Curriculum standards

About this resource

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

This resource outlines the curriculum standards for Advanced Training in Clinical Pharmacology for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Clinical Pharmacology 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 and/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
understand the range of team members’ skills, expertise, and roles
acquire and apply leadership techniques in daily practice
collaborate with and motivate team members
encourage and adopt insights from team members
act as a role model

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information 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
work with patients, families, carers, and other health professionals to resolve conflict that may arise when planning and aligning goals
demonstrate rapport with people at all levels by tailoring messages to different stakeholders

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
understand 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:

understand 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
understand methods used to allocate resources to provide high-quality care
promote the development and use of organisational policies and procedures

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

support learners to deliver quality care while maintaining 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 of professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching by developing goals and strategies to improve
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in the supervision of learners
apply a standardised approach to teaching, assessment, and feedback without considering individual 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:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

role model a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural 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 whereby 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 and enhance health care
monitor one’s own practice and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use population health outcomes to identify opportunities for improvement in delivering appropriate care
regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols to adhere to best practice and prevent the occurrence of medication errors and related harms
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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
participate in organisational quality and safety activities, including morbidity and mortality reviews, clinical incident reviews, root cause analyses, and corrective 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
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve health care
explain health data sources and the influence of bias

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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, and identify strategies to address underperformance
resolve conflicts within a team
teach clinical pharmacology at both undergraduate and postgraduate level
prepare, deliver, and evaluate teaching in a variety of different modes
design a structured framework for virtual teaching and remote supervision techniques that align with the growing reliance on digital communication tools in the education sector

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:

prepare a research protocol for approval by a human research ethics committee
critically review clinical trial or research protocols against national standards
design, conduct, and complete a research study, including ethics application, full report, and/or publication
complete a peer review of a manuscript submitted for publication

direction
Requires some supervision

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

The trainee may:

understand that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research
prepare an ethics application for a drug trial

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

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:

participate in all aspects of the development, implementation, evaluation, and monitoring of governance processes
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving care are actively encouraged
measure, analyse, and report a set of specialty-specific process of care and outcome clinical indicators, and a set of generic safety indicators
contribute to the working of a drug committee
work with patients to promote shared decision making, the patient voice, and inclusivity in relation to research and quality improvement projects
take part in the design and implementation of the organisational systems for:
- clinical education and training
- defining the scope of clinical practice
- performance monitoring and management
- safety and quality education and training
- supporting the development of local drug policy

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
participate in the development or maintenance of paediatric formularies

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, including comprehensive medication histories
examine patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with patients
generate management plans
present findings to other health professionals

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, organised, and problem-focused medical histories, considering risk factors, including medication adherence and physical and psychosocial components
perform full physical examinations to establish the nature and extent of problems, including toxicities and overdoses
demonstrate initial assessment and management of suicide risk, mental capacity, and mental health status in poisoned patients
synthesise and interpret findings from histories, examinations, and investigations, integrate data from wearables, and devise the most likely diagnoses for clinical management
assess the severity of problems, likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account, including substance use or dependence
produce expert clinical / scientific reports

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 the clinical encounter and diagnostic categories
develop appropriate management plans

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
work in partnership with patients to construct medicine optimisation plans to address complex prescribing needs
communicate complex prescribing issues and proposed management choices to patients and their healthcare providers

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

direction
Requires some supervision

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

The trainee may:

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
provide poisons advice for common poisons exposures
communicate and teach pharmacokinetic principles to other staff, and apply to specific patients
participate in ongoing education about new drugs on the market, updates in pharmacotherapy guidelines, and emerging evidence in drug therapy
use resources for learning about global differences in drug availability and regulatory considerations

direction
Requires some supervision

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

The trainee may:

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
appropriately contribute to drug evaluation committees
write submissions to ethics committees
stay informed and up to date on advances in research and best practice clinical care
participate in conduct of randomised control trials

direction
Requires some supervision

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

The trainee may:

refer to guidelines and medical literature to assist in clinical assessments when required
demonstrate an understanding of the limitations of evidence and the challenges of applying research in daily practice
explain the safety requirements of research subjects
retrieve and interpret the literature on more complex issues

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 safe communication and care for Aboriginal and Torres Strait Islander peoples, Māori, and members of other cultural groups
use a professional interpreter, health advocate, or a family or community member to assist in communication with patients, and understand the potential limitations of each
acknowledge patients’ beliefs and values, and how these might impact on health

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the 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 optimal cost-effective patient care to allow maximum benefit from the available resources
aim to incorporate environmentally sustainable service delivery
advocate for patients when there are escalating concerns for their deteriorating condition

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 patients’ 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 patients’ 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 and medication-related information
perform this activity in multiple settings, appropriate to clinical pharmacology, including ambulatory, critical care, inpatient, and laboratory settings

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate an optimal transition of care for patients between settings with reference to pharmacotherapy and therapeutics
identify and manage key risks for patients during transition, especially involving high-risk medicines
anticipate possible changes in patients’ conditions and medication regimens, 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:

understand the details of patients’ conditions, illness severity, medication management, and potential emerging issues, with appropriate actions
provide accurate summaries of patients’ information and medications with accurate identification of problems or potential therapeutic misadventure during transitions of care

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, medication reconciliation, and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals, when required
communicate with patients about 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 adverse events at transition of care, and mitigate this risk
use electronic tools (where available) to securely store and transfer patient and medication-related information
use consent processes, including written consent if required, for the release and exchange of information
explain 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
examine the variations in medication management and the resulting outcomes among Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
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
demonstrate understanding of the clinical, ethical, and legal rationale for information disclosure
share information about patients’ health care in a manner consistent with privacy laws and professional guidelines on confidentiality
demonstrate understanding of the additional complexity related to some types of information, such as genetic information and blood-borne virus status, and seek appropriate advice about disclosure of such information
interact in a collegiate and collaborative way with professional colleagues during transitions of care

direction
Requires some supervision

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

The trainee may:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

contribute to processes for managing risks, and identify strategies for improvement in transitions of care, particularly in relation to medication regimens
engage in organisational processes to improve transitions of care, such as oversight of governance, auditing, and quality improvement

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: Longitudinal care

Learning Goal 7

Longitudinal care

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

This activity requires the ability to:

develop management plans and goals in consultation with patients
manage chronic and advanced conditions, complications, disabilities, and comorbidities
collaborate with other care providers
ensure continuity of care
facilitate patients’ 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 comorbidities, multimorbidity, 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
identify the use of tools used by allied health to assess function in care

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, including remotely, 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:

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

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
recognise appropriate use of review articles

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management
recognise that input may be required from cultural and diverse backgrounds, such as representatives in the community

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

share information about patients’ health care, consistent with privacy laws and confidentiality and professional guidelines
use consent processes for the release and exchange of health information
assess patients’ decision-making capacity, and appropriately identify and use alternative decision makers
identify that the least restrictive treatment options may require flexibility in medical management, and innovative solutions may be required

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
recognise that decision making is often team based, with input from multidisciplinary team members

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 for patients with multimorbidity 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 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 care delivery to patients with chronic conditions and disabilities
participate in government initiatives for chronic diseases management to reduce hospital admissions and improve patients’ quality of life
help patients access initiatives and services for patients with chronic conditions and disabilities
review transitional care and community initiatives from non-governmental and government organisations to bridge hospital-to-home care

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

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses, problems, and management plans with patients

This activity requires the ability to:

select suitable contexts, and include other team members
adopt a patient-centred perspective, including adjusting for cognition, language, culture, and disabilities
select and use appropriate modalities and communication strategies
structure conversations intentionally
negotiate mutually agreed management plans
verify patients’ 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
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options

direction
Requires some supervision

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

The trainee may:

apply knowledge of the scientific basis of health and disease to the management of patients
demonstrate an understanding of 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, or phone calls
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
use a health care interpreter where appropriate
ensure sensory aids are used if available, such as amplifiers or hearing aids
encourage questions, and answer them to the degree that is desired by the patient
ask patients to share their thoughts or explain their management plans in their own words, to verify understanding
encourage shared decision making
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
recognise the role of family or carers, and, when appropriate, encourage patients to involve their family or carers in decisions about their care

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 or patient advocates 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
consider capacity for decision making and consent
recognise and take precautions where patients may be vulnerable, such as issues of child protection, self-harm, or elder abuse
participate in processes to manage patients’ complaints
stay informed and up to date on advances in research and best practice clinical care
explain limitations, lack of, and evolving evidence for certain conditions or treatments

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:

obtain informed consent or other valid authority before involving patients in teaching, and recheck patients’ consent periodically during the teaching session
manage patients’ negative experiences resulting from teaching sessions

direction
Requires some supervision

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

The trainee may:

obtain informed consent or other valid authority before involving patients in teaching

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 or clinical trials
obtain an informed consent or other valid authority before involving patients in research and clinical trials

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication with 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 health care interpreters or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use information wisely when they make decisions
encourage and support patients 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 / expert opinions
manage relationships or potential conflicts of interest with external agencies or industry members

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
exercise caution with the use of social media
demonstrate a caring attitude towards patients
respect patients, including protecting their rights to privacy and confidentiality (in and out of the workplace, such as on social media)
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours, or the illness itself

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with team members involved in patients’ care, and with patients
discuss medical assessments, treatment plans, and investigations with patients and primary care teams, working collaboratively with all
discuss patients’ care needs with healthcare team members to align them with the 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
evaluate controversial issues and make effective decisions that balance efficacy, safety, ethics, and cost

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

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

adhere to the principles of quality use of medicines, including scheduled medications
take and interpret medication histories
consider principles of personalised medicine approaches, such as concentration-guided dosing, in order to optimise medicine use
choose medicines based on an understanding of pharmacology, taking into consideration age, benefits, comorbidities, potential drug interactions, and risks
communicate with patients about the benefits and risks of proposed therapies and appropriate non-drug therapies
provide instructions on medication administration effects and side effects
monitor medicines for efficacy and safety, and deprescribe where appropriate
collaborate with pharmacists

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ disorders requiring pharmacotherapy
consider non-pharmacologic therapies
elicit comprehensive drug histories, including complementary and alternative medicines (CAM)
apply principles of pharmacodynamics and pharmacokinetics to drug dosing regimens
consider age, allergies, chronic disease status, frailty, lifestyle factors, organ impairments, patient preference, pharmacogenomics, potential drug interactions, and therapeutic objectives prior to prescribing new medications
use pharmacokinetic equations to derive basic pharmacokinetic parameters
review patients’ drug concentrations, considering clinical condition, dosing history, and other factors that may affect interpretations of drug concentrations, such as age, lactation, pregnancy, and weight
predict the pharmacology and possible effects of a drug group from an understanding of its mechanism of action, including possible drug reactions
plan for follow-up and monitoring, and interpret the interpatient variability and factors contributing to it
consider critically reviewing medicines at each visit, deprescribing where appropriate, in discussion with patients and other relevant stakeholders
assess and introduce new medicines

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 understanding of the benefits, contraindications, dosage, drug interactions, rationale, risks, and side effects
identify and manage adverse events
interpret laboratory data

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 complete, clear, legible, and legal prescriptions in plain language, and include specific indications for the anticipated duration of therapy
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, other medicines being taken, and advice to carers administering medication, where appropriate
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
advise on off-label and unlicensed medication use
explore strategies to improve patient adherence, especially in chronic disease management

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients
explain the benefits and burdens of therapies, considering patients’ individual circumstances
write clearly legible scripts or charts using generic names of 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
use and advise about adherence aids

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
perform complex medication reviews, and provide advice on judicious prescribing
review medication charts and make suggestions to reduce inappropriate polypharmacy, drug interactions, and adverse drug reactions
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
evaluate and act upon drug prescription, dispensing, or administration errors
report suspected adverse events to the Therapeutic Goods Administration or Medsafe, and record it in patients’ medical records
develop evidence-based prescribing guidelines
stay informed and up to date on advances in research and best practice clinical care

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 and/or adverse drug reactions of prescribed medicines
identify medication errors and institute appropriate measures
use electronic prescribing systems safely
rationalise medicines to avoid polypharmacy

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

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
promote safe prescribing for children
discuss prescribing errors
contribute to formulary maintenance
deliver clinical pharmacology teaching materials to undergraduate and postgraduate students

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
analyse concentration-effect data
conduct and evaluate drug utilisation studies

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:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients about prescribed medicines and:
- how to take the medicine
- potential side effects
- what the medicine does
- what the medicine is for
- when it should be stopped
make prescribing decisions based on good safety data when the benefits outweigh the risks involved
demonstrate understanding of the ethical implications of pharmaceutical industry-funded research and marketing
explain the legislative and regulatory controls for drugs of abuse
adjust prescribing practices to accommodate the growing occurrence of multimorbidity and polypharmacy in ageing populations

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, judiciously, 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
recognise the opposing viewpoints and pressures involved to market and subsidise new drugs
assess pharmacodynamic variation over time, and how this impacts clinical decisions

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

interact with medical, pharmacy, and nursing staff to ensure safe and effective medicine use
act as a liaison between laboratory scientists and clinicians on matters related to drug concentrations
collaborate with laboratory scientists in matters relating to paediatric drug concentrations

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
participate in drug and therapeutics committees

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
use electronic clinical decision support
support national initiatives around safe and effective use of medicines, including immunisation

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy
explain the structure of medicine regulatory and health technology assessment bodies

LG10: Investigations

Learning Goal 10

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

select, plan, and use evidence-based clinically appropriate investigations
prioritise patients receiving investigations (if there is a waiting list)
evaluate the anticipated value of investigations
work in partnership with patients 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, and frame them 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 abnormal findings, considering patients’ specific circumstances, and act accordingly

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
understand the significance of abnormal test results, and act on these
consider patient factors and comorbidities
consider age-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 have understood the information they have been given and whether they need more information before deciding
use written or visual material or other aids that are accurate and up to date to support discussions with patients
explain findings or possible outcomes of investigations to patients
provide 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
evaluate information presented regarding medicines
stay informed and up to date on advances in research and best practice clinical care

direction
Requires some supervision

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

The trainee may:

consider safety aspects of investigations when planning them
seek help with interpretation of test results for less common tests or indications or unexpected results
evaluate laboratory performance via internal and external quality assurance activities, focusing on precision and accuracy

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
explain the interpretation of therapeutic drug monitoring

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
source and apply principles of evidence-based medicine

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

recognise patients’ views and preferences about any proposed 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 they 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 a clinical situation
adjust investigative paths depending on test results received
consider whether patients’ conditions may get worse or better if no tests are selected
apply decision-making aids to choose suitable examinations, minimising excessive testing

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 understanding of what parts of investigations are provided by different doctors or health professionals

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

assess important drug information

LG 11: Clinic management

Learning Goal 11

Clinic management

Manage an outpatient clinic

This activity requires the ability to:

manage medical consultations, procedures, and treatments
manage clinic services
manage time and tasks
oversee quality improvement activities
communicate with patients
liaise with other health professionals and team members
demonstrate problem-solving skills
responsibly use public resources
ensure competent use of technology, such as dictation and video consultation

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system to improve access to care by collaboration with other services, such as community health centres and consumer organisations
link patients to specific community-based health programs and group education programs
ensure accountability and adequate record keeping in line with billing requirements
avoid over-servicing and inappropriate investigations

direction
Requires some supervision

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

The trainee may:

wherever practical, meet patients’ specific language and communication needs
facilitate appropriate use of interpreter services and translated materials
ensure informed financial consent, and discuss relevant out-of-pocket costs

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:

practise health care that maximises patient safety
adopt a systematic approach to the review and improvement of professional practice in the outpatient clinic setting
identify aspects of service provision that may be a risk to patients’ safety
ensure that patients are informed about fees and charges, and seek financial consent
foster a culture of continuous quality improvement by proactively evaluating clinic services
ensure safe storage and retrieval of clinic data

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

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:

apply knowledge of the cultural needs of the community served, and how to shape service to those people
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement and health outcomes
identify the need to use official interpreter services appropriately

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
ensure environmentally and financially sustainable service, responsive to community needs

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 that allows maximum benefit from the available resources

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

prepare for and conduct clinical encounters in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups
document all important discussions with colleagues, multidisciplinary team members, and patients
review discharge summaries, notes, and other communications written by junior colleagues
support colleagues who raise concerns about patients’ safety
develop a comprehensive understanding of crisis management and emergency response in a clinical environment

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

demonstrate capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
identify funding programs from non-government organisations (NGOs) and government agencies that may benefit the clinic

direction
Requires some supervision

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

The trainee may:

explain common population health screening and prevention approaches

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.

LG12: Foundations of clinical pharmacology

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.

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 patients14, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

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

View

Drug dependence

Classes of drugs involved, both legal and illegal
Legislative and regulatory controls for drugs of abuse
Principles of dependence, overdose, and tolerance, including receptor downregulation / internalisation

Drug discovery and development

Drug development principles, such as:
- considerations of using generic medicines, such as bioequivalence studies and drug patents
- delivery and formulation
- design and research, including lead generation and target identification and validation
- efficacy, quality, and safety of new drug applications
- opposing viewpoints and the pressures involved to market and subsidise new drugs
- role of the national regulatory authorities
Ethical aspects of drug-related research, including safety requirements of research subjects
Preclinical and clinical development principles, such as:
- International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidance
- phases of drug trials
- pre-clinical pharmacology and toxicology studies
- principles to determine the maximum safe starting dose and dose-escalation in first-in-human clinical trials, such as:
  - minimal anticipated biological effect level (MABEL)
  - no observed adverse effects level (NOAEL)
  - pharmacologically active dose (PAD)
- regulatory documents, such as:
  - Australian Public Assessment Reports (AusPAR)
  - European Public Assessment Reports (EPAR)
  - Food and Drug Administration (FDA)
- significant regulatory milestones
Principles of quality improvement methodology
Principles of research methodology, such as:
- awareness of more complex statistics, such as Mendelian randomisation (MR) and high-dimensional propensity score (hdPS) matching
- basic biostatistics, such as power analysis and survival analysis
- critical appraisal of a manuscript being submitted for publication
- hypothesis development and testing
- principles of good clinical research practice
- review of ethics application against national statement
- role of ethics, and ethics committees

Drug safety and toxicity

Adverse drug reactions (ADRs) and pharmacovigilance, such as:
- drug safety post-marketing
- mechanisms of toxicity
- monitoring adverse effects
Drug-drug interactions and contraindications

Multimorbidity

Clinical assessment, such as Charlson Comorbidity Index
Clinical guidelines and medications used in the treatment of common comorbidities
Conflicting therapeutic objectives
Contribution to polypharmacy and drug interactions
Definition
Epidemiology
Frailty as an effect modifier for medicines
Pathophysiology

Pharmacodynamics and drug mechanisms

Concentration-effect relationships, and factors that may alter these
Drug-receptor interactions, such as:
- agonists
- antagonists
- inverse agonists
- partial agonists
Enzyme activity in the presence of drugs
Ion channel function across various systems
Mechanisms of drug action, such as:
- biologicals
- gene therapy
- receptor pharmacology
Potency versus efficacy
Role of transport proteins in pharmacokinetics
Tolerance
Use of biomarkers in drug therapy monitoring
Variability in drug action

Pharmacoeconomics

Economic implications of drug therapy, such as:
- budget impact analyses
- cost-effectiveness analyses
- cost-minimisation analysis
- cost-utility analysis

Pharmacoepidemiology

Case control studies
Cohort studies
Cross-sectional studies
Data sources, such as electronic medical records (EMRs) and Pharmaceutical Benefits Scheme (PBS)
Repositories
Use and effects of drugs in large numbers of people, and how it can inform public health decisions

Pharmacogenomics

Databases available for pharmacogenomic research, including the Clinical Pharmacogenetics Implementation Consortium
Genetic variability of drug response and metabolism, such as:
- genetic variation of therapeutic targets
- polymorphisms of key drug metabolising enzymes and transporters
- race-associated pharmacogenetic variation
Ontogeny of expression and function of key pharmacodynamic and pharmacokinetic genes
Role in precision medicine
Tailoring drug therapies to individual genetic profiles

Pharmacokinetics

Basic pharmacokinetic equations
Gene therapy principles, such as:
- delivery vectors
- expression kinetics
- modalities
Principles of pharmacokinetics, such as:
- absorption, distribution, metabolism, and excretion (ADME)
- area under a plasma drug concentration-time curve (AUC)
- bioavailability and first-pass effect
- clearance, including extraction ratio and total body clearance
- drug behaviour in the body
- drug metabolism and elimination
- drug transport
- first- and zero-order processes, such as saturation kinetics
- half-life
- nonlinear kinetics
- plasma protein binding and free drug concentrations, considering the impact on parameters and effects
- receptor-mediated drug disposition
- volume of distribution
Principles of pharmacodynamics and pharmacokinetics in special circumstances, such as:
- extremes of size and age – development / senescence
- hepatic disease
- kidney failure
- lactation
- pharmacogenomics
Receptor concepts

Substance use disorders

Acute toxicity
Demographics
Mental health factors
Social factors
Tolerance
Withdrawal and abstinence syndromes of common substances, such as:
- antidepressants
- cannabis
- ethanol
- gabapentinoids
- nicotine
- opioids
- sedative hypnotics
- stimulants

Toxicology care

Anti-epileptic drugs
Common poisonings, such as:
- antibiotic
- anticoagulant and antiplatelet
- antihypertensive
- antipsychotic
- benzodiazepine
- beta blocker
- diuretic
- glucose-lowering medicine
- nonsteroidal anti-inflammatory drug (NSAIDs)
- opioid
- paracetamol
- salicylate
- steroid
Impact of specific interventions on the outcome
Novel psychoactive agents
Principles of toxicodynamics and toxicokinetics
Toxidromes, such as:
- anticholinergic, including antimuscarinic
- beta blocker
- calcium channel blocker
- cholinergic
- opioid
- sedative or hypnotic
- serotonergic
- sodium channel blocker
- sympathomimetic

AIM

Modelling and simulation, including physiologically based pharmacokinetic modelling (PBPK)
Principles of pharmacodynamics and pharmacokinetics in geriatric, lactating, and pregnant patients

PCH

Clinical and legislative issues relating to drugs of dependence / abuse, including adolescent substance misuse and neonatal abstinence syndromes
Consent and other ethical issues specific to paediatric age groups
Developmental changes in metabolic and kidney elimination pathways
Mechanisms of action, modelling, and simulation in relation to paediatric age groups
Paediatric drug trial principles, such as age-specific drug responses, and dosing and ethical challenges
Pharmacodynamics and pharmacokinetics in:
- adolescents
- children
- infants
- intrauterine environment
- lactation
- neonates
- preterm neonates

Drug development

Efficacy, quality, and safety of new drug applications in the paediatric age
Formulation development

Toxicology

Antenatal and perinatal toxicity of maternal medications
Clinically relevant human teratogens
Drug exposure and toxicity through breastfeeding
Principles of paediatric poisons exposures, such as intentional or accidental poisoning

Analytical methodologies, such as:
- immunoassays
- liquid chromatography
- mass spectrometry
Assays, such as:
- analysis of results
- common methodology
- performance principles
- quality control
Model-dependent analyses, such as compartmental models
Model-independent analyses
Nonlinear mixed effect modelling
Simulation of new dosing regimens

PCH

Assays in paediatric age groups

Impact on drug safety of digital health technologies, such as:
- apps for medication management
- digital therapeutics
- dose modification using predictive software
- electronic health records
- electronic medication management and ordering
- medical informatics and dashboards
- telehealth for patient consultations
Multidisciplinary approach to care, such as when treating complex cancer patients
National and local guidelines for the quality use of medicines
Opportunities to stay informed and up to date on advances in research and best practice clinical care, such as participating in journal club to learn about new drugs and devices

Quality use of medicines

Complementary and alternative medicine (CAM) benefits and limitations, including their side effects and interactions, and their prominence in the population
Drug information, such as:
- gaps between lay, paramedical, and medical understanding of research methodology and evidence
- levels of evidence
- principles of evidence-based medicine
- sources of drug information
Drug policy stakeholders, such as:
- competing factions, including:
  - drug companies
  - government regulatory committees
- drug committees
- formularies
Drug safety principles, such as:
- contribution of adverse drug reactions (ADRs) and drug error to morbidity and mortality
- difference between ADRs and adverse drug events (ADEs)
- importance of considering risks as well as benefits of drugs
- methods of evaluating and classifying ADEs, ADRs, and drug errors
- responsibility to contribute to the national database of ADRs
- role of post-marketing surveillance / pharmacovigilance / risk management plans
- sources of information on ADRs
Impact of drugs on broader society, such as:
- climate health
- eco-pharmacovigilance
- globalisation and its impacts on the drug manufacturing chain, such as supply shortages
- sustainability
Pharmaceutical, pharmacodynamic, and pharmacokinetic drug interactions as a cause of morbidity, mortality, and variability
Principles behind compliance and adherence with medicines, and methods to these, including the benefits of compliance aids
Principles of drug use evaluation, such as the audit loop, and the orphan drug designation
Therapeutic drug concentration principles, such as:
- indications, limitations, and usefulness of therapeutic drug monitoring in patient management
- therapeutic ranges for commonly assayed medications

PCH

Benefits, limitations, and extent of CAMs use in the paediatric age group
Drug information, such as:
- appropriate methods for extrapolating adult data to children, and the limitations of these methods
- sources of drug information for the paediatric age group, and the limitations of this information
Drug safety considerations, such as:
- detection of ADRs and ADEs in children
- errors in administration, dispensing, monitoring, and prescribing
Principles of administration of medicines to children
Role of neonatal / paediatric formularies in drug policies

LG13: Clinical pharmacology by system

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

Patients referred for care

Conditions - cardiovascular

Arrhythmia
Heart failure
Hyperlipidemia
Hypertension

Conditions – dermatological

Cellulitis

Conditions – endocrine

Diabetes:
- type 1
- type 2
Thyroid disorders:
- hyperthyroidism
- hypothyroidism
- thyroid nodules
- thyroiditis

Conditions – gastrointestinal

Acid peptic disease:
- gastritis
- gastroesophageal reflux disease (GERD)
- peptic ulcer disease
Motility disorders:
- gastroparesis
- irritable bowel syndrome (IBS)

Conditions – haematologic

Anaemia

Conditions – kidney and urinary system

Kidney failure:
- acute injury (AKI)
- chronic (CKD)

Conditions – musculoskeletal

Arthritis:
- osteoarthritis
- rheumatoid arthritis
Gout
Musculoskeletal disorders:
- fibromyalgia
- osteoporosis
- soft tissue injury

Conditions – nervous system

Epilepsy
Neuropathies
Stroke

Conditions – respiratory

Asthma
Chronic obstructive pulmonary disease (COPD)
Pneumonia
Pulmonary embolism

AIM

Multimorbidity
Psychiatric comorbidities

Geriatric syndromes

Cognitive impairment
Delirium
Dementia
Falls
Fractures
Incontinence
Vertigo

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Patients referred for care

Conditions - dermatological

Cancer – skin
Infection
Psoriasis

Conditions – haematologic

Cancer
Clotting disorders
Leukaemia
Lymphoma

Conditions – immune

Autoimmune disorders
Deficiencies
Systemic lupus erythematosus (SLE)

Conditions – kidney

Glomerulonephritis
Nephrotic syndrome

Conditions – neurological

Multiple sclerosis

Conditions – reproductive system

Infertility
Menstrual disorders
Prostate conditions
Sexually transmitted infections

Less common conditions

Genetic disorders, rare

PCH

Neonatal abstinence syndromes

Synthesise

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

Manage

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

Consider other factors

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

Anatomy and physiology of organ systems
Clinical sciences, epidemiology, and pathophysiology of the conditions listed above in ‘Key presentations and conditions’
Clinical sciences of therapies used to treat cancer, such as:
- chemotherapy
- radiotherapy
Impact of drugs on organ systems, such as:
- bone health, such as:
  - bisphosphonates
- kidney function
Pharmacology and toxicology of medications to treat or manage the conditions listed above in ‘Key presentations and conditions’, such as:
- cardiovascular conditions:
  - angiotensin II receptor blockers (ARBs)
  - angiotensin-converting enzyme (ACE) inhibitors
  - anticoagulants
  - antiplatelets
  - calcium channel blockers
  - HMG CoA reductase
  - loop diuretics
  - thiazide and thiazide-like diuretics
- endocrine conditions:
  - antiresorptive
  - biguanides
  - carbimazole
  - dipeptidyl peptidase-4 (DPP4)
  - glucagon-like peptide 1 receptor agonist (GLP1RA)
  - insulin
  - sodium-glucose cotransporter 2 inhibitors (SGLT2i)
  - sulfonylureas
  - thyroxine
- gastrointestinal conditions:
  - aperients
  - proton pump inhibitors
- haematologic conditions:
  - antiplatelets
  - direct oral anticoagulants (DOACs)
  - heparins
  - low molecular weight heparin (LWMH)
  - warfarin
- immune conditions:
  - steroids
- nervous system conditions:
  - anaesthetics
  - analgesics
  - anti-epileptics
  - antipsychotics
- respiratory conditions:
  - bronchodilators
  - inhaled corticosteroids (ICS)
  - long-acting beta-agonists (LABA)
  - long-acting muscarinic antagonists (LAMA)
  - short-acting beta agonists (SABA)

Cardiovascular clinical assessment tools

Cardiovascular disease (CVD) risk assessment tool
New York Heart Association (NYHA) classification for heart failure

Cardiovascular investigations

Angiogram – coronary
Apolipoprotein B and lipoprotein (a)
Blood pressure monitoring
Blood tests
CT / MRI – cardiac
ECG
Echocardiogram
Electrophysiology study (EPS)
Holter monitor
Lipid profile
Natriuretic peptides – NT-proBNP, PMN
Troponin test
Ultrasound – kidney, such as hypertension investigation
Urine albumin-creatinine ratio (ACR)

Cardiovascular procedures

Coronary artery bypass grafting (CABG)
Percutaneous coronary intervention (PCI)
Valve replacement or repair

Endocrine clinical assessment tools

Body mass index (BMI)

Endocrine investigations

Biopsy – fine needle aspiration
Catecholamines and metanephrines
Dexamethasone suppression test
Diabetes autoantibodies
Glucose:
- continuous monitoring
- fasting plasma
- oral tolerance test
Haemoglobin A1C (HbA1c)
Hormonal investigation
Renin-aldosterone ratio
Thyroid function tests, such as:
- free T3
- free T4
- thyroid stimulating hormone (TSH)
Ultrasound – thyroid
Urine ACR

Endocrine procedures

Hormone replacement therapy
Insulin therapy
Thyroidectomy

Gastrointestinal clinical assessment tools

Bristol Stool Scale
Gastrointestinal Symptom Rating Scale (GSRS)

Gastrointestinal investigations

Colonoscopy
CT
Endoscopy – upper
Gastric emptying study
Helicobacter pylori testing
Oesophageal manometry
pH monitoring
Ultrasound – abdominal

Gastrointestinal procedures

Biopsy – liver
Endoscopic retrograde cholangiopancreatography (ERCP)
Polypectomy

General

Biomarkers test
Radioimaging, such as:
- CT
- x-ray

Haematological clinical assessment tools

Ferritin levels
Haemoglobin levels
International normalised ratio (INR)

Haematological investigations

Biopsy – bone marrow
Coagulation profile
Complete blood count (CBC)
Flow cytometry

Haematological procedures

Blood transfusion
Stem cell transplantation
Therapeutic phlebotomy

Immune clinical assessment tools

Allergy symptom score
Clinical activity score (CAS) for autoimmune diseases

Immune investigations

Allergy testing
Autoantibody tests
Human immunodeficiency virus (HIV) and immunodeficiency tests
Immunoglobulin levels

Immune procedures

Administration of biologic agents
Immunotherapy
Plasmapheresis

Kidney and urinary system clinical assessment tools

Chronic kidney disease epidemiology collaboration (CKD-EPI) equation
Urine ACR

Kidney and urinary system investigations

Biopsy – kidney
CT – urogram
Glomerular filtration test
Serum creatinine and estimated glomerular filtration rate (eGFR)
Ultrasound – kidney
Urinalysis

Kidney and urinary system procedures

Dialysis:
- haemodialysis
- peritoneal
Transplantation – kidney

Musculoskeletal clinical assessment tools

Disease activity score in 28 joints (DAS28) for rheumatoid arthritis
Range of motion (ROM) measurements
Visual analogue scale (VAS) for pain

Musculoskeletal investigations

Arthroscopy
Biopsy
Bone density scan (DEXA)
MRI
X-ray

Musculoskeletal procedures

Fracture repair
Surgery:
- arthroscopic
- joint replacement

Nervous system clinical assessment tools

Glasgow Coma Scale (GCS)
Mini-Mental State Examination (MMSE)
Montreal Cognitive Assessment (MoCA)

Nervous system investigations

CT – brain
EEG
Lumbar puncture
MRI – brain

Nervous system procedures

Carotid endarterectomy
Deep brain stimulation (DBS)
Neurosurgical interventions for tumours

Respiratory clinical assessment tools

Asthma control test (ACT)
Chronic obstructive pulmonary disease (COPD) assessment test (CAT)
Pulmonary function tests

Respiratory investigations

Bronchoscopy
Chest tests:
- CT
- x-ray
Spirometry

Respiratory procedures

Biopsy – lung
Mechanical ventilation for critical care
Thoracentesis

Importance of informatics within health care, such as:
- electronic health records
- health roundtables
- hospital-acquired complications
Management of oncological conditions with therapies, such as chemotherapy and radiotherapy
National and local guidelines for the quality use of medicines

LG14: Prescribing

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

View

Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

View

Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

View

Undertaking therapy

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

View

Post therapy

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

View

Important specific issues

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

View

Clinical trials principles, such as:
- advantages and limitations of clinical trial designs:
  - adaptive
  - basket
  - case series
  - crossover
  - observational
  - parallel
  - platform
  - randomised
  - umbrella
- dosing strategies
- ethical, legal, and regulatory requirements for approval, registration, and reporting
- outcome measures
- phases of clinical trials
- relevant standards and guidelines, such as:
  - common terminology criteria for adverse events (CTCAE)
  - International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidance, including good clinical practice (GCP) guidelines
- sample size estimation and power calculation
- scope and limitations
- selection of participants and eligibility criteria
Digital therapeutics, such as:
- applications
- artificial intelligence (AI)
- consultations via phone and video platforms
- electronic medication management systems
Drug / Medication databases
Drug selection
Emerging technologies, such as:
- machine learning in drug discovery
- the role of AI:
  - decision support tools for prescribing
  - personalised therapy
  - predictive modelling
  - reshaping pharmacological research
Forms of target concentration and exposure
Laboratory methods
Principles of deprescribing
Principles of pharmacodynamics and pharmacokinetics
Rational prescribing

AIM

Geriatric pharmacology

Dosing in older patients, considering physiological changes with ageing
Managing polypharmacy
Monitoring and support devices for dementia patients

PCH

Appropriate methods for, and limitations of, extrapolating adult data to children
Principles of prescribing to children, such as:
- adjustments in dosing, such as mg / kg dosing
- selection and concentration of liquid formulations

Indications for, and adverse effects of, commonly used drugs, such as those used in:
- anaesthetics
- emergency medicine, such as:
  - fluid therapy
  - intravenous fluids
- internal medicine
- oncology
- psychiatry
- rheumatology
- vascular and metabolic medicine
Indications, limitations, and usefulness of therapeutic drug management (TDM) in patient management, such as:
- aminoglycosides
- busulfan
- tacrolimus
- warfarin
- vancomycin
Patient history, including previous adverse drug reactions and specific health conditions that influence drug choice
Patients’ current medications and potential drug-drug interactions
Presence of comorbidities, complex multimorbidity, or multimorbidity
Variation based on individual patients’:
- age, including paediatric growth and development and adult senescence
- concomitant medicines and complementary products
- genetics
- lactation
- pregnancy
- sex

AIM

Indications for, and adverse effects of, drugs mainly used for older persons’ health

PCH

Indications for, and adverse effects of, drugs commonly used within paediatrics

Literature search, such as:
- Embase
- New Zealand Formulary (NZF)
- PubMed
Medicine and drug information services
National formulary

Adjustments in therapy based on response and adverse effects
Development and use of patient information resources about drugs
Drug interactions, and their impact on therapy
Monitoring parameters
Off-label / Unlicenced medicines
Patient counselling about pharmacotherapy

PCH

Counselling parents about measuring doses and administering medicines to children
Extemporaneous formulations

Strategies for tapering or discontinuing therapy based on therapeutic goals and patient response
Techniques for monitoring therapeutic outcomes and recognising signs of drug toxicity, such as:
- bedside evaluation
- biomarkers testing, including:
  - hepatotoxicity markers, such as:
    - alanine aminotransferase (ALT)
    - aspartate aminotransferase (AST)
  - nephrotoxicity markers, such as:
    - creatinine

PCH

Strategies for blood sampling, and for measuring analyses with small sample volumes

Decision support tools to assist in drug selection and dosing
Ethical considerations, such as:
- access to treatment
- cost considerations
- managing conflicts of interest, particularly in relation to pharmaceutical industry relations
- patient autonomy in prescribing
Factors that affect drug use, such as:
- age and development
- comorbidity
- concomitant drugs and complementary products
- ethnicity
- lactation
- nationality
- pregnancy
- sex
- socioeconomic status
Factors that affect professional and public perception of drugs and their use, such as the effects of advertising, marketing, and media
Factors that determine the benefit to harm balance in therapeutic interventions
Legal considerations, such as:
- implications of prescribing errors
- importance of documentation and informed consent
- national and local guidelines for the quality use of medicines
Pharmaceutical policy and legislation, such as:
- national and international regulations in drug approval, availability and pricing
Regulation of scheduled substances and the associated scheduling process
Strategies to improve patient adherence, especially in chronic disease management, which is crucial for the efficacy of pharmacological interventions

AIM

Extrapolation of standards adult data to advanced ageing

PCH

Extrapolation of adult data to children
Prescribing and calculation errors in children

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

Printed by:	Guest user
Date:	Saturday, 29 November 2025, 12:06 AM

Description

Advanced Training in Clinical Pharmacology

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care

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