Curriculum standards

About this resource

The new Advanced Training in Endocrinology (AM) curriculum consists of curriculum standards and learning, teaching, and assessment (LTA) programs.

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

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

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

Download the curriculum standards PDF

LG1: Competencies

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

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

Competencies will be common across all or most training programs.

Medical expertise

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

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

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

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

Communication

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

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

Effective communication. Uses a range of effective and appropriate verbal, nonspeaking, and written communication techniques, including active listening.

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

Cultural safety*

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

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

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

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

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

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

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

*The RACP has adopted the Medical Council of New Zealand’s definition of cultural safety (below): 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 healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities.

References

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

Ethics and professional behaviour

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

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

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

Sustainability. Manage the use of health care resources responsibly in everyday practice.

Entrustable Professional Activities

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

LG 2: Team leadership

Learning Goal 2

Team leadership

Lead a team of health professionals

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information to develop optimal, goal-centred plans for patients
use evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members
provide coordinated and quality health care for populations or patients as a member of a multidisciplinary team

direction
Requires some supervision

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

The trainee may:

demonstrate adequate knowledge of healthcare 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

Communication

confident
Ready to perform without supervision

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

The trainee will:

provide support and motivate patients or populations and health professionals by effective communication
demonstrate a transparent, consultative style by engaging patients, families, carers, relevant professionals, and/or the public in shared decision making
work with patients, families, carers, and other health professionals to resolve conflict that may arise when planning and aligning goals
demonstrate rapport with people at all levels by tailoring messages to different stakeholders
engage other multidisciplinary team members in care of patients with appropriate communication of needs

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
place safety and quality of care first in all decision making

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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
engage in collaborative and ethical research practice with all stakeholders and acknowledge own and others contributions to research

direction
Requires some supervision

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

The trainee may:

understand that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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
encourage learners to tailor communication as appropriate for different patients, such as younger or older people, and different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication

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
observe learners to identify and reduce risk and improve health outcomes

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

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
identify and participate in new learning experiences

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 in a timely manner
participate in teaching and supervision professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in the supervision of learners
apply a standardised approach to teaching, assessment, and feedback
participate in activities that are aligned to learning goals
seek feedback and reflect on own teaching by developing goals and strategies to improve

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, providing feedback regarding the merits or challenges of proposed research
support learners to find forums to present research projects
encourage and guide learners to seek out relevant research to support practice
ensure that the research projects planned are feasible and of a suitable standard

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
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

integrate some public health principals into teaching and practice

LG 4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify and report actual and potential (near miss) errors
conduct and evaluate system improvement activities
apply best practice guidelines
audit clinical outcomes and implement clinical guidelines where applicable
contribute to the development of policies and protocols designed to protect patients and enhance healthcare
monitor one’s own practice and develop individual improvement plans.
participate in morbidity and mortality meetings and review systems to prevent adverse patient outcomes

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
evaluate practice to ensure it aligns with available evidence and guidelines
recognise the complex care needs of patients living with chronic endocrine conditions and proactively institute care planning to mitigate acute deterioration
use population health outcomes to identify opportunities for improvement in delivering appropriate care
regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures

direction
Requires some supervision

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

The trainee may:

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

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of a systematic approach to improving the quality and safety of health care
demonstrate understanding of the principles of organisational quality and safety activities, including root cause analyses and corrective and preventative action 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:

translate quality improvement approaches and methods into practice
participate in professional training in quality and safety to ensure a contemporary approach to safety system strategies
supervise and manage the performance of junior colleagues in the delivery of high-quality, safe care
maintain Continuing Professional Development obligations as per regulatory requirements

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

apply the principles underlying ethical research
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 and understand the processes for obtaining this approval within an organisation
communicate to patient that they will not be treated differently should they opt not to participate in research
ensure research adherence to the local and national codes for the responsible conduct of research¹

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
explain that routine care will continue if the participant decides not to participate in research

References

1. Trainees can refer to the National Health and Medical Research Council (NHMRC) code and/or Australian clinical trials code.

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with patients from diverse backgrounds, including through effective collaboration with interpreters
undertake professional development opportunities that address the impact of cultural bias on health outcomes

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

partner with clinicians and managers to ensure patients receive appropriate care and information on their care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

assess, investigate, manage, and treat common and less common endocrine presentations and syndromes
elicit an 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 with a list of reasonable differentials
arrange appropriate investigations as needed for diagnostic work ups
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop evidence-based management plans based on relevant information, consistent with current guidelines
balance benefit and harm of any investigations or interventions tailored to the patients' circumstances
identify areas where patients may require further support
consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions or adverse events, and patient preference prior to prescribing new medications
plan follow up and monitoring at appropriate intervals

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 relevant physical examinations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct clinical encounters 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:

demonstrate active listening, addressing patients’ concerns, with adequate opportunity to ask questions
provide information to patients and their family or carers to enable fully informed decision-making for various diagnostic, therapeutic, and management options
discuss sensitive issues related to fertility, including infertility and pregnancy risks enabling patients to make informed choices
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care, including in written correspondence, medical records and verbal communications

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
develop active listening skills
communicate patients’ situations to colleagues, including senior clinicians
document clinical encounters to convey clinical reasoning and the rationale for decisions
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:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

need assistance to set goals and clear objectives for self-learning
engage in self-reflection, requiring encouragement to do this more frequently
deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

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

The trainee will:

use appropriate search strategies to find, compile, analyse, interpret, and evaluate information relevant to the research subject
use relevant resources to assist with resolving clinical problems, including practice guidelines and current literature

direction
Requires some supervision

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

The trainee may:

refer to guidelines and medical literature to assist in clinical assessments when required
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
hold information about patients in confidence, unless the release of information is required by law or public interest
assess patients’ capacity for decision making, involving a proxy decision maker appropriately
demonstrate understanding of the ethical implications of pharmaceutical industry marketing and funded research
not advance personal interest or professional agendas at the expense of patient or social welfare

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
follow organisational policies on 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:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 6: Management of transitions in care

Learning Goal 6

Management of transitions in care

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

This activity requires the ability to:

manage transition of patient care to ensure the optimal continuation of care between providers
identify the appropriate health care providers and other stakeholders with whom to share patient information
exchange pertinent, contextually appropriate, and relevant patient information
perform this activity in multiple settings (appropriate to the speciality), including inpatient, ambulatory, and critical care settings

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate an optimal age-appropriate transition of care for patients
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them
deliver age-appropriate care and adapt care in recognition of the increased role for the young person in managing their chronic condition
assess patients’ health literacy and developmental readiness
assess adherence to treatment and monitoring plans
outline the key components of a transition program and the differences between the cultures of paediatric and adult care services, including the role of the adult physician
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
anticipate, prevent, and manage changes in health status at the time of transition
adapt transition to meet individual patients’ needs
identify youth-focused adult services and local transition coordinators/facilitators

direction
Requires some supervision

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

The trainee may:

understand the details of patients’ conditions, illness severity, and potential emerging issues
provide accurate summaries of patients’ information with accurate identification of problems or issues
recognise the importance of maintaining continuity of care and prevention of loss to follow up at the time of transition
assess psychosocial issues that may affect health and/or access to services
identify the ways in which disease may impact on patients’ lifestyles, such as contraception, pregnancies, employment, sport/leisure activities, and smoking
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:

write relevant and detailed medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
include appropriate transfer of care information from other multidisciplinary team members
initiate and maintain verbal or written communication with other health professionals involved in patients' care
communicate with patients, families and/or carers about transition of care, and engage and support these parties in decision making

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved
evaluate patients’ understanding of their health condition and ability to perform self-care at all transition points

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

include relevant information regarding patients’ cultural or ethnic background in handovers, and whether an interpreter is required
identify and link patients with culturally appropriate services to assist with transition in care

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patients’ care is in the most appropriate facility, setting, or provider and consider impact of age and comorbidities on types of supports needed

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

factor transport issues, costs to patients and continued access to appropriate care into decisions to transfer patients to other settings

LG 7: Acute care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately, including escalation to high acuity care and administration of appropriate initial treatment
perform advanced life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
demonstrate knowledge of potential risks and complications of resuscitation
identify possible diagnoses that may threaten patient safety and investigate appropriately
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
manage escalations or transitions of care in a proactive and timely manner
use hospital protocols for acute endocrine emergencies and be able to explain clearly when variations from these are necessary
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
optimise medical management before, during, and after operations, procedures, or hospital admissions

direction
Requires some supervision

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

The trainee may:

recognise seriously unwell patients requiring immediate care
apply basic life support as indicated
understand general medical principles of caring for patients with undifferentiated and undiagnosed conditions
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis and develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans
assess perioperative and periprocedural patients
manage most acute conditions independently with awareness of one’s own limitations, escalating to consultants as appropriate

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
use closed-loop and clear communication with other health care team members during resuscitation
relay the patient presentation, care progress and management plan to colleagues factually, clearly, succinctly and with prioritised clinical information
facilitate early communication with patients, families, and health care team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain the situation to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
determine the level of health literacy of individual patients and level of understanding of agreed care decisions
provide clear and effective discharge summaries with recommendations for ongoing care

direction
Requires some supervision

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

The trainee may:

demonstrate communication skills to sufficiently support the function of multidisciplinary teams
if possible, determine patients’ understanding of their diseases and what they perceive as the most desirable goals of care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

maintain up-to-date certification in advanced life support
use clinical information technology systems for conducting prospective and retrospective clinical audits
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
analyse adverse incidents and sentinel events to identify system failures and contributing factors
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability
document treatment given without consent in an emergency according to local guidelines

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective supervision skills and teaching methods which are adapted to the context of the training, including being informed of the RACP curriculum and assisting with assessments as required
encourage questioning among junior colleagues and students in response to unanswered clinical questions
seek guidance and feedback from healthcare teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

select studies based on optimal trial design, freedom from bias, and precision of measurement, and apply to clinical practice as appropriate
evaluate the value of treatments in terms of relative and absolute benefits, cost, potential patient harm, and feasibility
evaluate the applicability of the results of clinical studies to the circumstances of individual patients, especially those with multiple comorbidities
specify research evidence to the needs of individual patients

direction
Requires some supervision

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

The trainee may:

demonstrate efficient searching of literature databases to retrieve evidence
use information from credible sources to aid in decision making
refer to evidence-based clinical guidelines and protocols on acutely unwell patients
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

develop management plans that are based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
advise patients of their rights to refuse medical therapy, including life-sustaining treatment
consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
facilitate interactions within multidisciplinary teams respecting values, encouraging involvement, and engaging all participants in decision making
demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy

direction
Requires some supervision

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

The trainee may:

communicate medical management plans as part of multidisciplinary plans
establish, where possible, patients' wishes and preferences about care
contribute to building a productive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

recognise the need for escalation of care, and escalate to appropriate staff or services
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making
reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

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

The trainee may:

involve additional staff to assist in a timely fashion when required
recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units, and health professionals in the community with shared patients
manage the transition of acute medical patients through their hospital journeys
lead a team by providing engagement while maintaining a focus on outcomes
manage and initiate open disclosure as necessary

direction
Requires some supervision

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

The trainee may:

collaborate with and engage other team members, based on their roles and skills
ensure appropriate multidisciplinary assessment and management
encourage an environment of openness and respect to lead effective teams

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patient care based on need, and consider available resources
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

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

The trainee may:

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

LG 8: Longitudinal care

Learning Goal 8

Longitudinal care

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

encourage patients’ self-management through education to take greater responsibility for their care, and support problem solving
work in partnership with patients, and motivate them to adhere to agreed care plans
communicate with multidisciplinary team members, and involve patients in that dialogue

direction
Requires some supervision

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

The trainee may:

provide healthy lifestyle advice and information to patients on the importance of self-management
encourage patients’ access to self-monitoring devices and assistive technologies

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines

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
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery
educate patients regarding sick day management plans for common and important endocrine conditions

Research

confident
Ready to perform without supervision

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

The trainee will:

prepare reviews of literature on patients' encounters to present at journal club meetings
search for and critically appraise evidence to resolve clinical areas of uncertainty
prepare research protocols to evaluate interventions and outcomes for chronic disease

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 and limitations of review articles
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

confidentially share information between relevant service providers
acknowledge and respect the contribution of other health professionals involved in patients’ care
seek consent from patients to discuss their care at multidisciplinary team meetings

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG 9: Communication with patients

Learning Goal 9

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

discuss with patients their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand, before asking for their consent
recognise and take precautions where patients may be vulnerable, such as issues of child protection, family violence, self-harm, or elder abuse
participate in processes to manage patient complaints and participate in open disclosure discussions with patients

direction
Requires some supervision

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

The trainee may:

inform patients of the material risks associated with the proposed management plan
treat information about patients as confidential
consider young people’s capacity for decision making and consent

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

discuss the aetiology of diseases and explain the purpose, nature, and extent of the assessments to be conducted
obtain informed consent or other valid authority before involving patients in teaching
encourage questions and observations from junior staff and students to facilitate open communication and teaching
provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
engage with community organisations and public health channels to promote preventative and public health strategies in clear and relevant language
recognise the significance of role-modelling all aspects of the work of a physician in interactions with junior staff and medical students, for their learning

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

refer to evidence-based clinical guidelines
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication with Māori and Aboriginal and Torres Strait Islander peoples
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible
respect patients’ cultural views and incorporate these when developing management plans where possible
demonstrate effective and culturally competent communication with people of diverse gender identities (including use of correct pronouns and preferred name)

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG 10: Prescribing

Learning Goal 10

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

take and interpret medication histories
choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, comorbidities, potential drug interactions, risks, and benefits
communicate with patients and families or carers about the benefits and risks of proposed therapies
facilitate patient understanding of medication effects and side effects
empower patients to self-adjust medication doses and timing, where appropriate
understand differences between drug delivery devices and assist patient decision-making
educate regarding use of drug delivery devices and optimising functionality in different settings
monitor medicines for efficacy and safety
review medicines and interactions, and cease where appropriate
collaborate with pharmacists

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ disorders requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patient preference prior to prescribing a new medication
create a framework to enable patients to make appropriate adjustments to prescribed medicines in response to situations, including intercurrent illness
initiate devices for drug delivery and understand the differences between drug delivery devices, guiding patients in appropriate choice of device for their needs
understand the differences between continuous glucose monitoring devices and advise patients in choice of device for their needs
consider the patients’ fertility aspirations and plans when prescribing ongoing and new medications
modify patients’ medications as appropriate when planning for pregnancy and during pregnancy
modify patients’ medications perioperatively
prescribe therapeutic adjustments based on adherence, using a patient-centred approach to prescribing, tailored to patients’ biopsychosocial needs
plan follow-up and monitoring

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

review medicines regularly to reduce non‑adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
encourage the use of medication aides to facilitate adherence, where applicable
prescribe new medicines only when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
participate in clinical audits to improve prescribing behaviour, reduce adverse events and polypharmacy leading to a prescribing cascade
report suspected adverse events to the Advisory Committee on Medicines (Australia) or Centre for Adverse Reactions Monitoring (Aotearoa New Zealand), and record it in patients’ medical records
minimise harmful events associated with variable dose prescribed drugs in hospital

direction
Requires some supervision

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

The trainee may:

check medication doses before prescribing
check that the administration timing for prescribed medications is accurately and clearly documented
monitor side effects of medicines prescribed
identify medication errors and institute appropriate measures
use manual and/or electronic prescribing systems safely
rationalise medicines to avoid polypharmacy

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use continuously updated software for computers and electronic prescribing programs
use and analyse centralised reporting systems for continuous glucose monitoring to improve patient care outcomes
interpret and apply the different reporting software for drug delivery devices to patient care
ensure patients understand management plans, including adherence issues
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines

direction
Requires some supervision

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

The trainee may:

undertake continuing professional development to maintain currency with prescribing guidelines
undertake continuing professional development to maintain up-to-date understanding of new medications and the evidence for their use
undertake continuing professional development to maintain up to date understanding of drug delivery devices and their linkage to continuous glucose monitoring, and the evidence for their use
reflect on prescribing, and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

make therapeutic decisions according to the best evidence
recognise where evidence is limited, compromised, or subject to bias or conflict of interest
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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
offer approved patient information resources in languages other than English, where these are available

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 the medicine is for
- when it should be stopped
make prescribing decisions based on good safety data when the benefits outweigh the risks involved
demonstrate understanding of the ethical implications of pharmaceutical industry-funded research and marketing
prescribe according to best evidence based practice and in partnership with the patient, and without undue influence from pharmaceutical industry interactions

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

choose medicines in relation to comparative efficacy, safety, and cost-effectiveness against medicines already on the market
prescribe for individual patients, considering history, current medicines, allergies, and preferences, ensuring that healthcare resources are used wisely for the benefit of patients
advocate for patient access to medications that would be of benefit to their condition from evidence-based clinical assessment and judgement when necessary

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
prescribe in accordance with the Pharmaceutical Benefit Scheme

LG 11: Procedures

Learning Goal 11

Procedures

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

This activity requires the ability to:

select appropriate procedures in partnership with patients, their families or carers
obtain informed consent
set up the equipment, maintaining an aseptic field
perform procedures
manage unexpected events and complications during and after procedures
provide aftercare for patients
communicate aftercare protocols and instructions to patients and medical and nursing staff
interpret the results and outcomes of procedures, and reports
communicate the outcome of procedures to patients
perform this activity across multiple relevant settings

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by assessing patient-specific factors, risks, benefits, and alternatives
ensure team members are aware of all allergies/adverse reactions identified, and take precautions to avoid allergies/adverse reactions during procedures
ensure patients understand any pre-procedure changes to their usual treatment
confirm the correct position / site / side / level on patients for planned procedures (such as hormone implants or injections)
recognise and effectively manage complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of diagnostic procedures

direction
Requires some supervision

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

The trainee may:

assess patients and identify indications for procedures
check for allergies and adverse reactions
consider risks and complications of procedures
interpret results of common diagnostic procedures
organise and document postprocedural 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 the clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
explain procedures clearly to patients, families and carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
counsel patients sensitively and effectively, and support them to make informed choices
address patients’, families’ or carers’ concerns relating to procedures, providing opportunities to ask questions
tailor language according to individual patients’ age and capacity to understand
communicate effectively with team members, patients, families, and carers prior to, during, and after procedures
ensure team members are confident and competent in their assigned roles

direction
Requires some supervision

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

The trainee may:

explain the process of procedures to help patients, families and carers to understand the risks and benefits of a procedure
communicate with members of procedural teams so all team members understand who each member is
discuss postprocedural care with patients, families and carers
complete relevant patients’ documentation, and conduct appropriate clinical handovers

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before undertaking any procedure
set up all necessary equipment, and consistently use universal precautions and aseptic technique
confirm patients’ identification, verify the procedure, and where appropriate, the correct position/site/side/level for the procedure
ensure that information on patients’ consent forms match procedures to be performed
identify, document, and appropriately notify of any adverse events or equipment malfunction

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients, families, and carers are fully informed when consenting to any procedures

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

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 to develop new skills
actively seek feedback on personal technique until competent

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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

LG 12: 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 and only order investigations with appreciable benefit, e.g. to change management
work in partnership with patients and their families or carers to facilitate choices that are right for them
manage patients undergoing investigations to minimise risks and maximise diagnostic yield
interpret the results and outcomes of investigations
communicate the outcome of investigations to patients and discuss the next steps

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 in the context of comprehensive clinical assessments
understand the accuracy, limitations and indications of endocrine investigations and remain abreast of developments and local expertise in the various domains of endocrine testing, including imaging, biochemistry, dynamic testing and invasive investigations
provide appropriate care for patients undergoing dynamic and invasive endocrine investigations, to minimise risk and maximise diagnostic yield
assess patients’ concerns, and determine the need for specific investigations that are likely to result in overall benefit
develop plans for investigations, identifying their roles and timing
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
recognise investigation results that may be erroneous or misleading and understand the pathways for correcting these errors if required
liaise with colleagues and multidisciplinary teams to interpret findings in the context of specific patients when necessary

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
understand the significance of abnormal test results and act on these
consider patient factors and comorbidities
consider age and gender specific reference ranges where relevant
identify contraindications for, and complications of, dynamic and invasive endocrine investigations

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from a proposed investigation, focusing on patients’ individual situations
participate in clinical practice audits to ensure best available evidence-based practice is offered
where appropriate, collaborate with colleagues and multidisciplinary teams to ensure that investigations are accurate and of clinical value

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision support tools
participate in clinical audits to improve knowledge of test sensitivity/specificity and relevance for diagnoses and screening
teach junior staff about evidence-based use of investigations

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

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

The trainee will:

provide patients with relevant information if a proposed investigation is part of a research program
obtain written consent from patients if the investigation is part of a research program
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, and that patients may withdraw consent at any time

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
demonstrate adherence to the principles of ethical research including consent
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

understand patients’ views and preferences about any proposed investigation (including handling, storage, and disposal of test samples) and the adverse outcomes they are most concerned about

direction
Requires some supervision

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

The trainee may:

consider patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

remain within the scope of the authority given by patients (except for emergencies)
when necessary, discuss with patients how decisions will be made once an investigation has started and the patient is not able to participate in decision making
respect patients’ decisions to refuse investigations, even if their decisions may not be evidence-based or in their best interests medically
advise patients of the potential costs of investigations, which patients may wish to clarify before proceeding
explain the expected benefits as well as the potential burdens and risks of any proposed investigation before obtaining informed consent or other valid authority
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information and obtain documented informed consent from patients prior to proceeding with such investigations
comply with consent processes, privacy law, and professional guidelines to maintain patient confidentiality

direction
Requires some supervision

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

The trainee may:

identify appropriate proxy decision-makers when required
choose not to investigate in situations where it is not appropriate for ethical reasons
practise within current ethical and professional frameworks
practise within own limits, and seek help when needed
involve patients in decision making regarding investigations, obtaining the appropriate informed consent, including financial consent, if necessary

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
liaise with colleagues and other members of multidisciplinary teams, providing clinical context to investigation outcomes, when necessary
adjust the investigative path depending on test results received
consider the clinical impact if no tests are selected

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consider the role of other members of the healthcare team, and what other sources of information and support are available
ensure results are checked in a timely manner, taking responsibility for following up results and progressing management as appropriate based on these results

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

LG 13: Clinic management

Learning Goal 13

Clinic management

Manage an outpatient clinic

This activity requires the ability to:

manage medical procedures and treatments
manage clinic services
keep written documentation of all activity within the clinic
oversee quality improvement activities
communicate with patients, their families and/or carers
communicate with other care providers
liaise with other health professionals and team members
demonstrate problem-solving skills
responsibly use public resources

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

effectively identify and address current clinical concerns, as well as longer-term clinical objectives, as appropriate to patients’ context
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
create an accurate and appropriately prioritised problem list in clinical notes
maintain up-to-date documentation on patients’ presentation, intercurrent health conditions, management, and progress, including key points of diagnosis and decision making to inform coordination of care

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system to improve access to care by collaboration with other services, such as general practitioners, community health centres, and consumer organisations
ensure patients understand the need for, and purpose of, a valid referral at each visit and the duration of referral validity
link patients to specific community-based health programs and group education programs
use telehealth and digitally integrated support services to enable patients’ access to care
update referring doctors/teams on attendance outcomes and management plans in a timely manner, appropriate to the patients’ clinical situation

direction
Requires some supervision

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

The trainee may:

wherever practical, meet patients’ specific language and communication needs
facilitate appropriate use of interpreter services and translated materials
work in partnership with patients to develop an agreed care plan and optimise motivation for adherence

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

take reasonable steps to address issues if patients’ safety may be compromised
understand the different ways to evaluate and improve the quality and safety of outpatient health care
participate in organisational quality and safety activities, including clinical incident reviews

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

evaluate their own professional practice
demonstrate learning behaviour and skills in educating junior colleagues
obtain patient consent before involving students or other health professional observers in patient consultations
contribute to the generation of knowledge
provide supervision to junior colleagues to ensure the provision of quality patient care
maintain professional continuing education standards

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before involving patients in research
inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation before obtaining consent
ensure that usual care is not compromised if a patient decides to not participate in research

direction
Requires some supervision

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

The trainee may:

allow patients to make informed and voluntary decisions to participate in research
explain that routine care will continue if the participant decides not to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community being served, and how to shape service delivery to its’ people
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practices which improve patient engagement and health outcomes and are underpinned by cultural safety
refer to or engage culturally appropriate support services for those with chronic health conditions

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

understand the responsibility to protect and advance the health and wellbeing of individuals and communities
maintain the confidentiality of documentation, and store clinical notes appropriately
ensure that the use of social media is consistent with ethical and legal obligations
ensure appropriate consent procedures and evaluate capacity/competence of patients to make decisions regarding their health 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:

triage referrals according to urgency of care required
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
decide on effective use of telehealth, outreach, and liaison services when appropriate and available

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

prepare for and conduct clinical encounters in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups
work effectively with patient’s primary care provider
ensure that all important discussions with colleagues, multidisciplinary team members, and patients are appropriately documented
review discharge summaries, notes, and other communications written by junior colleagues and provide feedback
support colleagues who raise concerns about patients’ safety
consider urgency of care and work effectively to maximise patient access to health services

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly
ensure all members of the multidisciplinary team are respectful of colleagues and interact appropriately and professionally

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
partner with organisations to address aspects of service provision that may be a risk to patients’ safety such as overbookings, IT issues affecting efficiency, and clinic referral waitlists
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs

direction
Requires some supervision

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

The trainee may:

understand common population health screening and prevention approaches
identify tools required to improve quality of service provision and advocate for these within the health care organisation

Knowledge guides

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

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

LG 14: Scientific foundations of endocrinology

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.

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Anatomy, histology, and physiology of the endocrine organs, including

Adipose tissue
Adrenal cortex
Adrenal medulla
Bone
Female reproductive tract
Male reproductive tract
Pancreas
Parathyroid
Pituitary
Thyroid

Classes of hormones

Structure, function, and biosynthesis of hormones:
- aminergic hormones
- peptide hormones
- steroid hormones
- thyroid hormones

Mechanisms of hormone action

Classes of peptide and aminergic hormone receptors
Classes of nuclear hormone receptors
Distinguish between endocrine, paracrine, and autocrine functions of hormones
Principles of receptor signalling:
- G-protein coupled
- nuclear
- tyrosine kinase

Regulation of hormonal systems

Adrenal:
- adrenal androgens
- aldosterone/renin-angiotensin axis
- catecholamines
- cortisol/HPA axis
Calcium regulation and bone physiology:
- bone turnover markers
- calcitonin
- fibroblast growth factor 23 (FGF23)
- parathyroid hormone (PTH)
- parathyroid hormone-related protein (PTHrP)
- vitamin D biosynthesis pathway
Hypothalamus/anterior and posterior pituitary axes:
- anti-diuretic hormone
- CRH, ACTH, cortisol
- dopamine, prolactin
- GHRH, GH, IGF-1
- GnRH, FSH, LH, oestrogen, progesterone, testosterone
- oxytocin
- TRH, TSH, thyroid hormones
Key biosynthetic pathways of hormones
Lipid metabolism
Major stimuli and inhibitors of individual hormones
Negative and positive feedback regulation of endocrine systems
Pancreatic and gastrointestinal hormones:
- gastrin
- glucagon
- glucagon-like peptide (GLP)/gastric inhibitory polypeptides (GIPs) and peptide YY
- insulin
- somatostatin
Reproduction:
- AMH, inhibins and activins
- HPG axes (GnRH, FSH, LH, oestrogen, progesterone, testosterone)

Principles of statistics and epidemiology

Basic statistics:
- absolute and relative risk
- likelihood ratios and odds ratios
- null hypothesis and P-values, confidence intervals
- sensitivity, specificity, and predictive values
- statistical tests – chi-square, t-tests, ANOVA, linear vs logistic regression analysis, parametric vs non-parametric
- type I and II errors, power calculations
Clinical research studies:
- case reports
- cohort or registry studies
- ethical principles
- observational studies
- randomised control trials
- study types, advantages and limitations:
- systematic reviews and meta-analysis
Levels of evidence and classes of recommendations
Population risk determination of endocrine disease development:
- biomarker development
- community/policy prevention measures
- principles of population screening
- risk scoring systems

Non-invasive tests and clinical assessment tools

Ambulatory blood pressure
Clinical risk calculators (used with clinical judgment in the discussion of management with patients), such as:
- cardiovascular risk calculators
- breast cancer risk calculators
- Dutch lipid score
- fracture risk calculators
- MODY calculator
Diabetes management monitoring data:
- manual or digital BGL diary
- continuous glucose monitoring output data
- insulin pump upload data
Ferriman-Gallwey scoring
Salivary testing
Semen analysis
Tanner staging
Urine testing

Chemical pathology and laboratory testing of hormones

Assay indications and limitations
Assay interference (endogenous and exogenous parameters)
General laboratory processes for sample collection, storage and processing
Physiological influences on hormone assay results:
- age
- circadian rhythm
- exercise
- fasting
- menstrual cycle
- pregnancy
Reference ranges and how they are derived:
- indications for age-matched, sex-matched, gestational reference ranges
Sensitivity and specificity of testing choice
Types of assays, such as:
- antibody chemiluminescence
- liquid chromatography
- tandem mass spectrometry

Cytology and histopathology

Adrenal cortical tumours
Adrenal medullary tumours and paragangliomas
Hormone-secreting gonadal tumours
Other neuro-endocrine tumours
Pancreatic neuro-endocrine tumours
Parathyroid
Pituitary
Thyroid nodule FNA interpretation and scoring

Dynamic endocrine testing

Adrenal vein sampling
Calcium stimulation testing
Clonidine suppression test
Fludrocortisone suppression test
Glucagon and arginine stimulation tests
Insulin tolerance test
Mixed meal test
OGTT for glucose and growth hormone
Overnight metyrapone test
Saline suppression test
Short synacthen test for cortisol and 17OHP
Stimulated copeptin testing
Water deprivation test
Workup for suspected Cushing syndrome:
- dexamethasone suppression tests
- inferior petrosal sinus sampling

Radiological investigations

CT scan:
- adrenal
- metastases from endocrine malignancies
- ovary
- pancreas
- parathyroid
- pituitary
- thymus
- thyroid
MRI:
- adrenal
- hypothalamus
- ovary
- pancreas
- pituitary
PET scan
Ultrasound:
- endometrium
- ovary
- parathyroid
- testis
- thyroid

Nuclear medicine

Diagnostic utility of nuclear isotopes in endocrine disease, including thyroid, parathyroid and bone investigations
Therapeutic utility of nuclear isotopes in endocrine disease management, including radionuclide ablation

Bone density and structure

Densitometry investigations and limitations
Quantitative CT assessment of bone density

Genetic testing

For conditions where genetic testing is indicated, appropriate counselling and consent is provided to the patient prior to testing

Evidence for best practice and application of this, using clinical judgement for individual circumstances in partnership with patients
Endocrine medical emergencies, and knowledge of how to manage appropriately
Environmentally sustainable practices in clinical care
Improving equitable access to comprehensive endocrine care for individuals, including:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools
Seek multidisciplinary care/review wherever necessary

LG 15: Disorders of glucose metabolism

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

Asymptomatic with detection of hyperglycaemia on screening
Autonomic disease:
- cardiac
- gastroparesis
- postural hypotension
- sexual dysfunction
Cognitive decline
Diabetic amyotrophy
Diabetes foot disease:
- Charcot arthropathy
- prevention/management of foot ulcers
Hyperglycaemic metabolic emergencies
Hypoglycaemia:
- hypoglycaemia unawareness
- medication induced
- postprandial
Infection, often recurrent or severe
Macrovascular disease:
- cerebrovascular disease
- ischaemic heart disease
- peripheral vascular disease
Microvascular disease:
- peripheral neuropathy
- renal nephropathy
Mood changes
Polydipsia/Polyuria
Postprandial fatigue
Retinopathy
Visual disturbances
Weight loss

Conditions

Diabetes mellitus:
- gestational
- monogenic
- type 1
- type 2
Diabetes secondary to other conditions:
- cystic fibrosis
- haemochromatosis
- post-transplantation
- pancreatic insufficiency:
  - alcoholism
  - pancreatectomy
  - pancreatic cancer
  - recurrent pancreatitis
Drug induced diabetes, including steroid-induced and antipsychotic-induced
Hyperinsulinaemica
Hypoglycaemia
Latent autoimmune diabetes adult (LADA)
Mild age-related diabetes (MARD)
Mild obesity-related diabetes (MOD)
Prediabetes
Severe insulin deficiency (SIDD)
Severe insulin resistance (SIRD)

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

Pancreatic transplant or islet cell transplant indications and management
Rare syndromes associated with increased diabetes risk

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

Diabetes

Insulin dose adjustments (irrespective of insulin delivery method)

Safe dose adjustment in response to:
- alcohol and recreational drug use
- blood glucose levels
- concurrent treatments that impact blood glucose (e.g. glucocorticoids and parenteral nutrition etc.)
- exercise
- intravenous insulin regimens:
  - dosing
  - indications
  - initiation
  - transition to subcutaneous
- nutrition and fasting
- peri-operative and peri-procedures
- pregnancy, lactation, labour, and postpartum
- sick days
- titration

Lifestyle management

Counselling and best evidence-based lifestyle advice for individuals to prevent the development of Type 2 diabetes or to manage all forms of established diabetes:
- alcohol, recreational drugs, smoking, and vaping
- carbohydrate counting
- contraception and pre-conception planning, management during pregnancy and postpartum
- education and employment
- nutrition and diet
- physical activity and reducing sedentariness
- weight management

Pharmacological management

Apply up to date, evidence-based best practice and clinical judgement to individualised medication management plans
Action profiles of various insulins and combination regimens:
- effects of concurrent drug therapies on glycaemia
- evidence-based use of pharmacotherapy for non-glycaemic benefits in diabetes populations, e.g. cardiovascular or renal benefits
Knowledge of the pharmacological therapy indicated for:
- gestational diabetes mellitus
- MODY
- pancreatectomy or endocrine pancreatic insufficiency
- type 1 diabetes mellitus and LADA
- type 2 diabetes mellitus
Mechanism of action of major non-insulin drug classes in glycaemia
Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications

Screening

Depression, accelerated cognitive decline, and dementia
Diabetes complications screening (incorporating allied health and other health professionals wherever indicated) at appropriate intervals for microvascular and macrovascular disease burden
Diabetes distress, particularly for people living with type 1 or LADA diabetes
Diagnostic criteria
Hypertension and dyslipidemia
Individualised glycaemic targets determined by:
- complications and comorbidities profile
- duration of disease
- goals
- hypoglycaemia risk
- patient preferences
Metabolic syndrome and associated fatty liver disease (MAFLD)
Monitoring glycaemia
Obstructive sleep apnoea (OSA)
Referral and use of allied health and multidisciplinary professionals in providing holistic team care
Screening and managing referrals for associated conditions
Screening for other autoimmune conditions, such as:
- Addison's disease
- coeliac disease
- pernicious anaemia
- thyroid dysfunction

Hyperglycaemic emergencies

Diabetic ketoacidosis
Hyperglycaemic hyperosmolar state

Hypoglycaemia

Acute and preventive management of hypoglycaemia
Acute hypoglycaemic emergencies
Investigations and work up of hypoglycaemia in non-diabetes cases
Mechanisms and associated diseases, including insulinoma, dumping syndrome, nesidioblastosis, post-bariatric surgery
Recognition and management of hypoglycaemia unawareness

Euglycaemic diabetic ketoacidosis

Pregnancy-induced
SGLT2i-induced
Starvation
Type 1 diabetes

Diabetes

Advanced technology and devices

Blood glucose monitoring systems:
- benefits, limitations, and data interpretation (time in range, GMI)
- bolus calculators for multiple daily injection (MDI)
- continuous glucose monitoring (CGM) systems:
  - used with MDI therapy and insulin pumps
  - principles, benefits, and limitations of closed loop technology
  - glucose data interpretation (self-monitored blood glucose readings, continuous glucose monitoring)
- finger prick meters – glucose and ketones
Calculation and adjustment of:
- basal insulin dose/ratios
- carbohydrate ratio
- insulin sensitivity factor
Indications and suitability of CSII converting insulin doses from MDI to CSII
Insulin delivery devices:
- insulin pen devices for MDI therapy
- insulin pumps and features/functions
Interpretation of insulin pump data
Principles of continuous subcutaneous insulin infusion (CSII, ‘insulin pump’) therapy, such as:
- basal infusion rates
- pump specific attributes including suspend and exercise

Cardiovascular risk mitigation

Blood pressure:
- individualised target setting
- investigation for underlying secondary causes of hypertension where appropriate
- monitoring including home, clinic, and 24-hour ambulatory monitoring
Clinical assessment and comprehensive diabetes physical examination
Impact of alcohol on diabetes monitoring and management
Lipid management and targets in diabetes cohort
Smoking cessation/avoidance
Weight management

Hypoglycaemia

Dynamic tests – indications, performing tests, and interpretation:
- mixed-meal test
- 72-hour fast

Investigations

Gastric emptying study
Genetic screening:
- rare or suspected inherited forms of diabetes
Endogenous insulin reserves (when indicated), e.g. paired C-peptide and glucose
Limitations and interferences in pathology results, such as:
- fructosamine
- HBA1c
- lipid studies
Nerve conduction studies
Pancreatic autoimmunity (when indicated or suspected)
Urine albumin/creatinine ratio
Use of decision support tools to facilitate clinical decisions such as cardiovascular disease calculator

Evidence based clinical practice

Beta cell transplantation, including whole pancreas or islet cell transplantation
Evidence for best practice (e.g., AnnADA guidelines supplement, diabetes care) and application of this using clinical judgement and individual circumstances in partnership with patients
Fitness to drive according to guidelines

General management considerations

Educate, support, and empower people to self-manage their diabetes
Environmentally sustainable practices in clinical care
Impact of:
- cultural, health literacy, social, geographic and financial barriers to accessing comprehensive diabetes care
- diagnosis of diabetes and of living with diabetes on an individual, their family, their life, and their life stages
- hypoglycaemia unawareness on patients, their family, and carers
- socioeconomic determinants of health on health outcomes
Equitable access to comprehensive diabetes care delivery for individuals, such as:
- appropriate multicultural resources
- including multidisciplinary involvement
- use of telehealth and other digital health tools
Recognise the impact of management in the presence of comorbidities including:
- atherosclerotic
- cardiac failure
- chronic kidney disease
- cognitive decline
- obesity
- seizure disorders

Health needs of specific groups

Diabetes in youth:
- common risk-taking behaviour in young people and its effects on diabetes
- impact of practitioner’s behaviour on young people
- physiological, psychological and social factors affecting glycaemic levels in adolescence
- potentially negative effects of adolescent behaviour on diabetes and the impact it may have on family and personal relationships
- young people transitioning from paediatric to adult diabetes care
Older people and people living with significant disability or life-limiting comorbid conditions:
- adjust management and therapeutic targets based on individual needs and the principles of hypoglycaemia harm mitigation
- ensure careful utilisation of health service resources
- potential effects of these comorbidities on diabetes treatments and glycaemia
- specific social and medical needs of people with diabetes living in residential/nursing care, and those with neurological or cognitive disabilities including additional levels of supervision to ensure safety
- work with multidisciplinary teams and family members who can support people living in the community
Management of glycaemia:
- for people with type 1 or LADA diabetes, manage insulin delivery and insulin pump therapy in all stages of pregnancy, in labour and postpartum
- indications and safety of medication use prior to conception, in pregnancy and with lactation
- monitoring advice
- nutrition and exercise advice
Pre-conception, pregnancy, and lactation
- gestational diabetes:
  - diagnostic criteria and screening strategies, including progression of complications
  - glycaemic, blood pressure and weight management goals prior to and throughout pregnancy
  - impact of intercurrent illness and events on glycaemia, such as administration of glucocorticoids, and how to adjust insulin doses in these situations
  - monitor for risks, including progression of maternal complications on fetal development and growth
- recognise the need for pre-pregnancy assessment, counselling, and family planning in women of reproductive age
Recognise concerns and anxieties of parents and carers

LG 16: Disorders of weight

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

ADHD (untreated and treated)
Arthritis
Arthropathy
Autism (untreated and treated)
Corticosteroid treated conditions
Depression
Disorders of glucose metabolism:
- diabetes:
  - corticosteroid induced
  - type 1
  - type 2
Eating disorders
Exercise intolerance
Fatigue
Fatty liver disease
Hyperandrogenism
Hypoventilation syndrome
Infertility
Insulin resistance
Kidney disease with proteinuria
Male hypogonadism
Menstrual disturbance
Mood disorders (untreated and treated)
Obstructive or central sleep apnoea
Overweight/Obesity
Severe mental illness
Sexual dysfunction
Sleep apnoea
Weight gain:
- obesity
- overweight
- polycystic ovary syndrome (PCOS)
Underweight:
- electrolyte disturbances
- functional hypothalamic amenorrhoea
- nutritional deficiencies
- osteopenia
- osteoporosis
- stress fractures
Vascular disease:
- cardiovascular
- peripheral

Conditions

Endocrine consequences of underweight syndromes:
- electrolytes disorders
- fatty liver disease
- hypothalamic amenorrhoea
- subfertility
Overweight/Obesity:
- endocrine causes:
  - adrenal
  - Cushing syndrome
  - iatrogenic
  - other
  - pituitary
- energy overconsumption:
  - anxiety
  - binge eating disorders
  - drug-induced:
    - ADHD medications
    - anticonvulsants and other neuroleptics
    - antidepressants
    - antipsychotics
    - betablockers
    - corticosteroids
    - insulin
  - food and cooking literacy
  - food security
  - PTSD
- genetic causes:
  - monogenic
  - polygenic
  - Prader–Willi syndrome
- GH excess
- hypogonadism
- hypothalamic disease
- hypothyroidism
- menopause
- PCOS

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

Bidirectional relationship of the gastrointestinal tract and brain in appetite and intake control and satiety
Epidemiology and prevalence of overweight/obesity
Evidence basis for weight management strategies:
- physical, endocrine, and mental health consequences of overweight/obesity and similarly for the underweight syndromes
- psychosocial factors that contribute to obesity and to underweight syndromes
Evidence basis for weight regain avoidance in obesity
Neuroendocrine regulation of appetite
Principles of body composition and energy balance
Recommended nutritional, micronutrient, and energy intake according to life stage:
- athletes
- by age and in aging
- developmental stage
- menopause
- post-bariatric nutrition:
  - immediate
  - long-term
  - long-term nutritional evaluation and management
- preconception/pregnancy/lactation
- sex

Clinical assessment

Body composition, weight, height, and waist to hip ratio
Counselling and best evidence-based lifestyle advice for individuals, as part of weight management strategy
Edmonton obesity staging system
History taking and physical examination:
- obesity-focused
- underweight syndrome-focused
Screening for endocrine causes and consequences of weight derangement

Disease risk mitigation

Alcohol
Blood pressure control
Cancer, particularly:
- breast
- colon
- endometrial
- oesophageal
- prostate
Electrolyte derangement
Hepatosteatosis (including cirrhosis)
Hyperandrogenism
Hypoventilation syndrome
Infertility and hypogonadism
Obstructive and central sleep apnoea
Renal disease
Screening for:
- diabetes
- lipid derangement
Smoking and vaping

Lifestyle

Counselling and best evidence-based lifestyle advice for individuals, as part of weight management strategy:
- contraception and pre-conception planning
- exercise
- knowledge of dietary strategies for weight loss:
  - effectiveness
  - evidence
  - maintenance
  - manage patient medications safely
  - precautions
- normal growth and development
- nutrition:
  - individualised counselling
  - psychological strategies
- nutritional and supplementation management to avoid micronutrient deficiencies and bone loss
- refer to multidispliniary team members as required, including:
  - dieticians
  - exercise physiologists
  - psychiatrists
  - psychologists

Pharmacological therapy

Apply up to date, evidence-based best practice and clinical judgement to individualised medication management plans
Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications
Pharmacological therapy available for overweight/obesity:
- contraindications and precautions
- expected effectiveness
- indications
- monitoring requirements – short, medium and long term

Procedures

Bariatric surgery referrals:
- awareness of the evidence basis of various procedures
- manage patient medication (specifically obesity and diabetes medications) and nutritional therapy perioperatively
- manage pre- and post-dietary therapy, with knowledge in safe use of VLED
- selective referral according to patient suitability
Long-term management of patients post-bariatric surgery:
- complication monitoring
- diuretic and antihypertensive medications
- micronutrient supplementation, where indicated
- weight regain mitigation with knowledge of effective nutritional, motivations and psychological strategies

General management considerations

Environmentally sustainable practices in clinical care
Impact of culture, health literacy, social, geographic and financial barriers to accessing:
- comprehensive anorexia nervosa care
- comprehensive obesity care
Impact of living with obesity, anorexia and/or bulimia or other disordered eating on an individual, their family, their life and their life stages, and the long-term management considerations
Impact of socioeconomic determinants of health on an individual’s health outcomes
Options for improving equitable access to comprehensive weight management care for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools

Health needs of specific groups

Older people:
- consequences of weight loss on musculoskeletal system
- weight loss in older persons to avoid sarcopenia and excess bone loss
Pre-conception, pregnancy, and lactation:
- knowledge of evidence for safe pre-conception weight
- recommendations for timing of conception after rapid weight loss, including from bariatric surgery
- safety of medications in pregnancy and breastfeeding
- utilise medications safely and withdraw these in a timeframe that is safe for pregnancy
People living with mental health disorders:
- evidence for early screening and intervention for improved cardiovascular outcomes
- impact of medications for mental health disorders on appetite, body composition, and ability to comply with lifestyle advice

LG 17: Lipid disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Dyslipidaemia:
- elevated cholesterol
- elevated triglycerides
Elevated lipoprotein (a)
Hypercholesterolaemia
Hypertriglyceridemia
Opportunistic, cascade or universal screening
Pancreatitis with elevated triglycerides
Premature cardiovascular disease
Xanthomas:
- cutaneous
- tendon

Conditions

Genetic causes of hypertriglyceridemia
Heterozygous familial hypercholesterolaemia
Secondary hypercholesterolaemia due to:
- diabetes
- liver disease
- steroid treatment
Secondary hypertriglyceridemia due to:
- diabetes
- hypothyroidism
- lifestyle factors
- oncology treatment:
  - asparaginase
- side effect of medications

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

Pancreatitis
Premature cardiovascular disease

Conditions

Dysbetalipoproteinaemia
Familial chylomicronaemia
Homozygous familial hypercholesterolaemia
Hypobetalipoproteinaemia and abetalipoproteinaemia
Lipodystrophies and the cross over with monogenic diabetes
Sitosterolaemia

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

Incidence of familial hypercholesterolaemia and ethnic variations:
- early detection and multidisciplinary team management of severe lipid disorders
- genetics of familial hypercholesterolaemia and other inherited lipid disorders
- principles of opportunistic, cascade and universal screening

Investigations

Calculation of the Dutch Lipid Clinic Network Score
Cascade screening of family members
CT calcium score
Interpretation of genetic results
Interpretation of lipid and lipoprotein profiles
Screening and monitoring of lipid profiles
Screening for additional cardiac risk factors:
- hypertension
- obesity
- smoking

General management considerations

Access local guidelines regarding lipid screening, treatment options and treatment targets
Cascade testing
Genetic counselling
Multidisciplinary team approach including:
- cardiology
- dietitian
- genetic counsellor
- primary care physician
Recommendations for healthy lifestyle and cardiovascular risk mitigation, such as:
- diabetes
- hypertension
- obesity
Shared care with primary care and general paediatrics
Tertiary team approach for severe lipid disorders including:
- apheresis service
- cardiology
- genetics
- liver transplant team

Non-pharmacological interventions

Role of dietary measures, including plant sterols and omega-3 fatty acid supplements

Pharmacological interventions

Acute management of severe hypertriglyceridemia with pancreatitis:
- indications for use of insulin, heparin and plasmapheresis
Awareness and indications for agents:
- ANGPTL3 monoclonal Ab
- apheresis
- gene silencing agents,
Indications, dosing and side effects of:
- cholesterol biosynthesis inhibitors (statins)
- fibrates for hypertriglyceridemia
- mixed dyslipidaemias
- monoclonal antibody PCSK-9 inhibitors
- sterol uptake inhibitors (ezetimibe)
- use of combination therapies and risks

LG 18: Disorders of the pituitary, hypothalamus, and of water balance

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

Diabetes
Failure to lactate
Fatigue/Tiredness
Fractures
Galactorrhoea
Headache
Hypernatraemia
Hyponatraemia
Hypotension
Loss of axillary/pubic hair
Loss of libido
Menstrual disturbance
Polydipsia
Polyuria/Nocturia
Sleep disturbance
Visual disturbance
Weight gain
Weight loss

Conditions

Functioning pituitary adenomas:
- acromegaly
- Cushing syndrome
- prolactinoma
Hypopituitarism (1 or more axes):
- adenomas
- apoplexy
- hormone deficiencies:
  - ACTH deficiency
  - arginine vasopressin deficiency
  - GH deficiency
  - gonadotropin deficiency
  - prolactin deficiency
  - TSH deficiency
- inherited pituitary disorders
- late effects from past brain radiotherapy
- lymphocytic hypophysitis
- pituitary metastases
- post-surgical
- Sheehan syndrome
- trauma
Non-functioning pituitary tumours
Recognise acute hypopituitarism as a medical emergency
Sellar lesions:
- craniopharyngioma
- empty sella
- Rathke cleft cyst
Syndrome of inappropriate antidiuresis (SIAD)

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

Aggressive pituitary tumours
Familial syndromes associated with pituitary tumours
Gonadotropinoma
Infiltrative disease:
- haemochromatosis
- histiocytosis X
- Langherhans cell histiocytosis
- sarcoidosis
Pituitary carcinomas
Syndromes associated with hypopituitarism:
- CHARGE syndrome
- Prader-Willi syndrome
- septo-optic dysplasia
- stalk interruption syndrome
- pineal gland disorders
TSHoma:
- tuberculosis

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

Clinical science

Anatomy, physiology, and histopathology of the normal pituitary gland and of pituitary tumours
Epidemiology and natural history of pituitary tumour types
Functions and regulation of the hypothalamus and pituitary axes
Molecular pathways and epidemiology of genetic variants conferring predisposition to pituitary disease

Diagnostic work up

Aetiology, pathology, and clinical manifestations of hypothalamic and pituitary disease
Complex diagnostic work up and pitfalls in Cushings syndrome
Genetic disorders affecting the pituitary as an underlying cause of pituitary disease, and the indications and limitations of genetic tests
Limitations, indications, and interpretation of biochemical assays in the diagnostic work up of pituitary disorders
Thorough history, physical examination and diagnostic work up of people suspected of presenting with pituitary disease

Medical management considerations

Emergency management of acute hypopituitarism
Indications, precautions and contraindications, as well as prescribing and monitoring of pituitary hormone replacement:
- anti-diuretic hormone (Desmopressin)
- glucocorticoid
- gonadal steroids
- gonadotrophins
- growth hormone
Medical management of Cushing syndrome
Medical management of common pituitary disorders of excess hormone production:
- monitoring of treatment efficacy
- monitoring of underlying condition
Principles of pharmacology
Thyroid hormone

Investigations

Dynamic endocrine testing:
- specific understanding of indications and contraindications:
  - suspected acromegaly (including glucose tolerance test)
  - suspected ACTH deficiency, including:
    - insulin tolerance test
    - overnight metyrapone test
    - Synacthen stimulation test where appropriate
  - suspected arginine vasopressin deficiency, including:
    - stimulated copeptin testing
    - water deprivation test
  - suspected Cushing syndrome, including:
    - dexamethasone suppression tests
    - salivary testing
    - urine testing
  - suspected growth hormone deficiency (including glucagon stimulation test)
Imaging:
- familiarity with pituitary MRI neuroanatomy
- indications for imaging of the hypothalamus and pituitary
Laboratory biochemistry:
- interpretation of biochemical testing in the clinical context
- non-pathological causes for hyperprolactinaemia
- pituitary function testing in pregnancy
- properties, principles and indications for biochemical investigation of hypothalamic-pituitary disease:
  - baseline testing
  - dynamic testing
- specific understanding of the timing, patient preparation and assay platforms suited for pituitary hormone testing

Procedures

Indications for inferior petrosal sinus sampling
Indications for pituitary radiotherapy
Indications for pituitary surgery
Pre-, peri- and postoperative management of patient with pituitary disease, with particular emphasis on management of endocrine disturbances

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
Seek multidisciplinary care/review from centres of pituitary care expertise wherever necessary

General management considerations

Impact of hypothalamic/pituitary and/or genetic diagnoses on the patient, their partner and, where applicable, their family/carers
Incorporate environmentally sustainable practices in clinical care
Longitudinal and multidisciplinary care needs of people with pituitary disease
Mitigate clinical risk with intercurrent illness management planning, for example, use of medical alert bracelets and sick-day steroid plans when applicable
Pre-, peri- and postoperative management of patients with pituitary disease, with particular emphasis on management of endocrine disturbances, including anticipatory management of patients before and after pituitary surgery
Understand options for improving equitable access to comprehensive pituitary care for individuals, including multidisciplinary involvement, use of telehealth and other digital health tools, and appropriate multicultural resources

Health needs of specific patient groups

Assessment, diagnosis, and management of women with pituitary disorders first presenting in pregnancy
Endocrine care for women with pituitary disorders through pregnancy, labour, and postpartum
Fertility preservation and treatment options in patients with congenital or acquired pituitary disease affecting the reproductive axis
Screening and genetic counselling of patients with inherited pituitary or hypothalamic disease

LG 19: Thyroid disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Asymptomatic biochemical findings
Compressive symptoms
Goitre
Hoarse voice/stridor
Neck lump
Pretibial myxoedema
Symptomatic hyperthyroidism
Symptomatic hypothyroidism
Thyroid eye disease

Conditions

Benign thyroid nodule(s)
Hyperthyroidism:
- central (TSHoma)
- Graves disease
- medication-induced (e.g. amiodarone)
- thyroiditis
- toxic multinodular goitre
- toxic nodule
Hypothyroidism
- autoimmune (Hashimotos thyroiditis)
- central (pituitary)
- granulomatous thyroiditis
- iodine deficiency
- medication induced
- painless thyroiditis
- post-surgical
- suppurative thyroiditis
Perioperative management of patients with thyroid disease
Syndromes of resistance to thyroid hormones (alpha, beta)
Thyroid cancer:
- anaplastic
- follicular
- Hurthle
- lymphoma
- medullary
- metastases to thyroid
- papillary
- poorly differentiated/insular
Thyroid disorders in pregnancy and postpartum:
- Graves disease
- hypothyroidism
- postpartum thyroiditis
- thyroid cancer
- transient hyperthyroidism of pregnancy
Thyroid eye 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

Advanced or recurrent thyroid cancer
Thyroid emergencies:
- complications from anti-thyroid medications:
  - agranulocytosis
  - hepatitis
- critically unwell patients presenting with concurrent thyroid derangement
- patients presenting with myxoedema coma
- patients presenting with or at risk of thyroid storm
- suppurative thyroiditis

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

Risk factors for thyroid disease:
- concurrent autoimmune disorders
- exposure to high iodine loads – dietary or medical
- exposure to ionising radiation:
  - childhood malignancy
  - employment
  - environmental
  - head and neck cancer
- family history
- medications used to treat other conditions such as malignancy, such as:
  - amiodarone
  - biological agents (including immunotherapies)
  - lithium
- smoking

Investigations

Biochemical evaluation of the hypothalamic-pituitary-thyroid axis including:
- thyroid autoantibodies
- thyroid function (FT4 and FT3)
- tumour markers
Differences between primary and secondary hypothyroidism and differences in thyroid function on replacement in primary and secondary hypothyroidism
Imaging:
- CT scans – neck and thorax
- nuclear medicine uptake scanning (Technetium 99, I123 and I131)
- PET scans
- thyroid ultrasound
Surveillance of thyroid cancer and appropriate dosing of thyroxine
TIRADS risk stratification of nodules, the risk of malignancy with each category and knowledge of surveillance/biopsy recommendations

Referrals for procedures

Radioactive iodine code recommendations for:
- ablative doses (including use of recombinant TSH or thyroid hormone withdrawal)
- Graves disease
- low dose scans
- thyroid cancer therapeutic
- toxic nodule
Hemithyroidectomy versus total thyroidectomy
Hot nodule(s), MNG and thyroid cancer
Indications for surgery
Interpretation of cytology:
- Bethesda scoring system
- genetic testing
Risks, indications and contraindications, such as:
- lactation
- pregnancy
- thyroid eye disease
Thyroid nodule FNA
Thyroid surgery

Procedures (optional)

Fine needle aspiration biopsy of thyroid nodules
Thyroid ultrasound

Apply the general principles of triage according to clinical presentation
Work with colleagues in nuclear medicine, thyroid surgery, obstetrics, pharmacy, chemical pathology, histopathology and other doctors to deliver multidisciplinary input to patient care, as applicable to each case, and participate in multidisciplinary team meeting discussions for thyroid cancer

Management of common thyroid conditions

Adjust thyroid replacement medication, and screen for other autoimmune disease annually
Adjust anti-thyroid medication, and show awareness of complications of thionamides
Management following thyroid cancer, including thyroid replacement and surveillance for thyroid cancer recurrence, and understand the indications and role of chemotherapy agents

LG 20: Adrenal disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Cardiac arrythmia
Electrolyte disturbance
Fatigue
Fractures
Headache
Hirsutism
Hypertension:
- constant
- paroxysmal
Hypotension
Incidental adenoma
Menstrual disturbance
Metabolic syndrome
Pallor
Palpitations
Sweating
Weight gain/Obesity
Weight loss

Conditions

Adrenal cancer
Adrenal insufficiency/failure:
- adrenoleukodystrophy
- autoimmune:
  - Addison's disease
  - immunotherapy related
  - polyglandular autoimmune syndrome
- haemorrhage
- idiopathic
- infarction
- infection
Adrenal metastasis
Adrenal nodular disease:
- functional:
  - Conns syndrome/ hyperaldosteronism
  - Cushings syndrome/ hypercortisolism
  - phaeochromocytoma/catecholamine-producing
- non-functional
Congenital adrenal hyperplasia
Macronodular adrenal hyperplasia
Phaeochromocytoma
Primary adrenocortical

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

Inherited adrenal disorders:
- congenital adrenal hypoplasia
- MEN2A, MEN2B/3 VHL
- micronodular adrenal disease/Carney complex
X-linked adrenal leukodystrophy

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

Clinical science

Anatomy, physiology, and histopathology of the normal and the abnormal adrenal gland (cortex and medulla), hypothalamic-pituitary-adrenal axis and sympathetic/parasympathetic ganglia
Epidemiology and natural history of adrenal hormone excess disorders
Epidemiology of genetic predisposition to adrenal disease
Function and regulation of the adrenal gland

Diagnostic work up

Aetiology, pathology, and clinical manifestations of adreno-cortical hormone deficiency, primary and secondary
Aetiology, pathology, and clinical manifestations of adrenal hormone excess:
- hyperaldosteronism
- hypercortisolism
- phaeochromocytoma
- virilising tumours
History, physical examination, and diagnostic work up of patient suspected of presenting with adrenal disease
Limitations, indications, and interpretation of biochemical assays in the diagnostic work up of adrenal disorders:
- complex diagnostic work up and pitfalls in Cushing syndrome
- diagnostic work up and pitfalls in hyperaldosteronism
- different genetic disorders affecting the adrenal gland
- impact of medications on the assessment of hormone excess and deficiency

Medical management considerations

Emergency and long-term management of hypoadrenalism due to primary and secondary adrenal insufficiency:
- prescribing and monitoring of glucocorticoid and/or mineralocorticoid
- screening for associated disorders
Medical management of adrenal disorders of excess hormone production and monitoring of the underlying condition
Monitoring of treatment efficacy
Pharmacological principles of medications used in adrenal disorders:
- alpha and beta-receptor antagonists
- glucocorticoids
- mineralocorticoid receptor antagonists
- mineralocorticoids
- steroid biosynthesis inhibitors, such as:
  - ketoconazole
  - metyrapone

Investigations

Biochemical investigation of adrenal disease, including the hypothalamic-pituitary-adrenal axis:
- baseline testing
- dynamic testing
Imaging:
- CT adrenal protocol
- MRI
- PET scan
Interpretation of biochemical testing in the clinical context:
- dynamic endocrine testing
- specific understanding of indications (and contraindications):
  - investigation for suspected Cushing syndrome, such as:
    - dexamethasone suppression tests
    - salivary testing
    - urine testing
  - short synacthen test
Investigation for suspected Conn's syndrome:
- fludrocortisone suppression test
- seated saline suppression test
Laboratory biochemistry:
- timing, patient preparation, and assay platforms suited for adrenal hormone testing

Procedures

Indications for adrenal vein sampling
Indications for adrenalectomy
Indications for chemotherapy for malignant adrenal lesions
Pre-, peri- and postoperative management of patients with adrenal disease, with particular emphasis on prevention of adrenal crisis and preoperative preparation and perioperative management of phaeochromocytoma

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
Seek multidisciplinary care/review from centres of expertise wherever necessary

General management considerations

Impact of adrenal disease and/or genetic diagnoses on the patient, their partner and, where applicable, their family/carers
Incorporate environmentally sustainable practices in clinical care
Longitudinal and multidisciplinary care needs of people with adrenal disease
Mitigate clinical risk with sick day management plans when applicable, including use of medical alert bracelets or similar
Options for improving equitable access to comprehensive care for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools
Pre-, peri- and postoperative management of patients with adrenal disease
Screening and genetic counselling of patients with inherited adrenal disease and referral of their family members if appropriate and with informed consent

Health needs of specific patient groups

Preconception counselling and pregnancy management of women with congenital adrenal hyperplasia
Multidisciplinary care of patients with adrenal cancer or malignant phaeochromocytoma/paraganglioma

LG 21: Parathyroid, calcium and bone disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abdominal pain
Altered cognition
Asymptomatic with incidental findings
Bone pain
Cardiac arrythmias
Constipation
CKD-MBD
Fractures
Nausea or vomiting
Numbness of hands, feet, mouth
Preventative in hormone deprivation therapy for breast or prostate cancer
Renal stones
Tetany and/or cramping

Conditions

Hormone deprivation therapy for breast or prostate cancer
Hyperparathyroidism:
- medication-induced
- normocalcaemic
- primary
- secondary
- tertiary
Hypocalcaemia:
- hypoparathyroidism:
  - congenital
  - idiopathic
  - infiltrative
  - post-surgical
- vitamin D deficiency
Hypophosphatasia
Pseudohypoparathyroidism:
- autosomal dominant hypocalcaemia (calcium -sensing receptor mutations)
- medication-induced
- vitamin D receptor mutations
PTH-independent hypercalcaemia:
- malignancy-associated
- milk-alkali syndrome
- sarcoidosis
Osteomalacia
Osteopenia
Osteoporosis
Paget’s disease
Vitamin D deficiency

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

First presentation of hypercalcaemia in pregnancy

Conditions

Complications of osteoporosis therapies, atypical femur fractures and medication-related osteonecrosis of the jaw
Disorder of high bone mass:
- acquired
- inherited
Hyperparathyroidism due to underlying genetic disorder:
- familial hypocalciuric hypercalcaemia
- familial isolated idiopathic hyperparathyroidism
- hyperparathyroidism-jaw tumour syndrome
- MEN1
- MEN2A
Hypophosphataemia:
- acquired
- inherited, including x-linked
Inherited disorders of skeletal dysplasia:
- fibrous dysplasia
- hyperostosis
- osteogenesis imperfecta
Parathyroid cancer
Pregnancy-related conditions including transient osteoporosis of the hip and lactation-related osteoporosis

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

Inherited disorders/Disorders with a genetic basis

Incidence and prevalence of conditions in Australian population
Recognise and screen for the possibility of known genetic variants causing pathology
Referral for genetic counselling, wherever needed
Screening for associated pathology in known inherited disorders
Screening of family members, when indicated

Osteoporosis screening

Counsel patients with up-to-date best practice guidelines for nutritional lifestyle and exercise recommendations
Identify risk factors for poor bone health
Perform a fracture risk assessment using a validated fracture risk calculator (e.g. FRAX or Garvan tool)
Population-based screening
Provision of preventative care against osteoporosis
Screening for secondary osteoporosis, such as:
- glucocorticoid treatment, Cushing syndrome
- hypogonadism, androgen deprivation
- malabsorption
- premature menopause
- systemic mastocytosis

Therapeutics

Appropriate prescribing of nutritional therapy and physical activity
Prescribe anti-resorptive and anabolic bone medications according to best practice, employing an individualised approach
Hyperparathyroidism management with medical therapies
Emergent management of severe or symptomatic hypercalcaemia
Emergent management of severe or symptomatic hypocalcaemia:
- assessment and management of concomitant magnesium deficiency
- understand and interpret severity, including monitoring ECG changes
Prescribing for rickets and osteomalacia
Take preventative action to avoid or mitigate risk of adverse events from available pharmaceutical agents

Clinical assessment

Assessment of nutrition and physical activity, screening for restrictive eating and overexercise, identifying and modifying risk factors for falls (where appropriate)
FRAX
Identify and refer patients for surgery where appropriate:
- triage patients with indications for surgical intervention according to condition severity
Monitoring disease activity
Monitoring response to therapy
Provide perioperative care:
- long term management of post-surgical hypoparathyroidism and serum calcium management with calcitriol (to avoid nephrocalcinosis/hypercalciuria)
- patients undergoing parathyroid surgery
- patients with hypocalcaemia
Review medications (including over-the-counter and non-prescription agents) for drug-drug and drug-disease interactions

Imaging

Bone mineral density (and its limitations)
Bone scintigraphy
Localisation of parathyroid adenoma/cancer:
- 4D CT
- neck U/S
- nuclear medicine parathyroid scan
Plain radiographs (e.g. identify and quantify vertebral fractures on thoracolumbar spine radiographs)
Trabecular bone score, vertebral fracture assessment

Laboratory tests

1,25-dihydroxyvitamin D
24-hour or spot fasting urine collections for calcium, creatinine, and phosphate, with calculation of TmP/GFR and calcium/creatinine ratio
25-hydroxyvitamin D
Bone-specific ALP
Bone turnover markers
Calcium (corrected and ionised)
Electrolytes
FGF-23
iPTH, PTHrp
Kidney function
LFT
Magnesium
Phosphate
Screening for:
- nutritional deficits, including:
  - albumin
  - electrolytes
  - serum protein
- secondary causes of osteoporosis, including:
  - coeliac disease
  - hypogonadism
  - multiple myeloma
  - TFTs
- vitamin D deficiency
Tmp/GFR

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients

Management considerations

Conception counselling
Conservative management where able and individualised care
Genetic counselling
Incorporate environmentally sustainable practices in clinical care
Pregnancy management:
- first presentation of hypercalcaemia in pregnancy
- pre-existing hyperparathyroidism
- pre-existing hypocalcaemia
- pre-existing osteoporosis, including discussion of the duration of lactation
Osteoporosis considerations:
- intermittent secondary amenorrhoea
- malabsorption and lactose intolerance symptoms
- over exercise
- restrictive eating, including meat/protein and dairy avoidance
- underweight

LG 22: Neuroendocrine and inherited tumour syndromes

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

Diarrhoea
Flushing/Sweating
Hypoglycaemia
Incidental findings or screening due to associated or familial disease
Loss of consciousness
Paroxysmal hypertension
Rash
Weight loss

Conditions

Carcinoid tumours
Germ cell secretory tumours
MEN syndrome
Pancreatic neuroendocrine tumours
- gastrinoma
- glucagonoma
- insulinoma
- VIPoma
Paraganglioma/phaeochromocytoma
Paraneoplastic humoral syndromes:
- ectopic Cushing syndrome
- hypercalcaemia
- SIADH

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

Carney complex
McCune–Albright syndrome
Von Hippel–Lindau 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

Clinical science

Epidemiology, natural history, prognosis, and genetic predisposition of neuroendocrine disease

Diagnostic work up

Thorough history, physical examination, and diagnostic work up of people suspected of presenting with neuroendocrine disease or with a predisposition to a neuroendocrine syndrome
Limitations, indications and interpretation of biochemical assays, imaging, and genetic tests in the diagnostic work up and surveillance of neuroendocrine disorders

Investigations

Dynamic and invasive endocrine testing:
- specific understanding of indications and contraindications:
  - 72-hour fasting
  - calcium stimulation testing
  - clonidine suppression
  - workup for suspected ectopic Cushing syndrome
Imaging:
- indications for localisation and surveillance imaging for specific tumour syndromes
- limitations of imaging modalities for specific tumour syndromes:
  - CT
  - endoscopic ultrasound
  - functional PET scan
  - MRI
  - ultrasound
Laboratory biochemistry:
- interpretation of biochemical testing in the clinical context with consideration of limitations and interfering medications
- properties, principles, and indications for biochemical investigation:
  - baseline testing
  - dynamic testing
- specific understanding of the timing, patient preparation and assay platforms suited for hormone testing
Referral for surgical management, including preventative if appropriate

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
Seek multidisciplinary care/review from centres of neuroendocrine care expertise, such as:
- genetics
- nuclear medicine
- oncology
- radiotherapy services
- surgical service

General management considerations

Impact of neuroendocrine tumour/cancer and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers
Incorporate environmentally sustainable practices in clinical care
Longitudinal and multidisciplinary care needs of people with neuroendocrine disease or cancer
Options for improving equitable access to comprehensive care for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools
Referral for pre-conception counselling, if applicable
Screening and genetic counselling of patients with inherited endocrine disease and referral of their family members if appropriate and with informed consent

LG 23: Male reproductive endocrinology

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

Delayed/incomplete puberty
Erectile dysfunction
Gynaecomastia
Infertility
Lack/loss of virilisation
Loss of libido
Low bone density and/or fractures
Vasomotor symptoms

Conditions

Primary testicular failure
- chemotherapy
- cryptorchidism
- genetic conditions
  - congenital anorchia
  - Klinefelter syndrome
- infection
- radiation
- surgical
Hypogonadotropic hypogonadism
- structural:
  - autoimmune endocrinopathies
  - immunotherapy -related hypophysis (IRAEs)
  - infiltrative disorders:
    - histiocytosis (Langerhans)
    - iron overload syndromes
    - lymphocytic hypophysis
    - sarcoidosis
  - isolated GnRH deficiency
  - pituitary or hypothalamic:
    - radiation
    - trauma
    - tumours
- functional/impact from other conditions (with potential for reversibility)
  - androgen steroid abuse or recovery
  - intercurrent illness
  - medications (e.g. opiates)
  - obesity

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

Congenital adrenal disorders
Hypogonadotropic hypogonadism:
- developmental defects and genetic syndromes
- infiltrative disorders:
  - iron overload syndromes
  - lymphoma
- Kallman syndrome
Infertility:
- azoospermia/oligospermia:
  - non-obstructive
  - obstructive versus
- fertility preservation prior to chemoradiation
Malignancy:
- germ cell tumours
- testicular tumours
Primary testicular failure:
- myotonic dystrophy

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

Synthesise

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

Manage

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

Consider other factors

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

Diagnostic work up

Aetiology, pathology, and clinical manifestations of hypogonadism
Impact of environmental, psychological, and comorbid conditions on the HPT axis
- determine when hormonal replacement is and when it is not indicated
Thorough history, physical examination and diagnostic work up of men presenting with hypogonadism and/or infertility

Treatment

Androgen deprivation therapy (e.g., treatment of prostate cancer)
Approach to treatment according to fertility aspirations
- indications, contraindications and appropriate prescribing of testosterone replacement therapy, understanding that this is lifelong therapy
- monitoring of testosterone therapy and its’ potential complications with dose adjustment as needed
- utilisation of gonadotrophin therapy for spermatogenesis induction when indicated
Preventative screening as needed:
- bone health
- cardiovascular
- prostate
Androgenic steroid use and abuse
- drug types and regimens
- suppression and recovery of the HPT axis
- side effects, both short- and long-term
- strategies to deal with cessation and mental health challenges

Clinical assessment tools

Appropriate testicular examination including use of orchidometer

Investigations

Karyotype:
- Y chromosome microdeletion analysis when indicated
Laboratory biochemistry:
- specific understanding of the timing, patient preparation and assay platforms suited for sex steroid analysis
Radiology:
- bone mineral density
- MRI
- ultrasound
Semen analysis

Procedures

Referrals for:
- assisted reproduction services
- fertility preservation, when appropriate
- microscopic testicular sperm extraction to experienced specialist surgeon

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients

General management considerations

Cardiovascular risk mitigation
Impact of sexual dysfunction, infertility and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers:
- consider the sociocultural impact of infertility
Impact of socioeconomic factors on equitable access to fertility preservation and treatment services
Incorporate environmentally sustainable practices in clinical care
Interaction of androgen deficiency as a potential cause and consequence of mental health disorders
Side effects of testosterone therapy
Symptom management
Referrals and access to genetic, sexual, and relationship counselling

Health needs of specific patient groups

Ethical considerations in discussing fertility preservation procedures with adolescents and their family
Longitudinal care of men with genetic conditions such as Klinefelter syndrome:
- cardiovascular risk screening and mitigation
- collaboration with:
  - counselling services
  - education services
  - primary care providers
Screening in cancer survivorship

LG 24: Female reproductive endocrinology

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

Altered mood
Delayed or incomplete puberty
Depression
Fatigue
Genito-urinary symptoms
Hirsutism
Infertility
Loss of libido
Menstrual disturbance
Sexual dysfunction
Vasomotor symptoms
Virilisation

Conditions

Hyperandrogenism:
- adrenal
- ovarian
Menopause:
- premature menopause
Polycystic ovarian syndrome (PCOS)
Premenstrual syndrome:
- premenstrual dysphoric disorder
Primary amenorrhea:
- cancer survivorship
- central:
  - isolated GnRH deficiency
  - Kallman syndrome
  - pituitary dysfunction
- functional
- outflow tract disorders
Secondary amenorrhea:
- functional hypothalamic amenorrhoea
  - eating disorders
  - exercise
  - weight fluctuations
- ovarian dysfunction:
  - autoimmune polyendocrinopathy
  - chemotherapy
  - ovarian tumours
  - premature ovarian insufficiency:
    - fragile X
    - gonadal dysgenesis
    - Turners syndrome
  - radiation
- pituitary dysfunction:
  - hyperprolactinaemia
  - immunotherapy-related hypophysis
  - infiltrative disease:
    - histiocytosis
    - Langerhans
    - lymphoma
    - malignancy
    - sarcoidosis
  - other endocrinopathies
  - other 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 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

Congenital adrenal hyperplasia (non-classic)
Infertility
Malignancy:
- germ cell tumours
- ovarian 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 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

Pathophysiology

Normal stages of pubertal development
Regulation of the hypothalamic-pituitary-gonadal axis and hormonal variations in the menstrual cycle and menopause

Diagnostic work up

Aetiology, pathology, and clinical manifestations of hypogonadism:
- evaluation of oestrogen-dependent and oestrogen-independent amenorrhoea
Evaluation of delayed puberty, constitutional and pathological
Evaluation of menopausal symptoms
Impact of environmental, psychological, and comorbid conditions on the HPG axis:
- determine when hormonal replacement is and when it is not indicated
Principles of assessing ovarian reserve and fertility preservation in elective and oncology cases
Thorough history, physical examination and diagnostic work up of patient presenting with disorders of sexual development (e.g., delayed puberty), anovulation and/or infertility

Treatment

Consideration of contraceptive needs
Hormone deprivation therapy (often treatment of breast or ovarian cancer):
- bone preservation
- cardiovascular risk mitigation
- endocrine disruptors of the reproductive axis
- symptom management
Hormone replacement therapy, including menopausal hormonal therapy (MHT) and monitoring
Indications, contraindications and appropriate prescribing of hormone replacement therapy for patients in different life stages including, knowledge of pubertal induction
Monitoring of hormone replacement therapy and its potential complications with dose and route of administration adjustment as needed
Non-hormonal management of menopause
Preventative screening as needed:
- bone health
- breast
- cardiovascular
Treatment options for PCOS including ovulation induction and basic principles of artificial reproduction therapies (ART)

Investigations

Knowledge of timed measurement of reproductive hormones in relation to the menstrual cycle
Karyotype and genetic testing as applicable
Laboratory biochemistry:
- dynamic testing (e.g., short Synacthen in non-classic-CAH)
- specific understanding of the timing, patient preparation and assay platforms suited for sex steroid analysis and interfering factors
Radiology:
- bone mineral density
- MRI
- ultrasound

Procedures

When indicated, facilitate referrals for:
- assisted reproduction services
- fertility preservation services
- peri-implantation genetic testing

Evidence-based practice

Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients

General management considerations

Impact of sexual dysfunction, infertility and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers:
- consider the sociocultural impact of infertility
Impact of socioeconomic factors on equitable access to fertility preservation and treatment services
Incorporate environmentally sustainable practices in clinical care
Menopause management in the complex patient:
- premature ovarian insufficiency
- previous breast cancer
- prothrombotic comorbidities:
  - deep vein thrombosis
  - pulmonary embolism
Referrals and access to genetic, sexual, and relationship counselling
Referral for oocyte preservation prior to planned treatment potentially resulting in premature ovarian insufficiency (POI) or at diagnosis of POI with low AMH with residual oocytes

Health needs of specific patient groups

Care of hormone deprivation therapy recipients
Endocrine care of women with pituitary or adrenal dysfunction through pregnancy, labour, and postpartum
Ethical considerations in discussing fertility preservation procedures with adolescents and their family
Longitudinal and multidisciplinary care needs of women with genetic conditions such as Turner syndrome, such as:
- cardiovascular risk screening and mitigation
- collaboration with:
  - counselling services
  - education services
  - primary care providers
Screening in cancer survivorship

LG 25: Variations of sex characteristics and gender identity

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

Delayed puberty
Gender incongruence and/or dysphoria
Gynaecomastia in male
Labial fusion in female
Primary amenorrhoea
Short stature
Subfertility
Tall stature
Undervirilisation in male
Virilisation in female

Conditions

Congenital adrenal hyperplasia
Gender incongruence and/or dysphoria
Klinefelter syndrome
Turner syndrome

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

Differences of sex development (DSD)

46-,XX DSD
46-,XY DSD:
- complete gonadal dysgenesis
- defects in androgen action (CAIS, PAIS)
- defects in androgen biosynthesis
- disorders of AMH and AMH receptor
- gonadal regression
- LH receptor defects
- ovotesticular DSD
- partial gonadal dysgenesis
Ovotesticular DSD:
- androgen excess (CAH, aromatase deficiency, maternal/exogenous)
- gonadal dysgenesis
- testicular DSD
- other, such as:
  - cloacal exstrophy
  - MRKH
  - vaginal atresia

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

Assessment

Assessment of capacity to consent to gender affirming hormone therapy, psychological/cognitive comorbidities and referral to mental health professionals for formal assessment of capacity when indicated
Assessment of secondary sexual characteristics and genitals (when indicated for suspected variations of sex characteristics)
Biological, cultural, and environmental contributions to gender identity
Factors which may contribute to gender discomfort including:
- puberty
- sexuality
- other psychological co-occurring conditions
History, including gender development, treatment goals, and co-occurring conditions that may interact with gender affirming hormone therapy
Understand the range of gender diversity

Treatment

Consideration of contraceptive needs
Discussion and appropriate referral for fertility preservation
Discussion regarding benefits and side effects of treatment
Indications, contraindications, and appropriate prescribing of masculinising and feminising hormone therapy
Management of complications associated with hormone therapy
Monitoring of hormone therapy and its potential complications, with dose and route of administration adjustment as needed
Preventative screening and treatment as needed:
- bone health
- breast
- cardiovascular
- cervical screening and associated difficulties
Recognise the importance of multidisciplinary care

Investigations

Biochemistry:
- endocrine dynamic testing:
  - Synacthen stimulation test for diagnosis of congenital adrenal hyperplasia
  - treatment monitoring and targets
- interpretation of biochemical tests, including factors that affect results such as timing, interaction with medications, patient preparation and different assay platforms
Karyotype
Radiology:
- bone mineral density
- CT scan
- MRI
- ultrasound

Procedures

Hormone implants (optional)

Creation of a culturally safe clinical environment for trans and gender diverse people (e.g. preferred names, pronouns, gender identity)
Gender dysphoria – the distress associated with a conflict between gender identity and anatomy or sex
Marginalisation faced by the trans and gender diverse community, including barriers to accessing healthcare
National and state-specific legislation regarding the prescription of gender affirming hormone therapy
Spectrum of gender identities, including non-binary genders
Transgender – gender identity differs from sex designated at birth

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 Endocrinology (Adult Internal Medicine)

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

13

LG 2: 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

LG 3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG 4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG 5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG 6: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour