Curriculum standards

About this resource

The new Advanced Training in Medical Oncology (Adult Medicine) curriculum consists of curriculum standards and learning, teaching, and assessment (LTA) programs.

This document outlines the curriculum standards for Advanced Training in Medical Oncology (Adult Medicine) for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Medical Oncology (Adult Medicine) 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 a team of health professionals

This activity requires the ability to:

prioritise workload
organise multiple concurrent tasks
identify the range of team members’ skills, expertise, and roles
articulate individual responsibilities, expertise, and accountability of team members
ascertain and apply leadership techniques in daily practice
collaborate with and motivate team members
promote and adopt insights from team members
act as a role model

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information with other disciplines to develop optimal, goal-centred plans for patients
assess and effectively manage clinical risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

participate in audits and other activities that affect the quality and safety of patients’ care
participate in multidisciplinary collaboration to provide effective health services and operational change
apply appropriate use of electronic medical records and other technologies to improve safety

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
encourage open discussion of ethical and clinical concerns
respect differences of multidisciplinary team members
recognise the ethics of resource allocation by aligning optimal patients and organisational care
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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

combine high-quality care with high-quality teaching
explain the rationale underpinning a structured approach to decision making
consider the population health effect when giving advice
encourage the learner to consider the rationale and appropriateness of investigation and management options
encourage and support the use of evidence-based practice

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
actively encourage a collaborative and safe learning environment with learners and other health professionals
encourage learners to tailor communication as appropriate for different patients, such as younger or older people, and different populations
communicate effectively when teaching, assessing, and appraising learners
support learners to deliver clear, concise and relevant information in both verbal and written communication
listen and convey information clearly and considerately

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
maintain the safety of patients and organisations involved with education, and appropriately identify and action concerns

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate 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 goals and learning opportunities based on their individual learning needs
offer feedback
act as a role model
participate in teaching and supervision of professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching by developing goals and strategies to improve
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

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

The trainee may:

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

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

role model a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural competence
encourage learners to consider culturally appropriate care of Māori and Aboriginal and Torres Strait Islander peoples into patients’ management
consider factors that inform values and beliefs in teaching and learning, including gender identity, sexual orientation, cultural, ethical, and religious backgrounds

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
consider the patient during clinical teaching, and maintain standards of professional practice
act as a role model to promote professional responsibility and ethics among learners
respond appropriately to learners seeking professional guidance

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

integrate public health principles into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols and best available evidence to adhere to best practice
regularly monitor personal professional performance

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
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
participate in systems for surveillance of adverse events and near misses, including the reporting of such events
ensure that identified opportunities for improvement are raised and reported appropriately
improve health care through the use of clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure that any protocol for human research is:
- approved by a human research ethics committee in accordance with the national statement on ethical conduct in human research
- conducted in accordance with best Good Clinical Practice principles

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

identify and address biases, such as those regarding gender identity, sexual orientation, and cultural and religious diversity, in personal and group decision making to prevent harmful impacts on patient outcomes
use the expertise of culture-specific liaisons, such as Māori and Aboriginal and Torres Strait Islander peoples hospital liaison officers, to achieve best outcomes for patients and organisations

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds
effectively assess, understand, and respect cultural factors that contribute to patient decision making and health care engagement

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

contribute to developing an organisational culture that enables and prioritises patients’ safety and quality of care

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate attitudes of respect and cooperation among members of different professional teams, especially where concerns regarding the quality of health care provision are raised
partner with clinicians and managers to ensure patients receive appropriate care and information on their care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in all aspects of the development, implementation, evaluation, and monitoring of governance processes
measure, analyse, and report a set of palliative care-specific process of care and outcome clinical indicators, and a set of generic safety indicators
take part in designing and implementing organisational systems for:
- defining the scope of clinical practice
- performance monitoring and management
- clinical, and safety and quality education and training

direction
Requires some supervision

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

The trainee may:

maintain a dialogue with service managers about issues that affect patient care
contribute to relevant organisational policies and procedures
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement
identify local and major international agencies with a role in cancer control, research, and/or treatment
recognise legal issues relating to anticancer treatments, the institution and withdrawal of life support systems, and the Voluntary Assisted Dying Legislation across states, countries, and the Commonwealth

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

identify and access sources of relevant information about patients
retrieve patient histories
examine patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with patients
generate a management plan
present findings to other health professionals
enrol and manage patients on clinical trials, as appropriate

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, organised, and problem-focused medical histories, considering physical, psychosocial, and risk factors
perform full physical examinations to establish the nature and extent of problems
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses via reasonable differential diagnoses
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances and preferences into account

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients and their family, whānau, or carers to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care

direction
Requires some supervision

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

The trainee may:

anticipate, read, and respond to verbal and nonverbal cues
communicate patients’ situations to colleagues, including senior clinicians
demonstrate active listening skills

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting and effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviour through appropriate training
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
ensure patients are informed of the material risks associated with any part of proposed management plans

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

set clear goals and objectives for self-learning
self-reflect frequently
deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

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

The trainee will:

search for, compile, analyse, interpret, and evaluate information relevant to the research subject
describe Good Clinical Practice in line with international directives for all aspects of the conduct of clinical trials
recognise the role and limitations of clinical trials in regular practice
identify the rapidly evolving landscape in basic scientific, translational, and clinical research
identify relevant resources to access up-to-date evidence and guidelines
manage patients on clinical trials according to Good Clinical Practice and other protocols
identify and ethically enrol patients into clinical trials

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

display respect for patients’ cultures, and attentiveness to social determinants of health
display an understanding of at least the most prevalent cultures in society, and an appreciation of their potential culturally based beliefs, values, and perspectives, while recognising that there is individual variance within cultural groups
appropriately access interpretive or culturally focused services

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
hold information about patients in confidence, unless the release of information is required by law or public interest
assess patients’ capacity for decision making, involving a proxy decision maker appropriately

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 their families, whānau, or carers in decision making
not advance personal interest or professional agendas at the expense of patient or social welfare

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG6: Acute Care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

assess acutely unwell patients, and initiate management in the clinically appropriate care setting, such as community, sub-acute, or acute care settings
recognise clinical deterioration, and respond by following the local process for escalation of care in a patient-centred manner
recognise and manage acutely unwell patients who require decisions regarding goals of care with resultant acute resuscitation or palliation
communicate with ancillary services, such as intensive care or community-based teams

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
perform advanced life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
demonstrate knowledge of potential outcomes, risks, and complications of resuscitation
effectively assess, diagnose, and manage acute undifferentiated clinical presentations, including oncological emergencies
identify unwell patients that can be safely managed outside of hospital, and initiate robust and safe management for said patients
select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues, avoiding wasteful and morbid investigations that will not improve patient care
optimise medical management before, during, and after operations
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events, including consideration of prognosis and patient preferences
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
manage escalations, de-escalations, and transitions of care in a proactive and timely manner
provide clear and effective discharge summaries with recommendations for ongoing care

direction
Requires some supervision

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

The trainee may:

recognise seriously unwell patients requiring immediate care
apply basic life support as indicated
identify general medical principles of caring for patients with undifferentiated and undiagnosed conditions
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans
assess perioperative and periprocedural patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
use closed-loop and clear communication with other health care team members during resuscitation
facilitate early communication with patients, their families, whānau, carers, and health care team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain the situation to patients in an understandable, sensitive, and supportive manner, avoiding jargon and confirming patients’ comprehension
determine the level of health literacy of individual patients, and their level of understanding of agreed care decisions

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
determine patients’ understanding of their diseases and what they perceive as the most desirable goals of care if possible

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective supervision skills and teaching methods that are adapted to the context of the training
encourage questioning among junior colleagues and students in response to unanswered clinical questions
seek guidance and feedback from health care teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate efficient searching of literature databases to retrieve evidence
use information from credible sources to aid in decision making
refer to evidence-based clinical guidelines and protocols for acutely unwell patients
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:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
manage the transition of acute medical patients through their hospital journey
lead a team by providing engagement while maintaining a focus on outcomes

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients' 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:

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

LG7: Longitudinal care, including management of transitions

Learning Goal 7

Longitudinal care, including management of transitions

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

This activity requires the ability to:

develop management plans and goals in consultation with patients
administer chronic and advanced conditions, complications, disabilities, and comorbidities
collaborate with other health care providers to provide evidence-based, patient-centred, optimal management
facilitate patients’ self-management and self-monitoring
identify the appropriate health care providers and other stakeholders with whom to exchange pertinent, contextually appropriate, and relevant patient information
facilitate transitions of patient care to ensure optimal continuity of care between providers and settings, within the context of the patient’s goals of care and needs
collaborate within the broader health policy context

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

assess patients’ knowledge, beliefs, concerns, and daily behaviours related to their medical condition/s and/or disabilities and their management
recognise the details of patients’ medical conditions, illness severity, and potential emerging issues
contribute to medical record entries on histories, examinations, and management plans in a way that is accurate and sufficient as a member of multidisciplinary teams

Communication

confident
Ready to perform without supervision

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

The trainee will:

educate patients about their condition and expected prognosis or trajectory
encourage patients’ self-management through education to take greater responsibility for their care, and support problem solving
communicate with multidisciplinary team members, and involve patients in the dialogue
communicate with patients about their management plans and relevant transitions of care, and engage and support these parties in decision making
write detailed and relevant medical record entries and comprehensive handover documents, including accurate clinical assessments and management plans
initiate and maintain verbal communication with other health professionals as required
provide support for patients’ psychological, spiritual, and/or emotional concerns

direction
Requires some supervision

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

The trainee may:

provide healthy lifestyle advice and information to patients on the importance of self-management
work in partnership with patients, and motivate them to comply with agreed care plans
communicate clearly with clinicians and other health professionals
communicate accurately and in a timely manner to ensure continuity and quality of care, including during transitions of care settings and providers

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use innovative models of clinical care, including telehealth and digitally integrated support services
review medicine use, and ensure patients understand safe medication administration to prevent errors
support patients’ self-management by balancing between minimising risk and helping patients to become more independent
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living
demonstrate understanding of the medicolegal context of written communications, as well as relevant consent requirements and processes for the release and exchange of information
identify patients at risk of poor transitions of care, and identify strategies to mitigate this risk

direction
Requires some supervision

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

The trainee may:

participate in continuous quality improvement processes and clinical audits
identify activities that may improve patients’ quality of life and experience of health care
keep patient information secure, adhering to relevant privacy legislation
ensure clinical handovers are complete and accurate

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 patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery
contribute to the development of clinical pathways based on current evidence and guidelines
integrate clinical education in handovers and transition of care meetings

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management
provide opportunities to teach junior colleagues

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

search literature using problem / intervention / comparison / outcome (PICO) format
recognise appropriate use of review articles

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate with careful consideration to health literacy, language barriers, and culture, respecting patient choices
recognise the timing, location, privacy, and appropriateness of sharing information with patients
encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management

direction
Requires some supervision

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

The trainee may:

provide culturally safe medical care
consider whether an interpreter is required

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information, consistent with privacy laws and confidentiality and professional guidelines
use consent processes for the release and exchange of health information
assess patients’ decision-making capacity, and appropriately identify and use alternative decision makers

direction
Requires some supervision

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

The trainee may:

share information between relevant service providers
acknowledge and respect the contributing role of patients, their families, whānau, carers, and other health professionals in patient care

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patient care occurs in the most appropriate facility or setting
implement appropriate clinical care pathways in accordance with up-to-date clinical evidence
recognise patients’ needs in terms of both internal resources and external support on long-term health care journeys

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through all stages of the patients’ care journey
use a multidisciplinary approach to manage patient care, showing respect for the roles and expertise of all involved health professionals and care providers
develop collaborative relationships with patients, their families, whānau, carers, and other health professionals

direction
Requires some supervision

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

The trainee may:

participate in multidisciplinary team meetings
recognise factors which may impact upon optimal transfer and continuity of 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:

use health screening for early intervention
help patients access relevant initiatives, supports, and services
participate in government and local initiatives to reduce hospital admissions and improve patients’ quality of life

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of government initiatives and services available for patients with cancer and their carers, and display knowledge of how to access them

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses, management plans, and prognosis with patients

This activity requires the ability to:

select a suitable context, and include family and/or carers and other team members
devise a patient-centred perspective, including adjusting for cognition and disabilities
select and use appropriate communication strategies
structure conversations intentionally
negotiate a mutually agreed management plan
verify patient understanding of information
develop and implement a management plan
discuss expected life expectancy and end-of-life care preferences
document the conversation

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:

seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients about all aspects of their management to enable them to make informed decisions about diagnostic, therapeutic, and management options, including at the end of life
anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate communication strategies for communication, such as emails, face-to-face, or phone calls
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
elicit patients’ views, concerns, and preferences, promoting rapport
encourage questions, and answer them thoroughly
ask patients to share their thoughts or explain their management plan in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
treat children and young people respectfully, and listen to their views
recognise the role of families, whānau, and carers in decision making, and encourage patients to involve them when appropriate
share confronting information, including prognoses, in a compassionate, clear way and in a supportive environment
ensure communication is documented in a clear and accurate way, and in an appropriate format

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
collaborate with patient liaison officers as required
adapt communication style in response to patients’ age, developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

discuss with patients the potential benefits and harms of their management options
provide information to patients in a way they can understand before asking for their consent
consider young people’s capacity for decision making and consent
recognise and take precautions where patients may be vulnerable, such as issues of child protection, self-harm, or elder abuse
participate in processes to manage patient complaints

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

discuss the aetiology of diseases and explain the purpose, nature, and extent of the investigation and treatment options
produce informed consent or other valid authority before involving patients in teaching
role model good communication strategies and techniques for junior colleagues and learners

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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:

effectively communicate with members of cultural groups, including Māori and Aboriginal and Torres Strait Islander peoples, by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

respect the preferences of patients
communicate appropriately, consistent with the context, and respect patients’ needs and preferences
maximise patient autonomy, and support their decision making
avoid sexual, intimate, and 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, illness-related behaviours, or the illness itself
use social media ethically and according to legal obligations to protect patients’ confidentiality and privacy

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with team members involved in patients’ care
discuss medical assessments, treatment plans, and investigations with primary and other care teams, to align them with the appropriate resources
facilitate an environment where all team members feel they can contribute and their opinion is valued

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

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: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

collect and interpret medication histories
choose appropriate medicines based on an understanding of pharmacology, taking into consideration age, comorbidities, potential drug interactions, risks, and benefits
communicate with patients about the benefits and risks of proposed therapies
explain instructions on medication administration effects and side effects
monitor medicines for efficacy and safety
review medicines and interactions, and cease where appropriate
collaborate with pharmacists

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ disorders requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patient preference prior to prescribing new medications
plan for follow-up and monitoring
understand the mechanism of action, pharmacodynamics, and pharmacokinetics of chemotherapeutic agents

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
write clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
ensure patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after this single prescription
identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives
anticipate queries to help enhance the likelihood of medicines being taken as advised
ensure appropriate information is available at all steps of the medicine management pathway

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients
explain the benefits and burdens of therapies, considering patients’ individual circumstances
write clearly legible scripts or charts using generic names of required medications in full, including mg / kg / dose information and all legally required information
seek further advice from experienced clinicians or pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

review medicines regularly to reduce non‑adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
prescribe new medicines only when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
report suspected adverse events to the Advisory Committee on Medicines, 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:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

ensure patients understand management plans, including adherence issues
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
use continuously updated software for computers and electronic prescribing programs

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to ensure any new medicine improves patient-oriented outcomes
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines
consider enrolment in clinical trials, and understand the rational for trial medications

direction
Requires some supervision

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

The trainee may:

make therapeutic decisions according to the best evidence
recognise where evidence is limited, compromised, or subject to bias or conflict of interest
recognise the critical role of clinical trials in cancer drug development

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

explore patients’ understanding of and preferences for non-pharmacological and pharmacological management
offer patients effective choices based on their expectations of treatment, health beliefs, and cost
interpret and explain information to patients at the appropriate level of their health literacy

direction
Requires some supervision

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

The trainee may:

acknowledge how patients’ cultural and religious backgrounds, gender identity, sexual orientation, attitudes, and beliefs, might influence the acceptability of pharmacological and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

choose medicines in relation to comparative efficacy, safety, and cost-effectiveness against medicines already on the market
recognise the processes of drug approval and marketing in Australia / Aotearoa New Zealand
prescribe for individual patients, considering history, current medicines, allergies, and preferences

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy
explain issues surrounding cancer drug approval and prescribing, including equity of access to cancer care and drugs

LG10: Investigations and procedures

Learning Goal 10

Investigations and procedures

Select, organise, and interpret investigations and procedures

This activity requires the ability to:

select, plan, and use evidence-based clinically appropriate investigations
select, plan, and perform procedures if appropriate
produce informed consent, and perform procedures and post-procedure care
evaluate the anticipated value of the investigation or procedure
collaborate with patients to support the decisions that are right for them
interpret the results and outcomes of investigations
communicate the outcome of investigations and procedures to patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations, using them to complement comprehensive clinical assessments
assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefits
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
determine procedures by assessing patient-specific factors, risks, and alternatives, and perform if appropriate
avoid wasteful and morbid investigations that will not improve patient care

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations and indications for procedures
recognise the significance of abnormal test results, and act on these
interpret results of common diagnostic investigations and procedures
consider patient factors and comorbidities
consider age-specific reference ranges

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain to patients the potential benefits, risks, costs, burdens, and side effects of each option, including the option to have no investigations
use clear language, ensure patient understanding, and confirm their agreement to proposed investigations
provide explanations on the rationale for individual test ordering
use written, visual material, or other aids that are accurate and up to date to support discussions with patients
explain findings or possible outcomes of investigations to patients
deliver potentially distressing information to patients with care and empathy
address patients’ concerns relating to investigations and procedures, and provide the opportunity to ask questions

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from a proposed investigation, focusing on patients’ individual situations
document the notification and disclosure of adverse outcomes appropriately
ensure appropriate informed consent is obtained before undertaking any procedures

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision-making support tools
participate in ongoing self-education to improve test ordering strategies as per evidence-based guidelines
provide skills training, and specific and constructive feedback to junior colleagues

direction
Requires some supervision

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

The trainee may:

participate in continued professional development around procedures

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

recognise patients’ views and preferences about any proposed investigation and the adverse outcomes they are most concerned about

direction
Requires some supervision

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

The trainee may:

consider how patients’ gender identity, sexual orientation, cultural and religious backgrounds, attitudes, and beliefs might influence the acceptability of proposed investigations

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

practice within the scope of authority given by patients (with the exception of emergencies)
recognise own limitations and seek assistance when required
respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
advise patients if there are additional costs, which patients may wish to clarify before proceeding
explain the expected benefits, as well as the potential risks, of any proposed investigation before obtaining informed consent or other valid authority
demonstrate comprehension of genetic findings from investigations, and the complexities of subsequent disclosure

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consider the role other members of the healthcare team might play, and what other sources of information and support are available
ensure results are checked in a timely manner, taking responsibility for following up results

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

LG11: Clinic management

Learning Goal 11

Clinic management

Manage an outpatient clinic

This activity requires the ability to:

facilitate medical procedures and treatments
facilitate clinic services, including appropriate resource allocation, and use of time and services (e.g. telehealth)
measure quality improvement activities
communicate with patients, other health professionals, and team members in an inclusive and supportive manner
prepare appropriate and timely documentation, correspondence, and referrals to other health practitioners
demonstrate problem-solving skills
use public resources responsibly

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

effectively identify and address current clinical concerns, as well as longer-term clinical objectives, as appropriate to patients’ context
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
maintain timely documentation on patients’ presentation, management, and progress, including creation of accurate and appropriately prioritised problem lists in clinical notes or as part of ambulatory care reviews

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system to improve access to care by collaboration with other services, such as community health centres and consumer organisations
link patients to specific community-based health programs and group education programs
demonstrate compassion when dealing with clinical management
use appropriate written and verbal communication with other health practitioners and administrators
maintain privacy and confidentiality
demonstrate compassion and empathy in responding to verbal and nonverbal cues and emotion while giving medical information

direction
Requires some supervision

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

The trainee may:

wherever practical, meet patients’ specific language and communication needs
facilitate appropriate use of interpreter services and translated materials

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

evaluate own professional practice
demonstrate skills in educating junior colleagues
contribute to the generation of knowledge
maintain professional continuing education standards

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before involving patients in research
inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation before obtaining consent
identify up-to-date knowledge of availability of clinical trials relevant to patients

direction
Requires some supervision

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

The trainee may:

allow patients to make informed and voluntary decisions to participate in research
refer to evidence-based guidelines to assist with decision making

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community serving, and how to shape service to those people
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement and health outcomes

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

identify and respect the boundaries that define professional and therapeutic relationships
comply with the legal requirements of preparing and managing documentation
respect the roles and expertise of other health professionals
demonstrate awareness of financial and other conflicts of interest
manage factors of time and workload in a professional manner:
- clinic schedule
- feasibility
- punctuality
openly disclose and report errors

direction
Requires some supervision

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

The trainee may:

identify the responsibility to protect and advance the health and wellbeing of individuals and communities
maintain the confidentiality of documentation, and store clinical notes appropriately
ensure that the use of social media is consistent with ethical and legal obligations

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:

integrate prevention, early detection, health maintenance, and chronic condition management, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care that allows maximum benefit from the available resources
triage referrals appropriately by assessing urgency of care required
recognise the need to refer to other health professionals

direction
Requires some supervision

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

The trainee may:

identify the appropriate use of human resources, diagnostic interventions, therapeutic modalities, and health care facilities
identify general principles for local modalities

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

prepare for and conduct clinical encounters in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups
ensure that all important discussions with colleagues, multidisciplinary team members, and patients are appropriately documented
review discharge summaries, notes, and other communications written by junior colleagues
support colleagues who raise concerns about patients’ safety

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs

direction
Requires some supervision

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

The trainee may:

identify common population health screening and prevention approaches

LG12: Critical appraisal of evidence

Learning Goal 12

Critical appraisal of evidence

Critically appraise evidence to provide the best cancer care, ensuring patient safety, wise allocation of resources, and advancement of research through evidence-based practice

This activity requires the ability to:

examine research evidence to judge its value and relevance in a clinical context
prepare informed decisions about cancer treatments regarding efficacy and toxicities of treatment using the best available evidence
identify biases and limitations in research findings to prevent adoption of ineffective, clinically insignificant, or potentially harmful treatments
prioritise interventions with proven efficacy to optimise resource allocations and reduce health care costs
facilitate shared decision making between patients and clinicians using the best available evidence
identify gaps in existing knowledge to improve future research and oncology studies
demonstrate institutional policy and guidelines are evidence-based and up to date

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:

demonstrate proficiency in evidence-based medicine
use research critically to provide considered expert opinions in all aspects of clinical care, including at multidisciplinary team meetings
demonstrate the ability to have evidence-based discussions with colleagues in and out of the specialty where a difference in opinion is observed

direction
Requires some supervision

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

The trainee may:

discuss key findings from landmark trials related to cancer management
keep up to date with the publication and presentation of practice-changing evidence with reference to clinical cases

Communication

confident
Ready to perform without supervision

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

The trainee will:

facilitate informed and shared decision making with patients and their families, whānau and/or carers, including in-depth discussion of available evidence if required or appropriate
communicate evidence in a way that is understandable for patients
communicate effectively with multidisciplinary members, including allied health staff, scientists, and statisticians, regarding best practice updates
emphasise the use of clinically proven information to inform critical patient care decisions
acknowledge the significance of evidence-based clinical information in guiding patient care decisions

direction
Requires some supervision

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

The trainee may:

refer to the available evidence when making shared decisions with patients
recognise the timing, location, privacy, and appropriateness of sharing information with patients

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

document the rationale behind decisions, including factors considered, evidence, and research findings and patients’ input as reference for future care

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of updated consensus treatment guidelines and standards of care, with an ability to compare research findings with established best practices

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to teaching sessions to ensure critical appraisal skills are transferred successfully to the other members of the health care team

direction
Requires some supervision

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

The trainee may:

proactively seek to improve own ability for critical appraisal

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 proficiency in the principles of evidence-based medicine, such as hierarchy of evidence, systematic reviews, and critical appraisal tools, to evaluate research quality
appreciate and discuss the limitations of published research
identify gaps and evidence that will lead to future research

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of research methodology, such as study design, statistical analysis, and data interpretation, to identify biases, flaws, and limitations in research studies

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate with careful consideration to health literacy, language barriers, and culture, respecting patients’ choices
consider gaps in evidence surrounding cultural groups, and consider ways to improve equity in clinical trial opportunities

direction
Requires some supervision

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

The trainee may:

recognise the barriers to inclusion in clinical trials and the limitations of evidence due to cultural groups’ underrepresentation

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

reflect on ethical implications of applying evidence or research findings, especially in cases where evidence may be limited, experimental, or controversial
apply self-learning and share updates on critical appraisal techniques, new evidence, and best practices to ensure own knowledge remains current

direction
Requires some supervision

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

The trainee may:

understand the ethical aspects of oncology research, such as patient consent, research ethic boards, and conflicts of interest, to ensure research integrity

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

determine the applicability of research findings to patients, considering factors such as age, comorbidities, and patients’ treatment preferences
consider the potential benefits and risks of implementing treatments based on research findings or evidence in clinical practice, considering the impact on patients’ outcome, quality of life, and potential adverse effects
recognise the importance of being compassionate

direction
Requires some supervision

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

The trainee may:

assess the quality of research, including study design, methodology, and data analysis, to determine reliability and validity of presented evidence

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate with multidisciplinary members effectively to facilitate exchange of ideas and perspectives on new evidence
identify areas of improvement and implement evidence-based changes in own practice and/or institution

direction
Requires some supervision

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

The trainee may:

promote best practice treatment based on evidence-based findings

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:

provide recommendations for local and institutional guidelines based on best available evidence
make effective decisions on resource allocation for treatment options with best efficacy, considering adverse effects and impact on quality of life
advocate for improved access to new diagnostics, treatments, and research funding

direction
Requires some supervision

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

The trainee may:

promote shared decision making and patient-centred care based on best clinical evidence

Knowledge guides

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

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

LG13: Foundations of oncology

Epidemiology, pathophysiology, and clinical sciences

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

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Cancer biology

Cancer cell properties that differentiate it from normal cell biology:
- hallmarks of cancer
Carcinogenesis and tumour growth, including mechanisms of:
- angiogenesis
- metastasis
- proliferation
- tumour cell invasion
Cell cycle and programmed cell death:
- control by oncogenesis
- interaction with therapy
Cell mechanics, including cell adhesion and contact inhibition
Gene regulation and dysregulation
Intracellular signalling
Mechanisms of drug resistance:
- changes in drug transport
- intrinsic versus inherited
- mutations in target protein or pathway
Molecular alterations as they relate ttherapeutic targets
Protein function and aberration
Tumour immunology:
- concepts of:
  - cellular
  - humoral
  - immune checkpoints that can be therapeutically targeted
  - immune system components
  - immuno-evasion
  - immuno-surveillance
- regulatory action of cytokines on the immune system
- tumour and host immune systems inter-relationship:
  - action of cytokines on tumours
  - antigenicity
  - immune-mediated antitumour cytotoxicity

Epidemiology of cancer

Interpret measures of frequency and trends of disease, such as:
- incidence
- mortality and morbidity:
  - associated with the most common malignancies worldwide and within Australia / Aotearoa New Zealand
- odds ratio
- prevalence
- relative risk
Place epidemiological data from local and international sources intp context

Principles of cancer screening

Cancer development:
- methods of prevention
Preventive measures for cancer development:
- cancer control programs:
  - national
  - worldwide
- health promotion
- national screening programs
- prophylactic interventions:
  - chemoprevention
  - surgery
  - vaccine
- resources available
Promote health literacy for cancer prevention:
- cancer prevention strategies:
  - promote
  - recognise
- counsel patients appropriately regarding risk factors for subsequent malignancy

Scientific foundations of oncology

Aetiology of genetic and environmental factors in oncogenesis
Identification of risk factors for subsequent malignancy, such as modifiable and non-modifiable risks

Biomarkers:
- predictive
- prognostic
Indications for, and interpretation of, advanced molecular testing, such as:
- circulating tumour DNA
- next generation sequencing (NGS)
Interpretation of histopathological results
Omics, such as:
- genomic
- metabolomic
- proteomic

Communication

Breaking bad news
Cancer survivorship, such as:
- dietary
- exercise
- psychosocial wellbeing
- secondary malignancy risk
Discuss:
- clinical trials
- end-of-life care, including voluntary assisted dying
- prognosis formulation and estimation, including the use of aids in the formulation, estimation, and explanation of prognosis, risks, and benefits of treatment options
Unfunded / Novel therapy:
- embedded compassion-based practices
- management of complex family dynamics

Principles and conduct of oncology clinical trials and research

Clinical trial design:
- eligibility
- end points:
  - qualitative
  - quantitative
- study types and their respective benefits and limitations:
  - case reports
  - differences between phase I, II, III, and IV studies
  - meta-analysis
  - observational studies
  - randomised control trials
  - registry analyses
  - systematic reviews
Conduct of clinical trials:
- adherence protocol requirements and ensuring safe, patient-centred care in conduct and recording
- clinical trial assessments, such as:
  - common terminology criteria for adverse events (CTCAE)
  - response evaluation criteria in solid tumours (RECIST)
- ethics and governance
- Good Clinical Practice
Interpretation and communication of statistical analyses in relation clinical trials, and how it relates clinical practice

LG14: Oncological emergencies and acute care

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Altered bowel habit
Anorexia, malnutrition, and weight loss
Dyspnoea / Cough
Fatigue
Fever
Nausea
Organ failure
Malignant effusions
Pain
Psychospiritual crisis
Weakness

Conditions

Brain metastasis and raised intracranial pressure
Cancer-related thromboses
Cardiac tamponade
Febrile neutropenia
Severe acute electrolyte abnormalities of malignancy
Severe immune-related complications of immunotherapy
Spinal cord compression
Superior vena cava obstruction
Tumour lysis syndrome

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Paraneoplastic syndromes

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

Acknowledge:
- contributing factors
- emergencies
- pathophysiology
- risks of acute oncological presentations

Diagnose, systematically assess, and manage acute oncological emergencies requiring urgent intervention
Manage a range of symptoms and syndromes associated with an initial presentation of malignancy, and formulate appropriate diagnostic and treatment plans
Recognise the limitations of diagnostic investigations

Clinical assessments tools

Accurately stage cancers
Assessment of performance status:
- Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS) scores
- frailty screening tools, as appropriate
Interpretation of diagnostic testing, such as:
- biochemistry, haematology, and tumour markers
- imaging
- tissue pathology
Psychospiritual
Quality of life

Procedures

Insertion of subcutaneous or intravenous devices for drug delivery
Lumbar puncture
Pleural and ascitic paracentesis and pleurodesis
Selection and interpretation of biopsy techniques to obtain diagnostic tissue

Clinical trials in cancer:
- consider suitability of clinical trials for all patients presenting with cancer
- recognise vital role of research in advancing cancer care
Fertility considerations in men and women of child-bearing potential
Indications for urgent systemic therapy for acute symptomatic presentations of cancer
Recognition of the impacts of cancer on a patient and their family:
- cultural
- financial
- psychosocial
- spiritual
Recognition of the importance of:
- a multidisciplinary approach to care
- supportive care, including early introduction to palliative care teams

LG15: Management of specific malignancies

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

Breast cancer
Cancer of unknown primary site
Central nervous system malignancies:
- high grade glioma
Endocrine tumours:
- neuroendocrine neoplasms
Gastrointestinal cancers:
- colon and rectal cancer
- gastric cancer
- gastroesophageal junction cancer
- gastrointestinal stromal tumour
- hepatobiliary cancers
- oesophageal
- pancreatic adenocarcinoma
Genitourinary cancers:
- malignant germ cell tumours of the adult male
- prostate cancer
- renal cell cancer
- urothelial cancer
Gynaecologic malignancies:
- cervical cancer
- endometrial cancer
- ovarian cancer
Head and neck cancers:
- laryngeal cancer
- nasopharyngeal cancer
- oral cavity cancer
- oropharyngeal cancer
Skin cancers:
- melanoma
- squamous cell cancer
Thoracic malignancies:
- mesothelioma
- non-small cell lung cancer
- small cell lung cancer

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations and conditions

Central nervous system malignancies:
- non-high grade glioma
Endocrine tumours:
- adrenal carcinoma
- thyroid cancer
Gastrointestinal cancers:
- anal cancer
- appendiceal cancer
- small bowel cancer
Genitourinary cancers:
- penile cancer
Gynaecologic malignancies:
- gestational trophoblastic neoplasia
- ovarian germ cell
- vulvar and vaginal cancers
Head and neck cancers:
- salivary duct cancer
- sinonasal cancer
Sarcomas:
- bone sarcomas
- soft tissue sarcoma
Skin cancers:
- basal cell cancer
- Merkel cell carcinoma
Thoracic malignancies:
- thymoma and thymic cancer

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

Synthesise

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

Manage

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

Consider other factors

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

Epidemiology, pathophysiology, and clinical sciences of the aforementioned presentations and conditions.

Clinical assessments tools

Assess patients’ performance status using scoring systems, such as:
- Eastern Cooperative Oncology Group (ECOG)
- Karnofsky performance status (KPS)
Interpret diagnostic investigations to accurately stage cancers using appropriate staging systems, such as:
- tumour-node-metastasis
- tumour-specific staging systems, such as:
  - International Federation of Gynecology and Obstetrics (FIGO)
Use other clinical tools:
- frailty screening tools
- nutrition scores

Investigations

Investigations and procedures as they relate to specific cancer types, including:
- appropriate methods for obtaining diagnostic tissue
- genetic and genomic testing
- imaging
- laboratory diagnostics (e.g. blood tests)
- molecular biology / pathology
- tumour histopathology

Treatments

Detailed knowledge of:
- cancer-specific treatment protocols
- management of complications of therapy

Clinical trials in cancer:
- consider suitability of clinical trials for all patients presenting with cancer
- recognise vital role of research in advancing cancer care
Hereditary cancer syndromes:
- genetic syndromes
- principles of screening and counselling for affected patients and family members
Multidisciplinary cancer care indications for:
- other speciality care in the management of cancer
- radiotherapy
- surgery
Principles of:
- supportive care and symptom management, including early introduction to palliative care teams if indicated
- survivorship
Recognition of the psychosocial, cultural, and financial impact of cancer on patients and their families
Specific communication techniques to lead an empathetic, balanced, and culturally safe
discussion of the prognostic implications of a diagnosis of advanced cancer, including breaking bad news
Specific impacts of cancer and treatment:
- body image
- cognition
- fertility
- psychosocial wellbeing
- sexuality

LG16: Anticancer therapies

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

View

Eligibility considerations

Advanced Trainees will assess patients’ current conditions and plan the next steps.

View

Less common or more complex presentations and conditions

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

View

Undertaking therapy

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

View

Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

View

Important specific issues

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

View

For each pharmacological therapy:
- assessment and adaptation of dose and scheduling
- pharmacology:
  - pharmacogenomics
  - pharmacokinetics
- radiotherapy:
  - basic scientific principles and logistics
  - benefits and risks
  - indications
  - the role of concurrent chemotherapy as a radiosensitiser, and common chemoradiation regimens
- specific dosing considerations
- supportive care, such as antiemetics and bone modifying agents
- surgery:
  - indications in primary and palliative settings
- toxicity profile and monitoring (acute and long term)

Major therapies used in cancer

Systemic anticancer therapies:
- antibody-drug conjugates
- chemotherapy
- hormonal agents
- immune checkpoint inhibitor therapy
- molecularly targeted therapy
- monoclonal antibodies
- theranostics
- tumour vaccines
- tyrosine kinase inhibitors

Cancer stage and goals of care
Identification and assessment of special conditions that influence the treatment of older people with malignant disorders
Identification of the potential effect of patients’ comorbid medical conditions on the toxicity and efficacy of treatment
Impact of cultural, geographical, psychological, socioeconomic, and spiritual factors in the accessibility and suitability of specific treatments
Indications for specific anticancer therapies (pharmacological and non-pharmacological) in different settings, such as:
- adjuvant
- concomitant
- definitive
- neoadjuvant
- palliative

Indications and role of repeat biopsies and predictive testing:
- repeating immunohistochemistry or molecular testing after progression to guide future therapy
Management of complex presentations:
- conflicts in care decisions
- delayed diagnoses
- oncological emergencies
- pregnancy
- recognition of complex interplay between:
  - care wishes
  - medical and psychological comorbidities
  - socioeconomic and cultural factors in patient presentations
  - therapy choices
Principles and indications for specific predictive testing, such as:
- dihydropyrimidine dehydrogenase enzyme deficiency testing when considering fluoropyrimidine-based chemotherapy
- role of molecular oncology in guiding treatment decisions

Administration management of chemotherapy:
- informed consent for treatment
- management of extravasation
- management of infusion reactions
- types of venous access devices, management, and complications
Education of patients on identifying and managing toxicities related to anticancer therapies, including prompts for emergency escalation
Identification, assessment, and management of the unique toxicities associated with immune checkpoint inhibitors, including:
- cardiotoxicity
- cutaneous toxicity
- endocrinopathies, including such as thyroid toxicity
- gastrointestinal toxicity, including colitis
- haematological toxicity
- hepatotoxicity
- musculoskeletal toxicity
- neurological toxicity
- ocular toxicity
- pulmonary toxicity
- renal toxicity
Identification, assessment, and management of toxicities of systemic anticancer therapies, such as:
- constipation
- cytokine release syndrome (CRS)
- cytopenia and use of granulocyte-colony stimulating factors
- diarrhoea
- fatigue
- febrile neutropenia and infections
- impact on sex and fertility
- mucositis
- nausea and vomiting:
  - cardiac toxicities
  - cutaneous toxicities
  - neuropathy
  - ocular toxicities
  - organ-specific effects
  - pneumonitis
Knowledge of biochemical, clinical, and radiological markers of responsiveness to therapy
Supportive treatments during anticancer therapy:
- complementary therapies
- including role for multidisciplinary care

Post-treatment effects:
- fertility
- late complications of treatment:
  - chemotherapy:
    - cardiotoxicity
    - endocrine toxicities
    - secondary malignancy risk
  - immune-related complications of immunotherapy
- neuropathy
- psychosocial impact
Surveillance schedules and roles for shared care models

Clinical trials in cancer:
- consider suitability of clinical trials for all patients presenting with cancer
- recognise the vital role of research in advancing cancer care
Principles of:
- cancer drug development and the rapidly evolving landscape of clinical trials in cancer
- principles of survivorship, including assessment of chronic / late drug toxicities and management of the fear of cancer recurrence

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 Medical Oncology (Adult Medicine)

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Acute Care

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making