Curriculum standards

About this resource

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

This document outlines the curriculum standards for Advanced Training in General Paediatrics for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in General Paediatrics LTA programs.

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

Download the curriculum standards PDF

LG1: Competencies

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

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

Competencies will be common across training programs.

Medical expertise

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

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

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

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

Communication

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

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

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

Cultural safety*

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

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

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

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

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

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

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

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

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

References

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

Ethics and professional behaviour

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

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

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

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

Entrustable Professional Activities

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

LG2: Team leadership

Learning Goal 2

Team leadership

Lead and work collaboratively with a team of health professionals

This activity requires the ability to:

prioritise workload
manage multiple concurrent tasks
articulate individual responsibilities, expertise, and accountability of team members
acquire and apply leadership techniques in daily practice
collaborate with teams across multiple health care settings
act as a role model
conduct case conferences

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information with other disciplines and health care professionals to develop optimal, goal-centred plans for patients
promote and rationalise evidence-based care to meet the needs of patients or populations
take measures to minimise clinical risk
apply clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

demonstrate adequate knowledge of health care issues by interpreting complex information
assess the spectrum of problems to be addressed
provide coordinated and quality health care for populations or patients as a member of a multidisciplinary team
recognise the limits of personal expertise, and involve other health professionals as needed

Communication

confident
Ready to perform without supervision

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

The trainee will:

role model a transparent and supportive 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
lead challenging conversations competently and sensitively, such as breaking bad news and providing feedback to colleagues

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

promote commitment to high-quality teaching within the team and with learners who are attached to the team
role model openness to continuous learning, and commitment to professional developmental practices

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in facilitating colleagues’ learning
accept feedback constructively, and change behaviour in response

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 colleagues and patients, including ongoing listening, learning, and seeking to improve
promote and advocate for respect for culture and diversity
identify and attempt to address barriers to health care, including unconscious bias, discrimination, and systemic racism

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate the ability to effectively manage own workload, and prioritise concurrent tasks
promote a team culture of shared accountability for decisions and outcomes
encourage open discussions of ethical and clinical concerns
respect differences of multidisciplinary team members
effectively consult with stakeholders, achieving a balance of alternative views
acknowledge personal conflicts of interest and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment and bullying
promote and role model high standards of ethical and professional practice

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:

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

direction
Requires some supervision

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

The trainee may:

consult team members or senior staff when faced with multiple conflicting perspectives
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:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of organisational policies and procedures

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Demonstrate commitment to ongoing professional development and health professional’s education

This activity requires the ability to:

demonstrate commitment to health professional’s education opportunities
provide clinical teaching in a variety of settings
teach and role model professional skills
create a safe and supportive learning environment
plan, deliver, and provide work-based assessments
support learner-driven education experiences
supervise learners in day-to-day work, and provide timely and constructive feedback
support learners to prepare for assessments
role model commitment to lifelong learning and continuous professional development
reflect on and evaluate own teaching and supervision skills

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

combine high-quality care with high-quality teaching
support and undertake teaching on the run / bedside teaching, including explaining the rationale underpinning a structured approach to clinical decision making
enable learners to observe and/or participate in clinical experiences with appropriate supervision
use clinical activities as learning and teaching opportunities, appropriate to the setting and learner
support and facilitate medical students and health professionals to reflect and learn from clinical experiences
identify and support learners’ strengths and areas for development, and facilitate improvement

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

establish rapport and demonstrate respect for junior colleagues, medical students, and other health professionals
communicate effectively when teaching, assessing, and appraising learners
provide timely, clear and constructive feedback to learners, with suggestions on how to improve
actively promote a collaborative and safe learning environment with learners and other health professionals
role model and teach high-level communication skills
support learners to deliver clear, concise, and relevant information in both verbal and written communication

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

support learners to deliver quality care while maintaining their own wellbeing
apply lessons learned about patient safety by identifying and discussing risks with learners
assess learners’ competence, and provide timely feedback to minimise risks to care
obtain informed consent before involving patients in teaching activities
maintain the safety of patients and organisations involved with education, and appropriately identify and action concerns
participate in evaluation of teaching and supervision

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

reflect on, evaluate, and seek to improve own professional practice, including actively seeking feedback from supervisors, colleagues, and mentors
demonstrate commitment to own learning needs, training requirements, and professional development
develop appropriate learning plans for required learning outcomes
meet with supervisors regularly to receive feedback and support
keep records of supervision meetings and work-based assessments
plan and submit assessments and reports within required time frames
demonstrate knowledge of the principles, processes, and skills of supervision
provide direct guidance to learners in day-to-day work
work with learners to identify professional development and learning opportunities based on their individual learning needs
participate in teaching and supervision of professional development activities
encourage self-directed learning
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching and supervision skills
support learners to identify and attend formal and informal learning opportunities

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

demonstrate the ability to incorporate and critically analyse relevant and up-to-date evidence from the literature into clinical teaching
collaborate with learners and colleagues who are undertaking research projects
clarify junior colleagues’ research project goals and requirements, and providing feedback regarding the merits or challenges of proposed research
assist in reviewing research projects prior to submission and providing feedback to encourage and guide learners to seek out relevant research to support practice

direction
Requires some supervision

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

The trainee may:

direct learners to review relevant literature

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

apply principles of ethical practice to teaching scenarios
role model professional and ethical behaviours, including respect and collegiality
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
promote joint problem solving
support a learning environment that allows for independent decision making
escalate concerns about learners appropriately, and keep appropriate documentation

direction
Requires some supervision

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

The trainee may:

provide general advice and support to learners

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 professional, clinical, research, and/or administrative responsibilities while teaching
promote an inclusive environment whereby the learner feels part of the team

direction
Requires some supervision

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

The trainee may:

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

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
support innovation in health professional’s education
support collaboration and sharing of resources in health education

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Contribute to improving the safety, effectiveness, and experience of health care

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use standardised protocols to adhere to best practice, where applicable
demonstrate the ability to critically analyse relevant literature, refer to evidence-based guidelines and apply this to daily practice
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

ensure patients are informed of any risks associated with their care, including investigations, procedures, and therapies
obtain informed consent before undertaking any investigation, procedure, or therapy
ensure that patients are informed about fees and charges
assist patients to access their health information, as well as complaint and feedback systems
discuss with patients any safety and quality concerns they have relating to their care
implement the organisation’s open disclosure policy, where appropriate
engage consumers in quality improvement activities
provide clear, safe, timely, and effective handover during escalation and between transitions of care

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
provide information in a manner so that patients, families, and carers are fully informed when consenting to any procedures
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
participate regularly in organisational quality and safety activities, including:
- antimicrobial stewardship
- audits
- clinical incident reviews
- corrective action preventive action plans
- morbidity and mortality reviews
- review of clinical guidelines and protocols
- root cause analyses
participate in systems for surveillance and monitoring of adverse events and near misses, including reporting such events
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve health care

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of a systematic approach to improving the quality and safety of health care
raise appropriate issues for review at morbidity and mortality meetings
work within organisational quality and safety systems for the delivery of clinical care

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

participate in quality and safety trainings, meetings, and activities to ensure a contemporary approach to safety system strategies

direction
Requires some supervision

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

The trainee may:

use opportunities to learn about safety and quality theory and systems

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure that any protocol for human research is approved by a human research ethics committee, in accordance with the national statement on ethical conduct in human research
present critical analysis of relevant literature at departmental journal club meetings
participate in clinical research that aims to improve patient outcomes, where applicable

direction
Requires some supervision

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

The trainee may:

understand that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

undertake professional development opportunities that address the impact of cultural bias on health outcomes
demonstrate a commitment to improving cultural safety in own practice
apply frameworks and policies related to improving health care for Māori and Aboriginal and Torres Strait Islander peoples

direction
Requires some supervision

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

The trainee may:

demonstrate commitment to improving cultural safety in own practice

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients and health professionals
advocate for the safety of patients and staff using appropriate systems
demonstrate accountability for errors by identifying possible system issues to improve, while contributing to an organisational “no blame” culture that prioritises patients’ safety and quality
consider young people’s capacity for decision making and consent, involving a proxy decision maker where appropriate

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
assist in shaping an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement
consider patients’ decision-making capacity

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort involving all key health professionals
support multidisciplinary team activities to lower patients’ risk of harm, and promote multidisciplinary programs of education

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in all applicable health care 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
identify activities within systems to reduce errors, improve patient and population safety, and implement cost-effective change

direction
Requires some supervision

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

The trainee may:

comply with all relevant organisational policies and procedures

LG5: Clinical assessment

Learning Goal 5

Clinical assessment

Clinically assess paediatric patients across multiple settings

This activity requires the ability to:

identify and access sources of relevant information about patients
perform expert and efficient assessments of paediatric patients across the age range from birth to young adulthood, in inpatient and outpatient settings
select, organise, undertake, and interpret relevant investigations
synthesise findings to develop provisional and differential diagnoses
consider the comfort and safety of the child, and the values and beliefs of the family or carers

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

assess paediatric patients’ physical and psychological symptoms and signs
assess common and uncommon paediatric and adolescent inpatient presentations
assess common and uncommon paediatric and adolescent outpatient presentations
assess paediatric and adolescent patients with complex, multisystem, and/or chronic diseases
assess healthy newborns and common neonatal presentations
assess common developmental paediatric presentations
assess common paediatric and adolescent mental health presentations
identify and assess children presenting with signs or symptoms of child maltreatment
choose evidence-based investigations or assessment tools, and frame them as an adjunct to comprehensive clinical assessments
minimise unnecessary, potentially harmful, and/or painful investigations where possible
recognise and appropriately interpret abnormal findings, considering patients’ circumstances
synthesise and interpret findings from the history, examination, and investigations to devise the most likely provisional diagnoses via reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, and clinical outcomes

direction
Requires some supervision

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

The trainee may:

record patient-centred histories, considering psychosocial factors
perform accurate physical examinations
provide rationale for investigations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct the clinical encounter and diagnostic categories

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 respond to patients’ concerns
document clinical history, examination, investigations, impressions, and management plans in medical records
prepare timely and accurate communication in the form of letters and reports to disseminate relevant medical information to patients, other health professionals, and other relevant agencies

direction
Requires some supervision

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

The trainee may:

communicate appropriately with patients during assessments

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
enquire, acknowledge, and reflect on patients’ beliefs and values, and how these might impact on health
use qualified language interpreters or cultural interpreters where appropriate

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate and advocate for consideration of the comfort of patients by minimising distress and harm caused by medical assessments
hold information about patients in confidence, unless the release of information is required by law, under information sharing guidance, or public interest
assess patients’ capacity for decision making and providing consent for medical procedures
demonstrate an awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information
demonstrate an awareness of complex issues related to documentation of sensitive information gathered in clinical encounters, and subsequent sharing of such information

direction
Requires some supervision

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

The trainee may:

demonstrate professional conduct, honesty, and integrity
consider patients’ decision-making capacity
identify patients’ preferences regarding management and the role of families in decision making
prioritise patient and social welfare over own personal interest and professional agenda

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and experience to assess patients, making logical, rational decisions
evaluate the costs, benefits, and potential risks of each investigation in clinical situations
use a holistic approach to health, considering comorbidity, uncertainty, and risk
use the best available evidence to determine the most appropriate investigations, including not performing unnecessary investigations
determine the need for referral to subspecialists
make appropriate decisions in regard to referring or transferring patients to other services for further assessment, including regional and remote patients
make appropriate decisions in regard to reporting suspected child maltreatment to statutory child protection agencies
use appropriate guidelines, evidence sources, and decision support tools
consider possible sources of cognitive bias

direction
Requires some supervision

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

The trainee may:

demonstrate clinical reasoning by gathering focused information relevant to patients’ care
choose the most appropriate investigation for clinical scenarios, 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:

ensure results are checked in a timely manner, taking responsibility for following up results
collaborate with other health professionals to achieve accurate and thorough assessments of patients

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

aim to achieve the optimal cost-effective patient care, to allow maximum benefit from the available resources
support systems to improve access to health care

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

LG6: Clinical management

Learning Goal 6

Clinical management

Clinically manage paediatric patients across multiple settings

This activity requires the ability to:

manage general paediatric patients across the age span from birth to young adulthood, including transition to adult care and end-of-life care
manage paediatric inpatients, outpatients, and across health care settings
develop management plans and goals in consultation with patients, families, and/or carers
collaborate with other health professionals and/or community agencies
manage patients within their family and community context, considering cultural, socioeconomic and geographical factors
prescribe therapies tailored to patients’ needs, conditions, and goals
monitor, review, and adjust management plans
manage and coordinate longitudinal care of patients
manage the transition of care between health professionals, providers, and contexts

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify and address current clinical concerns and longer-term clinical objectives, as appropriate to patients’ context
holistically manage paediatric and adolescent patients across the age range within their family and community context, including physical and psychological symptoms
effectively plan for, and manage, patients’ pain, distress, stress, or discomfort during treatment
refer to, and liaise with, subspecialists and other health professionals where appropriate
manage general paediatric inpatients to a high standard
manage general paediatric outpatients to a high standard
manage patients with common neurodevelopmental and behavioural concerns
manage patients with common mental health concerns in liaison with mental health support services
manage patients with common neonatal / perinatal concerns
manage adolescent patients, including transition to adult services
manage patients where there are concerns for child maltreatment, in conjunction with other relevant agencies
manage patients with complex, multisystem, or chronic conditions, such as chronic pain
consider and select appropriate pharmacological and non-pharmacological therapies considering patients’ age, comorbidities, adverse reactions, preparations, availability, and patients’ preference
plan appropriate monitoring and follow up to promote wellbeing and prevent harm
monitor treatment outcomes, effectiveness, and adverse events
regularly review the goals of care and treatment plans with patients
initiate opportunistic screening and management of complications and comorbid conditions
demonstrate knowledge of the principles of care for patients at the end of their lives, in liaison with paediatric palliative care services

direction
Requires some supervision

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

The trainee may:

develop appropriate management plans for current concerns
develop safe management plans for general paediatric inpatients and outpatients that may not consider all holistic care needs
select medicines for common conditions appropriately, safely, and accurately
identify potential side effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
identify neurodevelopmental and behavioural concerns for patients
identify mental health concerns for 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:

communicate with patients about the benefits, risks, and potential side effects of proposed therapies
provide information to patients to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication
facilitate and support open family discussions or meetings to deliver bad news or prognostic information
educate patients to recognise and monitor symptoms and when to seek help
communicate effectively with other professionals involved in patients’ lives to promote wellbeing, such as those working in education, mental health, allied health, and statutory child protection services

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients
explain the benefits and burdens of therapies, considering patients’ individual circumstances
seek further advice from experienced clinicians or pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

prescribe medications in accordance with evidence, guidelines, and protocols (including schedule 8 prescribing)
review medicines regularly to reduce non-adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
report suspected adverse events to medications, and record it in patients’ medical records

direction
Requires some supervision

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

The trainee may:

identify medication errors, and institute appropriate measures

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters where appropriate
enquire, acknowledge, and reflect on patients’ beliefs and values, and how these might impact on health and choices
offer support to patients, families, and carers to include cultural or religious practices in their care

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

manage and share information about patients’ health care in adherence to privacy laws, confidentiality, and professional guidelines
prepare for, and conduct, clinical encounters in a well-organised and time-efficient manner
demonstrate an understanding of the medicolegal requirements of written communications
recognise complexities around patient consent when there may be disputes between parents, parent and child or court orders in place

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
identify patients’ preferences regarding management and the role of families in decision making
prioritise patient and social welfare over own personal interest and professional agenda

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
use appropriate guidelines, evidence sources, and decision support tools
plan appropriate investigations, considering risk, benefit, tolerance, resources, diagnostic yield, and contribution to management
identify and address patients’ concerns, expectations, and goals
develop management plans in consultation with patients and carers
develop management plans considering the balance of benefit and harm by taking patients’ personal sets of circumstances into account
manage patients within their family and community context, considering cultural, socioeconomic, and geographical factors
ensure patients’ care is in the most appropriate facility, setting, or provider make appropriate decisions regarding referring or transferring patients to other services for further management, including regional and remote patients
use medicines safely and effectively to get the best possible results
recognise professional limitations

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
consider and prioritise patients’ issues using a structured approach
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 holistic care for complex patients
work effectively as a member of multidisciplinary teams to achieve the best health outcome for patients
lead inpatient teams
efficiently manage outpatient clinics
manage, and plan follow up for, patients that live in regional or remote locations, in liaison with their local health services
ensure care plans are communicated to all teams involved in patients’ care, including primary care and other relevant community care providers
engage and facilitate multidisciplinary team meetings, family meetings, and complex case conferences
establish and follow clear transition plans for adolescent patients, utilising appropriate services

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
contribute effectively to inpatient teams
work effectively in outpatient clinics

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate appropriate utilisation of local, regional, and national health services and systems
aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
support and use innovative systems, such as telehealth and digitally integrated support services
contribute to processes for managing risks, and identify strategies for improvement in transition of care
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
follow and support processes for adolescents transitioning to adult health services

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
consider transport issues and costs to patients in arranging for transferring patients to other settings

LG7: Acute care and procedures

Learning Goal 7

Acute care and procedures

Assess and manage acutely unwell paediatric and neonatal patients

This activity requires the ability to:

assess seriously unwell paediatric and neonatal patients, and initiate management
perform paediatric and neonatal resuscitation
plan, prepare for, perform, and provide aftercare for procedures expected of a general paediatrician, as listed in this EPA
manage ongoing care of acutely unwell paediatric and neonatal patients suitable for inpatient ward and not needing intensive care
recognise and respond to clinical deterioration
escalate care where appropriate
participate in and, where appropriate, lead the resuscitation team
liaise with paediatric intensive care or neonatal intensive care units, retrieval services, and referral centres
safely prepare and handover acutely unwell patients at change of shift or change in patient status or location
communicate with family and carers regarding acute situations and plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening paediatric and neonatal conditions and critically unwell patients, and respond appropriately
prepare for, and perform, effective advanced paediatric life support and neonatal resuscitation
recognise and respond to clinical deterioration
assess, diagnose, and initiate management of acute undifferentiated clinical presentations
select investigations that exclude or diagnose critical patient issues
manage acutely unwell children and neonates suitable for the inpatient ward and not requiring intensive care
perform common procedures confidently and consistently, such as:
- lumbar puncture
- manual intermittent positive pressure ventilation via bag mask and T piece
- nasogastric tube placement
- paediatric and neonatal cannula insertion
- sterile urine collection via suprapubic and/or catheter
troubleshoot and manage patients with difficult intravenous access
demonstrate knowledge and skills in safe airway management on a mannequin and/or patient, such as:
- endotracheal intubation
- laryngeal mask and oropharyngeal / nasopharyngeal airway insertion
demonstrate knowledge and skills on a mannequin and/or patient in:
- intercostal catheter insertion
- intra-osseus needle
- needle thoracostomy
- umbilical venous catheterization
demonstrate knowledge of the principles and complications of midline, percutaneous long line (PICC) and central venous access insertion, and, where appropriate, practice insertion
demonstrate knowledge of the role for point of care ultrasound (POCUS) in diagnostic and procedural applications, and, where appropriate, practice on phantom models and/or patients
manage patients, in liaison with subspecialty teams, with:
- central venous access devices
- gastrostomy tube
- other in situ medical devices
- PICCs
- ventriculoperitoneal shunts
recognise and effectively manage complications arising during and after procedures
initiate care of seriously unwell paediatric and neonatal patients requiring surgery and/or transfer to intensive care unit
initiate ventilation and inotropic support of paediatric and neonatal patients, with support from appropriate intensive care specialists or emergency staff
systematically identify causes of acute deterioration in health status
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
optimise medical management before and after operations, where appropriate
effectively manage acute pain and distress
demonstrate knowledge and skills in procedural pain management, such as sedation and analgesia, as well as non-pharmacological strategies
demonstrate an awareness of the process for accurate collection of forensic samples for children with acute sexual assault concerns, in liaison with child maltreatment specialist paediatricians, child protection agencies, and police
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:

recognise seriously unwell patients requiring immediate care
initiate paediatric and neonatal resuscitation as indicated
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis
develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans
assess patients and identify indications for procedures
consider risks and complications of procedures
demonstrate knowledge and skills in:
- lumbar puncture
- manual intermittent positive pressure ventilation via bag mask and T piece
- nasogastric tube placement
- paediatric and neonatal cannula insertion
- sterile urine collection via suprapubic and/or catheter

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 closed-loop and clear communication with other health care team members during resuscitation and escalation
facilitate early sensitive communication with patients during escalation and resuscitation to allow shared decision making
explain procedures clearly to patients, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
accurately document procedures in clinical notes, including informed consent, indication for the procedure, medicines given, aseptic technique, difficulties encountered, and aftercare
liaise appropriately with paediatric and neonatal intensive care specialist and retrieval services
provide clear and effective clinical handover during change of shift or change in patient status or location

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
communicate with patients in a timely and appropriate manner
provide timely and safe handover during escalation and transitions of care
explain the process of procedures to patients without providing a broader context
discuss postprocedural care with patients
complete relevant patient documentation

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:

set up all necessary equipment required for procedures, 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

direction
Requires some supervision

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

The trainee may:

comply with safety requirements of the health service

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

maintain up-to-date certification in advanced paediatric life support and neonatal resuscitation
participate in multidisciplinary practice of resuscitation skills, including simulation where available
seek guidance and feedback from supervisors and other health professionals to reflect on clinical deterioration or resuscitation events and improve future patient care
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 appropriate supervision to learners carrying out procedures

direction
Requires some supervision

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

The trainee may:

maintain life support requirements of the health service

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, considering variation in family structures, cultures, religion, and belief systems
use qualified language interpreters or cultural interpreters where appropriate
integrate culturally safe care of Māori and Aboriginal and Torres Strait Islander peoples into patient 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 safety

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

apply ethical principles to life-saving treatments and patients’ and family members’ rights to decide management, including withdrawal of care
facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
hold information about patients in confidence, unless the release of information is required by law or public interest

direction
Requires some supervision

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

The trainee may:

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 or patient transfer, and escalate to appropriate staff or services
use appropriate guidelines, evidence sources, and decision support tools
identify roles and optimal timing for diagnostic procedures
select appropriate investigations on the samples obtained in diagnostic procedures
reconcile conflicting advice from other specialties, and support shared clinical decisions in the presence of uncertainty
use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

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

The trainee may:

involve additional staff to assist in a timely fashion when required
recognise personal limitation, and seek help in an appropriate way when required
assess personal skill levels, and seek help with procedures when appropriate

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

collaborate effectively with staff in the emergency department, paediatric and neonatal intensive care units, and other subspecialty inpatient units
demonstrate effective leadership and followership in acute care situations, including appropriate role allocation of team members
explain critical steps, anticipated events, and equipment requirements to team members before planned procedures
provide staff with clear procedural aftercare instructions
explain how to recognise possible procedural complications
identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
manage transitions of care of acute medical patients
check in and support team members’ wellbeing, and, where necessary, support psychological first aid and formal debriefing

direction
Requires some supervision

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

The trainee may:

collaborate with 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
involve appropriate team members to undertake procedures safely

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 health care 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

LG8: Communication with patients, families, and health professionals

Learning Goal 8

Communication with patients, families, and health professionals

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

This activity requires the ability to:

communicate and build rapport with children and young people
communicate and build working relationships with families and/or carers
practice patient and family-centred care
communicate with team members and other health professionals across different contexts and modalities
synthesise clinical information into accurate and safe handovers and summaries
negotiate mutually agreed plans
deliver education to patients, families, carers, and health professionals at appropriate levels of understanding

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly the working diagnosis, other possible diagnoses, and rationale behind management plans to patients and other health professionals
anticipate, and be able to correct, any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
provide patients with a chronic disease management plan
define, summarise, and clarify the concerns and goals of patients, and plan management in partnership with them
provide timely updates to patients and care providers when there are changes in plans or new results
use clinical encounters to provide appropriate education to patients, family, and/or carers on their health needs
synthesise clinical information into clear, accurate, comprehensive, and professional summaries and handovers for other health professionals, including discharge summaries, clinic letters, and transfer documentation
present succinct clinical cases to colleagues, providing justification for proposed plans, and raise points for discussion
provide safe and supportive expert advice for colleagues seeking professional paediatric opinion
consult specialists, such as child maltreatment specialist paediatricians, radiologists, neurosurgeons, and ophthalmologists, in cases of child maltreatment
formulate defensible evidence-based opinions in relation to likelihood of child maltreatment, in consultation with child maltreatment specialist paediatricians

direction
Requires some supervision

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

The trainee may:

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

use an appropriate communication strategy and modalities for communication, such as emails, face-to-face, or phone calls
actively support and effectively use professional interpreters and other communication assistance means during every clinical encounter with patients unable to communicate confidently or verbally in English, at a level required for health understanding, and document this in medical records
check patients’ level of literacy and access to the internet when considering use of written or online communications
actively and empathetically listen to, and prioritise, the needs and concerns of patients
communicate with patients respectfully and non-judgementally
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage patients to ask questions, and answer them thoroughly
encourage 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 patients respectfully, and listen to their views
undertake appropriate consultation with adolescents and young adults, including allowing review time independent of carer during part of the consultation
establish and apply requirements and limits of confidentiality when interviewing adolescents and young adults by themselves
recognise the development of health independence and requirements around consent when working with adolescent patients
support the role of family or carers, and, when appropriate, encourage patients to involve their family or carers in decisions about their care
use appropriate defusing and de-escalation strategies for angry patients, prioritising own safety and that of the team
demonstrate effective formal professional communication skills with different stakeholders across multiple platforms
establish rapport with people at all levels by tailoring messages to different stakeholders
ensure appropriate documentation in medical records or other appropriate means of record keeping
produce comprehensive medicolegal reports for the child protection and criminal justice system, that are appropriately peer reviewed

direction
Requires some supervision

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

The trainee may:

select appropriate modes of communication
engage patients in discussions, avoiding the use of jargon
check patients’ understanding of information
adapt communication style in response to patients’ age and developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors
anticipate, read, and respond to verbal and nonverbal cues
demonstrate active listening skills to communicate patients’ situations to colleagues, including senior clinicians

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

provide appropriate and ongoing education for patients and carers, including verbal, written, and digital information
reflect on communication interactions that did not go as expected, and demonstrate openness to feedback, continuous learning, and improvement
provide education to peers, junior doctors, medical students, and other health professionals that is tailored to their level of knowledge and current learning needs

direction
Requires some supervision

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

The trainee may:

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 research information to patients that is based on national guidelines
obtain informed consent or other valid authority before involving patients in research
provide information to patients in a way they can understand before asking for their consent to participate in research
communicate any research findings to appropriate stakeholders
understand when young people are able to consent for participation in research

direction
Requires some supervision

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

The trainee may:

obtain an informed consent or other valid authority before involving patients in research
refer to evidence-based clinical guidelines
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication with Māori and Aboriginal and Torres Strait Islander peoples
communicate effectively with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters where appropriate
demonstrate consideration and accommodation for differing gender and parenting roles in communication interactions
provide plain language and culturally appropriate written / digital materials to patients where appropriate
use qualified language interpreters or cultural interpreters where appropriate

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients and, when relevant, their families or carers, in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
demonstrate communicating strengths-based holistic care
prioritise honesty, patients’ welfare, and community benefit above self-interest
practice with a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions
manage and share information about patients’ health care in adherence to privacy laws, confidentiality, and professional guidelines
demonstrate strict adherence to patient confidentiality, and consideration for the setting of clinical discussions with patients and team members
seek consent from patients to communicate with other organisations involved in patients’ care
complete clinical notes and correspondence efficiently and within a reasonable time frame
ensure all appropriate recipients are included in patient correspondence
maintain professional boundaries with patients according to professional codes of conduct

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consistently communicate effectively, collaboratively, and respectfully with team members, other health professionals, and community members
communicate effectively with local service providers, primary care and other community organisations in planning and management of care, including referring and receiving health services
facilitate an environment where all team members feel they can contribute and their opinion is valued
formulate strategies to respectfully negotiate plans in the best interest of the patient at times when there are differences in opinions between health professionals

direction
Requires some supervision

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

The trainee may:

answer questions from team members
summarise, clarify, and communicate responsibilities of health care team members

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 appropriate digital technologies and systems to facilitate improved communication

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG9: Promote improved outcomes in child and adolescent health and development

Learning Goal 9

Promote improved outcomes in child and adolescent health and development

Take actions to promote improved health and developmental outcomes for paediatric patients in healthcare systems and the community

This activity requires the ability to:

identify strengths, capacities, and barriers to health at individual, family, community, and policy level
identify and manage child and adolescent safety concerns
actively work to improve health equity and address barriers to health at an individual, family, community, and policy level
provide effective holistic care for children and adolescents with consideration for their family, community, and cultural context
take a leadership role in advocating for improved health and developmental outcomes for paediatric patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

provide specialised holistic paediatric care to address the needs, according to local, national, and international guidelines and best practice, of:
- children from low socioeconomic backgrounds
- children from rural and remote areas
- children in out-of-home care
- children with disability
- children with diversity
- Māori and Aboriginal and Torres Strait Islander peoples
- refugee and asylum seeker children, and children with refugee-like backgrounds
provide goal-directed care, aiming to improve function and quality of life, to patients with complex needs
devise strategies that consider and improve the social and emotional wellbeing of patients
provide medical evidence, assessments, and correspondence to support patients to access disability, mental health, and other support services
support strategies that promote inclusion and participation
identify and refer patients to appropriate early intervention and developmental services
devise a strengths-based approach to the care of patients with developmental or behavioural challenges, neurodiversity, or disabilities
advocate for the effective mitigation of risks in patients’ physical and social environments
identify and address, or advocate for reducing, individual barriers to health, including adverse childhood experiences
advocate for conditions that promote optimal child and adolescent development across the age range
undertake screening and develop management plans for psychosocial risks of adolescents

direction
Requires some supervision

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

The trainee may:

identify children with specific vulnerabilities
identify barriers to health
address and manage patients with child protection and safety concerns
undertake screening for psychosocial risk factors with adolescent patients
identify patients needing to access disability and other support services
identify risks present in children’s physical and/or social environments

Communication

confident
Ready to perform without supervision

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

The trainee will:

prioritise positive and strengths-based language in communication regarding patients
practice trauma-informed care
sensitively and constructively explore barriers to health and adherence to management plans
provide opportunistic health education to families and carers, and promote optimal patient health
safely and appropriately communicate with police and statutory child protection agencies, including limitations of knowledge, evidence base, and expertise

direction
Requires some supervision

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

The trainee may:

explore socioeconomic backgrounds with patients
refer to local service providers

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

educate families, carers, medical students, other health professionals, and/or community members about strategies to improve child health in all domains
build knowledge of community resources that support patients' health and wellbeing within community of practice

direction
Requires some supervision

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

The trainee may:

provide health promotion education to families and carers

Research

confident
Ready to perform without supervision

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

The trainee will:

contribute to research that improves health equity, where applicable

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:

collaborate with families and communities to optimise patient health outcomes in a culturally safe manner
use qualified language interpreters or cultural interpreters where appropriate
support improving patient health and development within the patients’ cultural and family context
advocate for cultural safety in clinical settings
link patients with culturally appropriate support services

direction
Requires some supervision

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

The trainee may:

demonstrate cultural safety

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:

practice advocacy with respect for patient confidentiality, autonomy, and dignity
facilitate and advocate for the safety and rights of children, including adherence to child protection laws and policies
support and empower families and carers to provide optimal care for children

direction
Requires some supervision

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

The trainee may:

adhere to child protection laws and policies

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:

practice patient-centred care, considering the family, community, and cultural context in establishing management plans
demonstrate an understanding of relevant consent and information-sharing laws
demonstrate an understanding of the role and requirements of paediatricians as expert witnesses in cases of child maltreatment

direction
Requires some supervision

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

The trainee may:

seek support to manage patients in challenging contexts

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively within teams that aim to improve patient health and developmental outcomes
advocate for quality, safe, and effective care in the best interest of patients and health priorities

direction
Requires some supervision

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

The trainee may:

advocate for appropriate care for patients

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 child and family friendly clinical and support services
seek to address, or advocate for addressing, the determinants of health of the population
advocate for, and promote, child safety and the rights of children
participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
demonstrate an awareness of population health priorities
contribute to advocacy or policy activities to improve child health and developmental outcomes nationally and globally
direct families and carers to resources and services targeted at improving child health
advocate for, or contribute to, systems or structures that provide equitable access to care for all paediatric patients
apply knowledge of long-term impacts of adversity and methods to ameliorate harm to health policy and advocacy

direction
Requires some supervision

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

The trainee may:

demonstrate an awareness of activities that promote health and prevent disease in children and young people
support patients to link with relevant community services
identify systems or structures that are a barrier to equitable access to health care

LG10: Care for patients from rural / remote areas

Learning Goal 10

Care for patients from rural / remote areas

Provide high-level paediatric care for patients from rural and remote areas

This activity requires the ability to:

manage patients with consideration for their geographical context and access to health resources
identify and work to address barriers to health in rural and remote areas
adopt an independent, flexible, and resourceful approach to rural paediatrics
provide optimal paediatric care with effective utilisation of health care resources, within and beyond the patients’ local community
provide care to patients that is linked between inpatient, outpatient, and community settings liaise and coordinate with local, regional, and referral services
liaise and coordinate with local, regional, and referral services
plan and coordinate appropriate longitudinal follow-up that is closest to the patients’ home

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:

perform comprehensive assessments of paediatric patients with broad presentations across all organ systems
independently manage inpatients and outpatients in a regional setting, while recognising when to seek assistance from colleagues
liaise appropriately with off-site subspecialists (eg. metropolitan or tertiary centre) to instigate investigation and management where appropriate
undertake opportunistic health screening, considering local and environmental health priorities
provide opportunistic and directed health promotion education, considering local and environmental health priorities
demonstrate the ability to function effectively across inpatient and community contexts in parallel
consider local and regional burden of disease in possible differentials and antibiotic selection
tailor management plans to target the strengths and limitations of patients’ context
provide safe and effective phone advice for health professionals caring for patients in rural and remote locations

direction
Requires some supervision

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

The trainee may:

identify own limitations, and seek support of other health professionals
manage patients’ presenting complaints without consideration for their broad health needs or context
provide phone advice without consideration for the local context

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 closely with regional paediatricians, GPs, child health nurses, and other community health professionals in planning patient management and follow-up
communicate sensitively, respectfully, and collaboratively with local health professionals, appreciating the challenges and limitations of rural and remote services
communicate in a variety of means appropriate to the context, including remote, virtual, and telehealth
communicate and make joint decisions with retrieval services including discussion around stabilisation and mode of retrieval

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:

comply with local safety and quality standards
monitor and report adverse events
consider practical solutions to improving health care safety and quality in rural and remote sites

direction
Requires some supervision

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

The trainee may:

identify errors or limitations in care

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

take action to develop knowledge and skills to improve care provided to local populations
provide planned and opportunistic education of local health care workers and students in paediatric medicine

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:

support the management of patients within cultural and family contexts, appreciating the importance of connection to Country and family roles
use qualified language interpreters or cultural interpreters where appropriate
advocate for, and practice, culturally safe care

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of cultural considerations

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 consideration of the social, cultural, and psychological impact of referral and travel to large metropolitan hospitals on patients and families
appropriately use health care resources, considering cost and benefit
take efforts to ensure patients access available services to reduce barriers to health care, such as subsidised patient transport

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 sound initiative to problem solve independently, where appropriate
recognise disease burden and risk in patients’ geographical locations
recognise the limitations of local health services, and refer and transfer care appropriately and in a timely manner
use available investigations appropriately, and consider the cost, benefits, and potential impact of referral for further investigations in metropolitan centres
demonstrate a flexible and adaptable approach to managing patients to a high standard with limited resources
demonstrate consideration for medical, physical, and logistical complexities of patient retrieval

direction
Requires some supervision

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

The trainee may:

communicate with referral hospitals to assist with 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:

lead and coordinate care of patients with multisystem and chronic disease, with input from metropolitan subspecialists
work collaboratively within teams to optimise patient-centred care in the regional setting
demonstrate effective teamwork skills to support other members of the health care team within regional or remote settings
advocate for quality, safe, and effective care in the best interest of patients
advocate for access to necessary resources to benefit the health and development of patients in rural and remote settings

direction
Requires some supervision

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

The trainee may:

liaise with metropolitan subspecialists when required

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 an awareness of population health priorities in regional areas
recognise and work within limitations of local health services, such as reduced access to primary care
communicate with local stakeholders and community members to address the health care needs of rural and remote patients
seek to address and/or advocate for addressing the determinants of health of the population, and mitigate barriers to access to care
participate in health promotion, disease prevention and control, screening, and reporting of notifiable diseases
contribute to, or participate in, advocacy and policy activities to improve health for rural and remote children
use telehealth services and other technology to facilitate access to health care remotely, where appropriate

direction
Requires some supervision

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

The trainee may:

understand the structure of local and regional health services

Knowledge guides

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

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

LG11: Foundations of general paediatrics

Key presentations and conditions

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

More detailed conditions and presentations according to organ system are presented as an appendix.

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

Appendix

Advanced Trainees will have knowledge of a variety of presentations and conditions across the scope of general paediatrics, including but not limited to those listed here.

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

Infant / Child health / Undifferentiated presentations

Abdominal pain
Allergy
Anaemia
Anaphylaxis
Behavioural concerns
Bloody stools
Breath holding
Brief resolved unexplained event
Carer stress / concern
Chest pain
Constipation
Continence issues
Cough
Chronic pain
Developmental delay
Diarrhoea
Diurnal enuresis
Emotional dysregulation
Enlarged lymph nodes
Enuresis
Faltering growth
Fatigue
Feeding difficulties
Fever
Fit / Faint / Funny turn
Floppy infant / Hypotonia
Growth and puberty issues
Headache
Head size / Head shape
Hearing impairment

Heart murmur
Jaundice
Learning difficulties
Limping or non-weight bearing
Musculoskeletal and joint pain
Nausea
Neurodiversity
Obesity
Oncological presentations
Palpitations
Rash
Recurrent fever / Recurrent illness
Recurrent urinary tract infection
School refusal
Seizures
Sensory issues
Skin conditions
Shortness of breath
Speech / Language delay
Sleep difficulties
Suspected abuse and neglect, including suspected sexual abuse
Syncope / Collapse
Toxidrome
Unsettled infant
Unwell infant or child
Vision impairment
Vomiting
Vulnerability and neglect
Wheeze

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions, the trainee must also seek expert opinions
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

Aetiology and natural history for common and uncommon paediatric medical conditions
Diagnosis, natural history, and treatment options for infants, children, and young people with complex, multisystem, and chronic disorders
Epidemiology, pathophysiology, and basic sciences as required for Basic Training in Paediatrics and Child Health, with a focus on clinical manifestations and complications of disease, pharmacology, and evidence-based management
Pharmacology of medications prescribed in children and adolescents, including paediatric use of:
- ADHD medications
- anti-depressants
- anti-psychotics
- anxiolytics
- mood stabilisers
- simple analgesics
- strong analgesics

Investigations

Audiology
Blood tests, such as:
- bacterial and viral PCR
- biochemistry
- blood gases
- endocrinological
- genetic investigations
- haematological
- immunological and allergen testing
- inflammatory markers
- metabolic screening tests
- microscopy, culture, and antimicrobial sensitivity
- serology
Bone densitometry scan
Cardiac investigations:
- echocardiography
- electrocardiography (ECG)
- exercise testing
- Holter monitoring
Other pathology, such as:
- cerebral spinal fluid:
  - culture and antimicrobial sensitivity
  - indications for additional testing (e.g., autoimmune / metabolic)
  - microscopy
- genetic:
  - chromosomal microarray analysis (CMA)
  - whole exome sequencing (WES)
- site swabs (from sterile and non-sterile sites):
  - culture and antimicrobial sensitivity
  - microscopy
  - viral and bacterial PCR
- stool:
  - calprotectin
  - culture
  - faecal occult blood
  - malabsoprtion tests
  - microscopy
  - ova, cysts, parasites
  - specific antigen (e.g., Helicobacter pylori)
  - toxin
- sweat test
- urine:
  - biochemistry
  - culture and antimicrobial sensitivity
  - microscopy
  - toxicology screening
Radiology:
- CT scan
- MRI
- plain x-ray
- ultrasound
- knowledge of indications for additional specialist radiological investigations, including:
  - barium studies
  - nuclear medicine studies, including MAG3 and bone scan
  - PET
  - specialist x-rays, including bone age and skeletal survey
Respiratory investigations:
- bronchoalveolar lavage
- nasopharyngeal aspirate
- overnight oximetry
- polysomnography
- pulmonary function tests
Skin biopsies
Skin prick testing
Wood lamp examination

Procedures

Blood collection
Blood product transfusion
Bowel wash out protocol
Cannulation
Food allergen challenge
Fundoscopy
Iron infusion
Joint aspiration
Lumbar puncture
Nasogastric tube insertion
Pleural aspiration and drainage
Procedural sedation
Skin scraping
Sterile urine collection

Clinical assessment tools

Anthropometric assessment
Blood pressure monitoring
Cognitive assessment and developmental screening tools
Growth charts
Orchidometry and pubertal staging
Pain severity measurement:
Psychosocial assessments (e.g., HEADSS)
Visual acuity

Adolescent health
Biological, physical, and psychosocial elements of infant and child feeding
Broad health and wellbeing considerations of the child and their context, such as:
- adverse childhood experiences and early life trauma
- caregivers who are neurodiverse, have mental health issues, or sustance misuse
- cultural, geographical, and socioeconomic barriers to health
- inequities in child health
- intergenerational trauma
Child and adolescent education access
Child health and wellbeing implications and impact of colonisation, and current and historical government policies on First Nations People
Child health and wellbeing implications and impact of conflict / persecution / disaster fled, transit journeys, and current and historical government policies on refugee and asylum seeker children
Child health promotion and education, such as:
- child safety
- food allergy prevention and management
- safe sleeping
- screen time and online safety
- sleep habits
Child safety and maltreatment (see LG16)
Chronic and complex care, such as:
- awareness and access to appropriate school and disability services and aids
- coordination of care, including prevention of hospitalisation
- developing acute and chronic care plans
- identification and management of complex or multiple comorbidities and complications
- impact of chronic health conditions on children, adolescents, and families
- impact of cognitive, intellectual, and physical disabilities
Chronic pain management:
- awareness of referral criteria and conditions treated at children’s chronic pain clinics
- awareness of the psychosocial consequences of chronic pain:
  - anxiety
  - depression
  - family disharmony
  - insomnia
  - school loss
  - work loss
- awareness of treatment strategies for chronic pain management including pharmacological and non-pharmacological and specific strategies for children with ASD and ADHD
Collaboration with primary and community health to provide continuity of care
Continence management
Critical appraisal of research evidence
End-of-life and palliative care considerations, such as:
- advanced care planning for children with life-limiting conditions
- considering ethical and practical aspects of advance care planning
- considering suitability of discussions regarding organ donation
- determining the goals of care and interventions that should and should not be provided
- discussing resuscitation and ceiling of care
- importance of assessing needs of families and carers, and respecting their wishes
- medicolegal aspects of end-of-life care
- recognition of the dying phase
- responding to the questions of a dying child
- undertaking a process of discussions between families and health care providers about preferences for care, treatments, and goals in the context of the patient’s current and anticipated future health
Expected behaviours and care needs of infants, children, and young people
Family violence awareness and screening
Gender diversity considerations, such as:
- appreciation of gender diversity
- principles of medical care and referral pathways
Health status and needs of children and families from special populations, such as:
- Aboriginal and Torres Strait Islander peoples
- asylum seekers, migrants, refugees, and children with refugee-like backgrounds
- children in out-of-home care
- Māori and Pasifika peoples
- regional and remote communities
- socioeconomically disadvantaged communities
Immunisation
Infant mental health impacts, such as:
- attachment styles and infant temperament
- cognitive development of infants
- emotional
- families, and wider social and cultural context
- influence of maternal-infant dyad
- social
Population and global health consideration, such as:
- burden of disease in population groups, nationally and globally
- child health indicators and priorities locally, nationally, and globally
- disease prevention
- environmental influences on child health
- global emergencies and the broad impact on children
- immunisation health
- impact on child health of climate change
- outbreak and disease control
Principles of patient / family-centred care
Principles of trauma-informed care
Procedural pain and anxiety management, such as:
- non-pharmacological
- pharmacological
Psychosocial impacts of child health, such as:
- bullying
- family functioning and parenting styles
- maternal-infant dyad
- social media
Rehabilitation considerations, such as:
- assessment of degree of impairment, disability, and activity limitation or participation restriction, and potential for rehabilitation
- assessment of patients following head injury, including assessment of the severity of injury and the need for ongoing therapy and follow-up
- biopsychosocial model, and its application to patient care
- indications for referral to occupational therapy, orthotics, physiotherapy, psychology, speech therapy, and other allied health services
- long-term follow-up of infants born premature, low birth weight, or with serious medical conditions
- pain and irritability assessment in children with severe disability
- sequelae following brain injury, and appreciation of executive dysfunction and its impact on learning
- use and purpose of early screening for cerebral palsy, including General Movements Assessment and Hammersmith Infant Neurological Examination, and referral pathways for children identified as at risk
Role of primary health and local and community-based services in delivery of health care for infants, children, and young people
Rural and remote paediatric medicine (see LG17)
Support services available in the local community for specific case management, such as:
- allied health
- financial
- medical
- respite
- support groups
Technology assisted conditions, including:
- CPAP
- tracheostomy
The importance of Te Tiriti o Waitangi
The importance of the United Nations Convention on the Rights of the Child
Transitions in care, such as:
- adolescents with chronic health conditions transitioning to adult health care services
- transitions between practitioners
- transitions between settings
Typical infant, child, and adolescent growth and development, including importance of the first 1000 days
Values, beliefs, and traditions related to country, family, identity, and spirituality of First Nations People, and the relation to health and wellbeing

Cardiovascular

Presentations

Abnormal pulses
Cyanosis
Dyspnoea
Hypertension
Murmur
Palpitations
Syncope

Conditions

Arrythmia syndromes, including:
- Brugada syndrome
- Wolf–Parkinson–White syndrome
Congenital cardiac disease
Hyperlipidaemia
Innocent murmurs
Kawasaki disease
Long QT syndrome
Myocarditis
Pericarditis
Rheumatic heart disease
Supraventricular tachycardia

Dermatological

Presentations

Drug reactions
Rash
Skin lesions

Conditions

Burns
Cellulitis
Congenital skin disorders
Eczema
Fungal infections
Haemangioma and other vascular lesions
Naevi
Scabies
Urticaria
Viral skin infections

Endocrinological

Presentations

Hypoglycaemia
Polydipsia
Polyuria
Precocious puberty
Pubertal delay
Short or tall stature

Conditions

Constitutional delay of growth and puberty
Diabetes insipidus
Diabetes mellitus
Hyperthyroidism
Hypothyroidism
Metabolic syndrome
Obesity
Vitamin D deficiency

Ear, nose, and throat

Presentations

Dysphagia
Ear pain or discharge
Neck lumps
Snoring
Sore throat
Stridor

Conditions

Croup
Dental caries
Laryngomalacia
Lymphadenitis
Otitis externa
Otitis media
Pharyngitis
Sleep apnoea
Tonsilitis

Gastrointestinal

Presentations

Abdominal mass
Abdominal pain – acute, chronic
Anorexia
Bloody stools
Constipation
Diarrhoea
Dysphagia
Encopresis
Jaundice
Malnutrition
Mucousitis
Vomiting and nausea

Conditions

Abdominal migraine
Chronic abdominal pain / Functional abdominal pain
Coeliac disease
Functional constipation
Gastroenteritis
Gastro-oesophageal reflux disease
Inflammatory bowel disease
Liver disease

Genetic and metabolic medicine

Presentations

Acute hypoglycaemia
Congenital abnormalities
Developmental delay / Developmental regression
Dysmorphisms
Macro or microcephaly
Short or tall stature

Conditions

22q11.2 deletion or duplication syndromes
Cystic fibrosis
Duchenne muscular dystrophy
Fragile X syndrome
Inborn errors of metabolism / Metabolic disorder
Kleinfelter syndrome
Neurofibromatosis type 1
Noonan syndrome
Trisomy 21
Tuberous sclerosis
Turner syndrome

Genitourinary / Gynaecological

Presentations

Circumcision
Daytime wetting (diurnal enuresis)
Dysmenorrhea
Dysuria
Enuresis
Haematuria
Heavy menstrual bleeding
Recurrent urinary tract infections
Scrotal swelling
Urinary retention
Vaginal discharge

Conditions

Endometriosis
Labial adhesions
Management of antenatal kidney tract dilation
Neurogenic bladder
Sexually transmitted infections
Undescended testes
Urinary tract infection (and recurrent urinary tract infections)
Vulvovaginitis

Haematological / Oncological

Presentations

Bruising
Jaundice
Lymphadenopathy
Pallor
Petechiae / Purpura
Soft tissue and organ masses
Thrombocytopaenia

Conditions

Anaemias
Bleeding disorders, including haemophilia
Brain tumours
Haemolytic disorders, including G6PD deficiency
Haemophagocytic lymphohistiocytosis (HLH)
Idiopathic thrombocytopaenic purpura (ITP)
Iron deficiency
Late effects of cancer treatment
Leukaemias
Lymphomas
Neutropenia
Red cell structural disorders
Sickle cell disease
Solid tumours
Tumour lysis syndrome
Vitamin B12 deficiency

Immunological

Presentations

Allergic reactions
Food intolerance
Recurrent infections
Serious or unusual infections

Conditions

Adverse drug reactions
Allergic rhinitis
Food allergy (IgE mediated)
Insect allergy
Non-IgE mediated food allergy, including food protein induced enterocolitis syndrome (FPIES)
Primary immune deficiencies

Infectious disease

Presentations

Fever and associated symptoms
Fever and petechiae
Fever without a focus
Prolonged or recurrent fevers

Conditions

Fever in returned traveller
Gastroenteritis
Measles
Meningitis and encephalitis
Ophthalmological infections
Osteomyelitis and septic arthritis
Respiratory tract infections
Septicaemia and toxic shock syndrome
Skin and soft tissue infections
Urinary tract and genitourinary infections
Vaccine-preventable diseases
Viral infections
Varicella

Inflammatory and vascular

Conditions

Acute rheumatic fever
Henoch–Schonlein purpura
IgA vasculitis
Kawasaki disease
Paediatric multisystem inflammatory syndrome – temporally associated with SARS-CoV-2 (PIMS-TS)
Systemic lupus erythematosus (SLE)
Other autoinflammatory conditions

Kidney

Presentations

Antenatally diagnosed hydronephrosis
Anuria
Haematuria
Hypertension
Oedema
Polyuria

Conditions

Acid-base and electrolyte disturbance
Acute kidney injury
Chronic kidney disease
Glomerulonephritis
Hypertension
Nephrotic syndrome
Posterior urethral valves (PUV)
Vesicoureteric reflux

Mental health

Presentations

Distress
Insomnia
Risky behaviours
Self-harm
Social withdrawal
Somatisation
Suicidal ideation
Trauma – direct, indirect, and intergenerational

Conditions

Anxiety disorder
Attachment difficulties
Complex developmental trauma
Depression
Grief and bereavement
Medical trauma
Needle phobia
Post-traumatic stress disorder
Separation anxiety

Musculoskeletal and rheumatological

Presentations

Joint pain
Joint swelling
Limp / Non-weight bearing
Pain of musculoskeletal origin
Plagiocephaly
Torticollis

Conditions

Arthritis
Developmental dysplasia of the hip
Hypermobility and associated syndromes
Irritable hip / Transient tenosynovits
Musculoskeletal complications of neuromuscular conditions
Osteomyelitis
Perthes disease
Regional pain syndromes
Septic arthritis
Slipped upper femoral epiphysis
Talipes

Neurological and rehabilitation

Presentations

Abnormal eye movement
Abnormal gait
Altered sensation
Chorea
Developmental regression
Headache
Hypotonia
Macrocephaly
Microcephaly
Seizures
Visual disturbance
Vertigo
Weakness

Conditions

Acute disseminated encephalomyelitis (ADEM)
Bell’s palsy
Central nervous system infections
Cerebral palsyDuchenne muscular dystrophy
Encephalopathy
Epilepsy
Functional neurological disorder
Guillain-Barre syndrome
Hydrocephalus
Infantile spasms
Malformations of central nervous system
Migraine
Spina bifida
Spinal cord injury
Tension headache and other chronic headache disorders
Transverse myelitis
Traumatic brain injury

Pain medicine

Presentations

Chronic abdominal pain
Chronic back pain
Chronic headache
Muscle spasm
Non-cardiac chest pain
Non-inflammatory joint pain
Pain in children following head injury / spinal cord injury

Conditions

Anxiety
Avascular necrosis; Perthe’s disease
Cerebral palsy
Chronic mixed headache
Complex regional pain syndrome (CRPS)
Connective tissue disorders
Costo-chondritis
Depression
Functional abdominal pain
Functional neurological disorder (FND)
Hypermobility / EDS / Connective tissue disorders
Inflammatory bowel disease
Long-term cancer side-effects
Migraine
Muscular dystrophy
Pelvic pain
Scoliosis, spondylolisthesis, spinal cord injury
Short-gut syndrome
Visceral hyperalgesia

Respiratory and sleep

Presentations

Aspiration
Cough
Dyspnoea
Shortness of breath
Sleep disturbance
Snoring
Stridor
Wheeze

Conditions

Asthma
Bronchiectasis
Bronchiolitis
Chronic neonatal lung disease
Croup
Cystic fibrosis
Obstructive sleep apnoea
Parasomnias
Protracted bacterial bronchitis
Respiratory tract infections
Sleep-wake phase disorders
Tracheomalacia

Cardiology

Cardiomyopathies
Heart failure
Hypertension
Infective endocarditis
Pericarditis
Rare congenital cardiac conditions

Ear, nose, and throat

Airway stenosis
Cleft palate
Pierre Robin Sequence
Tracheostomy

Endocrinological

Addison disease
Congenital adrenal hyperplasia
Cushing syndrome
Disorders of growth
Disorders of sexual differentiation
Hyperthyroidism
Osteoporosis
Parathyroid disease
Pituitary disease
Rickets
Transgender endocrine management

Gastrointestinal

Congenital GIT malformations
Cyclical vomiting
Eosinophilic oesophagitis
Hirschprung disease
Liver disease
Malabsorption syndromes
Neurogenic bowel
Pancreatitis

Genetic and metabolic medicine

Achondroplasia
Alagille syndrome
Alpha-1 antitrypsin deficiency
Angelman syndrome
Beckwith–Wiedemann syndrome
Fragile X syndrome
Genetic malignancies
Marfan syndrome
Mitochondrial disorders
Myotonic dystrophy
Osteogenesis syndromes
Prader–Willi syndrome
Storage disorders
Sturge–Weber syndrome
Substrate metabolism disorders
Treacher Collins syndrome
Trisomy 13
Trisomy 18
Williams syndrome

Haematological / Oncological

Asplenia
Bone marrow failure
Cancer predisposing syndromes
Hypersplenia
Hyposlenia
Iron overload
Leucocyte disorders
Neutropenia
Rare leukaemias
Rare solid tumours
Red cell structural disorders
Thrombosis

Immunological

Autoimmune disorders
Complement deficiencies
Immunodeficiency syndromes
Neutrophil abnormalities

Infectious diseases

Arboviruses
Dengue fever
Emerging viruses
Hepatitis viruses
Human immunodeficiency virus (HIV)
Infections with antibiotic resistant organisms
Infective endocarditis
Japanese encephalitis
Malaria
Mycobacterial infections
Parasitic infections
Tuberculosis
Typhoid fever

Kidney

Alport syndrome
Bartter syndrome
Chronic kidney disease
Diabetes insipidus (nephrogenic)
Gitelman syndrome
Haemolytic uraemic syndrome
Interstitial nephritis
Kidney tubular disorders
Nephrotic syndrome
Renal calculi

Mental health

Bipolar and related disorders
Psychosis

Musculoskeletal and rheumatalogical

Chronic musculoskeletal pain
Juvenile dermatomyositis
Juvenile idiopathic arthritis
Localised scleroderma
Systemic lupus erythematosus

Neurological

Autonomic dysreflexia
Central nervous system inflammatory and immune mediated disorders
Central nervous system tumours
Central venous sinus thrombosis
Cerebellar disorders
Charcot–Marie–Tooth disease
Congenital eye abnormalities
Congenital myasthenic syndromes
Demyelinating disorders
Idiopathic intracranial hypertension
Motor neurone disease
Movement disorders
Muscular dystrophy
Myopathy
Neural tube defects
Neurocutaneous syndromes
Neurodegenerative disorders
Peripheral neuropathy
Spinal cord compression
Spinal muscular atrophy
Stroke

Respiratory

Chylothorax
Congenital lung abnormalities
Excessive daytime sleepiness and hypersomnolence
Interstitial lung disease
Narcolepsy
Pleural effusion
Pneumothorax
Respiratory failure

LG12: Neonatal and perinatal medicine

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

Antenatally diagnosed conditions
Billious vomiting
Cardiac murmurs
Collapsed neonate
Cyanosis
Dysmorphic features
Floppy infant
Hypoglycaemia
Hypothermia
Jaundice
Large for gestational age
Neonatal resuscitation
Poor feeding
Preterm neonates
Respiratory distress
Seizures
Slow growth
Small for gestational age
Vomiting

Conditions

Air leak syndromes:
- pneumomediastinum
- pneumothorax
Anaemia
Apnoea
Birth trauma:
- brachial plexus palsy
- cephalhaematoma
- clavicular fracture
- subgaleal haemorrhage
Bronchopulmonary dysplasia
Chronic lung disease
Congenital anomalies of the kidney and urinary tract
Congenital heart disease, including duct-dependent circulation
Congenital malformations:
- cleft lip or palate
- digit / limb abnormalities
- Pierre Robin sequence
- sacral dimples
- single umbilical artery
Congenital pneumonia
Developmental dysplasia of the hips
Electrolyte abnormalities
Gastro-oesophegeal reflux
Group B strep sepsis screening and management
Head moulding
Hypoglycaemia
Hypoxic ischaemic encephalopathy
Infant of diabetic mother
Intracranial or intraventricular haemorrhage
Intrauterine growth restriction
Meconium aspiration syndrome
Meningitis and encephalitis
Necrotising enterocolitis
Neonatal abstinence syndrome
Neonatal asphyxia
Neonatal infection
Nasolacrimal duct obstruction
Persistent pulmonary
Plagiocephaly hypertension
Polycythemia
Respiratory distress syndrome
Retinopathy of prematurity
Sepsis
Shock
Skin conditions
Small for gestational age
Transient tachypnoea of the newborn

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Ambiguous genitalia
Choanal atresia
Chromosomal and genetic conditions
Congenital adrenal hyperplasia
Congenital and perinatal infections
Congenital brain abnormalities
Congenital diaphragmatic hernia
Congenital eye abnormalities
Congenital lung abnormalities
Congenital skin disorders, such as ichthyosis and epidermolysis
Disseminated intravascular coagulation (DIC)
Extreme prematurity
G6PD deficiency
Gastrointestinal emergencies
Haematological conditions:
- acute bleeding disorders:
  - lymphopenia
  - neutropenia
  - thrombocytopenia
  - vitamin K-deficient bleeding
- haemolytic disease of the newborn
Hereditary spherocytosis
Herpes simplex virus – approach to infants at risk or with suspected infection
Hyperthyrodism
Hypothyroidism
Larygneal lesions
Metabolic disorders
Neonatal encephalopathy
Neural tube defect
Perinatal stroke
Periventricular leukomalacia
Pulmonary interstitial emphysema
Respiratory failure
Stridor
Supraventricular tachycardia

Surgical problems in the neonate

Abdominal wall defects
Atresia:
- anal
- duodenal
- oesophageal
Hirschprung disease
Hypospadias
Inguinal hernia
Intestinal malrotation, with or without volvulus
Meconium ileus
Trachea-oesophageal fistula
Undescended testes

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Anatomy, neurodevelopment, and physiology aspects of feeding and gut maturation in term and pre-term infants
Drug metabolism in the neonate and breastfeeding mother, and appropriate and safe prescribing
Effects of intrauterine and perinatal events on outcome
Pathophysiology of common and uncommon neonatal conditions
Physiology of extra-uterine adaptation, including initiation of feeding, and changes to cardiac and respiratory physiology

Clinical assessment tools

Neonatal growth charts (Fenton)
Newborn hearing screening
Postnatal assessment of gestestional age (Ballard / Dubowitz)

Investigations

Blood tests:
- bacterial and viral PCR
- biochemistry
- blood gas
- endocrinological
- genetic investigations
- haematological
- inflammatory markers
- metabolic screening tests
- microscopy:
  - culture and antimicrobial sensitivity
- newborn screening
Cardiac studies:
- echocardiography
- electrocardiography (ECG)
Electroencephalography (EEG)
Other pathology:
- cerebral spinal fluid microscopy:
  - culture and antimicrobial sensitivity
- swabs from sterile and non-sterile sites
- urine microscopy:
  - biochemistry
  - culture and antimicrobial sensitivity
  - metabolic screening
- viral PCR
Radiology:
- MRI
- plain x-rays
- ultrasound
- upper gastrointestinal contrast study

Procedures

Awareness of role of adjuncts to diagnostic assessment and procedures, such as:
- point of care ultrasound (POCUS)
- transcutaneous bilirubinometer
- transilluminator
Intramuscular injections:
- vaccinations
- vitamin K injection
Intubation
Lumbar puncture
Needle thoracostomy and intercostal drain insertion
Nasogastric (N-G) tube placement
Peripheral intravenous (IV) access, including knowledge of:
- mid lines
- peripherally inserted central catheters (PICC)
Suprapubic aspirate
Surfactant administration
Transfusion of blood and blood products
Umbilical venous and arterial catheterisation
Urinary catheter insertion

Administration of maternal medications such as magnesium sulfate, steroids, and tocolytics for prevention of premature birth, prevention of perinatal morbidity, and neuroprotection
Antenatally diagnosed conditions, such as:
- cerebral ventricular dilatation
- choroid plexus cysts
- congenital heart disease
- dilated kidney system
Antenatal screening
Breastfeeding difficulties and support
Congenital conditions associated with maternal conditions, such as:
- maternal infections
- maternal medical diseases
- maternal substance use / misuse
- teratogens
Continuous positive airway pressure (CPAP) and humidified high-flow oxygenation
Developmental care for neonates
Early intervention services
Extreme prematurity – decision making, along with obsteric collegues, regarding:
- immediate care of the neonate
- limits of viability
- managing labour
Feeding difficulties
Growth patterns in newborn period
Immunisation of term and preterm infants
Implications and considerations in the redirection of care and palliative care
Implications of congenital abnormalities for continuation of pregnancy and method of delivery
Implications of congenital abnormalities for development, physical, and psychological function during childhood and adolescence
Implications of congenital abnormalities for genetic counselling
Infant care, feeding, and sleep
Infant caregiver relationship
Local resources available to ensure monitoring of growth and development in the newborn
Manual and mechanical ventilation, including bag mask and T-piece
Multiple pregnancies and complications
Neonatal fluid management, including intravenous fluid prescription
Neonatal resuscitation
Neurodevelopmental outcomes and follow-up
Normal growth and development in neonates
Normal neuro-developmental milestones in preterm infants
Nutritional requirements of term and preterm infants:
- enteral feeding and parenteral nutrition
Parental counselling
Perinatal epidemiology
Postnatal depression
Preterm neonate complications, such as:
- anaemia
- chronic neonatal lung disease
- electrolyte disturbances
- intraventricular haemorrhage
- long-term neurodevelopmental disability
- metabolic bone disease
- necrotising enterocolitis and spontaneous intestinal perforation
- nosocomial infection
- patent ductus arteriosus
- retinopathy of prematurity
Prevention of perinatal mortality and low birth weight
Principles of stabilisation and management of neonate prior to and during transport
Procedural pain management, including sucrose and non-pharmacological supports
Risk factors for neonatal sepsis and neonatal sepsis calculators
Transport and retrieval issues
Transport and retrieval services
Vitamin, probiotic, and mineral supplementation and fortification options in premature infants

LG13: Acute care

Key presentations and conditions

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

More detailed conditions and presentations are presented as an appendix.

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

Appendix

Advanced trainees will have knowledge of a variety of acute presentations and conditions across the scope of general paediatrics, including but not limited to those listed here.

Advanced trainees should be able to recognise conditions, and be familiar with initial stabilisation and resources / referral pathways for ongoing care.

View

Common and key presentation types

Abdominal pain
Accidental ingestion / poisoning
Acute behavioural disturbance
Acute mental health presentations
Acute presentations in adolescents / young adults
Acute presentations in child with developmental disability
Acute presentations in neonate / young infant
Altered conscious state
Anaphylaxis and allergy
Back pain
Breathing difficulties, such as:
- cough
- stridor
- wheeze
Cardiorespiratory arrest
Collapse
Constipation
Diarrhoea
Feeding difficulties
Fever
Fluid and electrolyte disturbance
Gait disturbance
Gynaecological conditions
Headache
Infection
Jaundice
Joint pain or swelling
Limp
Lymphadenopathy
Metabolic disorder
Neonatal resuscitation
Oncological presentations
Pain:
- generalised
- localised
Pallor
Penile and testicular conditions
Rashes
Recurrent unexplained presentations
Seizures
Seriously ill child
Seriously injured child
Shock
Slow growth
Substance use
Suspected child abuse and neglect
Vomiting
Weakness:
- generalised
- localised

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

Synthesise

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

Manage

provide evidence-based management including use of medications
for less common or more complex presentations and conditions, the trainee must also seek expert opinions
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

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

Basic toxicology
Clinical pharmacology
Pathophysiology of cardiovascular failure
Pathophysiology of coma
Pathophysiology of respiratory failure
Pathophysiology of shock
Physiology of acid–base and electrolyte disturbances

Investigations

Blood tests:
- bacterial and viral PCR
- biochemistry
- culture and antimicrobial sensitivity
- endocrinological
- haematological
- inflammatory markers
- serology
Cerebral spinal fluid:
- culture and antimicrobial sensitivity
- microscopy
- role for additional testing (autoimmune / metabolic)
Echocardiography
Radiology:
- CT scan
- MRI
- plain x-rays
- ultrasound
Site swabs and samples:
- culture and antimicrobial sensitivity
- microscopy
Urine:
- biochemistry
- culture and antimicrobial sensitivity
- microscopy
- toxicology screen

Clinical assessment

A – E assessment of the critically unwell child
Primary, seconday, and tertiary survey

Procedures

Airway stabilisation procedures
Indwelling catheter insertion
Intercostal catheter insertion
Intraosseous needle insertion
Intravenous cannulation
Lumbar puncture
Midline insertion
Nasogastric tube insertion
Needle thoracocentesis
Percutaneous long line
Point of care ultrasound (POCUS), including an understanding of its role in procedures and as a diagnostic aide
Suprapubic aspiration
Umbilical venous catheter insertion

Advanced paediatric life support algorithms
Basic principles of postoperative care for critically unwell surgical neonates, infants, children, or young people:
- preoperative requirements for newborns, infants, children, or young people undergoing major surgery
- risks of major surgery for newborns, infants, children, or young people with chronic disability and illness
Clinical handover and referral, including use of tools
Complications of in situ medical devices, such as:
- central venous access devices
- intrathecal baclofen pumps
- ventriculoperitoneal shunt
Crisis resource management principles
Criteria for ICU admission, and recognition of differing resources in different clinical contexts
Critical incident debriefing principles
Drug management of infants or children for safe ETT paralysis and sedation
Fluid management
Inotropes – understand the indications and commencement in resuscitation
Local escalation and emergency procedures
Manual and mechanical ventilation
Medicolegal requirements for certifying death of a child
Neuroprotective measures
Non-invasive ventilation:
- bilevel positive airway pressure (BiPAP)
- continuous positive pressure ventilation (CPAP)
- use of T-piece device (e.g., Neopuff)
Nutritional requirements of critically ill infants, children, or young people:
- enteral feeding and parenteral nutrition
Oxygen delivery, including evidence-based use of humified high-flow oxygen
Procedural sedation, anxiety, and pain management:
- non-pharmacological – child life therapist
- pharmacological
Resuscitation calculators and emergency guidelines
Retrieval services:
- receiving patients
- referral and transfer
- understanding of key issues for stabilisation
Use of modern ventilators, especially modes for neonatology and paediatrics in the work setting

Acute presentations in neonates / young infants

Apnoea
Bradycardia
Brief resolved unexplained event (BRUE)
Congenital abnormalities
Feeding difficulties
Jaundice
Meconium aspiration
Respiratory distress syndrome
Sepsis
Slow growth
Unsettled infant
Vomiting

Acute injury

Presentations

Acute sexual assault
Burns
Cervical spine injury
Envenomation
Foreign bodies:

ingested
inhaled
inserted

Fracture
Haemorrhage
Head injury or concussion
Immersion
Ingestion / Poisoning
Laceration
Ocular trauma or foreign body
Pulled elbow
Unexplained / Non-accidental injury

Allergy and immunology

Adverse drug reactions
Acute urticaria
Anaphylaxis
IgE mediated and non-IgE mediated food allergies, including food protein enterocolitis syndrome (FPIES)
Primary immune deficiencies

Behavioural and psychiatric

Presentations

Aggression
Agitation
Depression
Overdose
Substance use
Suicidal and self-harming behaviour

Conditions

Anxiety
Acute psychosis
Borderline personality disorder
Despression
Eating disorders

Cardiovascular

Presentations

Chest pain
Cyanosis
Hypertension
Palpitations
Tet spells

Conditions

Arrhythmias and rhythm disorders
Congenital heart disease, including duct-dependent lesions
Heart failure
Myocarditis
Pericarditis

Endocrinological and metabolic

Conditions

Adrenal crisis
Diabetic ketoacidosis (DKA)
Glucocorticoid insufficiency
Hypercalcaemia
Hyperglycaemia, including diabetes mellitus
Hypocalcaemia
Hypoglycaemia
Inborn errors of metabolism
Pituitary crisis
Thyroid crisis

Ear, nose, and throat

Presentations

Dental pain
Ear pain or discharge
Stridor
Throat pain

Conditions

Croup
Ear infections
Epiglotitis
Mastoiditis
Peritonsillar abscess
Retropharyngeal abscess
Tonsillitis:
- bacterial
- viral
Tracheitis

Fluid and electrolytedisturbance

Dehydration
Fluid overload
Hyperkalaemia
Hypernatraemia
Hypokalaemia
Hyponatraemia

Gastrointestinal and nutrition

Presentations

Abdominal pain:
- acute
- chronic or recurrent
Abdominal trauma
Bloody stools
Constipation
Diarrhoea
Vomiting

Conditions

Appendicitis
Coeliac disease
Colitis:
- allergic
- infective
- inflammatory
Gastritis
Gastroenteritis
Gastro-oesophegeal reflux
Hernias
Intussusception
Malnutrition
Meckel diverticulum
Mesenteric adenitis
Micronutrient deficiencies
Pancreatitis
Pyloric stenosis
Slow growth
Volvulus

Genitourinary

Presentations

Dysuria
Haematuria
Scrotal swelling
Testicular pain – acute
Urinary retention

Conditions

Epididymo-orchitis
Hernia
Nephrotic syndrome
Testicular / Appendage torsion
Urinary tract infection

Gynaecological

Ectopic pregnancy
Dysmenorrhoea and heavy menstrual bleeding
Mittelschmerz
Other pregnancy complications
Ovarian torsion
Pelvic inflammatory disease
Ruptured ovarian cyst
Sexually transmitted infections
Vaginal and vulval conditions

Haematological / oncological

Presentations

Disseminated intravascular coagulation
Febrile neutropaenia
Haemophagocytic lymphohistiocytosis / Macrophage activation syndrome
Jaundice
Lymphadenopathy
Oncological emergencies
Oncological new presentations
Pallor

Conditions

Anaemia
B12 deficiency
Bleeding disorders, including haemophilia
Haemolysis, including G6PD deficiency
Haemolytic uraemic syndrome
Iron deficiency
Sickle cell crisis

Infectious disease

Presentations

Fever:
- with a focus
- without a focus
Fever and petechiae
Fever in neonates / young infants
Fever in returned travellers
Prolonged fever
Toxic shock syndrome

Conditions

Lymphadenitis
Meningitis and encephalitis
Orbital and periorbital cellulitis
Osteomyelitis and septic arthritis
Post-infectious conditions, such as:
- paediatric multisystem inflammatory syndrome – temporally associated with SARS-CoV-2 (PIMS-TS)
- rheumatic fever
Pyelonephritis
Rare infections, including endocarditis
Respiratory tract infections, such as:
- complex pneumonia
- pneumonia
Sepsis
Skin and soft tissue infections
Urinary tract infections
Viral infections
Viral rashes

Inflammatory / rheumatological

Henoch–Schonlein purpura
Juvenile idiopathic arthritis, including systemic onset
Kawasaki disease
Other autoinflammatory conditions

Musculoskeletal

Presentations

Joint pain / swelling
Limp / Non-weight bearing
Torticollis

Conditions

Irritable hip
Osteomyelitis
Perthes disease
Septic arthritis
Slipped capital femoral epiphysis

Neurological

Presentations

Acute confusion
Acute visual disturbance
Altered conscious state
Ataxia
Headache
Seizure:
- afebrile
- complex
- febrile
- prolonged
Weakness:
- focal
- generalised

Conditions

Acute flaccid paralysis
Bell’s palsy
Central nervous system infections
Demyelinating conditions
Encephalopathy
Epilepsy
Inflicted head injury
Migraine
Raised intracranial pressure
Spinal cord injury
Stroke
Transverse myelitis
Traumatic brain injury

Respiratory

Presentations

Apnoea
Cough
Respiratory distress
Stridor
Upper airway obstruction
Wheeze

Conditions

Asthma
Bronchiolitis
Croup
Epiglotitis
Pneumonia
Respiratory infections
Tracheititis

Skin

Presentations

Angioedema
Blistering rashes
Petechiae / Purpura
Urticaria

Conditions

Birth marks
Eczema
Haemangioma
Molluscum contagiosum
Seborrhoeic dermatitis
Viral exanthem

Undifferentiated

Presentations

Death of a child
Somatoform disorder
Sudden infant death syndrome (SIDS) or sudden unexpected death in infancy (SUDI)

LG14: Developmental paediatrics

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

Academic and learning difficulties
Adverse childhood experiences (ACEs)
Aggression
Attention and concentration difficulties
Communication difficulties
Defiance
Delayed (motor) developmental milestones
Developmental risk factors
Emotional dysregulation
Hearing impairment
Hyperactivity
Neurodiversity
Repetitive behaviours
School refusal
Sensory difficulties
Separation anxiety
Sleep problems
Social skills concern
Tics and other motor stereotypies
Vision impairment

Conditions

Anxiety
Attachment difficulties
Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorder
Complex neurodevelopmental disorders
Developmental delay
Developmental language disorder
Fetal alcohol spectrum disorder
Gross motor delay
Intellectual disability
Learning disorders
Speech and language delay
Trauma
Visual impairment

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

Synthesise

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

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, work within, and lead multidisciplinary teams to optimise individual patient care

Consider other factors

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

Conduct disorder
Developmental regression
Functional disorders
Genetic conditions impacting development
Obsessive compulsive disorder
Oppositional defiant disorder

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

Synthesise

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

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, work within, and lead multidisciplinary teams to optimise individual patient care

Consider other factors

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

Clinical pharmacology, including:
- ADHD medication
- anti-depressants
- anti-psychotics
- anxiolytics
- mood stabilisers
- sleep medications
- other common psychotropic medications used in children and young people
Health, education, and support needs of children with developmental differences
Importance and impact of early intervention / investment
Physiological, psychological, and social factors influencing child development, including adverse childhood experiences and infant mental health
Typical child behaviour, development, and growth
Typical childhood development and variations

Clinical assessment tools

Behavioural questionnaires, such as Conners Early Childhood Screen
Developmental screening tools for focused assessment of development and behaviour
Visual assessment

Investigations

Audiology
Blood tests:
- biochemistry
- endocrinological
- genetic investigations
- haematological
- metabolic screening tests
- nutritional and toxin screening
Neuroimaging
Urine metabolic screening

Assessment and diagnosis:
- diagnostic criteria and assessment pathways
- information provided in reports by allied health professionals
- longitudinal aspects of and assessment intervals for infants, children, and young people with developmental delay / disabilities
- role of allied health in assessment of infants, children, and young people with developmental delay / disabilities
Broad health and wellbeing considerations of the child and their context, such as:
- adverse childhood experiences and early life trauma, including antenatal exposures
- cultural, geographical, and socioeconomic barriers to health
- inequities in child health
- intergenerational trauma
Child health and wellbeing implications and impact of colonisation, ongoing colonialism, and current and historical government policies on First Nations People
Child health and wellbeing implications and impact of conflict / persecution / disaster fled, transit journeys, and current and historical government policies on refugee and asylum seeker children, and those with refugee-like backgrounds
Culturally safe behaviour and attitudes by health professionals
Education system considerations, such as:
- impact of disrupted education
- preschool and school structures
- preschool, school, and education processes for infants, children, and young people with developmental delays / disabilities
- role of preschool and school-based assessments for infants, children, and young people with developmental delays / disabilities
- school access and educational support
Family consideration, such as:
- family violence awareness and screening
- impact of psychosocial issues on parenting behaviours
- parenting strategies for children and young people with developmental difficulties and neurodiversity
- parenting style and behaviour management resources available to parents
- range of parenting styles, considering psychosocial and cultural variations
Health policies, resources, and services, such as:
- availability of services in regional and remote communities
- communication processes and relationships between acute care services, community centres, primary health, and private sector
- delivery of health services within individual communities
- education resources and support for families with neurobehavioral and developmental conditions
- increasing role for digital solutions, especially for bridging access gaps
- local, regional, and national disability support accessibility, policies, services and resources
- local, regional, and national public health policy and legislation affecting the health and wellbeing of infants, children, and young people
- role of government and non-government agencies in managing infants, children, and young people with developmental delays / disabilities
- role of paediatrician in community care
- role of primary health, local, and community-based services in delivery of health care for infants, children, and young people
- services and service gaps
Health and wellbeing needs of children, families, and communities across multiple cultural domains, including:
- disability
- ethnicity
- gender
- Indigenous status
- religious or spiritual belief
- sexual orientation
- socioeconomic status
Health status and needs of children and families from priority populations:
- asylum seekers, migrants, and refugees
- children in out-of-home care
- regional and remote communities
Historical First Nations trauma and post-traumatic stress disorder
Interpersonal, personal, and structural racism
Management:
- alternative medications and methods of autism spectrum disorder (ASD) management
- awareness of behavioural modification techniques in children, adolescents, and young adults
- complications / comorbidities of ASD
- importance and role of case conferences
- medications used in the management of ASD, including atypical antidepressants and antipsychotics
- non-pharmacological and pharmacological behaviour management strategies for children and young people
- non-pharmacological and pharmacological management of ADHD and comordities
- psychoactive medications available for children and young people
- regulations for prescribing stimulant medications
- role of allied health professionals when managing infants, children, and young people with developmental delays / disabilities
Principles of Indigenous trauma infomed care
Principles of patient-centred care
Principles of trauma-informed care
Psychosocial impacts of child health, such as:
- bullying
- infant mental health
- maternal-infant dyad
- social media
Rehabilitation considerations, such as:
- assessment of degree of impairment, disability, and activity limitation or participation restriction, and potential for rehabilitation
- assessment of patients following brain injury, including assessment of the severity of injury and the need for ongoing therapy and follow-up
- biopsychosocial model and its application to patient care
- indications for referral to:
  - child life therapy
  - occupational therapy
  - orthotics
  - physiotherapy
  - psychology
  - speech therapy
- long-term follow-up of infants born low birth weight, premature, or with serious medical conditions
- pain and irritability assessment in children with severe disability who are nonverbal
- sequelae following brain injury, and appreciation of executive dysfunction and its impact on learning
- use and purpose of early screening for cerebral palsy, including general movements assessment and Hammersmith Infant Neurological Examination, and referral pathways for children identified as at risk
Social determinants of health, including Indigenous determinants
Values, beliefs, and traditions related to country, family, identity, and spirituality of First Nations People, and the relation to health and wellbeing

LG15: Adolescent and young adult medicine

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

Academic and learning difficulties
Acute-on-chronic neurodevelopmental disability
Anxiety / Depression
Attention and concentration difficulties
Body image concerns
Bullying and other forms of victimisation and social exclusion
Chronic pain
Constipation
Diarrhoea
Dysmenorrhoea or heavy menstrual bleeding
Eating issues:
- food refusal
- picky eating
Family dysfunction
Fatigue / Tiredness
Gender identity concerns
Headaches
Loss of consciousness / Fainting
Medication / Treatment non-adherence
Physical violence
School refusal and excessive absenteeism
Self-harm
Skin concerns
Sleep disorders
Social media use concerns
Suicidal ideation
Transition from paediatric to adult care
Underweight / overweight

Conditions

Acne
Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorder (ASD)
Avoidant restrictive food intake disorder
Chronic fatigue syndrome
Chronic health conditions
Complex neurodevelopmental disorders
Contraception
Depression and anxiety
Diabetes
Disabilities and associated conditions
Disorders of pubertal development
Eating disorders
Epilepsy
Functional neurological disorders
Gender incongruence / dysphoria
Headaches
Menstrual conditions
Sexually transmitted infections
Substance use disorders

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 developmentally 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
consider the impact of illness and disease on growth and the bidirectional impact on education, peers, and family relationships

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
identify educational / vocational pathways

Presentations

Amenorrhoea
Electronic device addiction
Genital dermatology
Sexual abuse
Sexual dysfunction
Suicide attempt
Unexplained physical symptoms

Conditions

Complex post-traumatic stress disorder
Hypermobile Elhers–Danlos syndrome
Postural orthostatic tachycardia syndrome
Pregnancy

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 developmentally 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
consider the impact of illness and disease on growth and the bidirectional impact on education, peers, and family relationships

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
identify educational / vocational pathways

Brain development
Cognitive development and capacity to consent
Common causes of mortality and morbidity
Early developmental trauma and its impact on adolescent development
Epidemiology of alcohol and other drug use
Epidemiology of mental health and risk-taking behaviours
Normal and abnormal adolescent development, including normal and abnormal patterns of growth and pubertal development
Social determinants of health

Clinical assessment tools

ADHD assessment tools
Broad psychosocial assessment, including HEEADSS assessment
Mental health questionnaires
Mental state examination

Investigations

Blood tests
ECG
EEG / Neuroimaging
Medical imaging
Sexually transmitted infection investigations

ADHD:
- management of sleep and other complications
- non-pharmacological and pharmacological management of ADHD and comorbidities
- regulations for prescribing stimulant medications
Adolescent development and stages:
- cognitive development and psychosocial development
- gender development and identity
- normal and abnormal physical development
- sexual development and identity
Autism spectrum disroder (ASD):
- awareness of behavioural modification techniques in adolescents and young adults with neurodevelopmental disorders
- complications of ASD
- medications used in management of ASD, including atypical antidepressants and antipsychotics
- neurodiversity and need for supports to change during adolescence
- role of allied health professionals when managing young people with developmental disabilities
Chronic pain:
- non-pharmacological and pharmacological management of chronic pain and comorbidities
- understanding the role of allied health and patient education
Eating disorders:
- acute medical complications
- liaising with allied health / mental health services
- medical and nutritional stabilisation of malnutrition in eating disorders / management of in-patient eating disorders
- refeeding syndrome
- understanding psychological treatment approaches, including FBT and CBT-E
Education system:
- impact of disrupted education
- school access and educational support
- school and education processes for young people with developmental delays / disabilities
- school and post-secondary education structures
Engage and build rapport with adolescents and young adults:
- HEEADSS assessment
- interviewing young people by themselves
- motivational interviewing
Families:
- family domestic violence awareness and screening
- impact of psychosocial issues on families and young people
- improving communication within families
- parenting strategies for young people with developmental difficulties and neurodiversity
- range of parenting styles appropriate for adolescents and young adults
Gender dysphoria:
- non-pharmacological and pharmacological management of gender dysphoria and comorbidities
- understand the role of allied health and capacity assessment
Health policies, resources, and services:
- availability of services in regional and remote communities
- common barriers to health care
- communication processes and relationships between acute care services, community centres, primary health, and private sector
- delivery of health services within individual communities
- education resources and support for young people with neurobehavioural and developmental conditions
- local, regional, and national disability support accessibility, policies, services, and resources
- local, regional and national public health policy and legislation affecting health and wellbeing of young people
- managing young people with developmental disabilities and neurodiversity
- role of government and non-government agencies
- role of primary health, local, and community-based services
- role of school health services for adolescents
Health status of priority populations:
- Aboriginal and Torres Strait Islander peoples
- culturally and linguistically diverse backgrounds, including young people in refugee and asylum seeker families
- Māori and Pasifika peoples
- neurodiverse young people
- regional and remote communities
- socioeconomically disadvantaged young people
- unhoused young people
- young people in out-of-home care / juvenile justice settings
- young people with disability
Integrating mental health within medical settings
Manage chronic health conditions, including promoting adherence to treatment
Management:
- biopsychosocial model and its application to patient care
- importance and role of case conferences
- role of allied health professionals when managing young people
- use of motivational interviewing for behavioural change
- use of patient-centred care with shared goal setting with young people
Mental health:
- counselling and supporting distressed young people
- management of common mental health conditions, both non-pharmacological and pharmacological
- management of risk-taking behaviours, violence, and harm minimisation
Peers:
- intimate partner violence and safe relationships
- personal safety with social media
- psychosocial impacts of bullying
- psychosocial impacts social media
Principles of effective health services for adolescents and young adults
Principles of trauma-informed care
Provision of health care:
- assessing capacity and consent
- legal aspects and limits to providing confidential health care
- mental health risk assessment
Strengths-based care:
- capability-based – build skills and promote participation
- holistic – understand the context of young peoples’ lives
- relational – partnership-, patient-, and family-centred
Substance use:
- complications of substance use disorders
- non-pharmacological and pharmacological management of substance use disorders
- withdrawal management
Support adolescents and young adults transitioning to adult health care settings

LG16: Child safety and maltreatment

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Child sexual abuse, such as:
- sexually transmitted infections and their relationship to child sexual abuse
Patterns of inflicted and accidental injury, such as:
- abdominal and thoracic injuries
- burns
- consideration of all injuries in pre-mobile infants
- fractures
- head injuries
- intra-oral bleeding and injuries
- perplexing presentations (PP) and fabricated or induced illness (FII) in children
- poisonings
- skin and soft tissue injuries
- strangulation and suffocation

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

Synthesise

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

Manage

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

Consider other factors

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

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

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

Forensic tests on biological specimens
Imaging (radiology), such as:
- bone scan
- CT scan
- MRI
- radiographic skeletal survey
- ultrasound
Pathology tests, such as tests for:
- bleeding disorders
- bone fragility
- drugs
- genetic conditions
- metabolic conditions
- toxins
Reporting requirements:
- ethical, legal, and professional responsibilities around sharing of information regarding child safety, harm, and protection
- reporting requirements and mandatory reporting obligations
Subspeciality consultations and procedures, including retinal examination
Tests for sexually transmitted infections

Physical examination

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

Awareness of personal reactions to childhood behaviours, disability, family situations, and illnesses, and the impact these may have on professional practice
Child rights
Different types of child maltreatment and child neglect:
- educational
- emotional
- medical
- physical
- supervisory
Effective prevention for child maltreatment
Effects on children of being a perpetrator of violence, victim, or witness
Enablers and barriers to obtaining information in child maltreatment situations
Family and domestic violence
Family dysfunction, including poverty and disadvantages, and impact of social determinates of health
Impact of vicarious trauma on clinician wellbeing
Impact on the long-term health and wellbeing of children involved in the care and protection system
Management of physical and emotional maltreatment
Methods involved in developing a differential diagnosis for maltreatment victims
Parent or carer involvement in shared decision making
Peer review processes and support
Principles and procedures of forensic sample collection, including collection of biological specimens for DNA analysis
Principles of advocating for children
Principles underpinning national, state, and local policies and procedures related to child protection
Role of courts involved in the criminal justice system
Role of courts responsible for child protection, family law, and relevant courts of appeal
Role of the paediatric medical expert in writing medicolegal reports, contributing to case conferences and testifying in court in cases of child maltreatment

LG17: Rural paediatrics

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

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

Undifferentiated general paediatric presentations (LG11)
Neonatal and perinatal medicine presentations (LG12)
Acute care paediatric presentations (LG13)
Developmental paediatric presentations (LG14)
Adolescent and young adult medicine presentations (LG15)
Child safety and maltreatment presentations (LG16)

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

Health and wellbeing status of rural children

Child health priorities for rural and remote populations
Disease prevalence in rural and remote populations
Key factors contributing to the discrepancy in health and developmental outcomes of children and young people in rural and remote areas when compared to those in metropolitan areas
Regional measures of the health and wellbeing of children and young people, eg. the Australian Early Development Census
The influence of the built environment on the health of children and young people in rural and remote areas, including factors such as:
- household crowding
- water quality and sanitation
The influence of the physical environment on the health and wellbeing of children and young people, including the role of:
- environmental exposures (eg. dust / smoke, lead exposure)
- environmental risks of injury / drowning
- exposure to natural environments
- regional climate and climate change
The influence of the social environment on the health and wellbeing of children and young people in rural and remote areas, including factors such as:
- connection to family and culture
- isolation
- social expectations

Clinical practice in rural and remote regions

Appreciate the relative costs and benefits of requiring travel for clinical investigations, interventions, and other aspects of paediatric care, noting the financial and other physical or social burdens that this travel places on families and health systems
Appreciation for nuances of providing safe and effective paediatric care with reduced access to on-site resources, such as:
- collaboration with communtity and primary health
- flexible approaches
- independent practice
- resource utilisation
- use of technology
Basic principles of retrieval medicine including key issues in preparing paediatric and neonatal patients for safe aeromedical transport
Broad paediatric knowledge, including robust knowledge of management strategies for common conditions while waiting for support or referral to tertiary services (refer to other General Paediatrics knowledge guides for specific presentations and conditions)
Importance of continuing professional development and upskilling
Level and type of paediatric care that can be provided within the regional context with guidance by subspecialist/s (at a distance) for complex paediatric patients or those with uncommon conditions
The uses and limitations of telehealth services for:
- developmental assessments and ongoing care
- disability services including allied health
- paediatric specialist medical care
- support for paediatric acute care and resuscitation

Rural and remote context

Appreciation of geographical distances between rural and remote communities and nearest hospital, and nearest metropolitan centre
Barriers to health for children living in rural and remote regions
Disparities in health status and access to health care of children living in rural and remote areas
Sociodemographic and cultural profile of rural and remote communities and regions within the jurisdiction of practice and more broadly

Rural and remote health services

Availability, functions, and access to patient retrieval services
Available resources of rural hospitals and remote clinics
Regional health service structures and referral pathways
Service availability in regions within jurisdiction of practice, including:
- allied health
- disability and other support services
- emergency care
- primary care
- specialist paediatric care
Strategies and availability of resources to improve access to health care, such as funding for transport
The role of rural generalist doctors, nurses, and allied health professionals who are not specialised in paediatrics in providing paediatric care in consultation with paediatric specialists

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 General Paediatrics (Paediatrics & Child Health)

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

LG2: Team leadership

Medical expertise

Communication

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment

Medical expertise

Communication

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Clinical management

Medical expertise

Communication

Quality and safety

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG7: Acute care and procedures

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour