and disabilities
demonstrate the capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
consider location and urgency of care / treatment to ensure that, when feasible, it is provided as close as possible to home, and that travel to and within the networked services only occurs when essential, ensuring timely care access and the best possible outcomes
effectively and safely utilise appropriate / approved digital technologies and systems to facilitate improved communication and access to care
for the care of young people with cystic fibrosis, recommend and advocate for transition of care to specialised adult cystic fibrosis multidisciplinary clinics

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of initiatives and services available for patients with chronic diseases and disabilities, and knowledge of how to access these support
identify common population health screening and prevention approaches

LG9: Communication with patients and their parents / caregivers, and other health professionals

Learning Goal 9

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

select a suitable context for discussions, and include family or carers and other team members
adopt a patient-centred perspective, including adjusting for age, cognition and disabilities
select and use appropriate modalities and communication strategies
structure conversations intentionally
negotiate mutually agreed management plans
verify patients’, families’ or carers’ understanding of information conveyed
develop and implement plans for ensuring actions occur
deliver education to patients, families, carers, and health professionals at appropriate levels of understanding
ensure conversations are documented

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and be able to correct any misunderstandings patients may have about their conditions, care, and/or risk factors
inform patients of all aspects of their clinical management and possible alternate approaches, including assessments and investigations, and give adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
recognise when to refer patients to psychological support services
provide safe and supportive expert advice for colleagues seeking tertiary respiratory paediatric opinions, (e.g., during phone consultations)

direction
Requires some supervision

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

The trainee may:

apply knowledge of the scientific basis of health and disease to the management of patients
demonstrate an understanding of clinical problems being discussed
present a working diagnosis to colleagues, and a rationale for management plans
formulate management plans in partnership with patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate communication strategies and modalities for communication, such as face-to-face, email, phone calls, and digital health platforms
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions and answer them thoroughly
ask patients to share their thoughts or explain management plans in their own words, to verify understanding
convey information considerately and sensitively to patients, and seek clarification if unsure of how best to proceed
treat children and young people respectfully, and listen to their views
recognise the role of family or carers and, when appropriate, encourage the young person to involve their family or carers in decisions about their care
explain diagnoses, incidental findings, management, and long-term impacts to parents and carers
utilise appropriate defusing and de-escalation strategies for angry patients / carers, prioritising safety for self and team members
ensure appropriate documentation in medical records or other appropriate means of record keeping

direction
Requires some supervision

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

The trainee may:

select appropriate modes of communication
engage patients in discussions, avoiding the use of jargon
check patients’ understandings of information
adapt communication styles in response to patients’ age, developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors
see adolescents and young adults by themselves during part of the consultation
utilise professional interpreters and other communication assistance means during every clinical encounter with patients who cannot communicate confidently or verbally in English at a level required for health understanding, and document this in medical records
collaborate with patient liaison officers as required
provide timely updates to patients and care providers when there is a change in plan or new result
demonstrate active listening skills
communicate patients’ situations to colleagues, including senior clinicians

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

provide education to peers, junior colleagues, and students, using appropriate language tailored to their level of knowledge and current learning needs
obtain informed consent or other valid authority before involving patients in teaching
provide appropriate and ongoing education for patients and carers, including verbal, written, and digital information
reflect on communication interactions that did not go as expected, and demonstrate openness to feedback, continuous learning, and improvement

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients that is based on evidence-based clinical guidelines
provide research information to patients that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of NZ
apply the principles of informed consent by providing information to patients in a way they can understand before asking for their consent to participate in research
understand when young people can consent for participation in research
obtain informed consent or other valid authority before involving patients in research
communicate any research findings to appropriate stakeholders, including patients’ communities

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

identify when to use interpreters
allow enough time for communication across linguistic and cultural barriers
when necessary, use qualified language interpreters or cultural interpreters to help meet patients’ communication needs

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

role model excellent communication with other health professionals and students
communicate effectively with team members involved in patients’ care, and with patients, families or carers, and other clinicians involved in patients’ care in the community
discuss medical assessments, treatment plans, and investigations with patients and primary care teams, and work collaboratively with them
discuss patients’ care needs with team members to align them with appropriate resources
facilitate an environment in which all team members feel they can contribute and their opinion is valued
formulate strategies to respectfully negotiate plans in the best interest of the patient at times when there are differences in opinions between health professionals

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system by working in collaboration with other services, such as community health centres and consumer organisations
advocate for appropriate immunisations and vaccines while maintaining respect for the views and wishes of individual patients
advocate for and support smoking and vaping cessation (in both young people and carers) through education and intervention where possible
effectively and safely utilise appropriate and approved digital technologies and systems to facilitate improved communication

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG10: Prescribing

Learning Goal 10

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

take and interpret medication histories, including immunisation history
choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, weight, comorbidities, potential drug interactions, risks, and benefits
determine appropriate treatment regimens while weighing up risks versus benefits
communicate with patients, families, and/or carers about the indications, benefits, and risks of proposed therapies
provide instructions on treatment administration effects and side effects
monitor medicines for efficacy and safety
review medicines and interactions, and cease where appropriate
collaborate with pharmacists
apply knowledge and competency in prescribing new therapies

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ disorder requiring pharmacotherapy
identify medicines that may cause a high risk of harm to children (including young women at child-bearing age)
consider non-pharmacological therapies
consider age, gestation, weight, chronic disease status, allergies, and potential drug interactions when prescribing
demonstrate an awareness of, and mitigate, calculation errors
optimise the use of antimicrobials with involvement with antimicrobial stewardship
plan for follow up and monitoring
demonstrate awareness of different formulations of common medications, and consider appropriate formulations and/or strengths for individual patients
recognise the impacts of age and metabolism on the absorption, distribution, and excretion of medicines
apply knowledge and competency in prescribing new drug therapies, changes in line with updates in guidelines and protocols, and rationalising therapies with regular medication reviews

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the risk and benefits of treatment options, making decisions in partnership with patients and their parents and/or carers
write clear, legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
demonstrate dosing / drug delivery techniques and include written instructions / plans, and ask the parent or carer to demonstrate to confirm knowledge
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common and the rare but serious side effects at the time of prescribing, to improve patients’ adherence to pharmacotherapy
outline strategies to assist with children taking unpalatable medicines
describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
ensure patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after this single prescription
identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients, families, and/or carers
explain the benefits and burdens of therapies, considering patients’ individual circumstances
write clearly legible scripts or charts using generic names of the required medication in full, including mg / kg / dose information and all legally required information
seek further advice from experienced clinicians, pharmacists, or physiotherapists (for nebulised therapy) 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 improve compliance, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions, miscalculation, and poor handwriting
consider available evidence and experience prior to prescribing new medications
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records
educate patients and families on nature and type of adverse events, including misconception of allergic reaction

direction
Requires some supervision

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

The trainee may:

check the dose before prescribing
monitor side effects of medicines prescribed
identify medication errors and institute appropriate measures
use electronic prescribing systems safely
rationalise medicines to avoid polypharmacy and reduce care burden
exhibit awareness of potential financial support to assist patient access to medication (e.g., Health Care Card and Close The Gap scheme in Australia)

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use continuously updated software for computers and electronic prescribing programs
role model how to ensure patients understand management plans, including adherence issues
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, and keep up to date on new medicines, changes in the use of existing medications, and updates in guidelines

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 and innovations in drug therapies
reflect on prescribing and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to understand the benefits and risks (including financial cost) of new medicines relative to medicines that have been on the market for longer
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients about:
- how to take the medicine
- potential side effects
- what it does
- what it is for
- when it should be stopped
make prescribing decisions based on good safety data when the benefits outweigh the risks involved
demonstrate understanding of the ethical implications of pharmaceutical industry marketing and funded research

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 pharmacological and non-pharmacological options
follow regulatory and legal requirements and limitations regarding prescribing
follow organisational policies regarding pharmaceutical representative visits and drug marketing

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

consider the following factors for all medicines:
- contraindications
- cost to patients, families, and the community
- funding and regulatory considerations
- generic versus brand medicines
- interactions
- risk-benefit analysis
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:

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

direction
Requires some supervision

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

The trainee may:

work collaboratively with pharmacists and other relevant medical experts (e.g., infectious disease physicians in antibiotic stewardship)
participate in medication safety and morbidity and mortality meetings

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

choose medicines in relation to comparative efficacy, safety, and cost effectiveness against medicines already on the market
prescribe for individual patients, considering history, current medicines, allergies, and preferences, ensuring resources are used wisely for the benefit of patients
advocate for appropriate immunisations and vaccines while maintaining respect for the views and wishes of individual patients
advocate for and support smoking and vaping cessation interventions, including nicotine withdrawal therapies for young people and carers
advocate for equitable access to effective treatment available overseas or not currently subsidised by the government for patients in Australia and New Zealand

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy

LG11: Procedures

Learning Goal 11

Procedures

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

This activity requires the ability to:

ensure appropriate procedures are selected in partnership with patients, their families, and/or carers
obtain informed consent
set up equipment, maintaining an aseptic field (if required)
perform procedures (if required)
manage unexpected events and complications during and after procedures (if required)
provide perioperative and aftercare for patients
communicate aftercare protocols and instructions to patients and medical and nursing staff
interpret results and outcomes of procedures, including bronchoscopy and reports
communicate the outcome of procedures and associated investigations to patients, their families, or carers

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by assessing patient-specific factors, risks, benefits, and alternatives
ensure team members are aware of all identified allergies / adverse reactions, and take precautions to avoid allergies / adverse reactions during procedures
ensure patients have complied with pre-procedure preparations
recognise and effectively manage complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of diagnostic procedures
consistently perform a range of procedures common to paediatric respiratory medicine, including flexible bronchoscopy
establish the use of respiratory support, such as oxygen therapy and non-invasive ventilation (including high flow nasal cannulae oxygen)

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

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 broader context
help patients, families, and/or carers to choose procedures
communicate with members of procedural teams so all team members understand who each member is
discuss postprocedural care with patients, families, or carers
complete relevant patients’ documentation, and conduct an appropriate clinical handover

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before undertaking any procedure
set up all necessary equipment for bronchoscopy, and consistently use universal precautions and aseptic technique
confirm patients’ identification and verify the procedure and, where appropriate, the correct site / side / level for the procedure
ensure that information on patients’ consent forms match procedures to be performed
identify, document, and appropriately notify of any adverse event or equipment malfunction
demonstrate principles of physician safety, such as infection control when performing bronchoscopies

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients, families, or carers are fully informed when consenting to procedures
demonstrate an inconsistent application of aseptic technique
identify patients using approved patients’ identifiers before any treatment or intervention is initiated
attempt to perform a procedure in an unsafe environment

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
provide specific and constructive feedback and comments to junior colleagues
initiate and conduct skills training for junior staff

direction
Requires some supervision

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

The trainee may:

participate in continued professional development
help junior colleagues develop new skills
actively seek feedback on personal technique until competent
organise or participate in in-service training on new technology

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

respect religious, cultural, linguistic, and family values and differences
involve patient liaison officers where appropriate

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:

understand institution / department protocols and ethical practices and guidelines around performing procedures
if required to perform procedures, do so in accordance with institution / department protocols and ethical practices and guidelines
demonstrate knowledge of how respiratory-related procedures are performed in their institution
identify appropriate proxy decision makers when required
show respect for knowledge and expertise of colleagues
maximise patient autonomy (for both young people and carers) in decision making

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify roles and optimal timings for diagnostic procedures
critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on a waiting list
make clinical judgements and decisions based on available evidence
select the most appropriate and cost-effective diagnostic procedures
adapt procedures in response to assessments of risks to individual patients
select appropriate investigations on the samples obtained in diagnostic procedures

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with organisational guidelines and policies

LG12: Investigations

Learning Goal 12

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessments
weigh up the cost, risks, and potential benefits of investigations
assess patients’ and carers’ concerns, and determine the need for tests that are likely to result in overall benefits
develop plans for investigations, identifying their roles and timings
assess additional needs and impacts of sedation or general anaesthesia needed for procedures or investigations for paediatric patients
recognise and correctly interpret abnormal findings considering patients’ specific circumstances, and act accordingly

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
understand the significance of abnormal test results and act on these
consider patients’ factors and comorbidities
consider age-specific reference ranges for lung function interpretation

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain to patients and carers the options, including the potential benefits, risks, burdens, and side effects, including the option to have no investigations
use clear and simple language, and check that patients and carers understand the terms used and agree to proceed with proposed investigations
confirm patients and carers understand the information they have been given, and the need for more information before deciding
identify patients’ and carers’ concerns and expectations, and provide adequate explanations on the rationale for individual test ordering
use written material, visual aids or other aids that are accurate and up to date to support discussions with patients and carers
explain findings or possible outcomes of investigations to patients, families, or carers
give information that patients and carers may find distressing in a considerate and culturally safe way

direction
Requires some supervision

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

The trainee may:

discuss the indications, risks, benefits, and complications of investigations with patients before ordering investigations
explain the results of investigations to patients in a timely manner
arrange investigations providing accurate and informative referrals, liaising with other services where appropriate

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

consider safety aspects of investigations when planning them
seek help with interpretation of test results for less common tests or indications, or for unexpected results, when required

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision-making support tools when selecting and interpreting investigations
participate in clinical audits to improve test ordering strategies for diagnoses and screening
provide education to peers, junior doctors, medical students, and/or other health professionals that is tailored to their level of knowledge and current learning needs

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

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

The trainee will:

provide patients with relevant information if a proposed investigation is part of a research program
obtain written informed consent from patients if the investigation is part of a research program

direction
Requires some supervision

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

The trainee may:

refer to evidence-based clinical guidelines
consult current research on investigations

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

understand and mitigate patients’ and their families’ views and preferences about any proposed investigation and the adverse outcomes they are most concerned about

direction
Requires some supervision

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

The trainee may:

consider patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations
involve patient liaison officers where relevant

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

remain within the scope of the authority given by patients and carers, except in emergencies
advise patients and carers when there may be additional costs, which patients may wish to clarify before proceeding
discuss with patients and carers how decisions will be made once the investigation has started and the patient is not able to participate in decision making
respect patients’ and carers’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
demonstrate awareness of escalation mechanisms if decisions made by parents or carers pose the risk of harm to a minor (e.g., legal entities)
explain expected benefits as well as potential burdens and risks of any proposed investigation before obtaining informed consent or other valid authority
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information

direction
Requires some supervision

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

The trainee may:

identify appropriate proxy decision makers when required
choose not to investigate in situations where it is not appropriate for ethical reasons
practice within current ethical and professional frameworks
practice within own limits, and seek help when needed
involve patients in decision making regarding investigations, and obtain appropriate informed consent, including financial consent if necessary
collaborate with other subspecialties, where appropriate, to ensure informed consent is provided to patients and their carers

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
adjust the investigative path depending on test results received
consider whether patients’ conditions may get worse or better if no or alternative tests are selected

direction
Requires some supervision

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

The trainee may:

choose the most appropriate investigations for the clinical scenario, in discussion with patients
recognise personal limitations, and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consider the role other members of the health care team might play, and what other sources of information and support are available
consistently communicate effectively, collaboratively, and respectfully with team members and other relevant health professionals involved in the investigation process
ensure results are checked in a timely manner, and take responsibility for following up on results and communicating them to other clinicians, patients, family members, or carers

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

select and justify investigations regarding the pathological basis of disease, utility, safety, appropriateness, and cost
consider resource utilisation through peer review of testing behaviours

Knowledge guides

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

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

LG15: Scientific foundations of cardiology

Epidemiology, pathophysiology, and clinical sciences

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

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

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Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Abnormal lung development:
- congenital lung disease
Aerosol drug delivery:
- aerosol delivery through different interfaces, such as:
  - endotracheal tubes
  - facemasks
  - spacers
  - tracheostomies
- aerosol delivery through high flow, positive pressure (CPAP and BIPAP), and ventilator circuits
- mechanisms and adverse effects of aerosol treatments
- principles of aerosol delivery to the lungs
- principles of infection control in aerosol therapy
- principles of pressurised metered dose inhalers, dry powder inhalers, and nebulisers
Air pollution, including active and passive smoking / vaping
Biochemical abnormalities relevant to respiratory disease (e.g., pleural disease)
Cellular and molecular biology as it pertains to respiratory disease
Developmental immunology, immunology, and host defence mechanisms:
- acquired immunity
- antibody classes and function
- atopy
- cell mediated immunity
- humoral immunity
- hypersensitivity reactions
- innate immunity
- pulmonary defence mechanisms, particularly the role, makeup, and function of cilia, cough, and mucus
- vaccines and vaccine responses
Developmental physiology of the respiratory system:
- infant pulmonary physiology
- physiology and development of the lung in the pre-term infant
- pulmonary physiology and pathophysiology
- the effects of early life lung disease on long term health
Effect of altitude on lung disease
Environment / Air quality and its impact on respiratory health outcomes
Fluid and caloric requirements, including alternative types of feed (e.g., Monogen)
Genetics of both common and rare but important respiratory conditions, such as cystic fibrosis and interstitial lung disease (ILD), and conditions that have comorbidities with respiratory disease, such as spinal muscular atrophy and Trisomy 21
Influence of upper airway disease on the lower airway
Methods for screening for exposure to environmental tobacco smoke, including urinary / salivary cotinine
Microbiology and infectious disease as it pertains to respiratory disease
Normal lung development:
- alveolisation, airspace septation, and microvascular maturation
- braking, grunting and lung protection strategies, airway closure and determination of end-expiratory level
- developmental changes in chest wall compliance
- developmental strategies, including the Hering–Breuer inflation reflex and preferential nasal breathing
- dysynaptic lung growth
- embryologic development
- growth factors
- maturation of control of breathing
- mechanics of breathing in an infant
- ongoing developmental changes throughout childhood, including the effect of puberty and ageing
- vasculogenesis
Nutrition / Fluid management:
- normal growth
Pharmacology:
- biologics in respiratory disease
- dosing and side effects
- drug-drug interactions / contraindications of medications
- effects of non-respiratory medications on the respiratory system
- formulations of medications
- mechanisms of action, including antibiotics, and recent therapeutic advances in respiratory health, such as biologics and CFTR modulators
- monitoring of drug levels
- pharmacodynamics
- screening for adverse effects
Smoking and vaping:
- adverse effects on health
- specific effects on respiratory health
Structure and function of the respiratory system
The normal and abnormal structure and function of the components of the respiratory system:
- airways (upper and lower)
- alveoli (including type 2, Clara and goblet cells)
- chemoreceptors
- chest wall
- interpretation of oxygen saturation and blood gases
- interstitium
- physiology of ventilatory drive and gas exchange
- pulmonary vasculature
- respiratory control centres
- neural pathways (upper motor neuron and lower motor neuron)
- respiratory muscles
- smooth muscle and receptors
- the oxygen-haemoglobin dissociation curve

Investigations

Altitude simulation tests and assessment of fitness to fly
Basic lung function tests, such as DLCO, lung volumes, and spirometry:
- clinical implications of test results
- clinical versus research role of the above investigations
- operator-dependant and patient-related issues
- reference values, including impact of reference values used on interpretation of results
- role of sedation in infant lung function testing
- technical aspects of tests, including limitations and data
Blood gas and measures of gas exchange
Cilia investigations, including:
- cilial function testing
- electron microscopy for cilial ultrastructure
- nasal nitric oxide
- primary ciliary dyskinesia (PCD) genotype
- newborn screening test
Lung function tests that can be used in younger patients, such as multiple breath washout and forced oscillation testing
More complex lung function tests, such as bronchial challenge tests and cardiopulmonary exercise tests
Other tests:
- allergy and delayed hypersensitivity tests (in conjunction with allergy team)
- genetic investigations as pertains to respiratory conditions such as bronchiectasis, cystic fibrosis, ILD, and PCD
- immunological investigations
- sweat test and other functional tests for cystic fibrosis, such as faecal elastase
Polysomnography, including diagnostic and pressure titration studies:
- the nature and limitations of abbreviated or limited channel sleep studies / gas exchange monitoring
Radiological tests:
- bronchography
- chest CT scan
- chest x-ray
- contrast swallow tests
- echocardiography
- fluoroscopy
- MRI of the chest / dynamic imaging
- oesophageal manometry and pH monitoring
- scintigraphy / nuclear medicine tests
- ultrasonography, including point of care ultrasound
Tests of respiratory muscle function (including maximal inspiratory and expiratory pressures, cough peak flow, and sniff nasal inspiratory pressure)

Procedures

Bronchoscopy (flexible):
- anatomy of the lower airway
- anatomy of the upper airway
- bronchial anatomy, including lobar
- cytology and microbiology from bronchoalveolar lavage fluid
- management of intra- and postoperative complications
- normal anatomical variants of airway anatomy
- process of bronchoscopic intubation
- segmental anatomy including 3D anatomy
- the anaesthetic process and drugs used during bronchoscopy
- the processes for sterilisation and maintenance of bronchoscopic equipment
- visual appearance of congenital upper and lower airway lesions, such as bronchitis, haemangiomas, and tumours
Pleural:
- diagnostic and therapeutic indications for pleural procedures
- indications for pleural procedures
- normal and abnormal anatomy of the pleura
- physiology and biochemistry of pleural fluid
- pleural anatomy and physiology
- potential complications
- procedural skills required
- procedure risks and benefits
- risks and benefits of each of the diagnostic / therapeutic interventions
- sedation, topical anaesthesia, and analgesia
- selection and assessment of patients for procedural intervention

Consideration of research / education opportunities
Critical analyses of literature relating to scientific foundations of paediatric respiratory medicine
Keeping up to date with current literature and guidelines and advanced technology (including potential implementation of AI, recent advances in imaging and microbiomes as pertains to respiratory health) in paediatric respiratory medicine

LG16: Acute respiratory care

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Apnoeas and apparent life-threatening events (ALTEs)
Chest pain
Concerns about breathing during sleep
Cough
Dyspnoea
Fatigue
Fever
Haemoptysis
Hypoxia
Respiratory distress (including in the newborn)
Stertor
Stridor
Tachypnoea
Wheeze

Conditions

Acute aspiration lung disease
Acute exacerbation of chronic lung conditions such as bronchiectasis, cystic fibrosis, neuromuscular disease / neuro-disability
Acute respiratory distress syndrome
Asthma flare-up
Atelectasis
Chylothorax
Foreign body aspiration
Haemothorax
Lung infection, including (but not limited to):
- atypical and/or fungal infections
- bronchiolitis
- empyema
- influenzae, COVID, RSV, and other viral infections
- lung abscess
- pneumonia
Pleural effusions
Pneumothorax
Pulmonary oedema
Severe upper airways disease

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

Acute respiratory deterioration of patient on ventilatory support (invasive or non-invasive)
Antenatal or postnatal diagnosis of respiratory conditions (e.g., congenital diaphragmatic hernia, congenital lung malformations)
Non-respiratory acute presentations of cystic fibrosis
Respiratory deterioration in patients undergoing treatment for oncological or haematological conditions
Respiratory distress in the patient with immune deficiency / immunosuppression
Respiratory distress of the newborn or young infant
Syncope

Conditions

Acute lung injury:
- toxic inhalation including vaping (EVALI)
- trauma
Congenital diaphragmatic hernia
Congenital lung malformations
Down syndrome
Drowning
Eosinophilic lung disease
Hypersensitivity pneumonitis
Interstitial lung disease
Post-stem cell transplant
Pulmonary disease associated with congenital heart disease
Pulmonary hypertension
Pulmonary vascular disease (including pulmonary arteriovenous malformation, vasculitides such as granulomatosis with polyangiitis)

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

Epidemiology

Asthma and preschool wheeze
Bronchiolitis
Obstructive sleep apnoea (OSA) / sleep disordered breathing (SDB)
Pneumonia
Respiratory disease in Aboriginal and Torres Strait Islander and Māori peoples
Smoking and e-cigarette use
Sudden infant death syndrome / sudden unexpected infant death

Investigations

Basic lung function tests, such as DLCO, lung volumes, and spirometry:
- abbreviated or limited channel sleep studies
- polysomnography
Radiological tests:
- airway fluoroscopy
- chest CT scan
- chest ultrasound
- chest x-ray
- contrast swallow tests
- nuclear medical tests

Procedures

Aerosol delivery systems (with or without additional oxygen):
- potential complications, including infection control
- procedural skills
- risks and benefits
Airway management, including emergency intubation
Bronchoscopy (flexible versus rigid) for acute presentations
Oxygen therapy:
- adverse effects
- assessment of ongoing therapy
- indications and guidelines for use
- oxygen delivery systems and their application:
  - different mask set-ups
  - nasal prongs, including humidified circuit and low flow versus high flow
Pleural procedures:
- intercostal tube placement and drainage (large and small bore)
- needle thoracentesis (fluid and air)
- pleural ultrasound imaging
Surgical procedures:
- intravascular line placement
- lung, lymph node, or lung mass biopsy, including radiologically guided
- thoracoscopy
- tracheostomy
Ventilatory support in the acute setting:
- adverse effects
- assessment of ongoing therapy
- delivery systems
- different modalities for delivery ventilatory support
- indications and guidelines for use

Acute management of pulmonary bleeding (mild to severe)
Impact of climate change on respiratory health, including:
- directly promoting or aggravating respiratory diseases, such as asthma and respiratory infections
- increasing exposure to risk factors for respiratory diseases, such as chemical air pollutants and effect on aeroallergens
Radiation dose related to CT scans and other imaging techniques, and variation between different equipment and scanning protocols
Smoking and vaping cessation strategies and interventions, including management of nicotine withdrawal in young people (both in the hospital and in the community)

LG17: Chronic respiratory care

Key presentations and conditions

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Apnoea
Chest pain
Concerns about breathing during sleep
Cough
Dyspnoea
Haemoptysis
Slow weight gain / Poor weight gain
Stridor
Syncope
Tachypnoea
Wheeze

Conditions

Chronic airway disease:
- asthma and related conditions
- cystic fibrosis and related conditions
- primary ciliary dyskinesia (PCD)
- protracted bacterial bronchitis and chronic suppurative lung disease / bronchiectasis
Chronic lung disease of prematurity
Congenital diaphragmatic hernia
Conditions relating to acute and chronic aspiration syndromes:
- feeding and swallowing disorders
Conditions relating to lung injury
Conditions relating to lung transplantation
Conditions relating to stem cell transplantation
Congenital lung malformations, including:
- bronchial atresia
- bronchogenic cyst
- bronchopulmonary sequestration
- congenital cystic pulmonary airway malformation
- congenital lobar emphysema
Diseases of the chest wall, spine, and respiratory muscles, including neurodisability
Disorders of breathing during sleep:
- non-obstructive
- obstructive
Disorders of the pleural space, including (but not limited to):
- chylothorax
- pneumothorax
Disorders of the pulmonary circulation, including (but not limited to) pulmonary hypertension
Environmental lung diseases
HIV / AIDS and its pulmonary manifestations
Interstitial and diffuse lung disease of childhood (chILD)
Newborn respiratory disorders
Obliterative bronchiolitis
Other orphan lung diseases
Paediatric thoracic tumours
Pleuropulmonary manifestations of systemic disease and extrapulmonary disorders
Pulmonary complications on the intensive care unit
Pulmonary conditions relating to hypereosinophilia
Pulmonary disorders in the immune-compromised host (excluding HIV / AIDS)
Pulmonary infections:
- bacterial
- fungal
- mycobacterial
- parasitic
- viral
Pulmonary haemorrhage syndromes and venous thrombo-embolic disease
Respiratory complications of congenital heart disease
Respiratory disorders related to syndrome / genetic conditions (e.g., Down syndrome, VACTRL)
Tracheoesophageal fistula

Investigations

Capnography
Longitudinal monitoring of chronic respiratory disease
Lung function testing (all the different modalities in clinical practice)
Overnight oximetry
Sleep study

Procedures

Aerosol delivery systems:
- correct use of different aerosol delivery systems
Airway management:
- indications
- management risks and benefits
- potential complications
- procedural skills required (e.g., nasopharyngeal airways)
- strategies for decannulation
- tracheostomy care
Chest physiotherapy and airway clearance techniques:
- basics of the different airway clearance techniques
- different airway clearance devices
- indications for chest physiotherapy / airway clearance
- medications which improve mucociliary clearance
- potential complications
- risks and benefits, including infection control consideration
- the role of exercise, vibrating vest devices, and cough-augmentation devices
Long term venous access:
- indications, benefits, and risks of long-term venous access
- long lines, central venous lines, peripherally inserted central catheters, and total implanted venous access devices
- management of complications
- management of long-term venous lines
- potential complications
- risks and benefits of long-term venous access
Lung transplant (with appropriate lung transplant physician support):
- absolute and relative contra-indications for referral
- indications for, and interpretation of, transbronchial biopsy
- indications for referral for consideration of lung transplantation
- issues relating to lung transplantation, including immunosuppression and complications (such as infection, malignancy, and renal disease)
Oxygen therapy
Smoking / vaping cessation (or appropriate referrals):
- concept of motivational interviewing techniques
- potential complications principles of smoking / vaping cessation for adolescents and adults
- risks and benefits of various strategies
- strategies to minimise exposure to environmental tobacco smoke / vapes
- understanding different smoking / vaping cessation strategies (pharmacological and non-pharmacological)
Ventilatory support in the chronic setting:
- different ventilatory strategies
- how to apply a mask and head gear to a child
- how to apply the principles of ventilation and adjustment of non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) settings
- how to monitor patient progress including compliance
- indications and limitations for ventilatory support interventions
- initiation, monitoring, and weaning
- intervention risks and benefits
- invasive ventilation
- NIV:
  - bi-level non-invasive ventilation (Bi-level NIV)
  - CPAP
  - high flow nasal cannula oxygen therapy (HFNC)
- potential complications
- the functioning of, and indications for, a variety of face masks use and management of humidification circuits in NIV

Consideration of cultural safety, and advocating for promotion of culturally safe health practices and management
Cystic fibrosis modulator therapies, and potential alternative therapies for those not eligible for modulator therapies
Impact of climate change on respiratory health, including:
- directly promoting or aggravating respiratory disease, such as asthma and respiratory infections
- increasing exposure to risk factors for respiratory diseases, such as chemical air pollutants and effect on aeroallergens
Increased life expectancy of patients with cystic fibrosis, and hence consideration of potential complications in people with cystic fibrosis, such as:
- cardiovascular complications
- gastrointestinal cancer
- impacts of cystic fibrosis on pregnancy and fertility
- mental health and wellbeing
Radiation dose related to CT scans and other imaging modalities, and variation between different equipment and scanning protocols
Smoking and vaping cessation strategies and interventions, including management of nicotine withdrawal in young people (both in hospital and community settings)
Use of biological agents in asthma and other respiratory diseases

LG18: Airways, chest wall, and breathing

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Lower airways

Chest pain
Cough
Decrease in exercise capacity
Dyspnoea (at rest and/or with exertion)
Haemoptysis
Respiratory distress (including in the newborn)
Tachypnoea
Wheeze

Other generalised symptoms

Fatigue
Fever
Slow weight gain
Syncope

Sleep disorders

Apnoea during sleep
Brief resolved unexplained event (BRUE) / Apparent life-threatening events (ALTEs)
Daytime somnolence
Disrupted sleep, including concerns about development or academic performance / daytime behaviour in the context of sleep-related symptoms
Sleep-related hypoventilation, including congenital central hypoventilation syndrome
Snoring and concerns about obstructive sleep-disordered breathing

Upper airway

Cough
Stertor
Stridor

Conditions

Chest wall and breathing

Chest wall deformity, including pectus excavatum
Conditions affecting the chest wall
Neuromuscular disease
Scoliosis

Lower airways

Allergic bronchopulmonary aspergillosis (ABPA)
Aspiration syndromes
Asthma
Churg–Strauss syndrome
Congenital airway anomalies:
- Suis bronchus
Cystic fibrosis (CF)
Drowning / Near drowning
Eosinophilic pneumonias (acute, chronic, and drug-induced)
Foreign body inhalation
Idiopathic hypereosinophilic syndrome
Inhalation lung disease, including EVALI
Non-CF bronchiectasis
Obliterative bronchiolitis
Primary ciliary dyskinesia (PCD)
Protracted bacterial bronchitis
Recurrent aspiration / gastroeosophageal reflux
Simple pulmonary eosinophilia (Loffler syndrome)
Trachea / bronchomalacia
Trachea-oesophageal fistula

Sleep

Conditions causing central sleep-disordered breathing, including sleep hypoventilation syndromes / obesity hypoventilation
Conditions causing obstructive sleep-disordered breathing
Seizure disorders

Upper airways

Acute conditions
Adenoid / tonsillar hypertrophy / nasal turbinate hypertrophy
Allergic rhinitis
Choanal atresia
Chronic conditions
Congenital malformations of the upper respiratory tract
Croup
Diphtheria
Epiglottitis
Foreign body in airway
Laryngeal cleft
Laryngeal web
Laryngomalacia
Retropharyngeal abscess
Sub-glottic stenosis
Syndromes that affect the upper airway anatomy, such as:
- craniofacial condition
- Crouzon syndrome
- Pierre Robin sequence
Tonsillitis
Tracheitis
Tracheoesophageal fistula
Tracheomalacia
Vocal cord palsy

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Chest wall and breathing

Central respiratory drive:
- congenital or acquired
Upper motor neuron:
- cerebral palsy
- hemiplegia
- quadriplegia
Lower motor neuron:
- Guillain–Barré syndrome
- phrenic nerve palsy or paralysis
- poliomyelitis
- spinal muscular atrophies
- tetanus
- traumatic nerve injury
Neuromuscular junction:
- botulism
- congenital myasthenic syndromes
- drugs
- myasthenia gravis
Respiratory muscles:
- congenital myopathies
- eventration and other diaphragmatic malformations
- metabolic myopathies
- muscular dystrophy
- steroid myopathy
Non-muscular, chest wall structures:
- congenital rib cage abnormality
- connective tissue disease
- giant exomphalos
- obesity
- thoracic burns

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

Developmental changes in chest wall compliance, and effects of chest wall pathology on respiratory mechanics
Knowledge of known sudden infant death syndrome risk factors (including social and family factors)
Mechanics of breathing in an infant, child, and adolescent
The normal and abnormal structure and function of the components of the respiratory system in relation to respiratory muscles (including neural mechanisms), chest wall, and airways (upper and lower)

Investigations

Additional investigations for ALTE (non-respiratory):
- assessments for gastroesophageal reflux disorder
- electrocardiography, echocardiography, and Holter monitoring
- electroencephalography
- home apnoea monitors and home oxygen saturation monitoring
Allergy testing
Polysomnography (diagnostic and pressure titration study), and measurement of gas exchange
Radiological imaging studies for assessment of airway (e.g., dynamic imaging and lateral neck x-ray)
Radiological imaging studies for patients presenting with haemoptysis, including angiography and bronchial artery embolisation
Respiratory function testing for assessment of airway and functions, such as forced oscillation technique and multiple breath washout
Respiratory muscle strength testing (non-invasive and invasive), including maximal inspiratory and expiratory pressures and peak cough flow
Spirometry, plethysmography, exhaled nitric oxide, and bronchial provocation testing

Procedures

Bronchoscopy (flexible versus rigid) and laryngobronchoscopy
Corrective surgery for chest wall deformities / spinal deformities
Non-invasive ventilatory support
Surgical intervention for airway abnormalities, including adenotonsillectomy

Evolving treatment for children with neuromuscular disease (e.g., gene therapy and its impact on the respiratory functions of children with neuromuscular disease)
NIV procedures for sleep-disordered breathing / airway management and utilisation of remote monitoring
Perioperative multidisciplinary assessment for children requiring surgical intervention for chest wall abnormalities / spinal deformities
Social and cultural factors that may affect the management of children with these disorders, including cultural safety

LG19: Pulmonary and pleural disease

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

Advanced Trainees will know how texplain the investigation or procedure tpatients, families, and carers, and be able texplain procedural risk and obtain informed consent where applicable.

View

Important specific issues

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

View

Presentations

Acute respiratory distress syndrome (ARDS)
Chest pain
Cough
Fever
Shortness of breath

Conditions

Pulmonary manifestations of cystic fibrosis

Acute lung injury

Barotrauma
Chest trauma
Drug-induced injury / disease (including illicit drugs)
Other inhalation injuries (e.g., EVALI)
Radiation
Thermal – smoke inhalation and burns

Infections

Community acquired pneumonia (CAP)
Extra-pulmonary tuberculosis (TB)
HIV / AIDS
Latent TB infection
Lung abscess:
- cryptococcal disease
- fungal infection
- other
Mycoplasma and other atypical infections (e.g., Legionella)
Non-tuberculous mycobacterial diseases
Nosocomial pneumonia
Para-pneumonic effusion and empyema
Parasitic infection:
- ascaris
- echinococcus
- strongyloides
Pertussis
Pulmonary TB
TB in the immunocompromised host
Upper and lower respiratory tract infections
Ventilator-associated pneumonia
Viral infection (including epidemic e.g., influenza, SARS, COVID), RSV

Neonatal conditions

Bronchopulmonary dysplasia / Chronic lung disease of prematurity
Hyaline membrane disease
Meconium aspiration
Pulmonary interstitial emphysema
Surfactant protein deficiency
Transient tachypnoea of newborn

Pleural disease

Chylothorax
Empyema
Haemothorax
Pleural effusions
Pneumothorax:
- secondary
- spontaneous

Thoracic lesions, nodules, and masses

Benign tumours
Congenital malformations of the lower respiratory tract and lungs
Malignant (primary, secondary, and metastatic)
Mediastinal cysts and tumours

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 tpatients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

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

Conditions

Cardiovascular disease that affects the lung:
- congenital heart disease
- pulmonary hypertension
- pulmonary oedema

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 tpatients’ 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

Anatomical relationships of pulmonary structures and congenital defects
Current classifications of congenital pulmonary airway malformation and management issues (e.g., potential association with lung malignancy)
Knowledge of other congenital lung malformation, including bronchopulmonary sequestration, bronchial atresia, and congenital lobar emphysema
Liaison with neurodevelopmental services
Management:
- acute management principles
- options for long-term care, particularly:
  - home oxygen
  - identification of other sequelae
  - nutrition
- options for patent ductus arteriosus (PDA) management
- role and use of surfactant
- role of steroids and diuretics
- ventilation strategies, including high frequency oscillation (HFO) and extracorporeal membrane oxygenation (ECMO)
- use of nitric oxide (NO) and other strategies in the management of pulmonary hypertension

Approach

Age-appropriate differential diagnosis of infective causes, including newborn, preschool, and school-aged child
Differential diagnosis of non-infective causes
Management:
- investigation and management of acute, recurrent, persistent, and atypical pneumonia
- long-term sequelae of RSV, adenovirus, mycoplasma, and bronchiolitis obliterans
- management options for allergic bronchopulmonary aspergillosis (ABPA)
- public health issues, including infection control guidelines, cohorting, smoking / vaping prevention and cessation, and climate change mitigation strategies
- relevant microbiology and choice of appropriate antibiotics
- role of immunological investigations
- the investigation and management of typical versus atypical croup
- treatment of community- and hospital-acquired pulmonary infections, including ventilator-associated pneumonia
- vaccination

Investigations

Blood tests:
- blood count and inflammatory markers
- blood cultures
- blood tests to identify potential infectious source (e.g., pneumonia serology, strep, and TB)
- screening tests for potential underlying primary immunodeficiency
- sterile site PCR (e.g., blood, CSF, and pleural fluid)
Investigations of pleural fluid / sputum / bronchoalveolar lavage, including microbiome investigation
Radiological tests:
- chest CT scan
- chest x-ray
- nuclear studies

Procedures

Home oxygen prescription
Identification and utilisation of community services and support (NDIS and other government funding facility for equipment)
Insertion of chest drains
Interpretation of blood gases
Interpretation of radiological investigations
Ventilation – invasive and non-invasive ventilation strategies

Appropriate timing to involve ENT and thoracic surgeons
Identification and management of congenital malformations in the context of a child with a syndrome
Impact of climate change on respiratory health, including:
- directly promoting or aggravating respiratory disease, such as asthma and respiratory infections
- increasing exposure to risk factors for respiratory diseases, such as chemical air pollutants and effect on aeroallergens
Management of empyema, including administration of thrombolytics / fibrinolytics or appropriate referral for surgical intervention
Management of TB in the immunocompromised host
Occupational health and safety issues for staff treating patients with HIV / AIDS or TB
Relevant public health legislation
Role of flexible bronchoscopy / bronchoalveolar lavage
Role of TB clinics, including contact tracing and screening
Ventilatory strategies for congenital malformations / congenital diaphragmatic hernia

LG20: Interstitial and diffuse lung disease, vasculitides, and systemic diseases

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Conditions

Diffuse lung disease

Disorders of infancy:
- acinar dysplasia
- alveolar capillary dysplasia with misalignment of pulmonary veins
- congenital alveolar dysplasia
- diffuse developmental disorders
Growth abnormalities:
- associated with chromosomal abnormalities (e.g., Trisomy 21)
- associated with congenital heart disease in chromosomally normal children
- chronic lung disease of prematurity / bronchopulmonary dysplasia (BPD)
- pulmonary hypoplasia
Surfactant dysfunction disorders and related abnormalities:
- neuroendocrine cell hyperplasia of infancy (NEHI)
- pulmonary alveolar proteinosis
- pulmonary interstitial glycogenosis
- specific conditions of less well understood aetiology
- surfactant dysfunction disorders:
  - ABCA3 genetic mutations
  - Sp-B genetic mutations
  - Sp-C genetic mutations

Disorders of the normal host

Acute interstitial pneumonia / idiopathic diffuse alveolar damage
Disorders related to environmental agents:
- hypersensitivity pneumonia
- toxic inhalation (including vaping)
Eosinophilic pneumonias
Idiopathic pulmonary haemosiderosis
Infectious and postinfectious processes:
- postinfectious airway injury, ranging from mild airway fibrosis to constrictive / obliterative bronchiolitis with and without preceding history of viral respiratory infection
Nonspecific interstitial pneumonia

Other systemic diseases that influence the respiratory system

Acquired immunodeficiencies
Congenital immunodeficiencies
Drug-induced disease
Graft versus host disease
Haematological disease (including sickle cell disease)
Post-lung transplant management
Post-stem cell transplantation immunodeficiency
Rheumatoid and connective tissue disorders

Vasculitides

Pulmonary embolism
Vasculitis (including capillaritis, small, medium, and large vessel disease)
Veno-occlusive disease

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

Disorders masquerading as interstitial disease

Alpha 1 antitrypsin deficiency
Arterial hypertensive vasculopathy
Congestive vasculopathy, including veno-occlusive disease
Lymphatic disorders (lymphangiectasis and lymphangiomatosis)
Thromboembolic disease

Disorders of the immunocompromised host

Disorders related to solid organ, lung, and stem cell transplantation, and rejection syndromes:
- graft versus host disease
- post-transplant lymphoproliferative disorder
Disorders related to therapeutic intervention:
- chemotherapeutic and/or radiation injury
- drug hypersensitivity
Lymphoid infiltrates related to immune compromise
Nonspecific lymphoproliferation:
- malignant
- with lymphoid hyperplasia
- with poorly formed granulomas
Opportunistic infections (e.g., pneumocystis)

Disorders related to systemic disease processes

Immune-mediated disorders:
- acquired pulmonary alveolar proteinosis / autoantibody to GMCSF
- Goodpasture syndrome
- lymphoproliferative disease
- nonspecific airway changes, including:
  - lymphocytic bronchiolitis
  - lymphoid hyperplasia
  - mild constrictive changes
- nonspecific interstitial pneumonia
- organising pneumonia
- other manifestations of collagen-vascular disease
- pulmonary hemorrhage syndromes
- pulmonary vasculitis syndromes
Nonimmune-mediated systemic disorders:
- Langerhans cell histiocytosis
- malignant infiltrates
- sarcoidosis
- storage disease

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

Basic histopathology of:
- chronic pneumonitis of infancy
- desquamative interstitial pneumonitis
- nonspecific interstitial pneumonia
- pulmonary alveolar proteinosis

Investigations

Basic histopathology of interstitial and diffuse lung disease of childhood (chILD)
Blood tests for diagnosis of immunodeficiency / immune mediated disorder / non-immune mediated systemic disorder
Diagnostic imaging including chest x-ray, CT, and MRI
Genetic testing where appropriate, e.g., chILD

Clear communication between the surgeon, physician, and pathologist in relation to lung biopsy
Differential diagnosis of infection versus rejection in the post-transplant setting
Genetic diagnostic technique, the role of the geneticist, and the importance of genetic counselling
Informed consent required from patients, families and carers
The role of the international community of practice when managing rare diseases
The role of the multidisciplinary team when managing rare disease
Timing of lung biopsy in the diagnosis of chILD
Transbronchial biopsy techniques

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

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

Description

Advanced Training in Respiratory Medicine

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

LG2: Team leadership

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

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions from paediatric to adult care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making