Curriculum standards

About this resource

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

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

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

Download the curriculum standards PDF

LG1: Competencies

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

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

Competencies will be common across training programs.

Medical expertise

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

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

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

Diagnosis and management. Develop diagnostic and management plans that integrate an understanding of individual patient circumstances, including psychosocial factors and specific vulnerabilities, epidemiology, and population health factors in partnership with patients, families, 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
articulate individual responsibilities, expertise, and accountability of team members
identify the range of team members’ skills, expertise, and roles
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, including demonstrating followership when 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:

synthesise information with other disciplines to develop optimal, goal-centred plans for patients
use evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risks 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, 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 by tailoring messages to different stakeholders
lead multidisciplinary discussions about patients’ cases and management

direction
Requires some supervision

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

The trainee may:

communicate adequately with colleagues, patients and 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

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
identify personal gaps in skills and knowledge, and engage in self-directed learning
maintain current knowledge of new technologies, health care priorities, and changes of patients’ expectations
teach competently by imparting professional knowledge
manage and monitor learner progress, providing regular assessment and feedback
participate in local, national, and international organisations, meetings, and/or craft groups

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
attend local, national, and international meetings and craft groups

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, religion, ethnicity, 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
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
work effectively as a member of a team
promote team values of honesty, discipline, and commitment to continuous improvement
demonstrate understanding of the negative impact of workplace conflict

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

acknowledge 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
plan, deliver, and provide work-based assessments
promote learners to be self-directed and identify learning experiences
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 patient-centric view during consultations
consider the population health effect when giving advice
encourage the learner to consider the rationale and appropriateness of investigation and management options
act as a role model demonstrating a flexible, holistic, reflective, evidence-based approach to practice
demonstrate the required knowledge, skills, and attitudes to provide appropriate teaching,learning opportunities, supervision, assessment, and mentorship

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

establish rapport and demonstrate respect for junior colleagues, medical students, and other health professionals
communicate effectively when teaching, assessing, and appraising learners
actively encourage a collaborative and safe learning environment with learners and other health professionals
encourage learners to tailor communication as appropriate for different patients, such as younger or older people and different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication
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 personal 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 and learning opportunities based on their individual learning needs
offer feedback and role modelling
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, 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 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 cultural, ethical, and religious values and beliefs in teaching and learning

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

prioritise workloads and manage learners with different levels of professional knowledge or experience
link theory and practice when explaining professional decisions
promote joint problem solving
support a learning environment that allows for independent decision making
use sound and evidence-based judgement during assessments and when 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 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
lead in multidisciplinary teams by promoting an open culture of learning and accountability by challenging and inspiring colleagues, and supporting the development of leadership qualities and critical decision-making skills

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
know about and work with local, national, and international advocacy and policy organisations

direction
Requires some supervision

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

The trainee may:

start to integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify and report actual and potential (near miss) errors
perform and evaluate system improvement activities
comply with best practice guidelines
inspect clinical guidelines and outcomes
contribute to 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
perform audits to identify areas of improvement in health care, and ideally perform re-audits to see the impact of amelioration strategies
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures
enrol patients on appropriate clinical trials and adhere to them as per Good Clinical 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 in clinical practice
use local guidelines to assist patient care decision making
be aware of appropriate clinical trials

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
discuss with patients any safety and quality concerns they have relating to their care
manage complaints appropriately, according to local policies
implement the organisation’s open disclosure policy
gain consent from families via an informed consent process for appropriate procedures, clinical trials, and other processes

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
understand informed consent processes for procedures and clinical trials

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of a systematic approach to improving the quality and safety of health care
demonstrate an understanding of the importance of standards of practice and clinical trials

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

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
take informed consent for research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort involving all key health professionals
support multidisciplinary team activities to lower patients' risk of harm, and promote multidisciplinary programs of education
actively involve clinical pharmacists in the medication-use process
take responsibility for investigating, reporting, resolving, and evaluating risk / hazard incidents

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

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 management plans
present findings to other health professionals

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

practice independently in a safe manner
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
recognise, assess, and manage acute general oncological issues, including:
- serious presenting complaints as described in acute care
- symptom management
- toxicity from treatment
work within multidisciplinary teams, including other medical specialities and allied health professionals
apply knowledge of the clinical and biomedical sciences relevant to oncological and haematological conditions
develop management plans based on relevant guidelines and current literature, considering the balance of benefit and harm by taking patients’ personal circumstances 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
recognise serious medical issues, including treatment toxicity, and escalate appropriately

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 to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
plan and manage patients’ transitions appropriately, considering the disease type / stage and treatment required
explain diagnoses to patients with compassion and awareness that this may be distressing

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviours
obtain informed consent before undertaking any investigation or providing treatment (except in emergencies)
ensure patients are informed of the material risks associated with any part of proposed management plans
participate in local, national, and international clinical trials for the best outcome for the patient and ongoing improved practice for all
present patients at multidisciplinary meetings, and follow meeting consensus

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
document history and physical examination findings, and synthesise with clarity and completeness
provide care in accordance with current guidelines

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
incorporate teaching into daily clinical activities

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, find, compile, analyse, interpret, and evaluate information relevant to research subject
enrol via informed consent process onto appropriate 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
consider available evidence, guidelines, and clinical trials
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge and 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 paediatric oncology care

Learning Goal 6

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

assess seriously unwell patients and initiate management
recognise clinical deterioration and respond by following the local processes for escalation of care
recognise and manage acutely unwell patients who require resuscitation
coordinate the resuscitation team initially, and involve other necessary services
communicate with transport services and medical teams
perform this activity in inpatient or outpatient settings, including day units

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 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 risks and complications of resuscitation
effectively assess, diagnose, and manage acute undifferentiated clinical presentations
effectively assess, diagnose, and manage specific oncological and haematological new diagnoses and emergencies
select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
provide clear and effective discharge summaries with recommendations for ongoing care
manage de-escalations, escalations, or transitions of care in a proactive and timely manner
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
optimise medical management before, during, and after operations
optimise supportive care, including for pain, other cancer- or therapy-related symptoms, and in the palliative setting

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
escalate care expediently to senior staff for any acute or concerning issues
apply advanced life support as indicated
recognise 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, including working closely with other medical specialists
use closed-loop and clear communication with other team members during resuscitation
facilitate early communication with patients, families, carers, and team members to allow shared decision making
negotiate and review realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ developmentally appropriate communication strategies appropriate for children, adolescents, and young adults and those with cognitive difficulties
maintain respect for parents’ / families’ wishes in regard to communications with their child, adolescent, or young adult
communicate with patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
determine individual patients' level of health literacy and 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
communicate appropriately to the age and developmental stage of patients, and to parents or carers
recognise adolescents and young adults as a specific group with specific communication needs
use interpreters

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
maintain up-to-date knowledge of acute oncological and haematological conditions, including specific toxicities from new therapies, such as immune mediated toxicities
use clinical information technology systems for conducting prospective and retrospective clinical audits
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
analyse adverse incidents and sentinel events to identify system failures and contributing factors
document treatment given without consent in an emergency according to local guidelines
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability

direction
Requires some supervision

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

The trainee may:

evaluate quality of processes through well-designed audits
recognise the risks and benefits of operative interventions
evaluate 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 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
seek opportunities to debrief after serious acute events

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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 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:

develop management plans that are based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
advise patients of their rights to refuse medical therapy, including life-sustaining treatment
consider the consequences of delivering treatment that is deemed futile, directing to other care
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 or de-escalation of care, and refer 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 manner when required
recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work 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:

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

LG7: Longitudinal care

Learning Goal 7

Longitudinal care

Manage and coordinate the longitudinal care of patients, including transitions, long-term follow-up, and palliative care

This activity requires the ability to:

develop management plans and goals in consultation with patients
manage chronic and advanced conditions, complications, disabilities, and comorbidities, including advanced symptom care and palliative care
collaborate with other health care providers
demonstrate continuity of care
develop management plans and goals in consultation with patients, including goals of transitions in care
facilitate patients' self-management and self-monitoring
assess the timing and risks in transition from paediatric to adult care, and patients' readiness for transition to adult care
schedule appropriately, and/or involve other specialists and allied health professionals, such as GPs, surgeons, radiation oncologists, subspeciality oncologists, clinical haematologists, and radiology and pathology specialists
communicate pertinent, contextually appropriate, and relevant patient information to appropriate health care providers and other stakeholders, such as GPs and local clinicians for rural patients
summarise and document patients' clinical cases for handover to other specialists, including adult oncologists / haematologists / survivorship teams, and/or palliative care
collaborate within the broader health policy context
perform this activity in multiple settings appropriate to the specialty, including inpatient, ambulatory, and critical care settings

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

monitor treatment outcomes and effectiveness, and adverse events
provide documentation on patients' presentation, management, and progress, including key points of diagnosis and decision making to inform coordination of care
ensure patients contribute to their needs assessments and care planning
assess adherence to treatment and monitoring plans
identify and manage key risks for patients during transition
regularly assess and review care plans for patients with serious and chronic conditions, including pain, and disabilities based on short- and long-term clinical and quality of life goals
facilitate optimal transitions of care for patients, including adapting transitions to meet individual patients' needs (e.g. if a patient has an intellectual disability)
assess patients' health literacy and developmental readiness for the demands of the adult care setting
outline the key components of a transitional care program and the differences between the cultures of paediatric and adult care services, including the role of the adult physician
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
anticipate, prevent, and manage changes in health status at the time of transition
provide symptom care and palliative care support to patients and families with and without formal palliative care involvement

direction
Requires some supervision

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

The trainee may:

assess patients' knowledge, beliefs, concerns, and daily behaviours related to their chronic condition and/or disability and its management
recognise the importance of prevention and early detection in clinical practice
assess psychosocial issues that may affect health and/or access to services
establish plans for ongoing care that include monitoring health status and managing adherence
identify the ways in which disease may impact on patients' lifestyles, such as contraception, pregnancies, employment, sport / leisure activities, and smoking
work with patients to increase opportunities to adopt healthy behaviours, such as good nutrition, good sleep hygiene, not smoking, and no excess alcohol intake

Communication

confident
Ready to perform without supervision

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

The trainee will:

encourage patients' self-management through education to take greater responsibility for their care, and support problem solving
build robust relationships with patients that will be sustainable for both parties throughout the cancer journey
encourage patients' access to self-monitoring devices and assistive technologies
communicate with multidisciplinary team members, and involve patients in that dialogue
write relevant and detailed medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals, when required
communicate with patients about transition of care, and engage and support these parties in decision making
explain the impact of oncological / haematological disease, acute or ongoing, on adolescents' and young adults' leisure and work activities

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 caregivers
use standardised verbal and written templates to improve the reliability of information transfer and prevent errors and omissions
communicate accurately and in a timely manner to ensure an effective transition between settings, and continuity and quality of care
assess patients' understanding of their illness and health care needs, and work with them to increase their understanding
use communication skills and strategies that help patients make informed decisions
recognise and explore the worries and concerns of adolescent and adult patients with cancer and haematological disorders
identify the need to shift responsibility for decision making from parents to patients, and work with patients on planning this
communicate sensitively with adolescents and young adults
recognise when it is appropriate to communicate with patients individually versus when it is appropriate to communicate with patients and their family members and/or carers
discuss with patients the differences between paediatric and adult care, such as the involvement of the parent or carer in decisions for adult patients versus paediatric patients

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use innovative models of chronic care using telehealth and digitally integrated support services
review medicine use and ensure patients understand safe medication administration to prevent errors
support patients' self-management by balancing between minimising risk and helping patients to become more independent
participate in quality improvement processes impacting on patients' abilities to undertake normal activities of daily living
identify patients at risk of a poor transition of care, and mitigate this risk
use electronic tools (where available) to securely store and transfer patient information
use consent processes, including written consent if required, for the release and exchange of information
demonstrate understanding of the medicolegal context of written communications
ensure patients are informed of the 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:

participate in continuous quality improvement processes and clinical audits on chronic disease management
identify activities that may improve patients' quality of life
ensure that handover is complete, or work to mitigate risks if the handover was incomplete
ensure all outstanding results or procedures are followed up by receiving units and clinicians
keep patients' information secure, adhering to relevant legislation regarding personal information and privacy
document patients' histories with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery
contribute to the development of clinical pathways for cancer treatment and toxicities, and chronic diseases management based on current clinical guidelines
integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved
educate adolescents and young adults about their conditions and their impacts on their lives (e.g. sexuality and contraception)
provide appropriate written / online information and resources relevant to the transition stage

direction
Requires some supervision

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

The trainee may:

explain how patient education can empower adolescents and young adults to take responsibility for their health
take opportunities to teach junior colleagues during handover, as necessary
use clinical practice guidelines for chronic diseases management

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 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)
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:

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

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management
include relevant information regarding patients' cultural, religious, and ethnic background in handovers, including 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:

share information about patients' health care, consistent with privacy laws and confidentiality and professional guidelines
use consent processes for the release and exchange of health information
assess patients' decision-making capacity, and appropriately identify and use alternative decision makers
disclose and share only contextually appropriate medical and personal information
share information about patients' health care in a manner consistent with privacy law and professional guidelines on confidentiality
demonstrate understanding of the clinical, ethical, and legal rationale for information disclosure
demonstrate understanding of the additional complexity related to some types of information, such as genetic information and blood borne virus status, and seek appropriate advice about disclosure of such information
interact in a collegiate and collaborative way with professional colleagues during transitions of care
explain the role of GPs in patients' care, including relevant guidelines and how they apply

direction
Requires some supervision

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

The trainee may:

share information between relevant service providers
acknowledge and respect the contribution of health professionals involved in patients' care
maintain respect for patients and other health professionals, including respecting privacy and confidentiality

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients' needs in terms of both internal resources and external support on a long-term health care journey
ensure patients' care is in the most appropriate facility, setting, or provider, including involving adolescent and young adult (AYA) services when necessary
identify the right time to start facilitating transition by considering the needs of individual patients
select appropriate specialists to transition patients to (e.g. GP, specialist in paediatric or adult sector, survivorship care, or palliative care)

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
use a structured approach to consider and prioritise patients' issues

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through involvement in all stages of patients' care journeys
use a multidisciplinary approach across services to manage patients with serious and chronic diseases and disabilities
develop collaborative relationships with patients and a range of health professionals
demonstrate understanding of the medical governance of patient care, and the differing roles of team members
show respect for the roles and expertise of other health professionals, and work effectively as a member of professional teams
ensure that multidisciplinary teams provide the opportunity for patients' engagement and participation when appropriate
recognise and work collaboratively with other health care providers, (e.g. allied health workers, psychologists, and AYA services)
ensure sufficient handover, including robust notes to convey complex history and/or rationale for past decisions
share the workload of transitions of care appropriately, including delegation

direction
Requires some supervision

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

The trainee may:

participate in multidisciplinary care for patients with serious and chronic diseases and disabilities, including organisational and community care on a continuing basis, appropriate to patients' context
recognise factors that impact on the transfer of care, and help subsequent health professionals understand the issues to continue care
work to overcome the potential barriers to continuity of care, appreciating the role of handovers in overcoming these barriers
recognise the importance of the multidisciplinary team in the management of adolescents and young adults

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use health screening for early intervention and chronic diseases management
assess alternative models of health care delivery to patients with chronic diseases and disabilities
participate in hospital / government initiatives for serious and chronic diseases management to reduce hospital admissions and improve patients' quality of life, using ‘hospital in the home' programs and shared care with providers closer to home
help patients access initiatives and services for patients with serious and chronic diseases and disabilities
contribute to processes for managing risks, and identify strategies for improvement in transition of care
engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital discharge
connect patients with local or online peer support groups
contribute to the development of a written transition policy, which is a document that sets out principles, standards, and practices of how transitions are managed at the centre
advocate for resources to support efficient and more effective transitions

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of government initiatives and volunteer / philanthropic services available for patients with serious and chronic diseases and disabilities, and display knowledge of how to access them
factor transport issues and costs to patients into arrangements for transferring patients to other settings
apply local and international guidelines around transitions

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

select a suitable context to discuss diagnosis and management plans, and include patients, their families, whanau and/or carers, and other team members, as appropriate
devise a patient-centred perspective, including adjusting for age, developmental stage, cognition, and disabilities
select and use appropriate communication strategies and modalities
structure conversations intentionally
negotiate mutually agreed management plans
verify patients’ understanding of information conveyed
develop and implement plans for ensuring actions occur
document conversations

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:

inform patients of all aspects of their clinical management, including assessments and investigations
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
provide patients with adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
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 clinical problems being discussed
formulate management plans in partnership with patients
attend family meetings

Communication

confident
Ready to perform without supervision

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

The trainee will:

convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
use appropriate communication strategies and modalities for communication, including:
- emails
- face-to-face
- telehealth
- phone calls
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients to share their thoughts or explain their management plan in their own words, to verify understanding
treat children, adolescents, and young people respectfully, and listen to their views
recognise the role of family and/or carers and, when appropriate, encourage patients to involve their family and/or carers in decisions about their care
inform patients / their families of multidisciplinary meeting and other professional meeting discussion outcomes

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

discuss with patients their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand before asking for their consent
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 or self-harm
participate in processes to manage patient complaints

direction
Requires some supervision

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

The trainee may:

inform patients of the 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:

encourage junior colleagues to participate in difficult or important family conversations, and provide an opportunity to debrief / reflect afterwards
discuss the aetiology of diseases and explain the purpose, nature, and extent of the assessments to be conducted
obtain informed consent or other valid authority before involving patients in teaching
encourage and support junior colleagues in their communication with families, providing feedback

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 in a way they can understand before asking for their consent to participate in research
obtain an informed consent or other valid authority before involving patients in research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

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 and/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
recognise own limitations and engage someone else in the team or a senior colleague for specific discussions if needed

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 patients’ autonomy, and support their decision making
avoid sexual, intimate, and financial relationships with parents and carers
demonstrate a caring attitude towards patients
respect patients, including protecting their rights to privacy and confidentiality
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours or the illness itself

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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
prescribe safely, as per treatment schedules of known protocols and clinical trials
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, including with drug levels, toxicity screening, and pharmacogenomics
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 patients’ disorders requiring pharmacotherapy
consider and prescribe non-pharmacologic therapies
consider age, chronic diseases, lifestyle factors, allergies, potential drug interactions, and patient preference prior to prescribing new medications
plan for follow-up and monitoring
maintain up-to-date knowledge of medications and therapies, including their interactions with other therapeutic modalities
apply commonly used treatment protocols

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
calculate body surface area for chemotherapy prescribing

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients
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
provide written / online information when available

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
identify patients at increased risk from medications in the home (e.g. risk of misuse or diversion), and initiate risk mitigation practices (e.g. locked box for injectable medications)
report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade

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:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to ensure any new medicine improves patient-oriented outcomes more than older medicines, and not just more a placebo
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines
enrol patients in treatments and supportive care clinical trials, understanding the rationales and medications involved

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
consider available evidence, guidelines, and clinical trials

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

make prescribing decisions based on good safety data when the benefits outweigh the risks involved
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
explain the use of orphan medications in children

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 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
prescribe for individual patients, considering their history, current medicines, allergies, and preferences, ensuring that health care resources are used wisely for the benefit of patients

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

LG10: Investigations and procedures

Learning Goal 10

Investigations and procedures

Select, organise, and interpret investigations, and plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

select, plan, and use evidence-based clinically appropriate investigations and procedures
prioritise patients receiving investigations and procedures
evaluate the anticipated value of investigations and procedures
gain informed consent
collaborate with patients to facilitate choices that are right for them
organise set up of equipment, maintaining an aseptic field
communicate aftercare protocols and instructions to patients and medical and nursing staff
perform investigations and procedures under appropriate sedation or anaesthetic
resolve unexpected events and complications during and after procedures
arrange procedural aftercare for patients
interpret results and outcomes of investigations and procedures, including imaging and reports
communicate the outcome of procedures and investigations to patients
perform this activity across relevant settings, including outpatients, theatre, and day clinics

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations and procedures, and frame them as an adjunct to comprehensive clinical assessments
know local and international guidelines for investigations and procedures
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
develop plans for investigations and procedures, identifying their roles and timing
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
select procedures by assessing patient-specific factors, risks, benefits, and alternatives
confidently and consistently perform a range of common procedures
ensure team members are aware of all identified allergies and adverse reactions, and take precautions to avoid allergies and adverse reactions during procedures
ensure patients have complied with pre-procedure preparations
recognise and effectively manage complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of investigations and procedures
demonstrate knowledge of how stem cell collection and stem cell transplants are performed

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 procedures
understand the significance of abnormal test results, and act on these
consider patients’ factors and comorbidities
consider age-specific reference ranges
assess patients, and identify indications for investigations and procedures
perform a range of common procedures
check for allergies and adverse reactions
consider risks and complications of procedures
interpret results of common diagnostic investigations and procedures
organise and document post-procedure review of patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

explain procedures to patients clearly and sensitively, including reasons for investigations and procedures, potential alternatives, and possible risks, to facilitate informed choices and obtain consent
use clear and simple language, and check that patients understand the terms used and agree to proceed with proposed investigations and procedures
identify patients’ concerns and expectations, providing adequate explanations on the rationale for individual test ordering
confirm whether patients have understood the information they have been given and the need for more information before deciding
address patients’ concerns relating to procedures, providing opportunities to ask questions
tailor language according to patients’ age and capacity to understand
use written or visual material or other aids that are accurate and up to date to support discussions with patients
explain findings or outcomes of investigations and procedures to patients in a considerate way
document procedures accurately and in detail in clinical notes, including:
- aftercare
- aseptic technique
- informed consent
- medicines given
- procedures requested and performed
- reasons for procedures
communicate effectively with all persons involved prior to, during, and after procedures, including team members and patients
identify appropriate proxy decision makers when required

direction
Requires some supervision

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

The trainee may:

discuss the indications, risks, benefits, and complications of investigations with patients before ordering investigations
arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate
explain the process of procedures to patients without providing broader context
help patients to choose aspects of the procedures that can be modified, such as timing
communicate with members of procedural teams so all team members understand who each member is
discuss post-procedural care with patients
complete relevant patients’ documentation, and conduct appropriate clinical handovers
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 proposed investigations and procedures, focusing on patients’ individual situations
obtain informed consent or other valid authority before undertaking any investigation or procedure
set up all necessary equipment, and consistently use universal precautions and aseptic technique
confirm patients’ identification and verify the investigation or procedure, and, where appropriate, the correct site / side / level for the procedure
ensure that information on patients’ consent forms match investigations and procedures to be performed
identify, document, and appropriately notify of any adverse event or equipment malfunction
demonstrate principles of physician safety:
- chemotherapy
- radiation safety
discuss serious incidents at appropriate clinical review meetings

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
provide information in a manner so patients are fully informed when consenting to any procedure
demonstrate a consistent application of aseptic technique
identify patients using approved patients’ identifiers before any treatment or intervention is initiated
perform investigations and procedures in a safe environment

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision-support tools
participate in clinical audits to improve test ordering strategies for diagnoses and screening
refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
organise or participate in in-service training on new technology
provide specific and constructive feedback and comments to junior colleagues
initiate and conduct skills training for junior staff

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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
be aware of relevant open clinical trials, and offer them to the patient
obtain consent for biobank samples and other biological samples as required for patient care or by clinical trials

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
consider samples required for biobanking or clinical trials

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

understand patients’ views and preferences about any proposed investigations and procedures, and the adverse outcomes they are most concerned about
consider individual patients’ cultural perceptions of health and illness, and adapt practice accordingly

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

remain within the scope of the authority given by patients, with the exception of emergencies
discuss with patients how decisions will be made once the investigation or procedure has started and the patient is not able to participate in decision making
understand and perform procedures in accordance with institution or department protocols, ethical practices, and guidelines around performing procedures
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information
show respect for knowledge and expertise of colleagues
maximise patient autonomy in decision making
advise patients there may be additional costs, which patients may wish to clarify

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
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
explain the expected benefits, burdens and risks of any proposed investigation or procedure before obtaining informed consent or other valid authority
perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate the costs, benefits, and potential risks of each investigation and procedure in a clinical situation
adjust the investigative path depending on test results received and in response to risks to individual patients
consider whether patients’ conditions may get worse or better if no tests are selected
identify roles and optimal timings for diagnostic procedures
critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on waiting lists
make clinical judgements and decisions based on available evidence
select the most appropriate and cost-effective diagnostic procedures
select appropriate investigations on the samples obtained in diagnostic procedures

direction
Requires some supervision

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

The trainee may:

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
prioritise which patients receive procedures first, if there is a waiting list
use tools and guidelines to support decision making
recognise optimal procedures for patients
consider whether a paediatric, adolescent and young adult (AYA), or adult setting may be more appropriate to conduct investigations or procedures

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

consider the role other members of the health care team might play, and what other sources of information and support are available
ensure team members are confident and competent in their assigned roles
coordinate efforts, encourage others, and accept responsibility for work done
ensure results are checked in a timely manner, taking responsibility for following up results
provide staff with clear aftercare instructions, and explain how to recognise possible complications

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

select and justify investigations regarding the pathological basis of disease, appropriateness, utility, safety, and cost effectiveness
initiate local improvement strategies in response to serious incidents
use resources efficiently when performing procedures and ordering investigations
know relevant local and international guidelines for investigations and procedures

direction
Requires some supervision

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

The trainee may:

perform investigations and procedures in accordance with organisational guidelines and policies

LG11: Critical appraisal of evidence

Learning Goal 11

Critical appraisal of evidence

Critical appraisal of 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’ 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
participate in developing institutional policy and guidelines to ensure they 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
be able to have evidence-based discussions with colleagues within 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:

interpret and discuss key findings from 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 shared decision making with patients and their families on treatment options based on the best evidence, with the ability to have detailed discussions of the available evidence if required and appropriate
communicate evidence in a way that is understandable for patients and their families or carers
communicate effectively with multidisciplinary team members, such as allied health staff, scientists, and statisticians, regarding best practice updates

direction
Requires some supervision

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

The trainee may:

be able to refer to the available evidence when making shared decisions with patients and their families

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 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
identify gaps and evidence that will lead to future research
prepare reviews of literature on patients' encounters to present at journal club meetings

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 timing, location, privacy, and appropriateness of sharing information with patients
recognise barriers to inclusion in clinical trials and the limitations of evidence due to under-representation of cultural groups

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

reflect on the ethical implications of applying evidence or research findings, especially in cases where evidence may be limited, experimental, or controversial
continue self-learning and sharing 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 to ensure research integrity, such as patient consent, research ethic boards, and conflicts of interest

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’ cohorts, considering factors such as age, comorbidities, and patient treatment preferences
consider the potential benefits and risks of implementing treatments based on research findings or evidence in clinical practice, considering the impact on patient outcome, quality of life, and potential adverse effects

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 the exchange of ideas and perspectives on new evidence
identify areas of improvement, and implement evidence-based changes in the practice 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 guide

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.

LG12: 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.

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Investigations, procedures, and clinical assessment tools

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

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Important specific issues

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

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Anatomy

Knowledge of anatomy, with an emphasis on tumour sites and common anatomical routes of metastases
Relevant anatomy related to type of cancer and potential for metastases

Epidemiology

Context within childhood illness
Incidence of childhood cancers:
- adolescent and young adult
- childhood
- ethnic and geographic variability
- infant
Risk factors
Survival and outcomes

Pathophysiology of childhood cancer (including but not limited to)

Cellular factors:
- cell cycle control:
  - cell cycle control in cancer
  - process of cell division and apoptosis
- gene expression and signal transduction pathways
- tumour microenvironment, such as:
  - angiogenesis
  - components of the microenvironment
  - immune system and tumour immunology
  - mechanisms of tumour cell invasion and metastasis
Genetic and molecular factors:
- germline / somatic:
  - chromosomal abnormalities
  - epigenetic changes
  - gene deletions / duplications / fusions / rearrangements / translocations
Growth, developmental, and environmental factors

Pharmacology

Nutrition and fluid management:
- alternative types of nutrition and administration techniques:
  - gastrostomy / nasogastric / nasojejunal tubes
  - parenteral nutrition
- fluid and caloric requirements by age and weight
- fluid requirements for treatment of various presentations and chemotherapies
Pharmacodynamics, pharmacogenomics, and pharmacokinetics, such as:
- compassionate access to therapeutic agents through direct interaction with sponsors and pharmaceutical companies
- differences between countries with respect to new drug development and approval mechanisms, equity, and availability of clinical trials
- drug approval and marketing processes in Australia / Aotearoa New Zealand, including off-label use of chemotherapy medications for paediatric patients
- indications, pharmacodynamics, pharmacogenomics, pharmacokinetics, potential interactions, and side effects of:
  - chemotherapy agents
  - chemotherapy combinations, interactions, and contra-indications
  - emerging novel therapies, including biologics and immune therapy
  - supportive care medications
- issues surrounding cancer drug approval, prescribing, and availability
- local policies for intrathecal cytotoxic therapy
- protective agents against toxicity, such as dexrazone with anthracyclines
- relevant regulatory requirements, such as opioid prescribing
- specificities of paediatric dosing, such as:
  - age
  - body surface area
  - size
  - weight

General

Informed consent / assent process
Interpretation of results
Local and international guidelines for investigations and procedures
Quality of life and patient-reported symptom measures
Safety guidelines for patients, families, whānau, and staff in relation to body fluids and radiation
Techniques, benefits, and potential complications of investigations and procedures

Imaging

Anatomical
Functional imaging, such as PET scans and other radionucleotide imaging
Image guided procedures

Pathology

Biopsy approaches, such as:
- excisional
- fine needle
- image guided
- open
- under general / local anaesthetic
Genetic and molecular testing
Samples required for accurate and complete diagnostics

Procedures

Access and collection of blood from central lines
Anaesthetic, analgesia, and sedation as per local and international guidelines
Bone marrow:
- aspiration and trephines
- harvests
Capillary blood sampling
ECG
Lumbar puncture and intrathecal chemotherapy administration
Nasogastric tube insertion
Non-invasive blood pressure measurement
Pleural aspiration
Skin biopsies
Urinary collection and testing
Venesection

Clinical trials and research

Analysis, interpretation, and application of results
Design, conduct, analysis, and reporting
Enrolment on and removal from a trial
Ethical issues
Role of collaborative study groups, such as:
- Australian and Aotearoa New Zealand Children’s Haematology and Oncology Group (ANZCHOG)
- Children’s Oncology Group (COG)
- International Society for Paediatric Oncology (SIOP)
Role of registries

Policy and provision of cancer care

Advocacy for patients
Contribution to implementation of national and local health policies, health service targets, and development of service
Duty of professionals working with children with respect to safety and child protection concerns
Government:
- policies on cancer notification
- programs and policies that affect the health of cancer patients
Legal and ethical guidelines relating to:
- competence
- confidentiality
- informed consent for treatment
- parents or carers as surrogate decision makers
- privacy
- the right to refuse treatment
Legal and practical issues related to:
- assisted dying legislation
- initiation of therapy
- postmortem and coroner referrals
- withdrawal of care
Local and major international agencies and organisations with a role in cancer control, research, and/or treatment
Role of government and legal aspects in the provision of health care

General management considerations

Adherence to treatments
Advance care planning and referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease, and known poorer outcomes
Communication appropriate to patients’ developmental stage and psychosocial circumstances
Complicating premorbid conditions or conditions related to treatment, such as:
- cognitive impairment
- fatigue
- mood changes
- neurological impairments
- vision and hearing loss
Consideration of patient demographics when managing and following up patients (travel from rural to metropolitan areas), such as geographic location, socioeconomic status, ethnicity, and cultural background
Consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
Educational and vocational considerations, such as supporting continued education through treatment, and assisting with facilitating special requirements
Family-centred and multidisciplinary models of care
Fertility preservation considerations
Genetic testing and implications
Goals of therapy
Individual patient clinical indications to determine patients’ needs and the most appropriate approaches to investigations and care
Late effects of cancer and therapies, and the importance of long-term follow-up
Monitoring and managing side effects during treatment
Principles of multi-modal therapy
Shared care with local practitioners for patients not living close to main treatment centres
Supportive care during cancer diagnosis and treatment (medical as well as psychosocial)
Unique and critical needs of children and young people with cancer

LG13: Acute and emergency paediatric oncology care

Key presentations and conditions

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

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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 (including but not limited to)

Cardiovascular:
- hypertension
- tachycardia
Gastrointestinal and nutrition:
- abdominal distension or pain
- abdominal mass
- altered bowel habit
- anorexia and reduced intake
- hepatosplenomegaly
- mouth ulceration
- nausea and vomiting
Genitourinary:
- haematuria
Haematological:
- anaemia
- bleeding, bruising, and petechiae
- lymphocytosis, lymphopenia, and neutropenia
- pallor
- thrombocytopenia and thrombocytosis
Lymphatic system:
- lymphadenopathy
Musculoskeletal:
- bony mass
- pain
- soft tissue mass
Neurological:
- headache
- impaired conscious state
- seizures
- visual loss
Ophthalmologic:
- loss of red reflex
- proptosis
Respiratory:
- chest pain
- cough
- dyspnoea
Skin:
- rash
Systemic / General:
- acutely unwell
- allergy symptoms and anaphylaxis
- fever
- pain
- weakness and fatigue

Conditions (including but not limited to)

Cardiovascular:
- cardiac tamponade
- cardiotoxicity from anthracyclines
- superior vena cava syndrome
Gastrointestinal and nutrition:
- constipation
- malnutrition
- mucositis
Genitourinary:
- haemorrhagic cystitis
Haematological:
- anaemia
- bleeding due to thrombocytopaenia
- coagulopathy
- hyperleucocytosis
Immunologic:
- cytokine release syndrome
- immune-related complications of cellular / immunotherapy, and grading of these
Infectious:
- febrile neutropenia
- sepsis
- pneumonia:
  - atypical
  - bacterial
  - fungal
  - pneumocystis jirovecii
  - viral
Metabolic:
- adrenal insufficiency
- tumour lysis syndrome
Neurological:
- posterior reversible encephalopathy syndrome (PRES)
- raised intracranial pressure from intracranial lesion or drug toxicity
- spinal cord compression
Respiratory:
- anterior mediastinal mass / airway compression from upper airway mass
Systemic / General:
- anaphylaxis
- dehydration

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

Adrenal insufficiency and acute adrenal crisis
Coagulopathy related to acute promyelocytic leukaemia
Disseminated intravascular coagulation
Horner syndrome
Immune effector cell-associated neurotoxicity syndrome (ICANS)
Opsoclonus myoclonus ataxia syndrome
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

Acute toxicities and complications of treatment on different organs and systems
Anatomical compression from masses on:
- airway
- bowel, such as Burkitt lymphoma
- spinal cord
- vascular systems
Haematological complications
Immunosuppression and infectious complications
New oncology diagnoses presentations

Assessment

Full examination and history, such as height and weight
Grading of toxicities, such as by Common Terminology Criteria for Adverse Events (CTCAE)
Mucositis score
Pain score
- chest x-ray
- CT scan
- others as clinically indicated
Immediate IV access, with aim of central venous access
Inflammatory markers as appropriate
Referral to other speacialist teams as appropriate

Investigations

As indicated by presentation and suspected diagnosis
Basic observations
Blood cultures (as per local guidelines) and other microbiological investigations as indicated
Blood work as indicated:
- biochemistry
- coagulation studies
- full blood examination (FBE)
Imaging:
- chest x-ray
- CT scan
- others as clinically indicated
Immediate IV access, with aim of central venous access
Inflammatory markers as appropriate
Referral to other specialist teams as appropriate

Procedures

Cardiorespiratory resuscitation
Central line / IV access
Conscious sedation
Indwelling urinary catheter
Insertion of intraosseous needle
Intradermal, intramuscular, intravenous, and subcutaneous injections
Nasogastric tube insertion
Needle thoracocentesis for pleural effusion

General management considerations

Consider goals of therapy
Consider patients’ demographics, including geographic location, socioeconomic status, ethnicity, and cultural background when managing and following up patients, such as travel from rural to metropolitan areas
Consider timing of decisions and risks for individual patients:
- advance care planning and referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease and known poorer outcomes
- compliance with treatments
- complicating premorbid conditions or those related to treatment, such as:
  - cognitive impairment
  - fatigue
  - mood changes
  - neurological impairments
  - vision and hearing loss
- consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
Impact of comorbidities on diagnosis and management
Multidisciplinary care in management and treatment
Tailor communication according to patients’ age, developmental stage, and psychosocial circumstances
Unique requirements of adolescents and young adults (appropriate language and setting)

Specific management considerations

Emergencies require prompt assessment and management, including escalation of care as required
Goals of care
Monitoring and managing side effects during treatment

LG14: Oncological conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abdominal mass
Abnormal movement issues, such as:
- limp
Asymptomatic finding on surveillance investigations
Bowel / Bladder dysfunction
Cytopaenias, such as:
- anaemia
- pancytopenia
- thrombocytopenia
Hyperleukocytosis
Lymphadenopathy
Pain, such as:
- bone
- joint
Raised intracranial pressure
Significant family history
Skin lesions, such as:
- atypical rashes
- nodules
- petechiae
Spinal cord compression
Systemic symptoms:
- anorexia
- fever
- weight loss
Thoracic mass, such as:
- mediastinal
Tumour lysis syndrome

Conditions

Central nervous system tumours:
- atypical teratoid rhabdoid tumour
- choroid plexus carcinoma
- craniopharyngioma
- embryonal tumours of the central nervous system
- ependymoma
- high-grade glioma, including diffuse midline glioma
- intracranial germ cell tumour
- low grade glioma
- medulloblastoma
Leukaemia:
- acute lymphoblastic leukaemia
- acute myeloid leukemia and subtypes
- juvenile myelomonocytic leukaemia
- other rare leukaemia, such as:
  - acute undifferentiated leukaemia
  - chronic myeloid leukaemia
Lymphoma:
- Hodgkin
- non-Hodgkin
Non-central nervous system solid tumours:
- endocrine tumours:
  - adrenocortical
  - phaeochromocytoma
  - thyroid cancers
- germ cell tumours
- hepatoblastoma
- hepatocellular carcinoma
- histiocytic disorders, such as Langerhans cell histiocytosis
- metastasis
- nephroblastoma
- neuroblastoma and other peripheral nerve cell tumours
- neuroendocrine tumours of childhood
- renal cell carcinoma
- retinoblastoma
- sarcomas:
  - Ewing sarcoma / primitive neuroectodermal tumours
  - osteosarcoma
  - rhabdomyosarcoma
  - soft tissue sarcoma
  - undifferentiated sarcoma
Non-malignant haematological conditions:
- anaemia and polycythaemia
- bone marrow failure / dysfunction, such as aplastic anaemia
- haematologic and thrombotic emergency conditions
- haemolytic disorders, such as:
  - hemolytic uremic syndrome
  - thrombotic thrombocytopenic purpura
- haemophilia
- histiocytic disorders, such as hemophagocytic lymphohistiocytosis
- lymphopenia and lymphocyte subsets
- myelodysplasia and myeloproliferation
- neutropoenia and neutrophilia
- other common bleeding disorders, such as von Willebrand disease
Stem cell transplant and cellular therapies:

complications, such as:
- graft-versus-host disease (GvHD)
- sinusoidal obstruction syndrome (SOS)
- veno-occlusive disease (VOD)
conditioning regimens
donor lymphocyte infusion
donor selection
GvHD prophylaxis
indications

Thrombocytopaenia and thrombocytosis

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

Adult cancers presenting in childhood, such as:
- gastrointestinal tumours
- nasopharyngeal carcinomas
All paediatric cancers can present with non-specific and undifferentiated symptoms, and in atypical locations
Lymphoproliferative diseases and malignancies related to immunodeficiency and infection, such as post-transplant lymphoproliferative disorders
Non-malignant conditions that are treated by oncologists as may benefit from similar pathways, such as neurofibromatosis lesions
Other leukaemia, such as:
- chronic subtypes, such as chronic myeloid leukaemia
- other variants
Other rare solid tumours, such as rhabdoid
Premalignant haematological conditions, such as:
- myelodysplasia
- myeloproliferative disorders
Skin cancers, such as:
- Kaposi sarcoma
- melanoma

Presentations

Horner syndrome
Malignant bone fractures
Paraneoplastic syndromes, such as opsoclonus-myoclonus-ataxia syndrome
Pruritis
Skin nodules
Undifferentiated symptoms

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

Anatomical biochemistry, cellular and molecular biology, genomics, immunology, pathology, and pharmacology of cancer, such as cancer immunology, including biologics and immunotherapy
Epidemiology, including (but not limited to) age, geographic, and sex distribution, incidence, and prevalence of cancers, along with predisposing factors, if known
Genetic disorders, genetics of malignancy, malignancy associations, and underlying syndromes
Pathophysiology of premalignant and malignant diseases, and non-malignant haematological diseases, including genetics and neoplasia development, and role of chronic inflammation and tumour microenvironment

Investigations

Appropriate aspirates, biopsies, and tissue samples:
- fine needle versus trucut versus excisional biopsies (image guided or open)
- importance of biobanking
- research or clinical trials samples
- role of second opinions and central review
- samples for anatomic pathology / morphology
- tissue samples (fresh / frozen) and their role in diagnosis / prognosis:
  - cytospin
  - fluorescence in situ hybridization / polymerase chain reaction
  - immunohistochemistry
  - molecular pathology and cytogenetics:
    - karyotyping and gene panel analysis
    - next-generation sequencing or whole exome sequencing
    - precision medicine programs
Cancer staging and risk stratification by tumour type in paediatrics
Complete history and examination
Establishing the diagnosis
Imaging and its relevance depending on cancer type:
- anatomical:
  - CT scan
  - MRI
  - plain film
  - ultrasound
- functional / nuclear medicine scans:
  - bone scans
  - metaiodobenzylguanidine
  - PET
Intent to cure and principles of management according to tumour risk, stage, and type, such as:
- local control measures, which may include surgery
- radiation
- systemic therapy
Other investigations:
- audiology assessment
- ECG
- electrocardiographic
- endoscopy
- fertility assessment and preservation
- formal renal function, such as:
  - diethylenetriaminepentaacetic acid
  - glomerular filtration rate
- lung function
Presentation of case at appropriate specialised multidisciplinary meetings
Relevant blood investigations
Special tests:
- alpha-fetoprotein
- beta human chorionic gonadotropin
- chromogranin A
- inflammatory markers, such as:
  - C-reactive protein (CRP)
  - erythrocyte sedimentation rate
- plasma metanephrines
- tumour burden markers, such as lactate dehydrogenase
- urine catecholamines

Procedures

Baseline height, nutritional assessment, physical activity level, and weight
Bone marrow aspiration and biopsy
Central line access
Fertility preservation
Lumber puncture and intrathecal chemotherapy administration
Omaya access

General management considerations

Advance care planning, such as referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease, and known poorer outcomes
Consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
Goals of therapy
Multidisciplinary care in management and treatment
Shared care with local practitioners for patients not living close to main treatment centres
Special considerations and communication related to patients’ age, developmental stage, and psychosocial circumstances
Other considerations, such as:
- drug levels and toxicity monitoring
- drug sensitivity testing, such as thiopurine methyltransferase genotype for thiopurine
- enrolment in appropriate clinical trials if appropriate, such as precision medicine programs
- genetic testing, including for predisposition syndromes as appropriate
- multidisciplinary team discussions of all new diagnoses
- pharmacogenomics testing
- precision medicine assessment techniques, and multidisciplinary curation of results
- prophylactic treatment as indicated, such as immunoglobulin
- quality of life and patient-reported symptom measures
- rehabilitation
- tumour surveillance post-treatment and in at-risk populations, such as:
  - genetic susceptibility
  - immunodeficiency
  - post-infectious
  - syndromes
Unique requirements of adolescent and young adult population

LG15: Principles of management, including anticancer therapies and supportive care

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

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

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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.

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Undertaking therapy

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

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Post therapy

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

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Important specific issues

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

View

Effects of cancer on growth and development

Cancer effects on young patients and their families, whānau, and/or carers regarding development, education, and functioning
Developmental assessments during and after treatment
Educational, employment, financial, and vocational impacts of cancer diagnosis and treatment
Effects of cancer, recurrence, and chronic illness on growth and emotional, physical, psychosocial, and sexual development
Impact of diagnosis and treatment on later development, such as brain radiation to learning
Impact on fertility, and the evidence, role and timing for fertility preservation
Importance of advocacy for patients and families
Physiological changes in growth and development as they relate to cancer and non-malignant haematological disorders, such as:
- maturation of organs and tissues
- normal laboratory values
Psychosocial impacts of cancer and possible interventions, such as:
- coping mechanisms of patients and their families / whānau within the context of the cancer diagnosis
- impacts on siblings of children with cancer

Indications for and basic principles of the major therapies used in cancer

Chemotherapy:
- chemotherapy concepts, interactions, and protocols
- classes of chemotherapy
- dosing and delivery
- monitoring compliance and side effects
- pharmacogenomics, side effects, and toxicity
- principles of chemotherapy
Immunotherapy:
- classes of immunotherapy
- other cellular therapies, such as:
  - cytotoxic T cells
  - donor lymphocyte infusions
- principles of immunotherapy
- side effects and monitoring of immune effects
Principles of transplants:
- allogeneic donor selection and source
- autologous transplant
- complications
- complications post-transplant
- conditioning, principles and toxicity
- indications and principles of stem cell transplant, autologous and allogeneic, across malignant and non-malignant conditions, such as:
  - benign haematology
  - inborn errors of immunity and metabolism
- principles of autologous transplant
Radiation:
- basic scientific principles
- benefits, indications, and risks
- role of chemotherapy as radiosensitiser
- timing and dosing of radiation
- types, including:
  - brachy
  - photon
  - proton
  - radionuclide
Surgery:
- impact of surgery on growth and development
- principles of surgical control
- timing
Targeted therapies:
- targeted therapy classes

Overriding principles of treatment

Biological, genetic, and molecular factors in diagnostics, prognosis, and treatment
Features and clinical presentations of childhood malignancy, and how to stage different cancers
How to manage patients from diagnosis to long-term follow-up or palliative care, taking into account age, cultural, environmental, and family circumstances, and pre-existing situation
Principles of biopsy, definitive surgery, and optimal handling of tissue for bio-banking, biological studies, and diagnosis
Principles of curative intent for most diagnoses with systemic treatment and local control, with aim of long-term survival and use of least toxic therapy for cure or best amelioration of symptoms
Role of multidisciplinary care required in oncology management, including oncologists, radiation oncologists, surgeons, and other subspecialty teams

Prevention and early detection

Application of cancer screening
Early detection principles and methods
Education of primary health care and the general population about recognition of potential cancer diagnoses
Immunisations and prevention of cancer, such as:
- human papillomavirus vaccination
- sun protection for skin
Promotion of healthy lifestyle in transition to adulthood
Risk of potential second malignancies in childhood cancer survivors
Role of genetics and cancer predisposition syndromes, and applicable screening surveillance

Principles and conduct of oncology clinical trials and research

Appropriate diagnosis, such as subtypes and risk / staging assignment to guide treatment
Biomarker development
Case reports
Community / Policy prevention measures
Concept of study types, and ability to explain these to patients and parents
Considerations / Difficulties around informed consent / assent, such as gaining consent for a randomised clinical treatment trial with a family who have recently been given a potentially life-threatening diagnosis
Ethical principles guiding research
Evolution of current clinical trials and treatment outcomes
Good clinical practice in line with international directives for all aspects of the conduct of clinical trials
Issues around collaborative working, both nationally and internationally, in the development of clinical trials for childhood malignancy, such as knowledge of large study bodies
Levels of evidence and classes of recommendations
National clinical guidelines and how they guide practice
Population risk determination of disease:
- randomised control trials
- registry analyses
Principles of cancer drug development and the rapidly evolving landscape of clinical trials in cancer
Role and importance of clinical trials in patient care and outcomes
Systematic reviews and meta-analysis

Principles of supportive care

Antiemetics for nausea and vomiting
Appropriate referral and involvement of other specialities
Cardiac protection
Fertility preservation considerations prior to commencement of therapy
Haematological, such as:
- anaemia
- coagulation issues
- neutropenia
- thrombocytopaenia
Infection:
- febrile neutropenia
- fungal and viral infections
- immunisation
- immunity and infection
- prophylaxis
Management of side effects, such as the use of aperients and anxiolytics
Managing, monitoring, and recording toxicities
Nutrition:
- assessment of nutritional requirements
- cachexia and malnutrition
- fluid management
- management of nutrition
Pain and symptom control
Principles of survivorship and late effects, such as:
- assessment of chronic / late drug toxicities
- management of the fear of cancer recurrence
Psychosocial and allied health care

Diagnosis, stage of cancer, and goals of care
Impacts of cultural, ethnic, geographical, psychological, and socioeconomic factors in the accessibility, compliance, and suitability of specific treatments for patients
Indications for specific anticancer therapies (pharmacological and non-pharmacological) in the adjuvant, concomitant, definitive, neoadjuvant, and palliative settings
Off-label use of treatments, such as increasing trials in younger age groups of new agents
Potential effect of patients’ comorbid medical conditions on the toxicity and efficacy of treatments
Special conditions that influence treatment, including age and developmental stage

Conflicts in care decisions
Delayed diagnoses
Early palliative care involvement for high-risk cancers with poor prognosis, and role in symptom management for patients
Impact of underlying conditions on treatment, such as genetic disorders and immunodeficiencies
Indications and role of repeating biopsies, monitoring and predictive testing, such as repeating immunohistochemistry or molecular testing after progression to guide future therapy
Interplay between medical and psychological comorbidities, socioeconomic and cultural factors in patient presentations, and therapy choices and care wishes
Management of complex presentations
Oncological emergencies
Surgical techniques, such as limb sparing, and impacts on morbidity

Adjustment to drug dosing:
- as per body surface area of patient, drug / therapy interactions, pharmacogenomics (if known), radiosensitisation, and toxicity
- for pre-existing conditions:
  - obesity
  - pharmacogenomics
Awareness of protocols and clinical guidelines for conditions
Close monitoring of patients during treatment for acute or other side effects, and appropriate documentation
How to measure quality of life and patient-reported outcomes
How to recognise and manage oncological emergencies
Informed consent for treatments
Multidisciplinary team approach to treatment and management, such as:
- infectious diseases
- radiation oncologists
- surgeons
- other speciality teams as required, and re-present patients in multidisciplinary medical / psychosocial meetings to ensure optimal care
Tailoring management to specific ages

Monitor for and manage any side effects post-therapy, from diagnosis, different treatments used, and psychosocial impacts
Post-transplant care, and management of complications
Surveillance in cancer predisposition syndromes, and awareness of risk factors for second malignancies
Transition to adult care, palliative care, and other specialists in a timely manner

Late effects of treatment / survivorship care

Fertility and sexual health issues
Genetic counselling
Impacts on education, lifestyle, socialisation, and vocation
Impacts on normal growth and development
Mental health and neuropsychological effects
Potential:
- long-term complications of cancer, chemotherapy, surgery, radiation, surgery, and other systemic treatments in childhood
- second malignancies
Specific organ issues, such as:
- cardiac
- lung dysfunction
- neurological
- vascular

Childhood cancer in context of family and environment, such as the need for appropriate and sensitive communication around diagnosis and treatment initiation
Ethical issues within paediatric oncology
Importance of quality of life during treatment, and the associated need for supportive care and allied health support
Need to review and modify management plans, as required
Need to tailor management to specific age and developmental stage
Specific requirements and unique issues of adolescent and young adult patients
Timing of referral to palliative and end-of-life care services

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 (Paediatrics & Child Health)

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

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 paediatric oncology care

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork