Curriculum standards

About this resource

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

This document outlines the curriculum standards for Advanced Training in Paediatric Emergency Medicine for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Paediatric Emergency Medicine 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 all or most training programs.

Medical expertise

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

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

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

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

Communication

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

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

Effective communication. Use a range of effective and appropriate verbal, nonspeaking, and written 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 the families, communities and populations in a caring and respectful manner.

Physicians demonstrate their commitment and accountability to the health and well-being 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 patients’ 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 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 limitations 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 health care 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 health care 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

Leadership and accountability

Lead effective population and public health responses, programs, and organisations, adapting the leadership style to the situation

This activity requires the ability to:

identify the context you are working within
use an appropriate leadership style (for example, codesigning, delegating, participating, showing, listening, or integrating), dynamically switching styles according to the situation
apply a systems thinking approach to understand and manage complex problems
set priorities for action through consultation, establish and periodically review goals, recognise opportunities, and provide focus
manage uncertainty and unexpected challenges
inspire and enable others, and recognise and encourage individual contributions
effectively manage daily tasks, delegations, and time allocation, according to priorities
articulate individual responsibilities, expertise, and accountability of team members and staff
effectively resolve conflicts
establish effective partnerships and intersectoral action to achieve improved public health outcomes
scan for opportunities to mentor, coach, and support to strengthen current, emerging, and future leaders
undertake horizon scanning to identify emerging threats to public health and new technologies that can be implemented to advance public health
provide appropriate representation of your organisation (such as state, territory, district health board, or public health unit) on any committees or groups you sit on in your leadership role (for example, Communicable Diseases Network Australia or technical reference groups)

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

demonstrate medical expertise in situations other than patient care, such as providing expert legal testimony and advising governments
use evidence-based principles of practice to meet the needs of populations, adapting to cultural context and promoting self-determination
change viewpoints rapidly and responsibly between macro and micro, working on either big picture or details, as required
identify salient potential issues across a broad range of situations, including from issue analysis, policy development, implementation, response, and public or stakeholder communications
translate public health perspectives and required outputs between people with different expertise, such as clinical, research, and government

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of some of the nuances of the operational context
apply medical knowledge to assess the impact and outcomes of management initiatives and decisions
practise as a member of multidisciplinary teams
demonstrate competence and skills in public health medicine
recognise how the policy and practices of other sectors and organisations influence the health of the population
recognise the role of the public health physician within the broader health sector
recognise the role of the public health physician within the broader response landscape

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 effectively with a broad range of audiences, including writing, speaking, listening, sharing, and editing
demonstrate a transparent, consultative style by engaging patients4, families, whānau, carers, relevant professionals, and/or the public in shared decision making, taking into consideration cultural needs and styles of communication
collaborate across groups and identify shared understandings and core needs and goals to increase the efficiency and effectiveness of collaborations
work with stakeholders, other health professionals, and intersectoral colleagues to resolve conflict that may arise when planning and aligning goals
demonstrate rapport with people at all levels by tailoring messages to different stakeholders
present limitations and uncertainty honestly when communicating findings to others
produce effective reports, briefs, proposals, submissions, and articles on public health issues
deliver presentations in a variety of settings, tailoring the language and content to the audience and situation
demonstrate use of the principles of risk communication at a population level

direction
Requires some supervision

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

The trainee may:

recognise different communication approaches for different audiences and situations
develop presentation skills, under supervision, using available tools
develop media skills, under supervision, using available tools
respect the roles of team members
demonstrate excellent writing and word processing skills
use clear, concise language
use email and other written correspondence effectively
deliver presentations in a variety of settings
incorporate principles and methods of trauma-informed service delivery
be able to identify contextual factors that will frame risk communication, such as level of outrage

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 frameworks to guide intersectoral action, such as in disaster management
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
co-design, implement, and use methods to check benefits and harms as experienced by populations affected by public health policies and practice
demonstrate the ability to prioritise professional duties effectively and appropriately when faced with multiple issues and problems
build and apply leadership techniques in daily practice through ongoing learning
maintain personal health and wellbeing and recognise the importance of self-care in the workplace

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 address the priorities of populations with greater health inequity and improve the quality and safety of the health system
participate in multidisciplinary collaboration to provide effective health services and operational change
use and promote information resources and the ethical use of electronic medical record technology where available
develop and share reflective practice using available tools
encourage others to practice continuous quality improvement
advocate for system improvements in response to audit findings
lead by example in quality improvement activities

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, and implement active processes to maintain and improve performance
identify personal gaps in skills and knowledge, and engage in self-directed learning
maintain up-to-date knowledge of new technologies, health priorities, and changing health needs
learn and use methods to be culturally competent, including anti-racist reflection
teach competently by imparting professional knowledge
manage and monitor learners’ progress, providing regular assessment and feedback
evaluate the impact of educational material
advise on educational programs to improve practice
initiate and conduct skills training for junior staff
mentor junior colleagues and act as a role model
prioritise offers to Aboriginal and Torres Strait Islander and Māori (tangata whenua) colleagues to mentor, support, and learn

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
develop skills, under supervision, using available tools
choose appropriate communication media

Research

confident
Ready to perform without supervision

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

The trainee will:

establish interdisciplinary collaborations
engage with Aboriginal and Torres Strait Islander peoples and Māori (tangata whenua) and their political structures, and respect self-determination
display understanding of and support Indigenous-led research
apply for and secure funding
review research proposals
advocate for policy- and practice-relevant research
undertake and use systematic reviews to produce and implement best practice guidelines for the clinical and public health sectors
ensure that any protocol for human research is approved by a human research ethics committee, in accordance with national statements on ethical conduct in human research

direction
Requires some supervision

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

The trainee may:

recognise that participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of research
undertake systematic reviews under supervision
write and submit ethics applications under supervision

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 communities
demonstrate respect for diversity and difference
support Indigenous-led research
take steps to minimise unconscious bias, including the impact of gender, religion, cultural beliefs, and socioeconomic background on decision making
identify and apply the values and needs of potential health promotion partners, including Aboriginal and Torres Strait Islander peoples and Māori (tangata whenua)
co-design with and support self-determination of Aboriginal and Torres Strait Islander peoples and Māori (tangata whenua)

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, unconscious bias, prejudice, racism in all its forms (including pervasive, systemic, sinuous, and overt racism), and other forms of discrimination
work effectively and respectfully with people from different cultural backgrounds
recognise that different leadership styles may be more or less appropriate within a specific cultural context

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 concerns
respect differences of multidisciplinary team members
demonstrate an understanding of the ethics of resource allocation
effectively consult with stakeholders, achieving a balance of alternative views
work in partnership with Aboriginal and Torres Strait Islander peoples and Māori (tangata whenua), including community-controlled health sector services and political governance structures
acknowledge personal conflicts of interest, racism, prejudice, other types of discrimination (such as sexism, misogyny, transphobia, ableism, and homophobia), and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment, bullying, racism, sexism, misogyny, transphobia, ableism, homophobia, and exclusion
identify and appropriately respond to relevant ethical issues arising in the care of individuals, families, groups, organisations, communities, and populations
show respect for knowledge and expertise of colleagues

direction
Requires some supervision

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

The trainee may:

support ethical principles in decision making
maintain standards of medical practice by recognising the health interests of patients and 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:

use decision science approaches to formalise decision-making processes and optimise outcomes
make decisions when faced with multiple and conflicting perspectives
ensure medical input to organisational decision making
adopt a systems approach to analysing information from a variety of specialties to make decisions that accelerate health equity in populations
manage contracting processes for the purchase or provision of services, including specifying service and performance measures, selecting providers, and monitoring performance and outcomes

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 healthcare interventions and resources with a pro-equity approach to ensure systemic privilege is experienced by all
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:

switch between leadership styles as required by the situation
identify, prioritise, and develop a plan of action for issues of importance to public health, especially those that are inequitable
visualise a ‘better’ future, inspire with this vision, and consider the steps, resources, structures, and systems that will help achieve this (such as to enhance efficiency, improve access, and minimise harm)
develop and lead effective multidisciplinary teams by:
- building effective relationships
- developing and implementing strategies to motivate others
- recognising the range of team members’ skills, expertise, and roles
- combining team members' skills and expertise optimally
- expanding perspectives by including matua (elders) and others with expertise and wisdom
- collaborating with and motivating team members
- encouraging and adopting insights from team members
ensuring all team members are accountable for their individual practice
ensuring timely completion of agreed tasks
adopting a coordination or non-leadership role when required
give and receive positive and negative feedback
facilitate and manage meetings, and contribute to good decision-making processes and information and knowledge sharing
demonstrate understanding of public health legislation and regulations and relevant legislation in other sectors, including human rights commitments, such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the United Nations Convention on the Rights of the Child (UNCRC)
demonstrate understanding of human rights commitments to Aboriginal and Torres Strait Islander peoples and treaty obligations to Māori (tangata whenua)
lead and manage strategic planning, including business case development
lead and manage operational planning
lead organisational change
use processes for job enhancement, recognition, and dispute resolution
determine and analyse options and act within short timelines

direction
Requires some supervision

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

The trainee may:

recognise the range of other team members’ skills, expertise, and roles
acknowledge and show respect for the contribution of all health professionals involved in improving the health of the population
participate effectively and appropriately in multidisciplinary teams
seek out and respect the perspectives of multidisciplinary team members when making decisions
develop skills in chairing meetings, under supervision, using available tools

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:

apply principles of systems thinking to analyse and interrogate complex public health issues
identify the key elements of an effective public health advocacy campaign
identify key channels and mechanisms to conduct effective public health advocacy
use the media effectively
use negotiation skills effectively
influence the policy and practices of other sectors / organisations to promote, protect, and improve the health of the population
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
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 population health
apply methods used to allocate resources to provide high-quality population health care
promote the development and use of organisational policies and procedures
identify the determinants of health of the population, and mitigate barriers to access to care
recognise the perspectives of different sectors, organisations, cultural groups, and populations involved
recognise and prioritise the population health of Aboriginal and Torres Strait Islander peoples and Māori (tangata whenua)

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

direction
Requires some supervision

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

The trainee may:

demonstrate basic skills in the supervision of learners
apply a standardised approach to teaching, assessment, and feedback without considering individual learner needs
implement teaching and learning activities that are 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 projects’ goals and requirements, and provide feedback on the merits or challenges of proposed research
monitor the progress of learners’ research projects regularly, and may review research projects prior to submission
support learners to find forums to present research projects
encourage and guide learners to seek out relevant research to support practice

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

role model a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural competence
encourage learners to consider culturally appropriate care of 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 with and teaching with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

prioritise workloads and manage learners with different levels of professional knowledge or experience
link theory and practice when explaining professional decisions
promote joint problem solving
support a learning environment that allows for independent decision making
use sound and evidence-based judgement during assessments and when communicating 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 performances and continuing professional development
maintain professional, clinical, research and/or administrative responsibilities while teaching
create an inclusive environment whereby the learner feels part of the team
help to 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: Patient safety and quality improvement

Learning Goal 4

Patient safety and quality improvement

Individual to system-level harm prevention and provision of high-quality care

This activity requires the ability to:

identify and report actual and potential (‘near miss’) errors
conduct and evaluate system quality improvement activities
adhere to best practice guidelines
conduct simple clinical audits
present at departmental meetings
participate in and present at morbidity and mortality meetings
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
review all relevant documentation and investigations before providing a holistic response

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
review patients’ or population health outcomes regularly to identify opportunities for improvement in delivering appropriate care
promote health advocacy
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures
use available guidelines and evidence-based practice to provide high quality medical care
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:

practice shared decision making with patients, families, and carers
implement the organisation’s open disclosure policy
support patients, their families, whānau, and/or carers to have access to, and use, easy-to-understand, high-quality information regarding their child’s medical condition
encourage patients to provide feedback and make complaints when appropriate, providing information on these processes and services

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
respond holistically to patient complaints, including investigating and reviewing all relevant documentation
perform incident reporting in line with local procedures
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
raise and appropriately report identified opportunities for improvement
use clinical audits and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to inform best practice in care

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
respond to patient complaints

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

confirm that any protocol for human research is approved by a human research ethics committee, in accordance with the national statement on ethical conduct in human research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

access information and advice from other health care 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

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 that patients receive appropriate care and information on their care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

maintain a dialogue with service managers about issues that affect patient care
contribute to relevant organisational policies and procedures
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG5: Emergency department management

Learning Goal 5

Emergency department management

Manage an emergency department

This activity requires the ability to:

lead emergency department staff effectively during shifts
demonstrate oversight management of emergency department services, including human resource management
manage patient flow in the emergency department
oversee quality improvement activities
communicate with patients, their families, and/or carers
liaise with other health professionals and team members
demonstrate problem-solving skills
use crisis resource management principles appropriately, and understand principles of disaster management

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:

assist junior colleagues proactively in the assessment and management of their patients
create accurate and appropriately prioritised differential lists in the clinical notes when reviewing patients
update documentation in a timeframe appropriate to patients’ clinical situations
maintain oversight of patients in the department and their current medical condition, and how their condition or required treatment is prioritised against other patients in the department

direction
Requires some supervision

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

The trainee may:

demonstrate the ability to alert senior colleagues to issues arising within the department
create basic differential lists and clinical notes when reviewing patients
assist junior colleagues when directed in the assessment and management of their 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:

refer patients to colleagues using recognised handover tools
help patients navigate the healthcare system to improve access to care by collaboration with other services, such as outpatient services to which they are referred, community health centres, and consumer organisations
communicate with patients who have concerns regarding the management of their condition
provide education to patients, using appropriate resources as well as directing them to appropriate follow-up care

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

practice health care that maximises patient safety
be aware of issues that are mandatory to report, and how to report them
demonstrate an understanding of how to manage and respond to patients’ complaints
adopt a systematic approach to the review and improvement of professional practice
demonstrate an understanding of how to assist trainees in distress or those requiring performance management
identify aspects of service provision that may be a risk to patients’ safety
ensure that patients are informed about fees and charges if applicable

direction
Requires some supervision

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

The trainee may:

take reasonable steps to address issues if patients’ safety may be compromised
demonstrate an understanding of a systematic approach to improving the quality and safety of health care
participate in organisational quality and safety activities, including clinical incident reviews
raise appropriate issues for review at morbidity and mortality meetings

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

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:

mitigate the influence of own culture and beliefs on interactions with patients and decision making
challenge individual and systemic forms of discrimination within the emergency department and healthcare service
adapt practice to improve patient engagement and health outcomes
advocate for the provision of appropriate resources for culturally diverse and Aboriginal and Torres Strait Islander peoples and Māori within the emergency department, hospital, and community

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, at both individual and population levels

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate an understanding of the responsibility to protect and advance the health and wellbeing of individuals and communities
maintain the confidentiality of documentation, and store clinical notes appropriately
use social media in a manner 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
maintain minimum safe staffing levels recommended for an emergency department
demonstrate understanding of the dynamics of patient flow through the emergency department, and factors and choke points that affect the department’s ability to provide quality care

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of the appropriate use of human resources, diagnostic interventions, therapeutic modalities, and health facilities
prioritise patients appropriately, balancing competing priorities

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:

demonstrate oversight of factors affecting patient flow through an emergency department
manage emergency department staffing allocations to improve patient flow
liaise with hospital stakeholders, such as the head of department or nursing manager, to discuss strategies on improving patient flow through the department
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

direction
Requires some supervision

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

The trainee may:

demonstrate some understanding of the challenges facing patient flow through the emergency department
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:

obtain consent for procedures on children who may be under the care of the state
apply and document use of local mental health act policies and legal rulings when detaining children, including within a room, or with chemical or physical restraints
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
demonstrate understanding of the role of clinical teams in the emergency department and in the field during mass casualty incidents
manage the department when a disaster code (both internal and external) is activated
contribute to the creation of tailored management plans, with a focus on complex patients with recurrent presentations

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of local mental health act policies and legal rulings when detaining children, including within a room, or with chemical or physical restraints
consistently apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
demonstrate desire to build good relationships with health agencies and services

LG6: Acute illness clinical assessment and management

Learning Goal 6

Acute Illness clinical assessment and management

Assess and manage the early care of acutely unwell children

This activity requires the ability to:

recognise and manage patients with an acute illness
assess the severity of illness, and initiate appropriate management
recognise clinical deterioration, and respond by following the local process for escalation of care
manage multiple acutely unwell patients simultaneously
liaise with transport services and medical teams to ensure patients are managed in the most appropriate setting, if required

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 assess, diagnose, and manage acute undifferentiated clinical presentations, as listed in the acute illness knowledge guide
select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
recognise immediate life-threatening conditions and critically unwell children, and respond appropriately
manage escalations or transitions of care in a proactive and timely manner
optimise medical management before surgical interventions

direction
Requires some supervision

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

The trainee may:

demonstrate an understanding of general medical principles of caring for children with undifferentiated and undiagnosed conditions
recognise seriously unwell children requiring immediate care
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
facilitate early communication with patients, families, and team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain situations to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
determine the level of health literacy of individual patients, and their level of understanding of agreed care decisions
develop clear and effective discharge summaries for patients, general practitioners, community health providers, or specialist teams, with recommendations for ongoing care

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee may:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee may:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available resources
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

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

The trainee may:

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

LG7: Acute injury clinical assessment and management

Learning Goal 7

Acute injury clinical assessment and management

Assess and manage children with suspected acute injuries

This activity requires the ability to:

assess patients with suspected acute injury
perform primary, secondary, and tertiary surveys when assessing trauma patients
order and interpret appropriate investigations
provide appropriate treatments for patients with acute injuries
perform relevant procedures for managing acute injuries in the emergency department
manage urgent life- or limb-threatening injuries
demonstrate knowledge and understanding of trauma systems, and use these when indicated
provide leadership in managing trauma patients
create resuscitation and treatment plans for multi-trauma patients
diagnose injuries, and refer on for further specialised treatment and management as required
consider the impact of injuries on patients’ lives, and counsel on management strategies
pre-empt and prevent potential complications of injury, and implement follow-up plans
identify potential inflicted injuries, and manage appropriately

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

assess and examine suspected injuries accurately
perform trauma primary, secondary, and tertiary surveys, using a thorough, systematic approach
rationalise and arrange appropriate investigations
interpret investigations
provide acute treatment of injuries, including analgesia and procedural sedation options appropriate for patients’ age and presentation
treat and manage injuries as listed in acute injury knowledge guide
demonstrate knowledge of the potential risks and complications of injury and the prescribed treatments
recognise and sensitively work-up potential inflicted / non-accidental injuries

direction
Requires some supervision

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

The trainee may:

identify potential cases of inflicted / non-accidental injury, and, with guidance, perform appropriate work-ups
provide basic treatment and management of common injuries
recognise potential inflicted / non-accidental injuries
demonstrate awareness of need for sensitivity with potential inflicted / non-accidental injuries

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 and communicate clear roles, responsibilities, and priorities within the trauma team
effectively communicate with all members of the trauma team, and apply closed-loop communication where appropriate
communicate treatment and management plans to patients, families, and/or carers, including gaining consent, and, where appropriate, engaging patients, family, and/or carers in decisions around treatment options
clearly document in medical records the assessment, diagnosis, treatment, and management plans for patients with acute injuries
communicate concerns for suspected inflicted injuries via appropriate local processes

direction
Requires some supervision

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

The trainee may:

communicate with patients in a developmentally and age-appropriate way when assessing and managing acute injuries
communicate with families or carers, including gaining consent for investigations and management 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:

use up-to-date evidence-based practice in the management of children with acute injuries
check processes are in place so investigations and results are reviewed, and injuries not missed
engage in local processes in reviewing and analysing multi-trauma presentations in multidisciplinary team meetings, such as trauma review meetings

direction
Requires some supervision

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

The trainee may:

follow local processes and protocols in managing children with acute injuries
evaluate quality and safety processes in the workplace

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:

actively participate in multidisciplinary practice of trauma presentation assessment and management, including simulation where available
demonstrate effective supervision and teaching of junior colleagues in the assessment and management of children with acute injuries

direction
Requires some supervision

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

The trainee may:

supervise and support junior doctors in the management of acute injuries in children, including interpretation of investigations

Research

confident
Ready to perform without supervision

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

The trainee will:

incorporate current evidence-based trauma and injury guidelines into local processes and protocols
consider enrolling eligible patients in approved clinical trials with informed consent

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 protocols on the management of trauma and injuries in children

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:

assess and manage patients with acute injuries in a culturally sensitive and appropriate way
integrate culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori into patients’ management

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making

direction
Requires some supervision

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

The trainee may:

establish, where possible, patients’ wishes and preferences about care
show respect for knowledge and expertise of colleagues and other specialties

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

recognise the need for escalations of care, and escalate to appropriate staff or services
use appropriate guidelines, evidence sources, and decision support tools
investigate acute injuries appropriately while taking multiple factors into consideration, including resources available locally, and the risks of these, including radiation and the potential need for sedation to be able to perform procedures

direction
Requires some supervision

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

The trainee may:

recognise the bounds of their own abilities, and know when and how to seek assistance from other colleagues in the department or other specialities

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

lead a trauma team, including multidisciplinary members internal and external to the emergency department
apply crisis resource management principles when managing multi-trauma patients
work collaboratively with other health professionals to formulate appropriate management plans, including the appropriate timing and location of these events

direction
Requires some supervision

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

The trainee may:

lead a trauma team with supervision / support, demonstrating a structured approach and clear communication

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
follow policies on mandatory reporting, such as abuse and sexual assault
advocate for paediatric emergency care resources and policies

direction
Requires some supervision

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

The trainee may:

know and follow local processes for referring potential inflicted injuries to the appropriate services

LG8: Transitions, transfers, and handovers of care

Learning Goal 8

Transitions, transfers, and handovers of care

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

This activity requires the ability to:

manage transitions of patient care to ensure the optimal continuation of care between providers
identify the appropriate care providers and other stakeholders with whom to share patient information
exchange pertinent, contextually appropriate, and relevant patient information
perform this activity in multiple settings, appropriate to the speciality and current environment, including ambulatory, critical care, inpatient and retrieval settings
organise or perform prehospital and interhospital transfers
appropriately accept transfer of patients into the department
appropriately handover patient care to other teams or at end of shift

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate optimal transitions of care for patients
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them
identify ideal locations and management teams, and arrange transfers required to achieve this
identify time-critical versus team-critical transfers of care
take appropriate referrals into the unit
provide appropriate phone and/or telehealth advice to external clinicians

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of the details of patients’ conditions, illness severity, and potential emerging issues, with appropriate actions
provide accurate summaries of patients’ information with accurate identification of problems or issues
identify patients who require expertise not available in the emergency department, but need assistance to determine where and how to arrange this expertise
require assistance with incoming referrals and providing phone and/or telehealth advice to external clinicians

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate accurately and in a timely manner to ensure effective transitions between settings, and continuity and quality of care
communicate clearly with clinicians and other caregivers
use standardised verbal and written templates to improve the reliability of information transfers and prevent errors and omissions

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify patients at risk of poor transitions of care, and mitigate this risk
use electronic tools (where available) to securely store and transfer patient information
use consent processes, including written consent if required, for the release and exchange of information
demonstrate understanding of the medicolegal context of written communications

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate with careful consideration to health literacy, language barriers, and culture regarding patient preferences, and whether they are realistic and possible, respecting patient choices
recognise the timing, location, privacy, and appropriateness of sharing information with patients, their families, whānau and/or carers
identify the appropriate family / whānau connections, and facilitate these as required

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’ care in a manner consistent with privacy law 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, families, carers, and other health professionals, including respecting privacy and confidentiality

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
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 on transfers of care, and help subsequent health professionals understand the issues to continue care
work to overcome the potential barriers to continuity of care, appreciating the role of handovers 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
engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital discharge

direction
Requires some supervision

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

The trainee may:

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

LG9: Communication with patients and families

Learning Goal 9

Communication with patients and families

Communicate with children, their families, whānau, and/or carers

This activity requires the ability to:

communicate effectively and build rapport with children and young people
adopt a patient-centred perspective during communication, including adjusting for cognition and disabilities
use interpreters when communicating with patients and families, if required
use AUSLAN or NZSL interpreters or other appropriate communication aides, such as digital devices, for communication with patients, families, whānau, and/or carers with hearing or other communication impairments
consider communication with LGBTQIA+ patients, and the importance of exercising caution around language and providing gender inclusive care
select suitable settings for difficult conversations, and include family and/or carers and other team members
through communication, negotiate mutually agreed management plans with patients, families, whānau, and or carers
verify patients’, family members’ or carers’ understanding of information conveyed
consider the impact of patients’ cultural diversity, and communicate in a culturally diverse manner.
document conversations

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

communicate to patients, families, whānau, and/or carers all aspects of their clinical management, including assessments and investigations
provide the medical knowledge required to patients, families, whānau, and/or carers to enable them to make informed decisions about diagnostic, therapeutic, and management options
use thorough communication, assessing for red flags or injuries that medical teaching instructs doctors to be concerned about, with patients, families, whānau, and/or carers to establish if there are any concerns for child maltreatment
anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors

direction
Requires some supervision

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

The trainee may:

apply knowledge of the scientific basis of health and disease when communicating with patients, families, whānau, and/or carers
demonstrate an understanding of the clinical problems being discussed
formulate management plans in partnership with patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate communication strategies and modalities for communicating with patients, families, whānau, and/or carers
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients to share their thoughts or explain their management plans in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
communicate with children at a developmentally and age-appropriate level and manner
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
use an appropriate manner and recommended tools when communicating with adolescents
communicate with patients individually, as well as with their families, whānau, and/or carers, to encourage patient autonomy, decision making, and preparation for adulthood
communicate with patients in their preferred manner, including the use of pronouns
treat children and young people respectfully, and listen to their views
assess that the information communicated to patients, families, whānau, and/or carers has been understood
provide gender inclusive care and promotion of equality to patients accessing care (for example, some patients may be apprehensive about accessing 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
use culturally safe interpreters, if required, when communicating with patients, families, whānau, and/or carers
collaborate with patient liaison officers as required
ensure all conversations with patients, families, whānau, carers, and other clinicians are well documented

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients based on current up-to-date guidelines that are consistent with international best practice (with local variations to account for local populations and local health service needs)
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain an informed consent or other valid authority before involving patients in research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use this information wisely when they make decisions
encourage and support patients and, when relevant, their families, whānau, and/or carers, in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
prioritise honesty, patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions
consider the zone of parental control and decision making with regards to legal, moral, and ethical considerations when conflicts in management occur between health professionals and families, whānau, and/or carers

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

communicate effectively with team members involved in patients’ care, and with patients, families, whānau, and/or carers
facilitate an environment in which all team members feel they can contribute and their opinion is valued
communicate accurately and succinctly, and motivate others on the healthcare team

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other services, such as community health centres and consumer organisations, to help patients navigate the healthcare system
advocate for patients and their families, whānau, and/or carers to seek the support and resources they need

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG10: Procedures

Learning Goal 10

Procedures

Plan, prepare for, perform, and provide aftercare for important practical procedures across different settings

This activity requires the ability to:

select appropriate procedures in partnership with patients12, their families, whānau, and/or carers
obtain informed consent from patients, their families, whānau, and/or carers
prepare for procedures, including patient positioning, equipment, medications, and staff
perform procedures independently, technically, efficiently, and safely
anticipate and manage the known risks and potential complications of procedures
provide appropriate aftercare following procedures
clearly communicate the outcome of procedures, aftercare protocols, associated investigations, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff
interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

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 facilitate procedures as required to appropriately manage critically unwell patients with life-threatening neonatal / paediatric conditions
select procedures by assessing patient-specific factors, including alternatives, benefits, and risks
confidently and consistently perform a range of common procedures
inform team members of all allergies / adverse reactions identified, and take precautions to avoid these during procedures
check that patients have complied with preprocedural preparation
confirm the correct position / site / side / level on patients for planned procedures
recognise and manage complications arising during or after procedures
recognise and correctly interpret normal and abnormal findings of diagnostic procedures
effectively manage acute pain and distress
demonstrate knowledge and skills in procedural pain management, such as sedation and analgesia, as well as non-pharmacological strategies

direction
Requires some supervision

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

The trainee may:

assess patients, and identify indications for procedures
check for allergies and adverse reactions
consider risks and complications of procedures
interpret results of common diagnostic procedures
organise and document postprocedural reviews of patients
perform procedures with support or help

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients, families, whānau, and/or carers are fully informed when consenting to any procedures
demonstrate an inconsistent application of aseptic technique
identify patients using approved patients’ identifiers before any treatment or intervention is initiated
attempt to perform procedures in an unsafe environment

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

manage departmental workloads to ensure the safety of patients and staff and the delivery of timely, appropriate, and high-quality clinical care
identify roles and optimal timing for diagnostic procedures
critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on a waiting list
make clinical judgements and decisions based on available evidence
select the most appropriate and cost-effective diagnostic procedures
adapt procedures in response to assessments of risks to individual patients
select appropriate investigations on the samples obtained in diagnostic procedures

direction
Requires some supervision

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

The trainee may:

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

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:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss serious incidents at appropriate clinical review meetings
initiate local improvement strategies in response to serious incidents
use resources efficiently when performing procedures

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with the organisational guidelines and policies

For each procedure/investigation, trainees should be able to perform the components of the procedure indicated below. Please select a procedure/investigation from the dropdown to see its components.

Yes

Not applicable n/a

Select appropriate procedures in partnership with patients, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable*

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable*

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

if applicable*

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

n/a

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Select appropriate procedures in partnership with patients13, their families, whānau, and/or carers

Obtain informed consent from patients, their families, whānau, and/or carers

Prepare for the procedure, including patient positioning, equipment, medications, and staff

Perform procedures independently, technically, efficiently, and safely

Anticipate and manage known risks and potential complications of procedures

Provide appropriate aftercare following procedures

Clearly communicate the outcome of procedures, associated investigations, aftercare protocols, and instructions to patients, their families, whānau, and/or carers, and medical and nursing staff

Interpret the results and outcomes of procedures, including imaging and reports, and provide / arrange appropriate follow-up care

Definition of ‘if applicable’: These procedures are often performed in an emergency and/or resuscitation situation, and as a result it may not always be appropriate or possible to gain consent or full consent prior to commencing the procedure

LG11: Resuscitation assessment and management

Learning Goal 11

Resuscitation assessment and management

Resuscitate critically ill / injured paediatric patients

This activity requires the ability to:

assess and recognise seriously unwell or injured children
recognise clinical deterioration
follow the local process for escalation of care
manage acutely unwell patients who require resuscitation
lead the resuscitation team, and involve other necessary services
liaise with transport services and medical teams
conduct debriefs with the resuscitation team

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
conduct structured assessments of acutely unwell children
follow planned courses of action with appropriate urgency
perform advanced neonatal and paediatric life support, according to resuscitation council guidelines, to a high level of advanced resuscitation skills
use defibrillators during shockable Advanced Paediatric Life Support (APLS) algorithms and for cardioversion
manage compromised airways, using bag valve mask ventilation and basic and advanced techniques
obtain intravenous access with standard cannulas and intraosseous devices
place central venous lines and arterial lines
assess children with traumatic injuries, and prioritise interventions
perform finger thoracostomies and intercostal chest drains
prescribe resuscitation fluids and blood products
prescribe critical medications such as antibiotics, antiepileptics, antivirals, and insulin
enact neuroprotective measures for children with head trauma
demonstrate knowledge of the potential risks and complications of resuscitation
identify critical toxicology emergencies and manage them appropriately, including cardiac arrythmias, hyperthermia, and seizures, and anticipate and respond to complications
recognise when it is appropriate to change the focus of care from resuscitation and life preservation to comfort care with dignity
develop appropriate post-resuscitation plans

direction
Requires some supervision

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

The trainee may:

recognise seriously unwell patients requiring immediate care
initiate paediatric and neonatal resuscitation as indicated
adequately manage compromised airways, using bag valve mask ventilation and by using oropharyngeal and nasopharyngeal airways and laryngeal mask airways (LMAs)
obtain intravenous access with standard cannulas and intraosseous devices
use defibrillators during shockable APLS algorithms
re-evaluate patients and their situations with sufficient frequency
respond to complications as they arise

Communication

confident
Ready to perform without supervision

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

The trainee will:

concisely and clearly communicate all vital information to team members during resuscitation
communicate with all members of the paediatric resuscitation team, using closed-loop communication where appropriate
establish and communicate clear roles, responsibilities, and priorities within the resuscitation team
summarise the clinical evolution of the situation to the resuscitation team
communicate with families, whānau, and/or carers of children during resuscitation
keep families, whānau, and/or carers informed throughout the resuscitation, if staffing allows
allocate a member of staff to conduct hot debriefs with staff members involved with resuscitation

direction
Requires some supervision

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

The trainee may:

communicate sufficiently to support the function of multidisciplinary teams
communicate with patients in a timely and appropriate manner

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

maintain up-to-date certification in advanced paediatric life support
analyse adverse incidents and sentinel events to identify system failures and contributing factors
maintain a safe department while paediatric resuscitation is occurring
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
establish a psychologically safe practice to debrief and catch up a team after a critical incident, such as resuscitation that results in the death of a patient, to support team mental wellbeing and staff retention

direction
Requires some supervision

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

The trainee may:

comply with safety requirements of the health service
evaluate the quality of processes through well-designed audits
evaluate the quality and safety processes implemented within the workplace, and identify gaps in their structure
raise appropriate issues for review at morbidity and mortality meetings

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

actively participate in multidisciplinary practice of resuscitation skills, including simulation where available
demonstrate effective supervision skills and teaching methods for junior colleagues around resuscitation skills and knowledge

direction
Requires some supervision

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

The trainee may:

maintain life support requirements of the health service
provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
coordinate and supervise junior colleagues from the emergency department and wards

Research

confident
Ready to perform without supervision

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

The trainee will:

incorporate current evidence-based resuscitation guidelines and protocols
consider enrolling eligible patients in approved clinical trials
accurately document the resuscitation course to contribute to quality improvement / research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

negotiate care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems
practise culturally safe care of all patients, with particular focus on Aboriginal and Torres Strait Islander peoples and Māori
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams
identify and respect cultural, religious, and other cultural concerns in end-of-life care

direction
Requires some supervision

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

The trainee may:

practise culturally safe care appropriate for the community serviced
proactively identify barriers to healthcare access

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

advise patients of their rights to refuse medical therapy, including life-sustaining treatment
consider the consequences of delivering non-beneficial treatment, directing to other care as appropriate
consider cases where organ donation may be appropriate, and how this process may occur or may be limited by access to local paediatric intensive care unit services

direction
Requires some supervision

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

The trainee may:

communicate medical management plans as part of multidisciplinary plans
establish, where possible, patients’ wishes and preferences about care

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:

frequently re-evaluate patients and their situations
recognise the need for escalations of care, and escalate to appropriate staff or services
use appropriate guidelines, evidence sources, and decision support tools
consolidate information given from many members of staff during resuscitations to make informed decisions regarding further treatment and investigations for patients

direction
Requires some supervision

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

The trainee may:

recognise the bounds of their own abilities, and know when and how to seek assistance from departmental colleagues or other specialities

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

lead paediatric resuscitations
identify the roles and scopes of practice of health professionals related to resuscitation, and use their expertise appropriately
work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
monitor the resuscitation team’s activities, and constructively intervene when needed
liaise with other appropriate healthcare providers if patients require transport to another service
use resources to allow the ongoing running of a safe emergency department while safely transporting acutely unwell children to other facilities

direction
Requires some supervision

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

The trainee may:

collaborate with other team members, based on their roles and skills
deliver appropriate multidisciplinary assessment and management

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available healthcare resources
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
follow policies on mandatory reporting
advocate for paediatric emergency care resources and policies
implement disaster plans and processes

direction
Requires some supervision

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

The trainee may:

apply escalation of care procedures for deteriorating patients
use leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes

LG12: Acute behavioural and psychiatric presentation and management

Learning Goal 12

Acute behavioural and psychiatric presentation and management

Manage paediatric patients presenting with behavioural and/or psychiatric disturbances in the emergency department

This activity requires the ability to:

identify possible causes of patients’ distress and behaviour
understand how neurodivergence may result in behavioural differences that require different assessment and management strategies
use techniques to de-escalate patients
assess patients’ mental states and level of risk for injury, suicide, or violence
formulate differential diagnoses and management plans
determine the need for medical intervention or admission
coordinate multidisciplinary care
communicate assessments and plans with patients, families, whānau, and/or carers, emergency mental health services, and admitting teams
document all interactions, discussions, assessments, and management decisions

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:

take relevant histories and examinations for psychiatric or acute behavioural disturbance presentations, including mental state exams, assessments of cognition, and, if appropriate, developmental assessments
conduct appropriate risk assessments and psychosocial screenings, including assessment of suicide / self-harm risk, and risk to others
differentiate between acute behaviour psychiatric disturbances and psychiatric disorders or organic cause
assess for potential medical causes / contributions
determine the need for inpatient admission criteria due to safety concerns
initiate psychotropic medications if indicated
administer methods of sedation
manage complications of sedation if they arise, including resuscitation
develop appropriate discharge plans, including outpatient mental health referrals, safety planning, and psychoeducation for patients discharged home

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of the symptoms and examination findings that concur with the diagnosis of acute psychiatric presentations
demonstrate understanding of the symptoms and examination findings that suggest the diagnosis of an organic cause for behavioural disturbances

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 in a style that allows pertinent psychiatric histories to be obtained
use a communication style that allows young people to be asked sensitive questions about the cause of their distress without distressing them further, when required
maintain a non-judgemental attitude towards the behaviour of children or adolescents
use crisis intervention and de-escalation techniques
check with, and, where appropriate, involve family, whānau, and/or carers in using calming or de-escalation techniques
provide documentation, including relevant histories, evaluations, risk assessments, and disposition plans

direction
Requires some supervision

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

The trainee may:

demonstrate proficiency in adolescent interview techniques
demonstrate communication skills to sufficiently support the function of multidisciplinary teams

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:

assess patients in a space where distractions are minimised
remove other patients and bystanders from the immediate vicinity, acknowledging that family and significant others may have an important role in assessment of patients
consider risks in the context of the emergency department setting, such as absconding or environmental hazards
evaluate and explain the benefits and risks of clinical interventions based on individual patients’ circumstances
identify and manage key risks for patients during transitions of care

direction
Requires some supervision

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

The trainee may:

evaluate quality and safety processes implemented within the workplace, and identify gaps in their structure
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:

participate in debriefing sessions following sedation of patients
obtain informed consent before involving patients in teaching activities

direction
Requires some supervision

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

The trainee may:

set goals and objectives for self-learning

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 analyse relevant literature and refer to evidence-based guidelines
participate in clinical research, and follow research protocols where appropriate

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

use interpreters where required
liaise with Aboriginal and Torres Strait or Māori liaison officers or Indigenous mental health workers
engage with patients, families, whānau, and/or carers to gather information in an atmosphere of trust and cooperation
acknowledge and reflect on 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
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:

assess patients’ capacity for decision making, involving a proxy decision maker appropriately
obtain consent from patients, families, whānau, and/or carers prior to the administration of any treatments or any restrictive practice

direction
Requires some supervision

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

The trainee may:

consider patients’ decision-making capacity
identify patients’ preferences regarding management and the role of families, whānau, and/or carers in decision making

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

recognise the need for escalations of care, and escalate to appropriate staff or service
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and causes into clinical decision making
assess the impact of developmental conditions and neurodiversity on behaviour

direction
Requires some supervision

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

The trainee may:

involve additional staff to assist in a timely fashion when required
recognise situations in which to ask for help

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:

consult with psychiatry and/or social work staff as needed
coordinate multidisciplinary care for potentially high-risk presentations
provide support to the emergency department team, including junior clinicians and nursing staff, when managing acutely behaviourally disturbed patients

direction
Requires some supervision

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

The trainee may:

collaborate with other team members, based on their roles and skills
deliver appropriate multidisciplinary assessment and management

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:

follow legislation, such as guardianship requirements and mental health acts, relevant to the local area, to assess if patients can legally be held in the hospital against their will or can be restrained, such as with the use of safe rooms or physical or chemical restriction
complete the appropriate state-based documentation when enacting forms of restriction, and follow local health protocols, guidelines, and policy

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 patient care
identify and access relevant community resources to support patient care

Knowledge guides

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

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

LG13: Foundations of paediatric emergency medicine

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 tinterpret the reported results of each investigation or procedure.

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

View

Important specific issues

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

View

Anatomy and physiology, including normal and abnormal ranges and development
Basic sciences, epidemiology, and pathophysiology of critical paediatric illness and injury, including:
- diagnosis
- evidence-based management
- pharmacology
- treatment
High-risk clinical features and comorbidities
Patterns of clinical and physiological decompensation
Pharmacological and non-pharmacological pain relief
Pharmacology of pain relieving and sedative agents, such as:
- analgesics, including:
  - nitrous oxide
- general anaesthetics, including:
  - sedatives
- local anaesthetics
Physiological and clinical responses to pain
Stabilisation and emergency treatment in critical illness or injury

Clinical assessment tools

Comparative pain scale
Local / Statewide / National clinical assessment tools, including, but not limited to:
- anaphylaxis
- asthma
- bronchiolitis
- burns
- cervical spine injury
- diabetic ketoacidosis
- gastroenteritis
- head injury
- hydration status
- sepsis
- stroke
Oximetry and capnography tmonitor intubated patients
Resuscitation and critical care structured assessment

Investigations

Biochemical:
- blood gases
- endocrinological:
  - blood glucose level
  - ketones
- inflammatory markers
- stool:
  - faecal calprotectin
- urine
ECG
Haematological:
- full blood count
- transfusion sample
Metabolic:
- hypoglycaemia screen
- metabolic screening tests
- newborn blood spot screening
- urine screen:
  - drug
  - metabolic
Microbiological:
- antimicrobial sensitivity, culture, and microscopy
- blood tests, such as:
  - bacterial
  - viral polymerase chain reaction (PCR)
- cerebral spinal fluid
- serology
- skin / fluid swabs:
  - antimicrobial sensitivity and culture
  - bacterial and viral PCR
  - microscopy
- stool:
  - culture and antimicrobial sensitivity
  - cysts, ova, and parasites
- urine:
  - antimicrobial sensitivity and culture
Patient monitoring
Radiological:
- CT
- MRI
- ultrasound – including point of care ultrasound
- x-ray

Procedures

Advanced airway support, including difficult airways:
- intercostal catheters
- intubation and rapid sequence inductions
- laryngeal mask use
- nasotracheal intubation
- needle cricothyroidotomy
- orotracheal
- percutaneous needle thoracocentesis
- surgical airways
Advanced life support:
- cardioversion for arrhythmia
- defibrillation
- fluid resuscitation
- pericardiocentesis
- pharmacology, including:
  - antiarrhythmics
  - inotropes
  - vasodilators
Analgesia and sedation procedures:
- general anaesthetic administration, including:
  - inhalation analgesics
  - sedation:
    - benzodiazepine – with or without fentanyl
    - choral hydrate
    - dexmedetomidine
    - ketamine
    - nitrous oxide
    - propofol
- immobilisation techniques, including splinting
- nerve blocks:
  - Bier block
  - digital nerve block
  - fascia iliaca compartment block
  - femoral nerve block
  - other nerve blocks
Foreign body removal, from:
- ear
- eye
- mouth
- nose
- skin
- soft tissue
Lumbar puncture
Practical trauma procedures:
- airway management, including:
  - bag and mask ventilation
  - circulation management
  - endotracheal intubation
  - manoeuvres and adjuncts
  - mechanical ventilation
  - oxygen delivery systems
  - ventilation:
    - invasive
    - non-invasive
Temperature homeostasis
Ultrasound guided procedures, including, but not limited to:
- cannulation
- fracture manipulation
Vascular procedures:
- arterial:
  - cannulation
  - puncture
- cardiac pacing
- vascular access:
  - central
  - intraosseous

Child protection
Emergency Medical System (EMS), including communicating with pre-hospital providers
Management of mental health / behaviours of concern in the emergency department
Neurodiversity
Reducing overuse of investigations and treatments
Understand the techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures

Disasters involving children

Considerations of disaster site management:
- equipment and supplies
- field hospitals
- media management
- roles and responsibilities
- transport
Disaster preparation – planning and training
Emergency department resources required to receive victims of a disaster:
- equipment
- personnel
Essential information that must be communicated following a disaster
Management of collegial, nursing, and transport staff
Methods of disaster site triage and on-site treatment
Occupational health and safety risks
Potential medical issues:
- mental health
- public health
Regional, state, and national governments’ responsibilities following disasters

Manage the death of a child

Criteria for:
- coronial investigation
- determining death
Grieving process
Organ donation requirements
Religious and cultural attitudes to death
Staff support, and organisations to assist mourning families

Retrieval and/or transfer

Inter-hospital transfer:
- handover protocol
- risk factors
- transfer:
  - disposition
  - method
- transfer of responsibilities
Intra-hospital transfer:
- clinical handover
- handover protocol
- monitoring devices
- risk factors
Retrieval medicine

Risk management

Australasian triage scale indicators
Clinical risk management processes, including:
- complaint and incident report management
- consent
- consultation
- documentation
- quality assurance
Medical advice that may be provided by telephone triage
Risk components of an emergency medical department

LG14: Acute illness

Key presentations and conditions

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

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abdominal:
- distension
- mass
- pain
Acute scrotum
Altered level of consciousness
Anaphylaxis
Angioedema
Bites:
- snake
- spider
Anorexia
Apnoea / Irregular breathing
Ataxia
Bleeding
Bruising
Chest pain
Chronic illness
Chronic pain
Collapse
Complications of immunisation
Constipation
Cough
Cyanosis
Dehydration
Developmental:
- abnormalities
- delay
- syndromes
- regression
Diarrhoea
Difficulty swallowing / Drooling
Dysuria
Ear discharge
Electrolyte abnormalities
Emergency contraception
Epistaxis
Erythrodermas and skin failure
Facial swelling
Fever, including:
- in the returned traveller
Focal neurological deficit
Foreign body:
- ingestion
- inhalation
Goitre
Haematemesis
Haemoptysis
Seizures
Hair problems
Headache
Haematuria / Change in urine
Hernia
Hyperpigmentation
Hypertension
Hyperthermia
Hypoglycaemia
Hypothermia
Inborn errors of metabolism
Infections in immunocompromised children
Insulin pump failure
Intoxication from alcohol or drugs of abuse
Jaundice
Joint:
- stiffness
- swelling
Lethargy
Limp
Lumps and bumps
Lymphadenopathy
Movement disorders
Nail problems
Oedema
Organomegaly
Paediatric resuscitation
Pain, such as:
- ear
- joint
- pelvic
Palpitations
Photosensitivity
Polydipsia
Polyuria
Poisoning and overdose
Poor:
- dentition
- feeding
Poor or abnormal growth
Post-tonsillectomy haemorrhage
Problems of the penis and foreskin, acute
Precocious puberty
Rash, such as:
- eczematous
- neonatal
- non-blanching
- papular
- papulosuamous
- pustular
- vesiculobullous
Rectal bleeding
Recurrent / Severe infection
Reduced urine output
Respiratory distress
Rhinitis
Seizures
Sexual assault
Shock
Sore throat
Stomatitis
Stridor and noisy breathing
Swelling / Protrusion of the ear
Syncope
Tooth pain / swelling
Ulceration
Unsettled baby
Urinary retention
Urticaria
Vaginal:
- bleeding
- discharge
Vascular malformations
Vomiting
Weakness
Weight loss
Wheezing

Conditions

Cardiovascular

Cardiac murmurs
Coarctation of the aorta
Hypertrophic obstructive cardiomyopathy (HOCM)
Myocarditis
Palpitations
Pericarditis
Supraventricular tachycardia
Syncope and causes, including, but not limited to:
- breath-holding spells
- tetralogy of Fallot
- vasovagal syncope
- ventricular tachycardia

Dental

Abscess
Caries

Dermatological

Bacterial skin infections
Dermatitis
Eczema, including eczema herpeticum
Erythema multiforme
Henoch–Schönlein purpura
Impetigo
Kawasaki disease
Petechiae
Purpura
Scabies
Skin changes associated with bacterial infections, such as:
- rheumatic fever
- scarlet fever
- staphylococcal scalded skin syndrome (SSSS)
Skin changes associated with immunological conditions, such as:
- Kawasaki disease
Stevens–Johnson syndrome
Toxic shock
Urticaria
Viral exanthems, including warts
Viral rashes, including:
- measles
- non-specific

Developmental and congenital

Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorder
Spina bifida
Trisomy 21

Ear, nose, and throat

Mouth ulcers:
- bacterial
- viral
Otitis:
- externa
- media
Quinsy
Sinusitis
Tonsillitis

Endocrinological

Adrenal:
- crisis
- gland disorders
Diabetes mellitus:
- type 1
- type 2
Diabetic ketoacidosis
Hypoglycaemia
Insulin pump failure
Polydipsia
Polyuria

Gastrointestinal

Appendicitis
Bilious vomiting
Bowel obstruction
Cholecystitis
Constipation
Gastroenteritis
Haematemesis
Hernia:
- incarcerated
- irreducible
Hirschsprung disease
Infectious diseases
Inflammatory bowel diseases
Ingested foreign body
Intussusception
Jaundice
Malrotation or volvulus
Pancreatitis
Pyloric stenosis
Umbilicus disorders

General

Dehydration
Shock

Haematological and oncological

Anaemia
Haemorrhage and haemorrhagic shock
Haemorrhagic and thrombotic disease
Idiopathic thrombocytopenic purpura (ITP)
Leukaemia
Lymphoma
Neutropoenia and sepsis
Pancytopenia
Solid organ tumours
Thrombocytopaenia

Immunological

Allergies
Anaphylaxis

Infectious disease

Bacterial tracheitis
Kawasaki disease
Rheumatic fever, acute
Sepsis
Vesicoureteral reflux

Metabolic

Hypoglycaemia

Musculoskeletal

Limp, acute
Osteomyelitis
Parathyroid disorders
Perthes disease
Septic arthritis
Slipped upper femoral epiphysis
Thyrotoxicosis
Transient synovitis

Neonatal

Jaundice
Neonatal acne

Neurological

Bell’s palsy
Cerebral palsy
Encephalitis
Facial weakness
Intracranial neoplasms
Meningitis
Migraines
Raised intracranial pressure
Seizures and movement disorders

Renal

Glomerulonephritis
Henoch–Schönlein purpura

Respiratory

Asthma
Bronchiolitis
Croup
Empyema
Laryngomalacia and tracheomalacia
Lower respiratory tract infection
Lung abscess
Neonatal apnoea
Pertussis
Pleural effusion
Pneumonia and its complications
Pneumothorax
Respiratory distress
Stridor
Upper respiratory tract infection

Toxicological

Alcohol intoxication
Antidepressant and antipsychotic overdose
Clonidine overdose
Paracetamol overdose

Urological

Acute idiopathic scrotal oedema
Phimosis
Urinary retention
Urine infections

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Exposure to toxic gases
Marine envenomation
Poisonous fungi / plant ingestion and exposure

Conditions

Cardiovascular

Acute coronary syndrome
Anomalous left coronary artery
Aortic stenosis
Arrhythmogenic right ventricular cardiomyopathy
Atrial septal defect (ASD)
Atrioventricular (AV) blocks
Brugada syndrome
Cardiac transplantation
Coronary aneurysms, with Kawasaki disease
Ebstein anomaly
Endocarditis
Heart failure
Hypertensive emergencies
Patent ductus arteriosus (PDA)
Prolonged QT interval
Pulmonary:
- atresia / stenosis
- hypertension
Rheumatic heart disease
Single ventricle physiology (hypoplastic left / right heart)
Sinus node dysfunction
Total anomalous pulmonary venous return
Transposition of the great arteries
Tricuspid atresia
Truncus arteriosus
Ventricular septal defect (VSD)
Wolff–Parkinson–White syndrome

Dermatological

Bullous disease
Haemangiomas

Developmental and congenital

CHARGE syndrome
Developmental delay and regression
Foetal alcohol syndrome
Fragile X syndrome
Muscular dystrophy
VACTERL association

Ear, nose, and throat

Nasal polyps
Obstructive sleep apnoea

Endocrine

Addison disease
Adrenal crisis
Congenital adrenal hyperplasia
Diabetes insipidus
Goitre
Hyperpigmentation
Hypothalamus disorders
Parathyroid disorders
Pituitary:
- crisis
- gland disorders
Precocious puberty
Rickets
Thyroid crisis
Thyrotoxicosis

Gastrointestinal

Abdominal mass / organomegaly
Short gut

General

Sudden unexplained death

Haematological and oncological

Haemoglobinopathies
Transfusion reactions
Tumour lysis syndrome

Immunological

Angioedema
Immune deficiency-related infections

Infectious

Fever in the returned traveller
Immunisation and complications of immunisation
Infections in immunocompromised children

Metabolic

Amino acid metabolism
Carbohydrate metabolism
Inborn errors of metabolism
Lipids metabolism

Musculoskeletal and rheumatological

Inflammatory joint conditions:
- juvenile idiopathic arthritis
Neoplasms
Overuse syndromes
Skeletal dysplasia

Neurological

Acute disseminated encephalomyelitis
Ataxia
Autonomic neuropathies
Guillain–Barré disease
Haemorrhagic and ischaemic strokes
Neurodegenerative disorders
Neuromuscular disorders
Spinal cord disorders
Toxic neuropathies
Transverse myelitis
Vascular disorders
Venous sinus thrombosis

Obstetric and gynaecological

Non-pregnancy-related emergencies, including:
- dysfunctional uterine bleeding
- menorrhagia
- heavy per vaginum (PV) bleeding
- pelvic inflammatory disease
- sexually transmitted infections
- vaginal trauma
Pregnancy-related emergencies, including:
- bleeding in:
  - early pregnancy
  - late pregnancy
- ectopic pregnancy
- pre-eclampsia / eclampsia Renal

Renal

Kidney vein thrombosis
Neurogenic bladder
Polycystic kidney disease
Renal artery stenosis
Renal stones
Urinary tract obstructions
Vesicoureteral reflux

Respiratory

Chronic respiratory disease, such as:
- congenital abnormalities, such as:
  - congenital diaphragmatic hernia
- cystic fibrosis
- primary ciliary dyskinesia
Pneumomediastinum
Pulmonary:
- embolism
- sequestration
Subglottic stenosis
Tuberculosis
Vascular ring
Vocal cord dysfunction

Toxicological

Anticholinergic syndrome
Beta blocker overdose
Calcium channel blocker overdose
Carbon monoxide poisoning
Cholinergic syndrome
Drugs of abuse – use and withdrawal
Hydrocarbon toxicity
Neuroleptic malignant syndrome
Non-steroidal anti-inflammatory drug (NSAID) overdose
Opiate overdose
Organophosphate toxicity
Serotonin syndrome
Sodium channel blocker overdose
Sympathomimetic syndrome
Toxic alcohol overdose

Urological

Paraphimosis
Penile discharge

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

Synthesise

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

Manage

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

Consider other factors

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

Age- and anatomy-related normal physiology
Normal dental development

Prescribing and treatment

Basic toxicology
Clinical pharmacology
Infections that require medication prescription:
- antifungal
- antiparasitic
- antiviral
Pathophysiology of:
- acid-base and electrolyte disturbances
- cardiovascular failure
- coma
- respiratory failure shock

Clinical assessment tools

Airway, Breathing, Circulation, Disability, Exposure (ABCDE) assessment of critically unwell children
Development assessment
Home, Education / Employment, Eating / Exercise, Activities, Drugs and alcohol, Sexuality, and Suicide and depression, Safety (HEEADSSS) assessment
Mental state
Percentile growth chart
Primary, secondary, and tertiary survey

Investigations and procedures

Cardiovascular

Antiarrhythmic therapy
Blood:
- arterial and venous blood sampling and analysis
- blood, platelet, and clotting factor transfusion
Ductus arteriosus therapy
Intravenous catheter insertion:
- central
- peripheral
Use of defibrillator for resuscitation or for cardioversion

Dental

Assessment of dental injuries
Temporary fixation of injured secondary teeth

Developmental abnormalities and syndromes

Developmental screening

Ear, nose, and throat

Ear wick insertion
Epistaxis management with nasal packing
Nasal packing
Post-tonsillectomy haemorrhage management

Endocrinological

Blood glucose check
Ketone check
Venous blood gas, and interpretation of results

Gastrointestinal

External rectal examination
Gastrostomy tube replacement
Hernia reduction
Nasogastric tube insertion
Orogastric tube insertion

Haemtological and oncological

Central line access

Immunological

Coombs test
Immunisation

Infection disease

Abscess drain
Cultures from:
- cerebrospinal fluid
- mucosa
- secretions
- skin
- stool
- urine
Lumbar puncture (LP)
Malarial films
Perinasal swab
Serology
Suprapubic aspirate
Swab for:
- enzyme immunoassay
- immunofluorescence
- polymerase chain reaction (PCR)
Urethral catheterisation

Metabolic

Take and interpret glucose and ammonia levels

Musculoskeletal

Knee joint aspiration

Neurological

Consciousness levels using:
- Glasgow Coma Scale
- Paediatric Glasgow Coma Scale
Fundoscopy
Interpretation of CT scan
Measurement of opening pressure on LPs
Performing an LP for cell count, glucose, and protein, and interpretation of results

Obstetric and gynaecologic

External genital examination for injuries
Forensic examination of sexual assault victims
Pregnancy test
Vaginal speculum examination for pregnant patients experiencing significant miscarriage or cervical shock

Opthalmology

Bacterial and viral swabs of the eye
Use of slit lamp with fluoresceine

Respiratory

Ability to set up ventilators for acute medical conditions, such as a patient intubated for seizure control or severe asthma
Arterial and venous blood gas
Basic CT chest scan interpretation
Bubble continuous positive airway pressure (CPAP)
Chest x-ray interpretation
High-flow oxygen therapy
Lateral airway radiography
Non-invasive ventilation
Pulse oximetry
Spirometry and measures of gas exchange

Urological

Acute treatment of phimosis with urinary retention
Reduction of paraphimosis
Suprapubic aspirate of urine
Urethral catheter insertion
Urine dipstick

Awareness of ‘one pill can kill’ medications, such as:
- calcium channel blockers
- carbamazepine
- clozapine
- opioids
- propranolol
- sodium channel blockers
- sulfonylureas
- tricyclic antidepressants
- venlafaxine
Awareness of ‘one sip can kill’ medications, such as:
- camphor
- corrosives
- hydrocarbons
- naphthalene
- organophosphates
- paraquat
Expected clinical course and outcome of illnesses
High-risk clinical features of illnesses and comorbidities
Impact of long-term illness on development
Infection control:
- communicable disease reporting
- immunisation
- isolation
Management of infection in travellers
Management process following needlestick injury
Medical and support agencies for pregnancy referral
Methods of:
- behaviour modifications
- physical restraint
Paediatric resuscitation
Potential risks to patients’ safety
Safety issues for patients and staff:
- personal protective equipment
- universal precautions
Sexual assault counselling agencies
Signs of severity and patterns of decompensation
Techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures
The need for medical clearance

Treatment therapies

Treatment of haematological and oncologic conditions:
- chemotherapy
- radiation therapy

LG15: Acute injury

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Environmental injury

Barotrauma
Bites and stings:
- animal
- human
- insect
- marine
- reptile
Burns:
- chemical
- contact
- lightning injury
- radiation injury
- scalds
- smoke inhalation
- sunburn
Cold injury:
- peripheral cold injuries
- systemic hypothermia
Decompression illness
Drowning
Environmental and burns, including:
- environmental exposures:
  - hyperthermia
  - hypothermia
Heat injury
Radiation
Toxic marine ingestions

General types of injury

Burns
Internal
Laceration
Non-accidental
Orthopaedic
Toxic

Injuries by region

Abdominal injury:
- hepatic
- hollow viscus
- kidney
- pancreatic
- splenic
Back injury:
- ligamentous injuries
- musculoskeletal back pain
- spinal cord injuries
- spinal fractures
Chest injury:
- flail chest:
  - fractured ribs
  - fractured sternum
  - injury of great vessels
- haemothorax
- penetrating thoracic injury:
  - myocardial contusion
  - pericardial tamponade
- pneumothorax
- pulmonary contusion
- traumatic asphyxia:
  - diaphragmatic eventration
  - tracheobronchial rupture
Face injury:
- burns
- dental
- ear
- eye, including:
  - foreign bodies
- facial fractures
- jaw dislocation
- lacerations
- nose
Genitourinary or pelvic injury:
- bladder rupture:
  - pelvic fracture
  - straddle injuries
- penetrating genitourinary trauma
- penile / perineal / vaginal injury
- sexual assault
- testicular trauma
- ureteric:
  - urethral
Hand injury:
- amputation
- crush injury
- cutaneous foreign bodies
- lacerations / skin injury:
  - contaminated
  - cutaneous foreign body
  - deep lacerations
  - degloving
  - marine wounds, including:
    - coral
  - non-venomous bites
  - puncture wounds
  - superficial lacerations
- nail and nail bed
- nerve
- pressure injection injury:
  - animal bites
  - fractures
  - penetrating injuries
  - tendon
Head injury:
- concussion
- diffuse axonal injury
- extra-axial
- haematomas
- intracerebral
- intracranial
- minor head injuries
- non-accidental
- penetrating head injury
- post-concussive syndrome
- skull fractures
Neck and spinal injury:
- fractures
- nerve injury
- spinal cord injury without radiologic abnormality
- spinal cord syndromes
- vascular injury

Orthopaedic injury

Dislocations:
- acromioclavicular joint
- ankle
- elbow, including:
  - pulled elbow
- hip
- jaw
- knee
- patella
- phalanges, including:
  - hand
  - foot
- shoulder
Ligamentous / Soft tissue injury:
- ankle
- apophysitis / osteochondrosis
- compartment syndrome
- elbow
- foot
- hand, such as:
  - trigger finger
- knee
- Lisfranc
- muscular sprain
- shoulder
- tendinopathies
Lower limb fracture:
- avulsion fracture of fifth metatarsal
- distal tibia, including:
  - epiphyseal-metaphyseal
- femoral neck and shaft
- fibula
- metatarsal
- midshaft and proximal tibia
- patella
- phalangeal
- slipped upper femoral epiphysis
- tarsal, including:
  - calcaneus
  - talus
- tibial plateau – tibial spine
- toddler’s fracture
Pelvic fractures:
- avulsion fractures
- superior iliac spine:
  - anterior
  - inferior
- ischial tuberosity
- pelvic rim fractures
Spinal injuries:
- ligamentous and soft tissue injuries
- spinal cord injury without radiologic abnormality
- spinal cord syndromes
- vertebral fracture and dislocation
Upper limb fracture:
- carpal
- clavicle
- distal radius and ulna, including:
  - epiphyseal-metaphyseal
- Galeazzi and Monteggia fractures
- lateral and medial humeral condyles
- metacarpal
- midshaft:
  - humerus
  - radius
  - ulna
- phalangeal
- proximal ulna
- radial head and neck
- scapular
- supracondylar:
  - grading
  - occult
- upper humerus, including:
  - epiphyseal-metaphyseal

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

Synthesise

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

Manage

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

Consider other factors

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

Age- and anatomy-related normal physiology of injured area:
- abdominal or pelvic
- chest
- facial
- genitourinary
- hand
- head
- neck
- orthopaedic
- soft tissue
- spinal
Signs of severity and patterns of decompensation
Toxic injury:
- antidotes for common poisons
- epidemiology of poisoning
- pharmacological techniques for drug removal
- toxicology and drug testing and screening methods

Clinical assessment tools

Burns

Burn depths categorisation

Head

Evaluate degrees of head injury – scalp lacerations
Level of consciousness

Facial

Eye examination, including:
- slit lamp

Toxic

Assess need for and administer activated charcoal
Drug testing and screening
Patient decontamination for chemical agents

Investigations

Investigations – general

CT
MRI
Pathology, including blood tests in trauma, including:
- chemistry
- cross-match
- full blood count
- lipase
Ultrasound
Urine testing, including:
- BHcG (when indicated)
X-rays

Burns

Burn nomogram

Chest injury

Investigations for inhaled foreign bodies
Ultrasound

Facial injury

Orthopantomogram

Head injury

CT
MRI
Radiological investigations, such as:
- fundoscopy

Vascular injury

Angiography
Doppler ultrasound
Sonography

Procedures

Burns

Dressing selection and application
Escharotomy
Fluid resuscitation

Chest injury

Intercostal drain insertion
Percutaneous needle thoracostomy
Pericardiocentesis

Facial injury

Anterior nasal pack
Facial burns:
- dressing for superficial and partial thickness burns
- refer higher degree burns
Foreign body removal:
- ear
- eye:
  - conjunctival
  - corneal
- nose
Irrigate conjunctival and corneal eye burns
Reduce temporomandibular joint dislocation
Reimplant secondary tooth
Repair lacerations:
- sutures
- tissue adhesives

General

Procedural sedation:
- contraindications and indications
- options for procedural sedation in the emergency department

Genitourinary or pelvic injury

Foreign body investigation and removal
Stabilise pelvic fracture

Hand injury

Digital nerve block
Ring removal
Splinting:
- interphalangeal joint dislocation
- metacarpal fracture
- metacarpophalangeal joint dislocation
- phalangeal fracture

Head injury

Laceration repair:
- glue
- staples
- sutures
Management of raised intracranial pressure, including:
- neuroprotective measures
Neurosurgical time-critical intervention, including:
- burr holes

Lacerations

Amputated area management
Fishhook removal
Foreign body removal
Wound:
- anaesthesia administering
- cleanse and debride
- dressing

Orthopaedic

Casting
Nerve blocks:
- fascia iliaca / femoral block with ultrasound guidance
Reduction of:
- dislocations, with and without compromise
- fractures, with and without compromise
Soft tissue injury
Splinting:
- limb fractures:
  - lower
  - upper

Spinal injury

Log roll
Spinal immobilisation

Toxic injury

Decontamination
Gastrointestinal (GI)
Skin
Whole bowel irrigation

Acute treatment of injuries and trauma
Aeromedical:
- safety considerations
- transfer
Expected clinical course and outcome
First aid procedures
HAZMAT principles
Indications and contraindications of varying routes of analgesia:
- gaseous
- intranasal
- intravenous
- local anaesthesia:
  - blocks
  - topical
- oral analgesia
Non-pharmacological treatment options:
- dexmedetomidine
- distraction
- ketamine:
  - intramuscular
  - intravenous
- nitrous oxide
- oral agents, such as:
  - clonidine
  - midazolam
- splints
Pharmacological treatment options for analgesia
Preparation and delivery of discharge instructions
Referral to:
- other relevant specialists
- radiologist
Rehabilitation, including:
- acute
Techniques, utility, and limitations of focused ultrasound in guiding paediatric procedures

LG16: Child safety and maltreatment

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Child abuse, including, but not limited to:
- emotional abuse:
  - fabricated illness or induced illness by proxy
- neglect
- physical abuse
- sexual abuse:
  - sexually transmitted infections
Symptoms and signs of inflicted / non-accidental injury, such as:
- abdominal and thoracic injuries
- burns
- chest injuries
- injuries in pre-mobile infants
- fractures
- genitourinary injuries
- head injuries
- intra-oral bleeding and injuries
- perplexing presentations (PP) and fabricated or induced illness (FII) in children
- poisonings
- skin and soft tissue injuries, including:
  - bruises
- strangulation and suffocation

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

Synthesise

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

Manage

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

Consider other factors

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

Biopsychosocial risk factors
Health needs of children and young people in the care and protection systems, such as:
- children in out-of-home care
- developmental, medical, and mental health conditions occurring in the population, including those in gateway clinics
Impact of societal biases in child protection systems
Legislative requirements
Population health significance of child maltreatment, and primary, secondary, and tertiary prevention strategies
Potential risk factors for harm to children and their siblings within the family / environment
Protective factors, such as positive relationships and supports, and how they may help modify risk and augment management
Referral pathways, and community and hospital services for vulnerable children and their families

Consideration of differential diagnosis or pathologies contributing to severity of presentation:
- bleeding disorders
- bone fragility
- drugs
- genetic conditions
- metabolic conditions
- toxins
Imaging (radiology), such as:
- bone scan
- CT
- MRI
- radiographic skeletal survey
- ultrasound
Investigations:
- differential diagnosis to presentations of child maltreatment
- role of investigations to assess for acute injury
Pathology tests to assess injuries and consider other potential differential diagnosis
Subspeciality consultations and procedures, including retinal examination
Time critical forensic specimen collection with chain of evidence / forensic sampling techniques

Physical examination

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

Awareness of personal reactions to childhood behaviours, disability, family situations, and illnesses, and the impact these may have on professional practice
Child rights
Discussion of sensitive issues with family
Family dysfunction, including poverty and disadvantages, and the impact of social determinants of health
Features of inflicted injury:
- history
- patterns of injury
- risk factors
Parent and/or carer involvement in shared decision making
Peer review processes and support
Principles of advocating for children
Reporting requirements:
- ethical, legal, and professional responsibilities around sharing information regarding child safety, harm, and protection
- reporting requirements and mandatory reporting obligations
Psychosocial hazards:
- impact of vicarious trauma on clinician wellbeing
- impact on the long-term health and wellbeing of children involved in the care and protection system
Medicolegal aspects:
- appropriate conduct of an expert witness
- courts, and the role of those:
  - involved in the criminal justice system
  - responsible for child protection, family law, and appeal
- legal considerations for treatment
- paediatric medical experts and their role in writing medicolegal reports, contributing to case conferences, and testifying in court in cases of child maltreatment
- principles and procedures of forensic sample collection, including collection of biological specimens for DNA analysis
- provide evidence to assist investigations, including swabs and photographs

Maltreatment and intergenerational trauma and conflict

Intergenerational trauma and conflict:
- Child maltreatment presentations, such as:
  - Exaggeration
  - Fabrication
  - Falsification
  - Induction of illness or symptoms
- Emotional maltreatment
- Exposure to interpersonal violence
- Neglect
- Special consideration of all injuries in non-ambulatory infants
- Unexplained or repeated incidents of inflicted / non-accidental injury, such as:
  - Abdominal and thoracic injuries
  - Burns
  - Child sexual abuse
  - Fractures
  - Head injuries
  - Intraoral injuries
Maltreatment:
- Behavioural or emotional presentation as a consequence of current or previous maltreatment, and the impact of neglect over time
- Different types of child maltreatment and child neglect:
  - Educational
  - Emotional
  - Medical
  - Physical
  - Supervisory
- Effective prevention of child maltreatment
- Effects on children of being a perpetrator, victim, or witness of violence
- Enablers and barriers to obtaining information in child maltreatment situations
- Family and domestic violence
- Local, state, and national policies, procedures, and services related to child protection
- Management of physical and emotional maltreatment
- Methods involved in developing a differential diagnosis for maltreatment victims

Specific management issues

Appropriate injury reporting, separate to reporting to child safety agencies, such as making an ACC claim in Aotearoa New Zealand
Disclosure and history-taking environment must be safe, including culturally safe, taking into consideration:
- Age
- Developmental stage
- Safe environment post-disclosure
Referrals:
- Appropriate referral pathways to ensure time-critical specimens are collected within the appropriate timeframe, and non-time-critical specimens are performed in a planned, coordinated manner
- Non-accidental injury and appropriate referral processes, such as knowing legislative processes and keeping thorough documentation
- Mental health / social support referrals as appropriate and available
Sexual health:
- Emergency contraception provision and counselling
- Sexually transmitted infection testing, and post-exposure prophylaxis

LG17: Psychiatric and behavioural disturbance

Key presentations and conditions

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

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

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Epidemiology, pathophysiology, and clinical sciences

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

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Investigations, procedures, and clinical assessment tools

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

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

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Important specific issues

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

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Presentations

Deliberate self-harm
Overdose / Intentional poisoning
Psychiatric disorders, acute
Suicide attempts, or risk of
Undifferentiated acute behavioural disturbance

Conditions

Anxiety
Attention deficit hyperactivity disorder (ADHD)
Autism spectrum disorder
Behavioural and psychiatric:
- agitation
- confusion
- deliberate self-harm
- substance abuse
Depression
Eating disorders
Intellectual disability and developmental delay with behavioural disturbance
Organic disorders causing behavioural disturbance, including, but not limited to:
- brain tumours
- encephalitis
- epilepsy
- pain
- sepsis
Psychosis

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations and conditions

Attachment disorder
Cannabis hyperemesis syndrome
Fabricated illness or induced illness by proxy
Functional disorder
Personality disorder
Psychosis, acute
Somatisation disorder

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

Synthesise

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

Manage

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

Consider other factors

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

Toxicology:
- ADHD epidemiology and medications
- antipsychotics and use in acute behavioural concerns
- chemical sedation and:
  - appropriate patient populations
  - benefits
  - minimum standards of monitoring throughout
  - risks
- common overdoses, including their antidotes, pathophysiological effects, and presentation, including, but not limited to:
  - alcohol
  - antidepressants
  - aspirin
  - ecstasy
  - methamphetamines
  - paracetamol
- life-threatening overdoses
- unclear toxin
- toxidromes

Investigations

Blood results related to behaviourally disturbed or toxicology patients:
- blood gas results
- for assessing risk in patients with eating disorders
- specific drug levels, such as paracetamol and iron
ECG:
- patient groups:
  - behaviourally disturbed
  - eating disorders
  - toxicology patients
- to assess for organic cause
Specific investigations for:
- aggressive / scared or heightened patients
- excluding underlying organic cause for presentation
- overdose patients, to determine type and severity of overdose

Procedures

Chemical restraint:
- intramuscular
- intravenous
- oral
De-escalation of disturbance in individuals across the age ranges
Intravenous / Venepuncture cannulation
Lumbar puncture for patients with possible organic cause for behavioural disturbance
Nasogastric (NG) insertion for:
- decontamination
- NG feeding
- NG medication administration
Non-chemical restraint
Urinary catheterisation for enhanced elimination

Clinical assessment

Acute suicide risk
Assessments to exclude underlying organic cause for presentation
Medical stability in eating disorder patients
Mental state examination
Physical examination to assess for organic cause for behavioural disturbance

Acute mental health impacts of other diseases, such as chronic disease or life-limiting disease
Addiction:
- drugs of addiction
- in eating disorders
- management of addiction
First presentation at emergency department of acute psychiatric disorders
Local referral pathways for young children with behavioural concerns
Medicolegal:
- legal framework regarding ADHD medications
- legal status of duty of care, mental health acts, and restraint
Possible contributors to behaviour:
- bullying
- family dynamics
- exposure to parental use of drugs and alcohol
- role of social media
- peer group interactions
Recognition of maternal / parental mental health crisis as factors in child presentations to health services
Recreational substance abuse
Treatment:
- antipsychotic and anti-anxiety medications, and administration with psychiatric specialist support
- restraint versus sedation, especially in the uncooperative child
- treatment pathways for acute mental health paediatric patients, including:
  - legal implications
  - safe transfer (if required)
  - units suitable for admission
- treatment pathways for long-term increasing disturbance, behavioural outbursts, and self-harm in neurodiverse patients

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 Paediatric Emergency Medicine

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

11

LG2: Team leadership

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

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: Patient safety and 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: Emergency department management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Acute illness clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour