Curriculum standards

About this resource

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

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

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information 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 risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

regularly self-evaluate personal professional practice, and implement changes based on the results
actively seek feedback from supervisors and colleagues on their own performance
identify personal gaps in 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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

support ethical principles in clinical decision making
maintain standards of medical practice by recognising the health interests of patients or populations as primary responsibilities
respect the roles and expertise of other health professionals
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

direction
Requires some supervision

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

The trainee may:

recognise 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 healthcare teams to achieve organisational priorities
influence the development of organisational policies and procedures to optimise health outcomes
identify the determinants of health of the population, and mitigate barriers to access to care
remove self-interest from solutions to health advocacy issues

direction
Requires some supervision

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

The trainee may:

communicate with stakeholders within the organisation about health care delivery
demonstrate understanding of 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:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

support learners to deliver quality care while maintaining their own wellbeing
apply lessons learnt about patient safety by identifying and discussing risks with learners
assess learners’ competence, and provide timely feedback to minimise risks to care
maintain the safety of patients 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 professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback, and reflect on own teaching by developing goals and strategies to improve
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

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 safety
encourage learners to consider culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori 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 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 personal and learners’ effective performance and continuing professional development
maintain professional, clinical, research, and/or administrative responsibilities while teaching
create an inclusive environment in which learners feel part of the team
help shape organisational culture to prioritise quality and work safety through openness, honesty, shared learning, and continued improvement

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify and report actual and potential (‘near miss’) errors
conduct and evaluate system improvement activities
adhere to best practice guidelines
audit clinical guidelines and outcomes
contribute to the development of policies and protocols designed to protect patients, reduce bias, achieve equity, and enhance health care for all
monitor one’s own practice with critical self-reflection, 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’ and population health outcomes to identify opportunities for improvement in delivering care that is appropriate and delivers equity for marginalised groups
evaluate socioeconomic determinants of health and environmental and lifestyle health risks, and advocate for healthy lifestyle choices and organisational changes
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures
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
actively ask and listen to factors that contribute to patients’ health, and tailor care based on patients’ personalised health goals

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, language-accessible, culturally safe, 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
implement the organisation’s open disclosure policy

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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 action 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, and follow up on resultant system changes
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve care

direction
Requires some supervision

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

The trainee may:

be cognisant of a systematic approach to improving the quality and safety of health care, with a specific focus on outcomes of marginalised groups

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
participate in cultural competency training

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
learn about principles of Indigenous data sovereignty to ensure that outcomes data do not cause inadvertent harm to Indigenous groups

direction
Requires some supervision

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

The trainee may:

recognise that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research
undertake training on the principles of Good Clinical Practice prior to engaging in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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 of care

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use decision-making support tools, such as guidelines, protocols, pathways, and reminders
analyse and evaluate current care processes to improve 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 interdisciplinary programs of education
actively involve clinical pharmacists in the medication-use process

direction
Requires some supervision

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

The trainee may:

demonstrate attitudes of respect and cooperation among members of different professional teams
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:

recognise 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

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 patients’ 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
obtain patient histories
examine patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with patients, families, and/or carers
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:

elicit accurate, organised, and problem-focused neurological histories, as well as relevant aspects of other medical history, including family, social, and occupational factors. Specific aspects of this include the determination of:
- the history of the presenting problem, including symptom onset, duration, and course of the condition, associated symptoms, and previous therapeutic interventions
- the patient’s view of the problem, their level of background knowledge, and their expectations
- other factors which may be relevant, such as
  - environmental
  - genetic
  - pharmacological
  - social
- other medical conditions (current or previous), and their relevance
perform targeted examinations to elicit relevant signs and exclude important negative signs in light of the history gathered. Trainees should be confident with performing examinations of:
- cognition / mental state
- coordination and gait
- cranial nerve function
- motor function and reflexes
- sensory function
where appropriate, use quantitative rating scales as part of clinical assessments, demonstrating awareness of the variety of scales available for use
synthesise and interpret findings from histories, examinations, and investigations to devise the most likely provisional diagnoses and reasonable differential diagnoses
plan necessary investigations, giving due consideration to appropriate prioritisation and timeliness of investigations
reconsider and, if necessary, revise a diagnosis in light of investigation findings
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account
consider consequences of treatment and the likelihood of treatment-related complications, and how these can be mitigated or managed
consider impacts of diagnosis and treatment on relevant legislation (such as assessing fitness to drive) and occupational risk

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

set unclear goals and objectives for self-learning
self-reflect infrequently
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 the research subject
access information from neurogenetic databases, such as Online Mendelian Inheritance in Man (OMIM)

direction
Requires some supervision

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

The trainee may:

refer to guidelines and medical literature to assist in clinical assessments when required
demonstrate awareness 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 linguistic sensitivity
demonstrate effective and culturally competent communication and care for Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
recognise the impact of familial interpreters as alternate information sources
acknowledge patients’ beliefs and values, and how these might impact on health
use a professional interpreter, health advocate, or a family or community member to assist in communication with patients, and understand the potential impact that different approaches have on accuracy and/or completeness of information

direction
Requires some supervision

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

The trainee may:

display respect for patients’ cultures, and attentiveness to social determinants of health
demonstrate awareness 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
recognise the laws that govern practice, such as disclosure of health information and mandatory reporting

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, risk, and uncertainty
use the best available evidence for the most effective therapies and interventions to ensure quality care
recognise how and when to access additional resources and/or to refer patients to other neurologists, neurosurgeons, rehabilitation physicians, or other specialist physicians

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 outcomes for patients
demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patients’ 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 healthcare 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
recognise the medicolegal issues relating to capacity and competence and relevant regulations, such as the state / national driving regulations as applied to neurological conditions

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: Management of transitions in care

Learning Goal 6

Management of transitions in care

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate optimal transitions of care for patients
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of the details of patients’ conditions, illness severity, and potential emerging issues, with appropriate actions
provide accurate summaries of patients’ information with accurate identification of problems or issues

Communication

confident
Ready to perform without supervision

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

The trainee will:

write relevant and detailed medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals, when required
communicate with patients, families, and/or carers about transitions of care, and engage and support these parties in decision making

direction
Requires some supervision

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

The trainee may:

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 effective transitions between settings, and continuity and quality of care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify patients at risk of poor transitions 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
recognise the medicolegal context of written communications

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

include relevant information regarding patients’ cultural or ethnic background in handovers, and whether an interpreter is required

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patients’ care is in the most appropriate facility, setting, or provider

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
recognise 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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

factor transport issues and costs to patients into arrangements for transferring patients to other settings

LG7: Acute care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
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
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
manage escalations or transitions of care in a proactive and timely manner
optimise medical management before, during, and after operations
develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
provide clear and effective discharge summaries with recommendations for ongoing care

direction
Requires some supervision

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

The trainee may:

recognise seriously unwell patients requiring immediate care
apply basic life support as indicated
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
use closed-loop and clear communication with other healthcare team members during resuscitation
facilitate early communication with patients, families, and healthcare team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain situations to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
determine the level of health literacy of individual patients and level of understanding of agreed care decisions

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

maintain up-to-date certification in advanced life support
use clinical information technology systems for conducting prospective and retrospective clinical audits
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
analyse adverse incidents and sentinel events to identify system failures and contributing factors
coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective supervision skills and teaching methods 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 healthcare teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

select studies based on optimal trial design, freedom from bias, and precision of measurement
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 awareness 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, or belief systems
integrate culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori 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 healthcare access

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 based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
advise patients of their rights to refuse medical therapy, including life-sustaining treatment
consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
facilitate interactions within multidisciplinary teams that respect values, encourage involvement, and engage 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 escalations of care, and escalate to appropriate staff or services
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making
reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
manage the transition of acute medical patients through their hospital journeys
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 patient care based on need, and consider available healthcare 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:

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

LG8: Longitudinal care

Learning Goal 8

Longitudinal care

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

encourage patients’ self-management through education to take greater responsibility for their care, and support problem solving
encourage patients’ access to self-monitoring devices and assistive technologies
communicate with multidisciplinary team members, and involve patients in that dialogue

direction
Requires some supervision

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

The trainee may:

provide healthy lifestyle advice and information to patients on the importance of self-management
work in partnership with patients, and motivate them to comply with agreed care plans

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 medicine use, and ensure patients understand safe medication administration to prevent errors
support patients’ self-management by balancing between minimising risk and helping them become more independent
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

assist patients from culturally and linguistically diverse backgrounds to receive the support needed for long-term self-management

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share information between relevant service providers
acknowledge and respect the contribution of health professionals involved in patients’ care

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG9: Communication with patients

Learning Goal 9

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

select suitable contexts, and include family and/or carers and other team members
adopt a patient-centred perspective, including adjusting for cognition, cultural background, and disabilities
select and use appropriate modalities and communication strategies
structure conversations intentionally
negotiate mutually agreed management plans
verify patients’, family members’, or carers’ understanding of information conveyed
develop and implement plans to ensure actions occur
ensure conversations are documented

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
present the following patient information verbally and document in written form:
- diagnoses or differential diagnoses
- key clinical findings of histories and examinations
- proposed management plans
- results of investigations
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate communication strategies and modalities for communication, such as emails, face-to-face, letters, phone calls, and telemedicine
speak directly to the patient rather than ‘over them’ to their family or carers
use active listening techniques
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
provide an environment that is private
ask for patients’ consent before speaking in front of family members, carers, or friends
convey information such as diagnoses, prognoses, and management plans considerately and sensitively to patients and their families, seeking clarification if unsure of how best to proceed
practice gender inclusive care and promote equality

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

discuss the aetiology of diseases and explain the purpose, nature, and extent of the assessments to be conducted
obtain informed consent or other valid authority before involving patients in teaching
obtain informed consent before involving patients in journal publications or medical education presentations

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of New Zealand
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain 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 awareness 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 Aboriginal and Torres Strait Islander peoples and Māori
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG10: Prescribing

Learning Goal 10

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify patients’ disorders requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, allergies, chronic disease status, lifestyle factors, patient preference, and potential drug interactions prior to prescribing new medications
plan for follow-up and monitoring

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the benefits, rationale, and risks 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
describe dosages and rate of change when titrating medication doses up or down
educate patients about the expected outcomes, intended use, and potential side effects for each prescribed medication, addressing the common, rare, and serious side 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
discuss consequences of non-adherence to pharmacotherapy, particularly in relation to factors such as driving and antiseizure medications

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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 than placebo
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

direction
Requires some supervision

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

The trainee may:

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

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:

recognise 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:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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, nursing staff, and general practitioners 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 allergies, current medicines, history, and preferences, ensuring that 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

LG11: Procedures

Learning Goal 11

Procedures

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by assessing patient-specific factors, including alternatives, benefits, and risks
confidently and consistently perform a range of common procedures
ensure team members are aware of all allergies and adverse reactions identified, and take precautions to avoid allergies and adverse reactions during procedures
ensure patients have complied with preprocedural preparation
confirm the correct position / site / side / level on patients for planned procedures
recognise and manage effectively complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of diagnostic procedures
perform a lumbar puncture (LP)

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

explain the process of procedures to patients without providing a broader context
help patients, families, and carers choose procedures
communicate with members of procedural teams so all team members understand who each member is
discuss postprocedural care with patients, families, and carers
complete relevant patients’ documentation, and conduct appropriate clinical handovers

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss serious incidents at appropriate clinical review meetings
initiate local improvement strategies in response to ‘near misses’ or serious incidents
undertake audits of practice
use resources efficiently when performing procedures

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with the organisational guidelines and policies
identify or be able to discuss incidents of concern with team

LG12: Investigations

Learning Goal 12

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

select, plan, and use evidence-based clinically appropriate investigations
appropriately prioritise patients receiving investigations by clinical need
evaluate the anticipated value of investigations
work in partnership with patients, including their families and/or carers if they so wish, to facilitate choices that are right for them
provide aftercare for patients (if needed)
interpret the results and outcomes of investigations
communicate the outcome of investigations to patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations as an adjunct to comprehensive clinical assessments
assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
develop plans for investigations, identifying their roles and timing
recognise and correctly interpret findings, considering patients’ specific circumstances, and act accordingly
recognise the concept of false positive and false negative results
respond appropriately to incidental findings
request and interpret reports on basic nerve conduction studies (NCS), such as studies for carpal tunnel syndrome, other common entrapment neuropathies, and peripheral neuropathies

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from proposed investigations, focusing on patients’ individual situations
identify risks that may result from not having an investigation
report ‘near misses’ and critical incidents
undertake regular audits

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision support tools
participate in clinical audits to improve test ordering strategies for diagnoses and screening

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

acknowledge patients’ views and preferences about any proposed investigations and the adverse outcomes they are most concerned about

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

LG13: Clinic management

Learning Goal 13

Clinic and community management

Manage an outpatient clinic

This activity requires the ability to:

oversee medical procedures and treatments
oversee quality improvement activities
communicate with patients, their families, and/or carers
liaise with other health professionals and team members
demonstrate problem-solving skills
responsibly use public resources

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

effectively identify and address current clinical concerns, as well as longer-term clinical objectives, appropriate to patients’ context
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
create accurate and appropriately prioritised problem lists as part of ambulatory care reviews
update documentation in a timeframe appropriate to the clinical situation of patients

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system through collaboration and communication with other services, such as community health centres and consumer organisations
link patients to specific community-based health programs and group education programs

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

practice health care that maximises patient safety
identify aspects of service provision that may be a risk to patients’ safety
ensure that patients are informed about fees and charges

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

critically appraise their own professional practice
demonstrate learning behaviour and skills in educating junior colleagues
maintain professional continuing education standards

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before involving patients in research
inform patients about their rights, the purpose of the research, procedures to be undertaken, and potential risks and benefits of participation before obtaining consent

direction
Requires some supervision

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

The trainee may:

allow patients to make informed and voluntary decisions to participate in research

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

seek and apply knowledge of the cultural needs of the community, and how to shape service provision appropriately
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve culturally safe patient engagement and health outcomes

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

integrate prevention, early detection, health maintenance, and chronic condition management, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

recognise common population health screening and prevention approaches

LG14: End-of-life care

Learning Goal 14

End-of-life care

Manage the care of patients at the end of their lives

This activity requires the ability to:

recognise the dying phase
support patients to plan for their advance care, and document their own wishes
manage end-of-life care plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

accurately assess patients’ physical and psychological symptoms
estimate prognosis and communicate this appropriately, if requested, including the uncertainties around such estimates
develop and clearly document individualised end-of-life care plans, including patients’ preferences for treatment options, resuscitation plans, preferred place of care, and preferred place of death
provide holistic symptom management, focusing on psychological and physical distress, according to patients’ wishes
avoid unnecessary investigations or treatments, ensuring physical and psychosocial support
review the goals of care and treatment plans with patients, families, and/or carers if significant changes in patients’ conditions or circumstances occur
recognise and manage the terminal phase in a timely way
discuss issues with patients and/or caregivers, and consult with patients and/or caregivers to determine management plans that prevent suffering
manage symptoms such as anxiety, dyspnoea, and pain
ensure spiritual and cultural factors are involved throughout the end-of-life process

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of the principles of care for patients at the end of their lives
provide timely assessment, and document patients’ care plans
manage physical symptoms in alignment with patients’ wishes
take steps to alleviate patients’ symptoms and distress
correctly identify patients approaching the end of life, and provide symptomatic treatment
adequately manage patients in their terminal phase
recognise the role of the palliative care physician, and when referral is appropriate

Communication

confident
Ready to perform without supervision

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

The trainee will:

establish supportive relationships with patients, families, and/or carers based on understanding, trust, empathy, and confidentiality
explore patients’ concerns across physical, spiritual, cultural, and psychological domains thoughtfully
identify opportunities to discuss end-of-life care, aligning it with patients’ values and preferences
identify proxy decision makers or other persons nominated by the patient to be involved in discussions about their end-of-life care
identify and document lists of close family members or carers, and develop support plans for them
provide bereaved families or carers with written information about access to bereavement support
communicate effectively and in a timely manner with other health professionals involved in patients’ care
acknowledge and convey the legal and ethical considerations of voluntary assisted dying

direction
Requires some supervision

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

The trainee may:

discuss with patients, families, and/or carers the goals of care and treatment, and document this in patients’ clinical records
ensure consistent messages are given to patients, families, and/or carers about treatment options, their likelihood of success, risks, and prognosis
provide honest and clear clinical assessment summaries of situations, using plain language and avoiding medical jargon
discuss with families and/or carers the availability of appropriate support and bereavement care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

conduct medication chart safety audits and multidisciplinary mortality and morbidity meetings, and provide feedback to colleagues
review all deaths to determine the safety and quality of patients’ end-of-life care and how it could be improved
develop monitoring and evaluation strategies to capture feedback about the quality of care from multidisciplinary team members, patients, families, and carers
review technological systems and processes that support safe and high-quality end-of-life care

direction
Requires some supervision

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

The trainee may:

collect and review data on the safety and effectiveness of end-of-life care delivery
communicate the content of discussions about prognoses and advance care planning to multidisciplinary teams
ensure that actual care is aligned with patients’ documented wishes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

provide supervision, support, and teaching to develop the skills of junior colleagues on end-of-life care
reflect on personal practice, and use this process to guide continuing professional development
ensure all members of multidisciplinary teams receive education on their roles and responsibilities for managing end-of-life care
promote education covering:
- competencies for providing culturally responsive end-of-life care to Aboriginal and Torres Strait Islander peoples and Māori, and to people from other cultural backgrounds
- ethical and medicolegal issues
- relevant legislation in the state, territory, or region

direction
Requires some supervision

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

The trainee may:

participate in education on disease-specific symptom assessment and evidence-based symptom management
participate in upskilling in best practice of end-of-life care management
encourage junior colleagues to participate in multidisciplinary case reviews, mortality and morbidity meetings, and adverse event reviews

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure that quality end-of-life care management processes are evidence based and outcome focused
use systematic reviews or personal reviews and appraisal of literature as evidence for the appropriate management
support clinical trials to build the end-of-life care evidence base

direction
Requires some supervision

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

The trainee may:

recognise that the evidence may be insufficient to resolve uncertainty and make definitive decisions

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:

practise culturally responsible medicine based on understanding the personal, historical, and cultural influences on patients, families, and carers
develop strategies for identifying culturally appropriate decision makers, and obtain their input in discussions of patients’ end-of-life care
offer support to patients, families, and/or carers to include cultural or religious practices in their care

direction
Requires some supervision

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

The trainee may:

recognise, respect, and respond to individual preferences and needs of patients, regardless of their culture and religious beliefs
support patients, families, and carers with communication difficulties associated with cultural and linguistic diversity

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:

ensure all team members discuss end-of-life care with patients, and act on expressed patient preferences
enhance the quality of life for patients at the end of life to minimise pain and suffering caused by ineffective treatments
recognise the complexity of ethical issues related to human life and death when considering the allocation of scarce resources
recognise feelings of moral distress and burnout in themselves and colleagues

direction
Requires some supervision

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

The trainee may:

ensure that information on advance care plans, treatment plans, goals of care, and patients’ treatment preferences is available to all involved in patients’ care
ensure patients’ dignity is preserved
respond appropriately to distress or concerns of colleagues, patients, families, and carers

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

maximise patients’ autonomy and their best interests when making treatment decisions
liaise with other relevant services, providing referrals as necessary

direction
Requires some supervision

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

The trainee may:

define and document patients’, families’, and/or carers’ goals and agreed outcomes

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

ensure care plans are communicated to all teams involved in patients’ care, including relevant community care providers
define the responsibilities and roles of team members involved in patients’ care
achieve agreement between multidisciplinary teams about patients’ treatment options
coordinate care and support to be provided in patients’ preferred place of care
effectively manage personal challenges of dealing with death and grief

direction
Requires some supervision

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

The trainee may:

coordinate end-of-life care to minimise fragmentation of care
document multidisciplinary care plans, including the terminal phase

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 developing frameworks for organisational advance care planning
allocate resources according to the organisational strategic plan to support systems for effective delivery of end-of-life care
advocate for the needs of individual patients, social groups, and cultures within the community who have specific palliative care needs or inequitable access to palliative care services

direction
Requires some supervision

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

The trainee may:

allocate scarce resources effectively
support community-based service providers to build capacity for people to be cared for in their preferred place of death

Knowledge guides

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

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

LG15: Scientific foundations of neurology

Epidemiology, pathophysiology, and clinical sciences

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

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

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Investigations, procedures, and clinical assessment tools

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

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

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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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Central and peripheral nervous system

Anatomy and physiology of the nervous system, including neuroembryology
Fundamental principles of neurophysiology
Mechanisms by which underlying neuroanatomical, neuropathological, and neurophysiological processes result in neurological symptoms and abnormal neurological signs
Microanatomy and histology of brain, meninges, and peripheral nerves

Neuropsychiatry

Diseases which present as, and can be confused with, neurological conditions, such as weakness due to conversion disorder and non-epileptic seizures
Pharmacological and behavioural treatment of neuropsychiatric illnesses
Psychological aspects of illnesses and their management, such as:
- anxiety
- conversion
- depression
- psychosis

Neurorehabilitation

Formulate a prognosis based on an understanding of the natural history of the relevant condition coupled with clinical assessment of the relevant markers for recovery
Neurorehabilitation, including:
- goal setting
- indications for referral
- setting realistic outcome expectations
- the techniques employed
Recovery from neurological illness and/or injury, including the natural history and neuronal plasticity
Referral to rehabilitation physicians and/or allied health professionals involved in rehabilitation, including:
- continence advisors
- occupational therapists
- physiotherapists
- social workers
- speech pathologists

Therapeutic interventions

Devices used in the specialist management of neurological diseases, such as implantable brain stimulators and focused ultrasound:
- common and uncommon adverse effects
- indications
- monitoring requirements
- neuroanatomy, neurophysiology, and neuropathology, where relevant
- safe and rational use
Endovascular procedures, including, but not limited, to thrombectomy / therapy (EVT) for stroke
Immunotherapy and cytotoxic drugs
Management strategies for drug-resistant conditions, such as drug-resistant epilepsy, including surgical management
Medication to treat acute and chronic neurological illness:
- common and uncommon adverse effects
- indications
- monitoring requirements
- potential drug interactions
- safe and rational use
Neuropharmacology drug interactions, metabolism, pharmacodynamics, and pharmacokinetics, along with the potential role of pharmacogenomics
Pharmacological therapy and other forms of management for various diseases and disorders
Plasmapheresis:
- common and uncommon adverse effects
- indications
- monitoring requirements
- safe and rational use

Cerebrospinal fluid (CSF)

Abnormalities seen on lumbar puncture (LP)
Interpret CSF results, including:
- opening pressure
- special tests:
  - amino acids
  - antibodies:
    - autoimmune
    - paraneoplastic
  - CSF cytology
  - glucose ratio
  - neurotransmitters
  - oligoclonal bands
  - polymerase chain reaction (PCR) for viruses
- standard tests:
  - cell counts
  - culture
  - glucose
  - gram stain
  - protein
  - xanthochromia
Limitations of interpretation, and the implications for formulating diagnoses
LP:
- contraindications
- limitations to interpretation
- requests
- urgent investigation
Neuroanatomy and neurophysiology of CSF, including the pathological mechanisms that underlie abnormalities of pressure and CSF constituents
Normal ranges of CSF opening pressure and the various laboratory measurements
Potential complications of LP and the management of post-LP symptoms, including the role of blood patch in treating post-LP headache

Clinical neurophysiology

Abnormalities on clinical neurophysiology investigations
Clinical neurophysiology modalities
Interpret and report EEG and evoked potentials results, including:
- abnormal and normal EEG waveforms
- EEG electrode placement and recording
- localising focal epileptiform discharges and slow wave activity
- physiological basis of EEG potentials and waveforms
- reporting EEG studies, and interpret findings in clinical context
- role and limitations of EEG in clinical neurology
- skills and knowledge required to appropriately request studies and interpret reports as an informed consumer
- technology used for EEG recording
- the change in normal EEG patterns across the lifespan
Interpret and report electromyography (EMG) and nerve conduction study (NCS) results, including:
- interpreting EMG and NCS reports
- physiological basis of EMG and NCS potentials and waveforms
- skills and knowledge required to appropriately request studies and interpret reports as an informed consumer
- technology used for EMG and NCS recording
Interpret results of clinical neurophysiology tests, and synthesise these findings with other clinical data in the management of patients with neurological conditions
Neuroanatomy and neurophysiology of:
- muscle
- neuromuscular junction
- peripheral nervous system
Neurophysiological investigations:
- discuss the results with a neurophysiologist
- limitations to interpretation
- potential complications
- questioning a formal report
- requesting further test(s)
- requests
- urgent investigation
Role of evoked potentials

Neurogenetics

Abnormalities on neurogenetic testing in appropriate conditions
Genetics and the patterns of inheritance of inherited neurological conditions, including classifications of genetic syndromes
Limitations of interpretation, and the implications for formulating a diagnosis
Pre-test counselling and potential implications of a positive diagnosis for patients and families
Referral to neurogeneticist
Techniques used in neurogenetics laboratories, including limitations in interpretation of the results
Utility of genetic testing in neurological diagnosis, even in asymptomatic individuals

Neuroimaging

Abnormalities on neuroimaging investigations
Appearance of a normal brain and spinal cord on neuroimaging techniques, including vascular anatomy
Basic principles underlying the various imaging modalities
Considerations of performing neuroimaging, including radiation risks and technical difficulties
Limitations of interpretation, and the implications for formulating a diagnosis
Neuroimaging investigations:
- limitations to interpretation
- potential complications
- questioning a formal report
- requesting further test(s)
- requests
- urgent investigation
Pathological mechanisms that underlie imaging abnormalities
Recognise when to request further tests, and when to discuss the results with a neuroradiologist
Relevant neuroanatomy of the brain and spinal cord and their respective vascular supply

Neuroimmunology

Abnormalities seen on neuroimmunological testing in appropriate conditions
Immunology and the processes involved in the generation of immunologically mediated neurological conditions
Limitations of interpretation, and the implications for formulating a diagnosis
Neuroimmunologist referral
Pharmacology management of neuroimmunology disease
Techniques used in the neuroimmunology laboratory, including limitations to interpretation of the results

Neuropathology

Importance of communication with neuropathologists regarding suspected diagnosis and differential diagnosis
Limitations of interpretation, and the implications for formulating a diagnosis
Neuroanatomy of brain, muscle, and nerve, coupled with an understanding of the pathological mechanisms that underlie abnormalities seen on neuropathology
Neuropathology investigations, such as when to request them and what limitations there might be to interpretation
Potential complications of neuropathology investigations, and the management of these complications

Neuropsychology

Abnormalities detected in neuropsychological testing
Limitations of interpretation, and the implications for formulating a diagnosis
Neuroanatomy and cognitive functions of the brain, and broadly how the various neuropsychological domains are tested by the neuropsychologist
Role of the neurologist and neuropsychologist in assessing competence and determining patients’ decision-making and testamentary capacity
When to request neuropsychological testing, and what limitations there might be to interpretation

Neurosurgery, including vascular surgery and interventional radiology

Common techniques used by neurosurgeons, vascular surgeons, and interventional radiologists in the management of neurological conditions
Potential complications of procedures
Procedures:
- brain tumour surgery, such as:
  - biopsy
  - debulking
  - excision
- CSF shunting, CSF diversion procedures, and neuroendoscopy
- emergency surgical procedures for the management of trauma, such as evacuation of intracranial haematoma and decompressive hemicraniectomy
- functional neurosurgery, such as:
  - deep brain stimulation
  - movement disorders
  - procedures for epilepsy
  - spinal surgery, such as:
    - laminectomy
    - microdiscectomy
- vascular surgery, such as:
  - aneurysm clipping and coiling
  - carotid endarterectomy
  - endovascular thrombectomy / therapy (EVT)
  - surgical procedures for treatment of moyamoya disease
When to refer to the:
- neurointerventionalist
- neurosurgeon
- vascular surgeon

End-of-life (EOL) care

EOL issues and consulting with patients, families, and/or carers to determine management plans that prevent suffering
Manage symptoms, such as:
- anxiety
- dyspnoea
- pain
Principles of the techniques used by palliative care physicians, along with the potential complications of any procedures involved
Prognosis and implications of these disorders
Role of the neurosurgeon and the intensive care unit, and when referral is appropriate
Role of the palliative care physician, and when referral is appropriate

Neurological emergencies

Evidence-based pharmacological therapy, potential complications, and other forms of management of various conditions presenting as emergencies, as well an ability to instigate appropriate treatment
Neuroanatomy, neuropathology, and neurophysiology relevant to the various conditions presenting as neurological emergencies
Rapid clinical assessment of patients with a neurological emergency

Patient-centred care

Impact and interrelationship of comorbidities and neurological conditions on each other, including:
- clinical presentation
- diagnostics
- impact of illness
- management
- prognostics
Patient care considerations for specific patient groups and those with culturally diverse backgrounds, including:
- Aboriginal and Torres Strait Islander peoples
- adolescent
- elderly
- ethnic minorities
- low socioeconomic background
- Māori
- non-English speaking background
- overseas travellers
- pregnant or peripartum state
- refugees
- religious ideologies, such as Jehovah’s Witness

Pregnancy

Collaborate with obstetricians on treatment and management plans
Impact and management of primary obstetric disorders, including eclampsia and epidural anaesthesia, and other obstetric issues with neurological sequalae
Impact of neurological disease and management on fertility, pregnancy, and the postpartum period, including breastfeeding, method of delivery, and teratogenesis
Neurological investigations and treatment in pregnancy with reference to:
- limitations
- potential hazards
- safety issues
Pharmacological therapy and other forms of management for neurological conditions in pregnancy and when breastfeeding
Prognosis and longer-term implications of the various conditions

LG16: Pain, including headaches and facial pain

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 – emergency

Acute pain
Bladder / Bowel dysfunction
Sudden onset new severe headache
Sudden onset weakness / sensory disturbance

Presentations – headache

Asthenia / Fatigue
Dysesthesia / Numbness
Neuropathic pain
Pain / Stiffness, chronic
Weakness

Conditions – acute

Central causes, such as:
- demyelination
- stroke, including:
  - cerebral venous thrombosis
  - intracerebral haemorrhagic
  - ischaemic
Peripheral nerves, such as:
- Guillain–Barré syndrome
- inflammatory plexopathies
Primary headache disorders, such as:
- cluster headache
- glossopharyngeal neuralgia
- trigeminal autonomic cephalgias
- trigeminal neuralgia

Conditions – chronic

Conversion disorder / Functional neurological disorder
Peripheral nerves:
- entrapment neuropathies
- peripheral neuropathies:
  - acquired
  - inherited
- radiculopathies
Primary headache disorders, such as:
- migraine
- tension-type headache
- trigeminal autonomic cephalgias
Secondary headache disorders, such as:
- benign sex headache
- cervical arterial dissection
- cervicogenic headaches
- giant cell arteritis
- idiopathic intracranial hypertension
- low pressure headaches
- medication overuse headache
- myofascial pain syndrome
- reversible vasoconstriction syndrome
- space-occupying lesions
- temporomandibular joint disorders
- tumour

Conditions – emergency

Central / Peripheral:
- giant cell arteritis
- meningoencephalitis
- subarachnoid haemorrhage
- traumatic brain injury, including:
  - concussion
Spinal cord:
- demyelinating conditions, including:
  - multiple sclerosis
  - neuromyelitis optica spectrum disorder (NMOSD)
- extrinsic compression
- ischaemia, including:
  - stroke

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

Vasculitis / cerebrovascular inflammatory conditions

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

Common, rare, primary, and secondary diseases that result in headache, pain, and sensory disturbance
Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of headache and facial pain
Neuroanatomy, neuropharmacology, and neurophysiology of the pain pathway, peripheral nerves, and sensory pathways

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - glucose level
  - immunological tests
  - microbiological tests
  - protein level
  - xanthochromia
- opening pressure
- special tests:
  - oligoclonal bands
  - spectrophotometry

Clinical neurophysiology investigations

Electromyography (EMG):
- evoked potentials:
  - brainstem
  - somatosensory
  - visual
- needle EMG
Nerve conduction studies (NCS):
- motor and sensory studies

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
Myelography
Vascular imaging:
- catheter angiography
- neuroimmunology investigations

Neuroimmunology investigations

Autoantibody measurement:
- anti-aquaporin 4 and myelin oligodendrocyte antibodies
- paraneoplastic antibodies
Referral to a neuroimmunologist

Neuropathology investigations

Biopsy:
- brain
- muscle
- nerve
- temporal artery

Neuropsychological investigations

Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Rowland Universal Dementia Assessment Scale
Referral to a neuropsychologist

Other investigations

Polysomnography
Serum investigations:
- autoimmune screen
- blood glucose
- electrolytes
- full blood count
- infective serology
- inflammatory markers
- thrombophilia screen
- toxic / metabolic screen, including heavy metals, and mineral or vitamin deficiency

Importance of early diagnosis and treatment of acute conditions, such as:
- giant cell arteritis
- meningitis
- subarachnoid haemorrhage
Knowledge and treatment strategies for psychosocial effects and drivers of pain
Management strategies for the common types of headaches, such as:
- acute
- non-pharmaceutical interventions
- preventative
- rational use of medications
Overlap with other allied health and medical specialties, such as pain services, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
Overlap with other medical conditions, such as depression / anxiety and sleep apnoea
Prognosis and economic and lifestyle implications of these disorders

LG17: Disorders of consciousness and sleep

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 – disorders of consciousness

Anxiety
Confusion or somnolence
Dizziness
Fainting / Loss of consciousness
Fever
Hallucinations
Headache
Heart palpitations and/or shortness of breath
Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
Nausea and/or vomiting
Pain
Pins and needles and/or sensory loss
Seizures
Shakiness
Speech and/or swallowing difficulties

Presentations – disorders of sleep

Concentration / Memory impairment
Episodes of incomplete awakening and limited responsiveness
Excessive daytime sleepiness, narcolepsy, and sleep attacks
Insomnia
Loud snoring
Morning headaches
Sleep paralysis
Waking gasping or choking during the night

Conditions – cognition

Delirium
Metabolic and inherited disorders
Neurodegeneration

Conditions – inflammatory and infectious

Demyelinating disease
Encephalitis:
- autoimmune
- infective
- vasculitis
Meningitis
Systematic inflammatory disorders
Systemic infection

Conditions – metabolic and toxic

Hepatic
Hypoglycaemia
Kidney failure
Prescribed and illicit drugs

Conditions – other

Epilepsy, especially sudden unexpected death in epilepsy (SUDEP)
Obstructive sleep apnoea
Syncope
Traumatic brain injury, including:
- concussion

Conditions – structural

Raised intracranial pressure
Space-occupying lesions:
- abscess
- haemorrhage
- tumour
Stroke
Subarachnoid haemorrhage

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Non-rapid eye movement (REM), such as:
- confusional arousal
- night terrors
- sleep talking
- somnambulism
REM sleep behaviour disorder (RBD)
Sleep attacks

Conditions

Sleep disorders, such as:
- hypersomnia
- narcolepsy
- parasomnia

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 required for brain death diagnosis
Neuroanatomy, neuropharmacology, and neurophysiology of brain and brainstem mechanisms involved in the maintenance of normal consciousness
Neuroanatomy, neuropharmacology, and neurophysiology of normal sleep function
Pathological mechanisms that result in decreased consciousness
Pathological mechanisms that result in disturbed sleep and describe the way disorders of sleep can present

Assessments

Epworth Sleepiness Scale
Glasgow Coma Scale

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- CSF analysis:
  - cell count
  - cytology
  - immunological tests, including:
    - encephalitis panel
    - paraneoplastic
  - microbiological tests
  - oligoclonal bands
  - protein level
  - sugar level
  - xanthochromia
- opening pressure

Clinical neurophysiology investigations

EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
Evoked potentials:
- brainstem
- somatosensory

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
PET
Single photon emission computed tomography (SPECT)
Vascular imaging:
- catheter angiography
- doppler ultrasound

Neuropsychological investigations

Cognitive screening:
- Addenbrooke’s Cognitive Examination
- Mini-Mental State Examination
Referral to a neuropsychologist

Other investigations

Cardiac investigations:
- 24-hour ECG monitoring
- ECG
- echocardiography
Lung function tests:
- formal lung function tests
- vital capacity
Other laboratory tests, such as:
- autoimmune serology
- B12 level
- electrolytes
- full blood count and inflammatory markers
- hepatic and renal function
- metabolic testing, including:
  - glucose level
  - heavy metal and other toxins, including:
    - alcohol
    - ammonia levels
    - drugs
  - micronutrients
Multiple Sleep Latency Test (MSLT)
Polysomnography

Conditions that mimic disturbance of consciousness, such as:
- acute aphasia
- functional disorders, including:
  - non-epileptic status epilepticus
- locked-in syndrome
- stroke
Conditions that result in prolonged disturbance of consciousness, such as persistent vegetative state and minimally conscious state
Overlap with specific neurological syndromes, such as Parkinson disease and REM sleep behavioural disorders
Prognosis and implications of sleep disorders, such as driving
Role of neurologist in neuroprognostication for serious intercranial injury, including hypoxic ischaemic encephalopathy and subarachnoid haemorrhage

LG18: Disorders of memory, including dementia

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

Autonomic dysfunction
Behavioural / Personality changes, such as:
- apathy
Confusion
Emotional changes, such as:
- anxiety
- depression
Language difficulty
Loss of balance
Memory problems
Speech abnormalities
Perception / Vision changes
Weakness

Conditions

Alzheimer disease and related dementias
Atypical Parkinsonian disorders
Cerebrovascular inflammatory disease
Delirium
Dementia with Lewy bodies
Frontotemporal lobar degeneration syndromes, including:
- progressive aphasias
Immune-related encephalopathies
Metabolic disease
Normal pressure hydrocephalus
Parkinson disease
Poisoning / Toxins
Psychiatric diseases, including:
- depression
- schizophrenia
Systemic / Cerebrovascular inflammatory disease
Thyroid dysfunction
Toxins, including ethyl alcohol or ethanol (EtOH)
Transient epileptic amnesia
Transient global amnesia
Vascular dementia
Vitamin or mineral deficiency

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Catatonia
Hyperkinetic movement disorder(s)
Myoclonus
Neuroimaging abnormalities
Rapidly progressive cognitive decline

Conditions

Genetic / Inherited neurodegenerative disease
Inborn errors of metabolism
Leukodystrophies
Mitochondrial disease
Prion disease:
- Creutzfeldt–Jakob disease
- familial prion disorders
Repeat expansion disorders

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

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a 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, chronic, common, and rare diseases that result in disorders of behavioural change, language, memory, or movement
Neuroanatomy, neuropharmacology, and neurophysiology of normal memory and language function
Pathological mechanisms that result in disturbed memory or behavioural function

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - glucose level
  - immunological tests
  - microbiological tests
  - protein level
  - xanthochromia
- opening pressure
- special tests:
  - 14-3-3 protein
  - amyloid and tau levels
  - neurofilament light chain
  - oligoclonal bands

Clinical neurophysiology investigations

EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
Electromyography (EMG) / Nerve conduction studies (NCS):
- motor and sensory studies
- needle EMG

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
PET
Single photon emission computed tomography (SPECT)
Vascular imaging:
- catheter angiography

Neuroimmmunology investigations

Autoantibody measurement:
- limbic encephalitis panel
- paraneoplastic antibodies
Referral to a neuroimmunologist

Neuropathology investigations

Brain biopsy

Neuropsychological investigations

Cognitive screening:
- Addenbrooke’s Cognitive Examination
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Rowland Universal Dementia Assessment Scale
Referral to a neuropsychologist

Other investigations

Ethanol / Heavy metals / Toxins:
- autoimmune antibodies
- infective serology
Other laboratory tests:
- acanthocytes
- urinary porphyrins
- urine drug screen
Polysomnography
Serum investigations:
- electrolytes
- full blood count
- glucose level
- mineral and vitamin levels

Consider cultural implications and stigma related to diagnosis of neurodegeneration
Consider implications of genetic / inherited causes of neurodegenerative disease
Prognosis and implications of neurodegenerative diseases, such as:
- advance care planning
- driving
- increased care needs
- institutional care
Specific conditions that mimic disturbance of memory, including psychiatric disorders

LG19: Paroxysmal disorders, including seizures, syncope, and stroke

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

Confusion
Dyskinetic movement disorders
Epilepsy
Fainting / Loss of consciousness
Fatigue
Headaches
Jerky, rhythmic, or twitching motions
Light-headedness and/or dizziness
Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
Nausea and/or vomiting
Reduced level of consciousness
Seizures
Sensory disturbances
Speech difficulties
Staring
Stroke
Sweating
Syncope
Unresponsiveness

Conditions – epileptic

Lesion-related epilepsies
Metabolic disturbance
Primary generalised epilepsies
Status epilepticus

Conditions – haemorrhagic

Cerebral amyloid angiopathy
Primary intracranial haemorrhage
Subarachnoid haemorrhage
Venous infarction

Conditions – ischaemic

Amaurosis fugax
Cervical arterial dissection
Ischaemic stroke:
- acute thromboembolic
- arterial
Lacunar stroke
Transient ischaemic attacks
Venous sinus thrombosis
Watershed infarcts

Conditions – non-epileptic

Non-epileptic pseudo-status
Non-epileptic seizures

Conditions – stroke mimics

Conversion disorder
Migraine
Mitochondrial disorders

Conditions – syncope

Autonomic failure
Cardiac arrhythmias
Carotid sinus hypersensitivity
Dehydration
Vasovagal syncope

Other episodic conditions

Movement disorders

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

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a 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

Neuromuscular paroxysmal disorders
Paroxysmal movement disorders
Posterior reversible encephalopathy syndrome (PRES)
Reversible cerebral vasoconstriction syndrome (RCVS)

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

Arterial blood supply, vascular anatomy, and venous drainage of the brain and spinal cord
Causes of stroke syndromes, ischaemic and haemorrhagic diseases, and mimics, including those listed above
Classification and clinical features of the different types of epileptic seizure and epilepsy syndromes
Evidence-based pharmacological therapy and other forms of management of stroke and related syndromes, in relation to the acute situation, rehabilitation, and prophylaxis
Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of epilepsy and syncope

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - glucose level
  - immunological tests
  - microbiological tests
  - protein level
  - xanthochromia
- opening pressure

Clinical neurophysiology investigations

Autonomic testing
EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
Electromyography (EMG) / Nerve conduction studies (NCS)

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
PET
Referral to a neurointerventionalist or vascular surgeon
Vascular imaging:
- catheter angiography
- Doppler ultrasound

Neuroimmmunology investigations

Autoantibody measurement:
- autoimmune
- paraneoplastic
Referral to a neuroimmunologist

Neuropsychological investigations

Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
Referral to a neuropsychologist

Other investigations

Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
Other laboratory tests:
- acanthocytes
- alcohol
- B12 level
- creatine kinase (CK)
- electrolytes
- fasting lipid profile
- full blood count (FBC)
- lactate
- thrombophilia screen
- troponin
- urine drug screen
Polysomnography

Overlap with other allied health and medical specialties, such as occupational therapy, physiotherapy, rehabilitation medicine, and speech pathology, and when it is appropriate to refer
Overlap with other medical conditions, such as:
- cardiac disorders
- depression
- non-epileptic disorders
- syncope
Prognosis and implications of seizures, stroke, and syncope, such as driving and pregnancy
Prognosis, implications, and management strategies for stroke, such as:
- acute management
- impact on the family
- rehabilitation
- secondary prevention
Risk factors and comorbidities in stroke

LG20: Disorders of vision and other senses

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations – hearing and balance

Ataxia
Auditory hallucinations / Aura
Hearing loss
Loss of balance and/or coordination
Nausea and/or vomiting
Tinnitus

Presentations – smell and taste

Behavioural / Mood / Personality changes
Difficulties with vision and/or speech
Gustatory / Olfactory aura
Loss of smell
Loss of taste
Memory loss

Presentations – vision

Anisocoria
Binocular visual loss
Bi-temporal hemianopia
Blurry vision
Difficulty reading
Diplopia / Double vision
Headache
Hemianopia
Jaw claudication
Light sensitivity
Loss of depth perception
Monocular visual loss
Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
Myalgia
Nausea and/or vomiting
Nystagmus
Pain
Partial visual loss
Photopsia
Ptosis and/or exotropia
Quadrantinopia
Red eye
Seizures
Transient visual loss
Visual hallucinations

Conditions – double vision

Internuclear ophthalmoplegia
Myasthenia gravis
Ocular motor nerve palsies

Conditions – hearing

Acoustic neuroma
Raised intracranial pressure
Seizures
Stroke

Conditions – papilloedema / optic disc swelling

Cerebral venous thrombosis
Idiopathic intracranial hypertension
Intracranial space-occupying lesions

Conditions – positive visual phenomena

Charles Bonnet syndrome
Dementia with Lewy bodies
Migraine
Occipital epilepsy
Parkinson disease

Conditions – smell / taste

Neurodegenerative conditions
Orbitofrontal tumours
Seizures

Conditions – vision loss

Anterior pathway:
- anterior ischaemic optic neuropathy
- giant cell arteritis
- optic neuritis
Chiasmal compression
Demyelinating disease, such as:
- multiple sclerosis (MS)
- neuromyelitis optica spectrum disorder (NMOSD)
Diabetes with microvascular ischaemic complications
Posterior pathway:
- migraine
- occipital seizures
- posterior cortical atrophy
- stroke

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, chronic, common, and rare diseases that cause:
- disorders of the special senses
- double vision
- papilledema
- visual loss
Methods of assessing automated and confrontation perimetry, pupillary function, visual acuity, and visual fields, and performing a direct ophthalmoscopy
Neuroanatomy and neurophysiology of the auditory, oculomotor, olfactory, pupillary, and visual systems

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - immunological tests
  - microbiological tests
  - protein level
  - sugar level
  - xanthochromia
- opening pressure
- special tests:
  - 14-3-3 protein
  - oligoclonal bands
  - spectrophotometry

Clinical neurophysiology investigations

EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
Electromyography (EMG):
- needle EMG
- single-fibre EMG
Evoked potentials:
- repetitive nerve stimulation
- visual
Vestibular function tests

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
PET
Single photon emission computed tomography (SPECT)
Vascular imaging:
- catheter angiography
- Doppler ultrasound

Neuroimmmunology investigations

Autoantibody measurement:
- anti-aquaporin 4 antibodies
- autoantibodies associated with myasthenia gravis, such as anti-acetylcholine receptor antibodies
- paraneoplastic antibodies
Referral to a neuroimmunologist

Neuropathology investigations

Biopsy:
- brain
- temporal artery

Neuropsychological investigations

Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment

Other investigations

Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
Other laboratory tests:
- C-reactive protein (CRP)
- B12 level
- erythrocyte sedimentation rate (ESR)
- fasting lipids
- HbA1c
- serum angiotensin converting enzyme
- thrombophilia screen

Overlap with other medical specialties, such as ophthalmology and otolaryngology / ear, nose, and throat (ENT) surgery, and when it is appropriate to refer
Prognosis and implications of these disorders

LG21: Weakness and sensory change - central and peripheral disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Breathing difficulties / Shortness of breath
Cardiac arrhythmia
Confusion
Fatigue
Headaches
Muscle cramps, spasms, and/or twitches
Muscular difficulties, such as:
- aching
- coordination problems
- difficulty walking
- paralysis
- stiffness
- swelling
- weakness
Nausea and/or vomiting
Numbness
Pain
Sciatica
Sensory loss / sensitivity
Vertigo
Violaceous skin rash
Vision problems, including:
- pain
- vision loss
Weakness

Conditions – brain and brain stem

Bell’s palsy
Central nervous system (CNS) inflammatory disease, including:
- multiple sclerosis (MS)
- myelin oligodendrocyte glycoprotein (MOG)
- neuromyelitis optica spectrum disorder (NMOSD)
Stroke

Conditions – muscle

Dermatomyositis
Myotonic dystrophy
Polymyositis
Rhabdomyolysis

Conditions – neuromuscular junction

Botulism
Post-synaptic neuromuscular disorders, including:
- myasthenia gravis
Pre-synaptic neuromuscular disorders, including:
- Lambert–Eaton myasthenic syndrome

Conditions – peripheral nerves

Chronic inflammatory demyelinating polyneuropathy (CIDP)
Entrapment neuropathies
Guillain–Barré syndrome
Neuropathy:
- nutritional
- toxic
Other acquired and inherited peripheral neuropathies
Plexopathies
Radiculopathies

Conditions – psychological

Conversion disorder

Conditions – spinal cord

Motor neurone disease
CNS inflammatory disease, including:
- MOG
- MS
- NMOSD
Spinal cord compression

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Rapid fluctuation in weakness
Sporadic weakness

Conditions

Metabolic disorders, such as:
- metabolic myopathies
Paroxysmal weakness disorders, such as:
- periodic paralysis
Tetanus

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

Neuroanatomy and neurophysiology of the sensory pathways and peripheral nerves
Neuroanatomy, neuropharmacology, and neurophysiology of the:
- motor pathways
- neuromuscular junction
- peripheral nerves
- somatic musculature

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - autoimmune and paraneoplastic antibodies
  - cell count
  - cytology / flow cytometry
  - glucose level
  - microbiological tests
  - protein level
  - xanthochromia
- opening pressure
- special tests:
  - oligoclonal bands
  - spectrophotometry

Clinical neurophysiology investigations

EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
Electromyography (EMG):
- needle EMG
- single-fibre EMG
Evoked potentials:
- brainstem
- somatosensory
- visual
Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
- single fibre EMG

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
Myelography
Vascular imaging:
- catheter angiography
- Doppler ultrasound

Neuroimmmunology investigations

Autoantibody measurement:
- anti-aquaporin 4 antibodies and MOG
- autoantibodies associated with myasthenia gravis, such as:
  - anti-acetylcholine receptor antibodies
- paraneoplastic antibodies
Referral to a neuroimmunologist

Neuropathology investigations

Biopsy:
- muscle
- nerve

Other investigations

Cardiac investigations:
- 24-hour electrocardiography monitoring
- bedside spirometry
- lung function tests
- transoesophageal / transthoracic echocardiogram
- vital capacity
Serum tests:
- acanthocytes
- autoimmune panel
- fasting lipid profile
- HbA1c
- heavy metals and other toxins
- infective screen
- myositis panel
- paraneoplastic autoantibodies
- serum angiotensin converting enzyme
- serum free light chains
- thrombophilia screen
- urinary porphyrins
- vasculitis panel
- vitamin levels, including, but not limited to:
  - B1
  - B6
  - B12
  - vitamin E

Overlap with other allied health and medical specialties, such as geriatrics, immunology, medical genetics, physiotherapy, rehabilitation medicine, and speech pathology, and when it is appropriate to refer
Prognosis and implications of these disorders

LG22: Disorders of gait and balance, including disequilibrium, dizziness, and vertigo

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

Ataxia / Imbalance / Incoordination
Disequilibrium
Dizziness
Hearing problems, such as:
- ear pressure
- loss
- tinnitus
Vertigo

Conditions – brain

Cerebral palsy
Cerebrovascular disease
Demyelination
Drugs and toxins
Functional neurological disorder
Gait apraxia
Genetic causes, such as:
- spinocerebellar atrophy
Migraine
Neoplasm
Normal pressure hydrocephalus
Progressive supranuclear palsy

Conditions – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways

Benign positional vertigo
Labyrinthitis, acute
Menière’s disease
Neurofibromatosis:
- type 1
- type 2
Peripheral nerve diseases, such as:
- vitamin B12 deficiency
Spinal cord neoplasm
Transverse myelitis
Vestibular causes

Conditions – non-neurological causes

Cardiac arrythmia
Syncope

Conditions – psychological

Anxiety syndromes
Conversion disorder
Hyperventilation

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 – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways

Cerebellar ataxia neuronopathy vestibular areflexia syndrome (CANVAS)
Hereditary ataxias, including:
- episodic ataxias
Mal de debarquement syndrome
Superior canal dehiscence syndrome

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

Synthesise

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

Manage

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

Consider other factors

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

Acute, chronic, common, and rare diseases that cause:
- disequilibrium
- disorders of gait and balance
- dizziness
- vertigo
Neuroanatomy and neurophysiology of the:
- neurological pathways involved in gait and balance
- vestibular and cerebellar systems

Assessments

Audiogram
Caloric testing
Dix–Hallpike manoeuvre
Head impulse test
Rotatory chair vestibulo-ocular reflex testing

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - cytometry
  - immunological tests
  - microbiological tests
  - protein level
  - sugar level
  - xanthochromia
- opening pressure
- special tests:
  - 14-3-3 protein
  - oligoclonal bands
  - spectrophotometry

Clinical neurophysiology investigations

Evoked potentials:
- brainstem
- somatosensory
- visual
Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
Vestibular function tests

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
Myelography
PET
Single photon emission computed tomography (SPECT)
Vascular imaging:
- catheter angiography
- Doppler ultrasound

Neuroimmmunology investigations

Autoantibody measurement:
- anti-aquaporin 4 (AQP-4) and myelin oligodendrocyte glycoprotein (MOG) antibodies
- testing for:
  - angiotensin converting enzyme (ACE)
  - antinuclear antibodies (ANA)
  - anti-neutrophil cytoplasmic antibodies (ANCA)
  - double-stranded DNA (dsDNA)
  - extractable nuclear antigens (ENA) testing
  - paraneoplastic antibodies
Referral to a neuroimmunologist

Neuropathology investigations

Biopsy:
- brain
- nerve

Neuropsychological investigations

Referral to a neuropsychologist

Other investigations

Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
Other laboratory tests:
- acanthocytes
- B12 level
- fasting lipid profile
- serum angiotensin converting enzyme
- thrombophilia screen
- urinary porphyrins

Overlap with other allied health and medical specialties, such as ear, nose, and throat specialists, neurosurgery, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
Prognosis and implications of these disorders

LG23: Movement disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations – hyperkinetic

Athetosis
Ballism
Chorea
Dystonia
Fasciculations
Myoclonus
Myokymia
Myorhythmia
Stereotypies
Tics
Tremor

Presentations – hypokinetic

Bradykinesia
Catatonia
Freezing
Parkinsonism
Postural instability
Rigidity

Conditions – psychological

Conversion disorder
Malingering

Conditions – specific hyperkinetic disorders

Adult-onset focal dystonia
Blepharospasm
Cervical dystonia
Episodic ataxia
Facial dystonia
Functional movement disorder
Generalised dystonia
Hemifacial spasm
Huntington disease
Myoclonus dystonia
Tourette syndrome
Tremors:
- drug-induced
- dystonic
- essential
- essential tremor plus
- functional
- palatal
- systemic / metabolic causes
Wilson disease
Writer’s cramp

Conditions – specific hypokinetic conditions

Corticobasal syndromes
Dementia with Lewy bodies
Drug-induced Parkinsonism
Functional neurological disorder
Multiple system atrophy
Normal pressure hydrocephalus
Parkinson disease
Progressive supranuclear palsy
Stiff person syndrome
Vascular parkinsonism

Conditions – other

Functional neurological disorder
Prion disease
Stiff person syndrome

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Hereditary ataxia syndromes, including:
- spinocerebellar ataxias
Metabolic causes of movement disorders
Paroxysmal dyskinesias:
- exercise-induced
- kinesogenic
- non-kinesogenic

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, chronic, common, and rare diseases that cause disorders of movement
Neuroanatomy, neuropharmacology, and neurophysiology of the motor pathways

Cerebrospinal fluid (CSF) procedures and investigations

Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
  - cell count
  - cytology
  - cytometry
  - immunological tests
  - microbiological tests
  - protein level
  - sugar level
- opening pressure
- special tests:
  - 14-3-3 protein
  - real-time quaking induced conversion (RT-QuIC)

Neurogenetic investigations

Genetic testing, including, but not limited to:
- chromosomal testing, such as:
  - karyotype
  - microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
Referral to a neurogeneticist

Neuroimaging investigations

CT, including:
- CT angiography
- perfusion
- venography
Dopamine uptake transporter (DAT)
MRI, including:
- functional (fMRI)
- magnetic resonance:
  - angiography (MRA)
  - spectroscopy (MRS)
  - venogram (MRV)
- with contrast
Myelography
PET
Single photon emission computed tomography (SPECT)
Vascular imaging:
- catheter angiography
- Doppler ultrasound

Neuroimmmunology investigations

Autoantibody measurement:
- antinuclear antibodies (ANA)
- anti-amphiphysin, anti-GAD, and anti-glycine antibodies
- anti-phospholipid antibody testing
- double-stranded DNA (dsDNA)
- extractable nuclear antigens (ENA) antibody testing
Referral to a neuroimmunologist

Neuropathology investigations

Brain biopsy

Neuropsychological investigations

Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
Referral to a neuropsychologist

Other investigations

Other laboratory tests:
- acanthocytes
- B12 level
- copper
- fasting lipid profile
- iron studies
- serum angiotensin converting enzyme
- thrombophilia screen
- urinary porphyrins
Polysomnography

Overlap with other allied health and medical specialties, such as geriatrics, medical genetics, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
Prognosis and implications of these disorders

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

Printed by:	Guest user
Date:	Saturday, 29 November 2025, 12:02 AM

Description

Advanced Training in Neurology (Adult Medicine)

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

13

14

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: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour