Curriculum standards

About this resource

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

This document outlines the curriculum standards for Advanced Training in Neonatal and Perinatal Medicine for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Neonatal and Perinatal 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 training programs.

Medical expertise

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

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

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

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

Communication

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

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

Effective communication. Use a range of effective and appropriate verbal, nonverbal, written and other communication techniques, including active listening.

Communication with patients, families, and carers. Use collaborative, effective, and empathetic communication with patients, families, and carers.

Communication with professionals and professional bodies. Use collaborative, respectful, and empathetic clinical communication with colleagues, other health professionals, professional bodies, and agencies.

Written communication. Document and share information about patients to optimise patient care and safety.

Privacy and confidentiality. Maintain appropriate privacy and confidentiality and share information responsibly

Quality and safety

Professional standard. Physicians practice in a safe, high quality manner within the limits of their expertise.

Physicians regularly review and evaluate their own practice alongside peers and best practice standards and conduct continuous improvement activities.

Patient safety. Demonstrate a safety focus and continuous improvement approach to own practice and health systems.

Harm prevention and management. Identify and report risks, adverse events, and errors to improve healthcare systems.

Quality improvement. Participate in quality improvement activities to improve quality of care and safety of the work environment.

Patient engagement. Enable patients to contribute to the safety of their care.

Teaching and learning

Professional standard. Physicians demonstrate a lifelong commitment to excellence in practice through continuous learning and evaluating evidence.

Physicians foster the learning of others in their profession through a commitment to mentoring, supervising, and teaching.¹

Lifelong learning. Undertake effective self-education and continuing professional development.

Self-evaluation. Evaluate and reflect on gaps in own knowledge and skills to inform self-directed learning.

Supervision. Provide supervision for junior colleagues and/or team members.

Teaching. Apply appropriate educational techniques to facilitate the learning of colleagues and other health professionals.

Patient education. Apply appropriate educational techniques to promote understanding of health and disease amongst patients and populations.

References

1. Adapted from Richardson D, Oswald A, Chan M-K, Lang ES, Harvey BJ. Scholar. In: Frank JR, Snell L, Sherbino J, editors. The Draft CanMEDS 2015 Physician Competency Framework – Series IV. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2015 March.

Research

Professional standard. Physicians support creation, dissemination and translation of knowledge and practices applicable to health.

They do this by engaging with and critically appraising research, and applying it in policy and practice to improve the health outcomes of patients and populations.

Evidence-based practice. Critically analyse relevant literature and refer to evidence-based clinical guidelines and apply these in daily practice.

Research. Apply research methodology to add to the body of medical knowledge and improve practice and health outcomes.

Cultural safety*

Professional standard: Physicians engage in iterative and critical self-reflection of their own cultural identity, power, biases, prejudices and practising behaviours. Together with the requirement of understanding the cultural rights of the community they serve, this brings awareness and accountability for the impact of the physician’s own culture on decision-making and healthcare delivery. It also allows for an adaptive practice where power is shared between patients, family, whānau and/or community and the physician, to improve health outcomes.

Physicians recognise the patient and population’s rights for culturally safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making. This shift in the physician’s perspective fosters collaborative and engaged therapeutic relationships, allows for strength-based (or mana-enhanced) decisions, and sharing of power with the recipient of the care, optimising health care outcomes.

Physicians critically analyse their environment to understand how colonialism, systemic racism, social determinants of health and other sources of inequity have and continue to underpin the healthcare context. Consequently, physicians then can recognise their interfacing with, and contribution to, the environment in which they work to advocate for safe, more equitable and decolonised services and create an inclusive and safe workplace for all colleagues and team members of all cultural backgrounds.

Critical reflection. Engage in iterative and critical self-reflection and demonstrate cultural safety in the context of their own cultural identity, power, biases, prejudices and practising behaviours.

Allyship. Recognise the patient and population’s rights to culturally safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making.

Inclusive communication. Apply culturally safe communication, acknowledging the sharing of power, and cultural and human rights to enable patients, families and whānau to engage in appropriate patient care decisions.

Culturally safe environment. Contribute to a culturally safe learning and practice environment for patients and team members. Respect patients may feel unsafe in the healthcare environment.

*The RACP has adopted the Medical Council of New Zealand’s definition of cultural safety. Cultural safety can be defined as:²

the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.
the commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided.
the awareness that cultural safety encompasses a critical consciousness where health professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities.

References

2. Curtis et al. “Why cultural safety rather than cultural competency is required to achieve health equity”. International Journal for Equity in Health (2019) 18:174

Ethics and professional behaviour

Professional standard. Physicians’ practice is founded upon ethics, and physicians always treat patients and their families, communities and populations in a caring and respectful manner.

Physicians demonstrate their commitment and accountability to the health and wellbeing of individual patients, communities, populations and society through ethical practice.

Physicians demonstrate high standards of personal behaviour.

Beliefs and attitudes. Reflect critically on personal beliefs and attitudes, including how these may impact on patient care.

Honesty and openness. Act honestly, including reporting accurately, and acknowledging their own errors.

Patient welfare. Prioritise patients’ welfare and community benefit above self-interest.

Accountability. Be personally and socially accountable.

Personal limits. Practise within their own limits and according to ethical principles and professional guidelines.

Self-care. Implement strategies to maintain personal health and wellbeing.

Respect for peers. Recognise and respect the personal and professional integrity, roles, and contribution of peers.

Interaction with professionals. Interact equitably, collaboratively, and respectfully with other health professionals.

Respect and sensitivity. Respect patients, maintain appropriate relationships, and behave equitably.

Privacy and confidentiality. Protect and uphold patients’ rights to privacy and confidentiality.

Compassion and empathy. Demonstrate a caring attitude towards patients and endeavour to understand patients’ values and beliefs.

Health needs. Understand and address patients’, families’, carers’, and colleagues’ physical and emotional health needs.

Medical and health ethics and law. Practise according to current community and professional ethical standards and legal requirements.

Judgement and decision making

Professional standard. Physicians collect and interpret information, and evaluate and synthesise evidence, to make the best possible decisions in their practice.

Physicians negotiate, implement, and review their decisions and recommendations with patients, their families and carers, and other healthcare professionals.

Diagnostic reasoning. Apply sound diagnostic reasoning to clinical problems to make logical and safe clinical decisions.

Resource allocation. Apply judicious and cost-effective use of health resources to their practice.

Task delegation. Apply good judgement and decision making to the delegation of tasks.

Limits of practice. Recognise their own scope of practice and consult others when required.

Shared decision making. Contribute effectively to team-based decision-making processes.

Leadership, management, and teamwork

Professional standard. Physicians recognise, respect, and aim to develop the skills of others, and engage collaboratively to achieve optimal outcomes for patients and populations.

Physicians contribute to and make decisions about policy, protocols, and resource allocation at personal, professional, organisational, and societal levels.

Physicians work effectively in diverse multidisciplinary teams and promote a safe, productive, and respectful work environment that is free from discrimination, bullying, and harassment.

Managing others. Lead teams, including setting directions, resolving conflicts, and managing individuals.

Wellbeing. Consider and work to ensure the health and safety of colleagues and other health professionals.

Leadership. Act as a role model and leader in professional practice.

Teamwork. Negotiate responsibilities within the healthcare team and function as an effective team member.

Health policy, systems, and advocacy

Professional standard. Physicians apply their knowledge of the nature and attributes of local, national, and global health systems to their own practices. They identify, evaluate, and influence health determinants through local, national, and international policy.

Physicians deliver and advocate for the best health outcomes for all patients and populations.

Health needs. Respond to the health needs of the local community and the broader health needs of the people of Australia and Aotearoa New Zealand.

Prevention and promotion. Incorporate disease prevention, health promotion, and health surveillance into interactions with individual patients and their social support networks.

Equity and access. Work with patients and social support networks to address determinants of health that affect them and their access to needed health services or resources.

Stakeholder engagement. Involve communities and patient groups in decisions that affect them to identify priority problems and solutions.

Advocacy. Advocate for prevention, promotion, equity, and access to support patient and population health needs within and outside the clinical environment.

Resource allocation. Understand the factors influencing resource allocation, promote efficiencies, and advocate to reduce inequities.

Sustainability. Manage the use of healthcare resources responsibly in everyday practice.

Entrustable Professional Activities

Entrustable Professional Activities (EPAs) outline the essential work tasks trainees need to be able to perform in the workplace.

LG2: Team leadership

Learning Goal 2

Team leadership

Lead a team of health professionals

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

synthesise information with other disciplines to develop optimal, goal-centred plans for patients
use evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risk in various scenarios
demonstrate clinical competence and skills by effectively supporting team members

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

support learners to deliver quality care while maintaining their own wellbeing
apply lessons learnt about patient safety by identifying and discussing risks with learners
assess learners’ competence, and provide timely feedback to minimise risks to care
maintain the safety of patients and organisations involved with education, and appropriately identify and action concerns

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

role model a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural safety
encourage learners to consider culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori into patients’ management
consider cultural, ethical, and religious values and beliefs in teaching and learning

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address areas of improvement in health care delivery and value-based care

This activity requires the ability to:

adhere to current evidence-based best practice guidelines
identify and report actual and potential (‘near miss’) errors
undertake and further evaluate system improvement activities
audit clinical practice and outcomes
contribute to the development of guidelines, policies, and protocols designed to protect patients and enhance health care
participate in local, state, and national benchmarking activities
review own practice and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use evidence-based outcomes to identify and implement opportunities for improvement in delivering appropriate care
audit local patients’ or population health outcomes regularly to identify opportunities for improvement in delivering appropriate care
evaluate the effects of parents’ environmental and lifestyle health risks on the fetus or infant, and advocate for healthy lifestyle choices
lead development of up-to-date guidelines, policies, and protocols to adhere to best practice
undertake yearly professional performance reviews

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, policies, and protocols to assist patient care decision making

Communication

confident
Ready to perform without supervision

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

The trainee will:

support patients to have access to, and use, easy-to-understand, high-quality information about health care
support patients to share decision making about their own health care, to the extent they choose
assist patients to gain access to their health information, as well as complaint and feedback systems
discuss any safety and quality concerns patients have relating to their care
discuss adverse or unexpected, unplanned, iatrogenic events according to hospital or regional policy and frameworks, such as the open disclosure policy

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure compliance with good clinical practice guidelines
ensure that any protocol for human research is approved by a human research ethics committee, in accordance with the relevant national statement on ethical conduct in human research
review, present, publish, and disseminate results
undertake clinical research, including design, collaboration, enrolment, collation of data, and analysis and interpretation of results
participate in and provide education for junior doctors about critical appraisal of research, as well as the use of evidence-based medicine
evaluate the use of emerging technologies in identifying data and improving safety

direction
Requires some supervision

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

The trainee may:

recognise that patient participation in research is voluntary and based on an appropriate interpretation 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 systemic inequity on health outcomes

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort, involving all key health professionals
support multidisciplinary team activities to reduce patients’ risk of harm, and promote interdisciplinary programs of education
involve clinical pharmacists in the medication-use process

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in all aspects of the development, implementation, evaluation, and monitoring of governance processes
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving care are actively encouraged
measure, analyse, and report a set of specialty-specific process of care and outcome clinical indicators, and a set of generic safety indicators
use the Australian and New Zealand Neonatal Network (ANZNN) to guide benchmarking and management of clinical information
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 patients’ care
contribute to relevant guidelines, organisational policies, and procedures
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG5: Clinical assessment and management

Learning Goal 5

Clinical reasoning in diagnosis and management

Clinically assess and provide management to sick and healthy neonates

This activity requires the ability to:

identify and access sources of relevant information about patients
obtain patient histories
examine patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with patients
formulate management plans
present findings to other health professionals

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, systematic, and problem-focused medical histories, considering physical, psychosocial, and risk factors
perform systematic physical examinations to establish the nature and extent of problems in sick and healthy neonates
recognise the significance of maternal and fetal conditions on the health and developmental outcomes of the neonate
assess the severity of problems, the likelihood of complications, and the nature and extent of potential clinical outcomes
assess if patients’ current location (such as a regional unit, postnatal ward, or perinatal centre) can provide the appropriate level of care or if the patient needs to be transferred to another location
synthesise findings on histories and physical examinations to develop provisional and differential diagnoses
formulate patient-centred management plans
use new technologies, including artificial intelligence (AI), that support clinical practice for safety and efficacy

direction
Requires some supervision

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

The trainee may:

elicit limited patient-centred histories
perform targeted physical examinations
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct clinical encounters and diagnostic categories
develop appropriate management plans

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients and their family or carers to enable them to make fully informed decisions
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
use technology, such as AI, in development of written communication, where appropriate

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

provide accurate, clear, complete, and timely documentation of clinical information in patients’ medical records
demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
inform patients of the material risks associated with any part of proposed management plans
recognise the value and pitfalls of using evolving technologies, such as AI, to aid clinical decision making

direction
Requires some supervision

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

The trainee may:

perform hand hygiene, and take infection control precautions at appropriate moments

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

search for, find, collate, analyse, interpret, and evaluate information relevant to the research subject

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
recognise the limitations of evidence and the challenges of applying research in clinical practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

use plain-language patient education materials, and demonstrate cultural and linguistic sensitivity
demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
use a professional interpreter, health advocate, or a family or community member to assist in communication with patients, and recognise the potential limitations of each
acknowledge patients’ beliefs and values, and how these might impact on their health

direction
Requires some supervision

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

The trainee may:

demonstrate respect for patients’ cultures, and attentiveness to social determinants of health
appropriately access interpretive or culturally focused services
recognise cultural sensitivities

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients and colleagues
hold information about patients in confidence, unless the release of information is required by law or public interest
assess patients’ capacity for decision making, involving a proxy decision maker appropriately
demonstrate awareness of medicolegal and social issues around child protection
identify and manage families at high psychosocial risk, including taking full drug and alcohol histories
identify strategies for the safe discharge and community support of families at high psychosocial risk
identify ethical challenges with implementation of evolving technologies, including AI, into clinical practice

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the healthcare team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
demonstrate a collaborative approach to developing protocols, such as for the prevention and management of perinatal sepsis, hand washing, and infection control measures in clinical practice
advocate and support infection control policies and practices in the neonatal unit

direction
Requires some supervision

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

The trainee may:

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

LG6: Management of transitions in care and longitudinal care

Learning Goal 6

Management of transitions in care and longitudinal care

Manage the transition of patient care between healthcare providers and health settings to ensure the optimal continuation of care

This activity requires the ability to:

manage chronic and advanced conditions, comorbidities, complications, and impairments
ensure continuity of patient care
identify the appropriate care providers and other stakeholders with whom to share patient information
collaborate with other healthcare providers and exchange pertinent, contextually appropriate, and relevant patient information
facilitate patients’ self-management and self-monitoring
perform this activity in multiple settings, appropriate to the speciality, including ambulatory, critical care, inpatient, and retrieval settings
develop follow-up management plans and goals in consultation with patients
engage with the broader health policy context

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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
assess and review care plans for patients with chronic conditions and impairments based on short- and long-term clinical and quality-of-life goals
provide documentation on patients’ presentation, management, and progress, including key points of diagnosis and decision making, to inform coordination of care
ensure patients contribute to their needs assessments and care planning
monitor treatment outcomes, effectiveness, and adverse events
manage patients at risk of adverse neurodevelopment
plan and undertake neonatal retrievals
prepare patients for transport

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

write accurate, clear, complete, and timely medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals, when required
communicate with patients about transitions of care and follow-up plans, and engage and support these parties in decision making
apply communication and networking skills within the regional perinatal service
encourage patients’ self-management through education to take greater responsibility for their care, and support problem solving
encourage patients’ access to self-monitoring devices and assistive technologies
communicate with multidisciplinary team members, and involve patients in that dialogue
communicate with health providers for continuity of ongoing care outside the neonatal and early childhood setting
counsel patients about the impact of long-term illness on the child and family

direction
Requires some supervision

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

The trainee may:

communicate clearly with clinicians and other caregivers
use standardised verbal and written templates to improve the reliability of information transfer and prevent errors and omissions
communicate accurately and in a timely manner to ensure effective transitions between settings and continuity and quality of care
provide healthy lifestyle advice and information to patients on the importance of self-management
work in partnership with patients, and support them in accessing the care they need

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 implement strategies to mitigate this risk
use standardised handover tools to ensure a systematic and complete handover of relevant patient information
use electronic tools (where available) to securely store and transfer patient information
use consent processes, including written consent if required, for the release and exchange of information
recognise the medicolegal context of written communications
use innovative models of chronic disease care, using telehealth and digitally integrated support services
review medicine use, and ensure patients understand safe medication administration to prevent errors
support patients’ self-management by balancing between minimising risk and helping them become more independent
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living
follow up patients with the multidisciplinary team
discuss the impact of polypharmacy in chronic illnesses

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved
contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary
use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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
encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management
apply culturally safe practices to enhance patients’ and families’ care journeys

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
provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information
comprehend the clinical, ethical, and legal rationale for information disclosure
share information about patients’ care in a manner consistent with privacy laws and professional guidelines on confidentiality
comprehend 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
use consent processes for the release and exchange of health information
assess patients’ decision-making capacity, and appropriately identify and use proxy decision makers

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patients’ care is in the most appropriate facility, setting, or provider
implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients’ needs in terms of both internal resources and external support on long-term health care journeys

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
recognise 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
coordinate whole-person care through involvement in all stages of patients’ care journeys
use a multidisciplinary approach across services to manage patients with chronic diseases and impairments
develop collaborative relationships with patients and a range of health professionals
collaborate with paramedical staff, multidisciplinary teams, and community services
integrate care of sick neonates, considering multisystem interactions and long-term implications of complications of care in severely ill neonates
demonstrate multidisciplinary support, including local medical officers and community services
plan and appropriately manage transitions of patients and their families to ongoing care providers

direction
Requires some supervision

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

The trainee may:

recognise factors that impact transfers of care, and help subsequent health professionals understand the issues to continue care
work to overcome the potential barriers to continuity of care, appreciating the role of handover in overcoming these barriers
participate in multidisciplinary care for patients with chronic diseases and impairments, including organisational and community care on a continuing basis, appropriate to patients’ context

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

explain the regional organisation of health services in the outpatient setting and how to access them, such as postnatal services, dietetics, or physiotherapists
explain the organisation of hospital extension services as transitions to outpatient care, such as extended postnatal care, hospital in the home, and home enteral nutrition services for enteral tube feeding
explain the organisation of outreach educational programs
explain the organisation of perinatal / neonatal transport programs
recognise the requirements for down transfers of convalescent infants
contribute to processes for managing risks, and identify strategies for improvements 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
use health screening for early intervention and chronic diseases management
assess alternative models of health care delivery to patients with chronic diseases and impairments
participate in government initiatives for chronic disease management to reduce hospital admissions and improve patients’ quality of life
show patients how to access initiatives and services for patients with chronic diseases and impairments
recognise when a child is at risk, and escalate concerns to relevant child protection services as required

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

LG7: Acute care

Learning Goal 7

Acute care

Manage the early care of acutely unwell patients before and in the neonate period

This activity requires the ability to:

assess seriously unwell or injured patients
stabilise patients, and initiate appropriate investigations and management
anticipate and recognise clinical deterioration
reassess responses to interventions, and adjust plans accordingly
work effectively within a team to complete tasks and coordinate efforts
follow local processes for escalation of care, and involve appropriate additional services, including transport, subspecialists, or intensive care
document events, interventions, and patient responses
participate in event debriefing to review management and identify areas for improvement

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
anticipate the need for resuscitation at complex births
perform advanced neonatal life support, according to the Australian and New Zealand Committee on Resuscitation guidelines, to a high level of advanced resuscitation skills
demonstrate effective team leadership in acute resuscitation events
demonstrate knowledge of the potential risks and complications of resuscitation
assess, diagnose, and manage acute undifferentiated clinical presentations
select investigations that ensure maximum patient safety through excluding or diagnosing critical patient issues
identify systematic causes of acute deterioration in health status
manage escalations or transitions of care in a proactive and timely manner
develop clear and concise plans of ongoing multidisciplinary treatment following acute events

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
identify antenatal factors that may require life support interventions at birth
apply basic neonatal life support as indicated
demonstrate effective team membership in acute resuscitation events
explain general medical principles of caring for patients with undifferentiated and undiagnosed conditions
identify potential causes of current or anticipated deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans
assess perioperative and periprocedural patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly with other team members, and coordinate efforts of multidisciplinary team members
use closed-loop and clear communication with other healthcare team members during resuscitation
facilitate and lead debriefs following resuscitations
facilitate early communication with patients and healthcare team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
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
demonstrate principles of counselling parents in the case of an imminent extremely preterm birth

direction
Requires some supervision

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

The trainee may:

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

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 neonatal life support
use clinical information technology systems for conducting prospective and retrospective clinical audits
analyse adverse incidents and sentinel events to identify system failures and contributing factors
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 supervision skills and teaching specifically in neonatal resuscitation to a multidisciplinary team
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:

provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
coordinate and supervise junior colleagues from the emergency department, obstetrics, and wards

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

negotiate health care decisions in a culturally safe way by considering variation in family structures, cultures, religion, or belief systems
integrate culturally safe 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 nursing, midwifery, obstetrics, and other subspecialty inpatient units
manage the transition of acute medical patients through their neonatal journeys
lead a team by providing engagement while maintaining a focus on outcomes

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available resources
collaborate with obstetric 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:

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

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate communication strategies and modalities for communication, such as emails, face-to-face, or phone calls, and the use of interpreting services as required
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
consider the use of technology, such as artificial intelligence (AI), in the development of written communication, where appropriate
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
treat children and young people respectfully, and listen to their views
recognise the role of family and/or carers, and, when appropriate, encourage patients to involve their family and/or carers in decisions about their care

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

discuss with patients their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand before asking for their consent
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 that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of New Zealand
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain an informed consent or other valid authority before involving patients in research

direction
Requires some supervision

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

The trainee may:

refer to evidence-based clinical guidelines
recognise 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, and 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
communicate effectively with members of other cultural groups by meeting patients’ specific communication, cultural, and language needs
incorporate appropriate LGBTQIA+ safe language

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 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
document communications with patients accurately and thoroughly

direction
Requires some supervision

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

The trainee may:

respect the preferences of patients
communicate appropriately, consistent with the context, and respect patients’ needs and preferences
maximise patient autonomy, and support their decision making
avoid sexual, intimate, and/or financial relationships with patients
demonstrate a caring attitude towards patients
respect patients, including 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
discuss medical assessments, treatment plans, and investigations with patients and primary care teams, working collaboratively with all
discuss patient care needs with healthcare team members to align them with the appropriate resources
facilitate an environment in which all team members feel they can contribute, and their opinion is valued
communicate accurately and succinctly, and motivate others on the healthcare team

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

critically appraise research material to ensure any new medicine improves patient-oriented outcomes more than older medicines, and not just more than placebo
use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

consider the following factors for all medicines:
- contraindications
- cost to patients, families, and the community
- funding and regulatory considerations
- generic versus brand medicines
- interactions
- risk-benefit analysis
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:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

choose medicines in relation to comparative efficacy, safety, and cost-effectiveness against medicines already on the market
prescribe for individual patients, considering allergies, current medicines, history, and preferences, ensuring that resources are used wisely for the benefit of patients

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy

LG10: Procedures

Learning Goal 10

Procedures

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

document procedures accurately in clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
explain procedures clearly to patients, 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’ concerns relating to procedures, providing opportunities to ask questions
communicate effectively with team members 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 choose procedures
communicate with members of procedural teams so all team members understand who each member is
discuss postprocedural care with patients
complete relevant patients’ documentation, and conduct appropriate clinical handovers

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients are fully informed when consenting to any procedures
demonstrate an inconsistent application of aseptic technique
identify patients using approved patients’ identifiers before any treatment or intervention is initiated
attempt to perform a procedure 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
seek feedback proactively on personal technique until competent

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify roles and optimal timing for diagnostic procedures
critically appraise information from the assessment and evaluation of risks and benefits to prioritise patients on 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:

explain critical steps, anticipated events, and equipment requirements to teams on planned procedures
provide staff with clear aftercare instructions, and explain how to recognise possible complications
identify relevant management options with colleagues, according to their level of training and experience, to reduce 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:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

discuss serious incidents at appropriate clinical review meetings
initiate local improvement strategies in response to serious incidents
use resources efficiently when performing procedures
use reusable and/or compostable products where possible
explain environmental impacts of health care decisions

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

These procedures may be considered within scope of practice in Neonatal and Perinatal Medicine, however additional training and demonstration of competence is suggested: Mandatory, Desired (depending on exposure). Procedural competence includes procedure set up of equipment.

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Maintenance of procedural logbook and continuing education

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Mandatory

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

Select appropriate procedure in partnership with patients and relevant health care professionals

Obtain informed consent except in emergencies

Procedural proficiency & competence

Desired

Manage / discuss complications

Provide aftercare for patients

Communicate with patients and other health care providers

Perform in relevant setting(s)

LG11: Investigations

Learning Goal 11

Investigations

Select, organise, and interpret investigations relevant to the care of the sick and healthy infant

This activity requires the ability to:

select, plan, and use evidence-based clinically appropriate investigations
prioritise patients receiving investigations (if there is a waiting list)
evaluate the anticipated value of investigations
work in partnership with patients to facilitate choices that are right for them
interpret the results and outcomes of investigations
communicate the outcome of investigations to patients
provide aftercare for patients (if needed)

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

choose evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessments
assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
develop plans for investigations, identifying their roles and timing
recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
account for multisystem interactions in health and disease

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from proposed investigations, focusing on patients’ individual situations

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate the benefits, costs, and potential risks of each investigation in clinical situations
adjust the investigative path depending on test results received
consider whether patients’ conditions may get worse or better if no tests are selected
incorporate technologies for supporting decision making where possible, ethical, and safe

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

LG12: Clinic management

Learning Goal 12

Clinic management

Manage and lead outpatient services for infants

This activity requires the ability to:

manage clinic services, including multidisciplinary developmental and growth assessment clinics
oversee quality improvement activities
liaise with other health professionals and team members
demonstrate problem-solving skills
use public resources responsibly

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

recognise the importance of prevention, early detection, health maintenance, and chronic condition management
write patient letters, such as discharge summaries or letters to correspond with other healthcare providers, in an appropriate form

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge to deliver culturally safe and appropriate services for the community serviced
mitigate the influence of their own culture and beliefs on interactions with patients and decision making
mitigate one’s own conscious and unconscious bias in shared decision making
adapt practice to improve patient engagement and health outcomes

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

integrate prevention, early detection, health maintenance, and chronic condition management, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care that allows maximum benefit from the available resources

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

attend relevant clinical meetings regularly

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

recognise common population health screening and prevention approaches

LG13: Neonatal retrieval medicine

Learning Goal 13

Neonatal retrieval medicine

Managing emergency referral for possible neonatal and in utero transfers, consultation without the need for transfer, and undertaking emergency neonatal retrieval

This activity requires the ability to:

triage emergency referrals for retrieval or advice
collaborate with obstetricians in triaging requests for emergency in utero transfer
undertake an emergency neonatal retrieval
manage clinical and logistical elements of the retrieval process
lead the retrieval team
manage care of the patient during transport
handover to the receiving care 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:

assess patients’ eligibility for transport
recognise resource limitations of referring centres related to personnel, setting, medications, and equipment
provide pre-transfer advice to stabilise the patient, using telehealth where appropriate and available
ensure the availability and functionality of appropriate equipment
verify medication availability and calculations
maintain thermoregulation
manage respiratory support
monitor haemodynamic stability
provide ongoing assessment and interventions

direction
Requires some supervision

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

The trainee may:

recognise the process of assessing and initiating neonatal retrieval protocols
identify the need for retrieval, and prepare patients in advance
accept patients from retrieval teams and support transitions to the unit

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss ongoing care plans with families, whānau, and/or carers, and receiving medical teams
obtain comprehensive handovers from referring facilities
coordinate with transport teams and receiving units
collaboratively establish team member roles and responsibilities
conduct a pre-transport discussion with families, whānau, and/or carers
document case histories, vital signs, interventions, clinical changes, and transport timelines

direction
Requires some supervision

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

The trainee may:

provide partially complete or incorrectly structured handovers
refer patients for retrieval

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:

record quality metrics
participate in clinical debriefs and audits aimed to improve quality of care
debrief the transport team and document lessons learnt

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 concerning patients’ safety
demonstrate a systematic approach to improving the quality and safety of healthcare teams and patients during retrievals

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

ensure staff are informed about the relevant local protocols for retrievals and how to access them
develop and maintain skills in high-acuity, low-frequency events
engage in multidisciplinary teaching relevant to retrieval medicine
support the teaching and learning of personnel in referring centres

direction
Requires some supervision

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

The trainee may:

maintain knowledge of relevant protocols related to retrievals in their health service

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 patient- and family-centred care, taking into account and being respectful of cultural or social attitudes to pregnancy, parenting, birth, and illness
consider the impact of dislocation from social and cultural supports
refer to appropriate support services, such as social work

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:

obtain informed consent from parents, families, whānau, and/or carers
demonstrate high standards of professional behaviour when interacting with external stakeholders

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:

appraise appropriate mode and team composition for transport, considering patients’ location, acuity, asset and personnel availability, and relevant external factors
confirm transport vehicle readiness
consider external factors that may extend transit time, and have a backup plan
triage clinical needs of referrals for retrieval

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

ensure access to the appropriate equipment
ensure equipment functionality
direct the activities of the team
maintain situational awareness
adapt plans based on changing conditions
anticipate and manage unexpected events with effective leadership and teamwork

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 local processes and guidelines

LG14: End-of-life care

Learning Goal 14

End-of-life care

Recognise and manage the care of patients at the end of their lives

This activity requires the ability to:

recognise the dying phase
support patients to plan for their advance care
consult with other health disciplines, including palliative care teams
manage end-of-life care plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

accurately assess patients’ physical and psychological symptoms
estimate prognosis and communicate this appropriately, if requested, including the uncertainties around such estimates
develop and clearly document individualised end-of-life care plans, including patients’ preferences for treatment options, resuscitation plans, preferred place of care, and preferred place of death
provide holistic symptom management, focusing on psychological, spiritual, and physical distress, according to patients’ wishes
avoid unnecessary investigations or treatments, ensuring physical and psychosocial support
review the goals of care and treatment plans with patients if significant changes in patients’ conditions or circumstances occur
recognise and manage the terminal phase in a timely way
recognise the value of a multidisciplinary approach to the family of a dying neonate
discuss the process of autopsy and other postmortem investigations, and seek informed consent

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

establish supportive relationships with patients based on confidentiality, empathy, trust, and understanding
explore patients’ concerns across physical, spiritual, cultural, and psychological domains thoughtfully
identify opportunities to discuss end-of-life care, aligning it with patients’ values and preferences
identify proxy decision makers patients wish to be involved in discussions about their end-of-life care
identify and document lists of close family members or carers, and develop support plans for them
provide bereaved families or carers with written information about access to bereavement support, and follow up with the family
communicate effectively and in a timely manner with other health professionals involved in patients’ care, and debrief with the healthcare team

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

define and document patients’ goals and agreed outcomes

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Knowledge guides

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

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

LG15: Scientific foundations of neonatal and perinatal medicine

Epidemiology, pathophysiology, and clinical sciences

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

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

View

Investigations, procedures, and clinical assessment tools

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

Advanced Trainees will know how to explain the investigation or procedure to 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, management and outcomes.

View

Anatomy

Altered physiology states
Common congenital abnormalities identifiable in the fetus
Common maternal conditions that affect fetal growth and development
Common minor variants affecting the healthy neonate, such as:
- rashes
- skin tags
- tongue tie
Common neonatal complications associated with birth
Effects of maternal medications and substance misuse on fetuses, neonates, and growing children
Fetomaternal conditions that may influence the mode of delivery and/or resuscitation
Indications and outcome of common fetoplacental interventions
Normal fetal growth and development
Physiological changes involved in the transition to extrauterine life
Survival and long-term neurodevelopmental outcome data of extremely preterm and sick neonates by week of gestation

Epidemiology and statistics

Descriptive, qualitative, and quantitative statistics
Research methods, such as:
- audits
- cohort studies
- evidence synthesis
- quality improvement
- trial designs

Pharmacology

Assessment and management of differing pain severities associated with procedures
Dose monitoring
Drug excretion in breast milk
Drug interactions
Feeding and nutrition
Maternal medications and substance misuse on fetuses, neonates, and growing children
Pain management options:
- non-pharmacological
- pharmacological
Principles of pharmacology as applied to preterm and term neonates
Side effects
Support of parents in home administration of medications

Clinical assessment tools

Blood:
- blood counts
- interpretation of:
  - blood cultures
  - blood gasses
  - other blood tests, including inflammatory markers
- kidney and liver function tests
Developmental assessment tools, such as:
- Bayley Scales of Infant and Toddler Development
- general movements assessment
- Griffiths III
- Hammersmith Infant Neurological Examination (HINE)
Imaging and their interpretation:
- MRI
- ultrasound
- x-rays
Interpretation of monitoring:
- amplitude-integrated electroencephalography (aEEG)
- electroencephalogram (EEG)
- oximetry
- ultrasound
Other body fluids:
- biochemistry
- cultures
- interpretation of microscopy
Thermoregulatory principles in newborns, such as:
- fluid and electrolyte monitoring in sick and preterm neonates
- understanding of the thermoneutral environmen

Drains and catheters, and their insertion and removal

Endotracheal intubation
Intercostal drains
Nasogastric tube
Percutaneous:
- central venous lines
- long lines
Peripheral:
- arterial catheters
- intravenous cannulas
Umbilical catheters:
- arterial
- venous
Urinary bladder catheter

Procedures

Bladder taps
Blood cultures under aseptic techniques
Blood sampling from peripheral arterial and umbilical lines
Capillary blood sampling
Drainage of cerebrospinal fluid (CSF) reservoir
Exchange transfusions
Lumbar punctures
Paracentesis
Pericardiocentesis
Peripheral arterial punctures
Surfactant administration
Thoracocentesis

Resuscitation and stabilisation

Airway suctioning
Bag and mask ventilation
Cardiopulmonary resuscitation:
- chest compressions
Emergency thoracocentesis
Emergency umbilical venous access
Endotracheal intubation
Intraosseous needle insertion
Nasopharyngeal tube insertion
Supraglottic airway (LMA) placement
T-piece

Care of parents and neonates after birth

Anthropometry, including documentation
Bonding
Breastfeeding:
- advantages
- complications
- physiology
- practicalities
Child protection issues
Coordination of follow-up of high-risk infants and their families, including liaison with relevant community services
Current immunisation program and recommendations
Effects of maternal substance intoxication, misuse, and withdrawal, and treatment of these issues on fetuses and neonates
Factors impacting on the healthy maternal-infant dyad
Infant mental health, and recognition of the impact of hospitalisation on infants
Issues relevant to postnatal depression
Maternal postnatal care
Postnatal growth, with consideration to macro and micronutrient requirements
Routine care and assessment of a well infant through the first 12 months, including preventative advice
Safe sleeping

Chronic conditions of neonates

Chronic respiratory disease
Hearing impairment
Long-term mental health issues, neurodisability, and neurodiversity
Severe retinopathy of prematurity (ROP) and visual impairment
Short gut syndrome, malnutrition / poor growth, and chronic feeding issues

Considerations when undertaking neonatal retrievals

Airway management and monitoring:
- chest drain insertion and management
- emergency intubation
- endotracheal tube (ETT) suction
- nitric oxide administration
- options for non-invasive respiratory support
- surfactant administration
Cardiovascular support:
- inotropic support:
  - dosing calculations
  - drug selection
  - infusion preparation
  - threshold for prostaglandin administration
  - titration protocols
Effects of transport on neonatal physiology:
- impact of adverse physical environment on neonates, including acceleration / deceleration forces, light, noise, temperature, and vibration on:
  - cerebral circulation
  - endotracheal tube position and securement
  - equipment stability
  - fluid dynamics
  - monitoring:
    - accuracy
    - methods
  - neonatal eye protection
  - neonate securement
  - noise stress prevention
  - temperature regulation
  - vascular catheter security
- physiological effects of air transport on pregnancy / fetus or neonate
Infection:
- investigation and treatment of bacterial and viral infections
Neurological support:
- fluid management:
  - choice of fluids
  - prevent and manage hypoglycaemia
  - rate determination
  - response assessment
  - volume calculation
- management of gastric and Replogle tubes where indicated
- methods of achieving therapeutic hypothermia:
  - fluids and nutrition
  - management of seizures
  - neuroprotective care
  - sedation and analgesia
Risk mitigation:
- alternative routes
- backup planning
- communication protocols and equipment
- equipment redundancy
Use of equipment specific to retrieval, such as:
- stretchers
- transport:
  - incubators
  - ventilators

Ethical and legal considerations

Ethical considerations for the care of sick neonates, families, and the clinical community
Ethical issues, such as:
- borderline viability – awareness of attitudes
- congenital malformations
- discontinuation of life support measures
- non-initiation of resuscitation
Ethics of providing support for sick neonates within the wider society, such as:
- at the limits of gestational viability
- for culturally and linguistically diverse families and communities
- for infants anticipated to have poor outcomes
Issues relating to end-of-life care, such as:
- family (including sibling) emotional and behavioural issues
- medicolegal issues
- palliative care
- role and importance of autopsy
- role of cognitive, cultural, emotional, and spiritual factors in end-of-life decisions
Legal responsibility for documentation
Long-term outcome of infants of borderline viability and infants with major medical problems
Medicolegal knowledge:
- zone of parental discretion – the right to refuse / redirect care

Management of neonatal retrievals

Appropriateness and availability of receiving unit
Assessment of risks of fetal and neonatal transport
Assessment of urgency of response and transfer, and consideration of alternatives
Communication of patient clinical status, needs, and retrieval plan with retrieval coordinator and receiving unit, as appropriate
Equipment and asset requirements, such as:
- anticipated need for inhaled nitric oxide
- multiple infusion pumps
- phototherapy
- therapeutic hypothermia
Equipment considerations, including battery life, management, and alarm settings
Factors that may extend transit time, such as weather and traffic conditions
Indications and limitations of different transport modalities, such as:
- fixed wing
- road
- rotor craft
Maternal conditions requiring in utero transfer
Neonatal conditions requiring transport, including critically unwell infants and those with special conditions, such as:
- cardiac
- congenital anomalies
- hypoxic ischemic encephalopathy (HIE)
- surgical
Plan for transport / retrieval, and in the event of major deterioration
Principles of management of neonates during transport
Referral, stabilisation, transfer, and receipt of transported patients
Resuscitation, stabilisation, and management of critically ill neonates in a non-critical care environment
Situations / Conditions where speed of transit to receiving unit is prioritised over intervention at referring unit
Team:
- composition
- responsibilities
- roles
- skill mix
Use of the transport equipment

LG16: Infections and immune disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abnormal neonatal blood spot test for immune disorder
Antenatal infections or colonisation
Eye discharge
Immunosuppression as a result of maternal medication
Maternal illness in labour
Non-specific symptoms, including:
- lethargy
- poor feeding
- temperature instability
Overwhelming sepsis in a neonate
Rashes
Respiratory distress

Conditions

Bacterial, fungal, protozoal, and viral infections, such as:
- COVID-19
- cytomegalovirus (CMV)
- fungal infections
- group B streptococcus
- hepatitis:
  - B
  - C
- herpes simplex
- human immunodeficiency virus (HIV)
- meningitis:
  - bacterial
  - viral
- neonatal varicella
- nosocomial infection
- other respiratory viruses, including:
  - respiratory syncytial virus (RSV)
- septicaemia
- streptococci – group A
- syphilis
- urinary tract infection
Immune conditions, such as:
- iatrogenic immunosuppression, such as:
  - secondary to steroid exposure
- neutropaenia
- severe combined immunodeficiency

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Sepsis secondary to antibiotic resistant organisms, such as:
- extended spectrum beta-lactamase (ESBL)
- methicillin-resistant Staphylococcus aureus (MRSA)
Severe combined immunodeficiency
Tuberculosis
Viruses, such as:
- enteroviruses
Zoonoses

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

Pathophysiology of:
- overwhelming sepsis in neonates
- postnatal eye infection
Principles of:
- bacterial, fungal, protozoal, and viral infections, such as:
  - choice and use of antimicrobial therapy and management of drug toxicity
  - congenital infections
  - diagnostic tests, including interpretation of acute phase reactants and blood parameters
  - prevention and management of outbreaks within the neonatal intensive care unit (NICU)
  - risk factors
- immunosuppression due to:
  - maternal biologic agents
  - modifications to standard immunisation schedule
- prevention and treatment of nosocomial infection
- the developing immune system, especially in premature infants

Investigations

Interpretation of acute phase reactants
Management of outbreaks, such as:
- cohorting
- infection control
- screening
Newborn blood spot test as a screening tool for immune disorders
Septic work-up, such as:
- blood culture
- lumbar punctures
- sterile urine collection

Procedures

Abdominal paracentesis
Aseptic techniques
Blood cultures
Lumbar punctures:
- suprapubic aspirations
- urinary catheter insertion
- ventricular aspiration via reservoir device
Screening swabs for management of outbreaks
Use data-driven tools for clinical decision-making support, considering local context

Impact of therapies in the newborn period, and the potential subsequent development of allergies

LG17: Respiratory conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Antenatal pleural effusions
Antenatal presentation of space-occupying lesions in the thorax
Deterioration of the ventilated newborn
Hypoxemic respiratory failure and hypoxia
Radiological appearances of the conditions that cause neonatal respiratory disease
Respiratory distress

Conditions

Air leaks
Airway obstruction
Apnoea of prematurity
Chronic lung disease of prematurity / Bronchopulmonary dysplasia
Congenital diaphragmatic hernia
Meconium aspiration syndrome
Pleural disorders, including:
- chylothorax
- pleural effusions
Persistent pulmonary hypertension of the newborn (PPHN)
Pulmonary hypoplasia
Respiratory distress syndrome (RDS)
Sepsis / Pneumonia
Transient tachypnoea of the newborn

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Congenital lobar emphysema
Congenital pulmonary lymphangiectasia
Cystic adenomatoid malformation
Cystic lung disease
Mediastinal tumours

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

Embryology and physiology

Abnormal and normal morphological development of the lung
Fetal respiration and control of breathing
Gas delivery, exchange, and oxygen transport
Pulmonary function testing
Pulmonary surfactant
Respiratory mechanics:
- airway resistance concepts in perfusion and ventilation
- compliance
- lung volumes and capacities
- respiratory muscles
Stages and mediators of normal and abnormal cellular and structural development of all components of the lung

Genetics

Genetic conditions associated with respiratory pathologies

Investigations

Imaging:
- blood gases
Interpretation of:
- MRI
- non-invasive monitoring methods to manage ventilation and oxygenation, such as oximetry
- sleep studies
- ultrasound
- ventilation requirements
- x-ray

Procedures

Extracorporeal membrane oxygenation (ECMO)
Lung ultrasound
Nitric oxide therapy
Respiratory support:
- invasive:
  - conventional ventilation
  - high frequency oscillatory ventilation
- non-invasive:
  - continuous positive airway pressure (CPAP)
  - high-flow nasal cannula therapy
  - nasal intermittent mandatory ventilation
Surfactant administration – multiple methods
Thoracocentesis and intercostal chest drain insertion

Coordination of home-based care, including allied health care providers and liaison medical officers
Management of home oxygen therapy and other chronic respiratory problems

LG18: Circulatory conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abnormal blood pressure
Abnormal heart rate:
- bradycardia
- tachycardia
Abnormal heart rhythm / Arrhythmias
Cardiac arrest
Cardiac output (high- and low-output), including circulatory shock:
- hypertension
- hypotension
Cyanosis
Heart murmurs
Weak or absent femoral pulses

Conditions

Congenital heart disease
Patent ductus arteriosus
Persistent pulmonary hypertension of the neonate

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Cardiomyopathies
Vascular rings

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

Congenital cardiovascular disease:
- anatomy
- embryology
- physiology
Normal physiology and development of circulation in neonates
Pathophysiology of cardiac failure and circulatory shock
Tissue oxygenation and gas transport

Investigations

Chest radiograph
Echocardiogram
ECG

Procedures

Extracorporeal membrane oxygenation (ECMO)
Surgical options for the treatment of congenital heart disease, such as:
- arterial switch surgery
- balloon septostomy

Cyanotic infants
Emergency management and retrieval of postnatally suspected duct-dependent lesions in non-cardiac centres
Hypertensive infants
Hypotensive and shocked infants
Persistent pulmonary hypertension of the newborn (PPHN):
- management
- pathogenesis
Pharmacology:
- mechanism
- use of inotropes

LG19: Neurological and neuromuscular conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Altered conscious state
Antenatal detection of fetal:
- brain abnormalities
- neuromuscular conditions
Hypertonia
Hypotonia
Pain and distress, including:
- exposure to prenatal substances
- postoperative
Seizures
Structural abnormalities, including:
- head shape abnormalities
- macrocephaly
- microcephaly
- spinal dysraphism

Conditions

Cerebellar hypoplasia
Developmental malformations / deformation of the skeletal system
Developmental malformations of the brain and spinal cord, including:
- neural tube defects
Hydrocephalus
Neonatal abstinence syndrome
Neonatal encephalopathy, including:
- hypoxic ischemic encephalopathy (HIE)
- other causes
Neonatal stroke
Preterm brain injury, including:
- intraventricular haemorrhage
- post-haemorrhagic ventricular dilatation
- white matter injury, including:
  - periventricular leukomalacia
Seizure disorders and epilepsy
Structural neurological problems, such as:
- absent corpus callosum
- ventriculomegaly

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

Anencephaly

Conditions

Trisomy 18

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

Impact of exposure to drugs on the developing brain, such as drugs of addiction and other commonly used drugs
Impact on the developing brain in the preterm infant, and of postnatal conditions on the brain, such as hypoxia
Malformations / Deformation of the:
- brain
- skeletal system
- spinal cord
Normal physiology and fetal / embryological development of the nervous system
Pathophysiology and prognosis of:
- hypotonia and neuromuscular disorders
- neonatal encephalopathy
- neonatal neurological conditions
- neonatal stroke
- periventricular haemorrhage
- prenatal exposure to substances of addiction and other maternal medications or environmental problems
- seizure disorders
- white matter injury
Pharmacological principles of:
- medications and treatments for newborn withdrawal
- medications and treatments for pain
- medications for seizures
Treatment modalities for hypoxic ischemic encephalopathy (HIE)

Clinical assessment tools

Amplitude integrated electroencephalography (aEEG)
Electrophysiological studies, such as:
- electroencephalogram (EEG)
- electromyograms
Evaluation for:
- encephalopathy, such as:
  - Sarnat Score
  - Thompson score
- neonatal pain, such as:
  - Premature Infant Pain Profile (PIPP)
- neonatal withdrawal, such as:
  - Eat, Sleep, and Console
  - Finnegan Neonatal Abstinence Scoring System
Imaging modalities, such as:
- brain MRI
- cranial ultrasound
Microarray and exome sequencing
Neurodevelopmental assessments, such as:
- Bayley Scales of Infant and Toddler development

Procedures

Lumbar punctures
Neuroprotective treatments, such as cooling
Point-of-care cerebral ultrasound examination
Ventricular drainage

Research interest in emerging evidence of therapies for HIE

LG20: Haematological and malignant conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abnormalities detected on antenatal blood tests or imaging
Haematological disorders:
- anaemia
- bleeding
- decreased or increased white cells
- polycythaemia
- thrombocytopenia
- thrombocytosis
- thrombosis
Neonatal tumours and malignancies

Conditions

Disorders of platelets and coagulations
Disorders of white cells
Haemolysis
Hypoproduction
Leukaemias
Neonatal anaemia
Neonatal polycythaemia

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

Malignancies
Polycythaemia

Conditions

Genetic conditions associated with malignancy
Neonatal tumours and malignancies
Solid tumours
Uncommon congenital causes of anaemia, such as:
- congenital dyserythropoietic anaemia (CDA)
- other genetic causes of anaemia

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

Anaemia
Disorders of coagulation:
- disseminated intravascular coagulation (DIC)
- haemorrhagic disease of the newborn
- neonatal stroke
- thrombocytopaenia
- vascular malformations
Haemolysis
Hypoproduction
Iron transfer in the fetus
Pathophysiology and management of immune and non-immune neonatal haemolytic diseases
Pathophysiology of anaemia of prematurity
Physiology of red cell production and mechanisms of anaemia
Platelet disorder
Polycythaemia
Transfusions and component therapy
White cell disorders

Investigations

B12 and folate
Blood group
Coagulation studies
Ferritin
Full blood counts and films
Interpretation of blood counts and other tests related to haematological disorders
Red cell and platelet antigen tests

Procedures

Bone marrow biopsy and lumbar puncture as investigations of leukaemia
Exchange transfusion
Use of blood products and haematinic agents
Vitamin K prophylaxis

Medicolegal and ethical considerations in the use of blood products
Prevention of iatrogenic contributors to anaemia

LG21: Metabolic and endocrine conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Presentations

Abnormal newborn blood spot test
Acute life-threatening event
Ambiguous genitalia
Family history
History of unexplained childhood death
Hypertonia
Hypotonia
Lethargy
Maternal thyroid dysfunction
Parental consanguinity
Physical abnormalities
Pregnancy affected by diabetes
Pregnancy complications as a presentation of a metabolic condition, such as:
- acute fatty liver of pregnancy
- haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome
Respiratory distress
Seizures and encephalopathy
Shock
Weight loss / Poor feeding

Conditions

Adrenal insufficiency
Congenital adrenal hyperplasia
Hyperglycaemia
Hyperinsulinemia
Hypoglycaemia
Inherited metabolic disorders
Panhypopituitarism
Sex chromosome disorders
Thyroid disorders

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Acute life-threatening event

Conditions

Inherited metabolic conditions, such as:
- fatty acid oxidation disorders
- maple syrup urine disease
- organic acidemias
- urea cycle disorders
Thyroid hormone consumption in massive haemangioma

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

Normal intrauterine development of the endocrine axes and postnatal adaptation, including the impact of preterm birth
Pathophysiology of:
- important endocrine and metabolic disorders of the newborn, such as:
  - adrenal insufficiency
  - ambiguous genitalia
  - sex chromosome disorders
  - thyroid disorders
- inborn errors of metabolism
- metabolic disturbances, including electrolyte abnormalities
Pathophysiology and prevention of hyperglycaemia and hypoglycaemia

Investigations

Acid-base balance, including lactate
Blood glucose levels
Genetic testing, including:
- exome sequencing
- microarray
Hypothalamic pituitary gonadal axis tests
Imaging tests, such as:
- neuroimaging for hypothalamic / pituitary disorders
- nuclear scans for thyroid disorders
Liver function tests
Metabolic tests, such as:
- acylcarnitine
- ammonia
- ketones
- newborn blood spot tests
- plasma amino acids
- urine metabolic screen
Screening and investigation of hypoglycaemia, including:
- cortisol
- insulin
- ketones
Serum biochemistry
Thyroid function tests and thyroid antibodies

Procedures

Lumbar puncture
Skin biopsy for fibroblast culture

LG22: Kidney and urinary system conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abdominal masses
Abnormal urine output
Ascites
Biochemical abnormalities
Haematuria
Hypertension
Lethargy
Oedema
Poor feeding
Proteinuria
Respiratory distress
Sepsis
Structural abnormalities, such as:
- genital abnormalities
- Potter syndrome
Weight gain
Weight loss

Conditions

Congenital kidney disorders, such as:
- anatomical abnormalities
- hydronephrosis
Other causes of poor urine output, such as:
- kidney failure:
  - acute
- shock
- syndrome of inappropriate antidiuretic hormone ADH release (SIADH)

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

Growth faltering
Respiratory failure

Conditions

Kidney aplasia / hypoplasia
Other congenital kidney disorders

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

Synthesise

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

Manage

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

Consider other factors

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

Complex fluid and electrolyte problems, including those in very preterm neonates and those with surgical problems
Effects of kidney impairment on drug metabolism
Indications for urological intervention
Investigation of diagnosed kidney disorders, both antenatally and postnatally
Kidney development and physiological changes after birth in preterm and term neonates
Pathophysiology of congenital kidney disorders and kidney failure
Recognition and institution of treatment for acute and chronic kidney failure, including indications for dialysis

Investigations

Indications and interpretation of kidney vessel doppler studies
Kidney function assessment, such as:
- biochemical
- blood
- imaging, such as:
  - nuclide scans
- urine biochemical
Kidney tract imaging, such as:
- MRI
- ultrasound
Urological investigations, such as:
- bladder ultrasounds
- micturating cystourethrograms

Procedures

Bedside bladder ultrasound
Urethral catheterisation and suprapubic aspiration

Fluid and electrolyte management in at-risk neonates

LG23: Gastrointestinal and hepatobiliary conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Abdominal distension
Anorectal malformations
Bilious vomiting
Delayed passage of meconium
Faltering growth
Feeding difficulties
Jaundice:
- conjugated
- prolonged
- unconjugated
Sepsis
Structural gastrointestinal abnormalities

Conditions

Congenital gastrointestinal anomalies:
- antenatal
- postnatal
Cow milk allergy
Hepatobiliary and pancreatic disease, such as:
- biliary atresia
- cholestatic jaundice
- cystic fibrosis
- gestational alloimmune liver disease (GALD)
- neonatal hepatitis – infectious and non-infectious causes
- secondary disorders, such as:
  - total parenteral nutrition-associated liver failure
Infectious conditions
Inguinal hernias
Malabsorption syndromes and nutritional deficiencies
Metabolic bone disease of prematurity
Necrotising enterocolitis
Nutritional conditions
Short gut syndrome
Spontaneous intestinal perforation

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

Congenital gastrointestinal disorders
Jaundice
Sepsis

Conditions

Abdominal wall defects
Atresia:
- biliary
- gastrointestinal tract, such as:
  - oesophageal
  - small intestinal
Congenital duplications of the gastrointestinal tract
Cysts – biliary / choledochal
Hirschsprung disease
Stenosis:
- congenital
- infantile hypertrophic pyloric
Syndromes, such as:
- Alagille

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

Feeding of sick and preterm infants, including:
- breastfeeding
- expressed breast milk and donor breast milk / breast milk banking
- fortifiers
- haematinics
- special formulas
- supplements
- vitamins
Normal development and functional maturation of the gastrointestinal system, including:
- gut hormones
- infant feeding ability
- motility
Normal development of the hepatobiliary system:
- bile acid metabolism
- bilirubin
Normal growth, nutritional requirements, and organ maturation of fetuses and neonates
Normal lactation process and problems that can arise:
- management strategies to support problematic lactation
Pathophysiology of:
- faltering growth
- hepatobiliary and pancreatic disease
- jaundice:
  - non-physiological
  - physiological
- specific conditions, such as:
  - necrotising enterocolitis
Principles of parenteral nutrition, such as:
- indications for use, and recognition and treatment of complications secondary to parenteral nutrition
- mineral and vitamin requirements
- monitoring for complications of parenteral nutrition
- nutritional components
- trace elements

Investigations

Assessment and investigation of poor growth and nutrition
Gut imaging modalities, such as:
- bedside ultrasound
- contrast studies
- MRI
- nucleotide scans
- ultrasound
- x-rays

Procedures

Insertion and positioning of percutaneous long lines
Methods of delivering parenteral nutrition
Phototherapy and methods of treating different types of jaundice

Knowledge of different milks and nutritional supplements, including:
- different types of formulas for specific indications, such as:
  - formulas for allergy:
    - amino acid formulas
    - cow milk-free, such as rice or soy
    - extensively hydrolysed
  - formulas for kidney failure
  - formulas for metabolic conditions
  - preterm formulas
- donor human milk
- milk fortifiers – indication and management, including human and bovine derived
- parent's own milk
- supplementation:
  - fat
  - glucose
  - protein
Promotion of breastfeeding throughout the hospital, including the neonatal unit
Psychological issues around those who are unable to or choose not to breastfeed
Support for parents wishing to breastfeed sick and preterm babies

LG24: Dermatological conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Evolve postnatally
Present at birth
Rashes and other skin lesions
Structural malformations

Conditions

Common newborn conditions, such as:
- cradle cap
- eczema
- erythema toxicum
- giant congenital melanocytic nevus
- milia
- miliaria
- nappy rash
- pigmentation changes
Dermatological considerations related to prematurity
Disorders of the:
- hair
- nails
Iatrogenic conditions:
- extravasation and surgical wound care
Infectious causes of rashes:
- cytomegalovirus (CMV)
- syphilis
Pressure injuries
Skin manifestations of intrauterine infections
Skin manifestations of maternal conditions, including:
- systemic lupus erythematosus (SLE)
Structural problems, such as:
- cutis aplasia
- incontinentia pigmenti
- skin tags
Vascular malformations, such as:
- haemangiomas
- naevus flammeus
- naevus simplex
- vascular malformations

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

Cardiovascular compromise in high-flow vascular malformations
Congenital structural conditions

Conditions

Life-threatening conditions, such as:
- epidermolysis bullosa
- X-linked ichthyosis
Syndromes with characteristic skin lesions, such as:
- Klippel–Trénaunay syndrome
- Noonan syndrome
- port wine stains
- tuberous sclerosis

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

Characteristics and diagnosis of congenital and acquired infectious rashes and skin lesions
Pathophysiology and differences between:
- benign and pathological rashes in a newborn
- haemangioma and other vascular malformations
Recognition of severe and life-threatening congenital skin conditions, such as:
- epidermolysis bullosa
- severe ichthyosis
Skin care of newborns at all gestations
The role of healthy skin to prevent infections and allergies

Investigations

Genetic testing, including microarray where appropriate
Imaging of lesions and for investigation of associated conditions
Indications and interpretation of specific dermatological investigations, such as skin biopsy
Technique for swabbing of lesions for multiple chemical sensitivity (MCS)

Procedures

Irrigation of an extravasation injury
Skin scraping
Wound care

Aetiology, management, and pathophysiology of skin lesions
Minimisation of risk of disease transmission in the neonatal intensive care unit (NICU) or secondary infection of rashes, where relevant
Treatment of infectious rashes in consultation with a dermatologist and infectious disease specialist, where necessary

LG25: Ophthalmological abnormalities

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Atypical eye:
- appearance
- eye discharge or erythema
- family history
- function
- identified on screening
- nystagmus
- shape
- size
- visual disorders as part of genetic diagnoses

Conditions

Blocked tear ducts
Congenital eye disorders and syndromes, such as:
- anophthalmia
- congenital cataracts
- glaucoma
- microphthalmia
Disorders affecting the eyelashes and eyelids
Infection, such as:
- blepharitis
- conjunctivitis
Retinopathy of prematurity
Trauma

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Congenital eye disorders
Disorders of the neurological optic pathways
Severe neurological problems leading to cortical blindness
Trauma
Uncommon infections, such as:
- gonorrhoea

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

Community support, including:
- access to therapies
- financial support
- visual aids
Indications and options for treatment of retinopathy of prematurity and related risks
Indications for multidisciplinary and ophthalmology teams for the diagnosis and management of eye disorders
Indications for screening for retinopathy of prematurity
Long-term outcomes
Pathology of underlying eye conditions
Pathophysiology and development of the eye and visual pathways
Pharmacological and surgical methods of treatment

Investigations

Assessment for visual impairment
Genetic testing
Head imaging, including:
- cranial ultrasound
- MRI
Screening for eye disorders on newborn examination
Visual evoked potentials (VEP) to assess the electrical activity in the visual cortex in response to visual stimuli
Visual examination with ophthalmoscope

Procedures

Discuss the use of retinal cameras
Use of manual ophthalmoscope

Monitoring for retinopathy of prematurity in rural and regional centres

LG26: Ear, nose and throat abnormalities

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Cleft lip and/or palate
Ear abnormalities:
- malformations
- skin tags
Neck abnormalities:
- lumps
- malposition, such as:
  - wry neck
Obstructive apnoea
Stridor

Conditions

Choanal atresia
Congenital laryngeal abnormalities
Cystic hygroma
Genetic conditions involving ear, nose, and throat abnormalities
Laryngomalacia
Macroglossia, micrognathia, and retrognathia, including in the context of Pierre Robin sequence
Sensorineural deafness
Tracheoesophageal fistula
Vocal cord palsy

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

Congenital problems, including:
- life-limiting conditions

Conditions

Airway atresia

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

Causes of congenital deafness syndromes
Congenital malformations of the ear, and associated syndromes
Embryology of cleft lip and palate, and associated syndromes

Investigations

Airway and oesophageal assessment by endoscopy
Investigations for hearing impairment, including hearing screening programs

Procedures

Video laryngoscopy

Airway and feeding problems associated with cleft palate and Pierre Robin sequence
Delivery procedures, such as ex-utero intrapartum (EXIT), if the airway is thought to be significantly and critically compromised in utero by the congenital lesion
Involvement of multidisciplinary team members for diagnosis and short- and long-term management, such as:
- audiologist
- ear, nose, and throat surgeon
- plastic surgeon
- speech pathologist

LG27: Fetal and perinatal medicine

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Amniotic fluid volume changes, including:
- anhydramnios
- oligohydramnios
- polyhydramnios
Anatomical structural anomalies
Antepartum haemorrhage
Diabetes in pregnancy
Disorders of growth, such as:
- fetal growth restriction
- macrosomia
Factors affecting breastfeeding and the production of breast milk
Hydrops fetalis
Hypertensive disorders in pregnancy
Maternal mental health, including:
- anxiety
- attention deficit hyperactivity disorder (ADHD)
- bipolar disorder
- depression
- post-traumatic stress disorder (PTSD)
Maternal thyroid disease
Multiple pregnancies
Preterm labour
Preterm prelabour rupture of membranes
Significant maternal medical and surgical conditions
Substance use

Conditions

Anatomical structural malformations, including:
- congenital cardiac lesions
- congenital diaphragmatic hernia
- congenital pulmonary airway malformation
- developmental and acquired brain malformations
- multicystic dysplastic kidneys
- renal agenesis
- renal pyelectasis
Chromosomal and genetic abnormalities, including:
- aneuploidies:
  - triploidy
  - trisomy:
    - 13
    - 18
    - 21
Cleft palate
Congenital infection
Discordant growth
Hypoplastic lung
Shared placental physiology
Tracheoesophageal fistula or intestinal atresia
Twin anaemia polycythaemia sequence
Twin-to-twin transfusion syndrome

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Echogenic bowel
Fetal anaemia

Conditions

Agenesis of the corpus callosum
Cerebellar hypoplasia
Cystic hygroma
Fetomaternal alloimmune thrombocytopaenia
Neural tube defects, such as:
- spina bifida
Neurological presentations, such as:
- ventriculomegaly

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

Knowledge of the basic sciences relevant to maternal and fetal medicine

Embryology

Absent and reverse diastolic flow significance in antenatal ultrasound scanning
Factors involved in initiation of labour
Fetal adaptions to stress
Fetal origins of disease and factors relevant to providing a healthy start, such as:
- folate
- iodine
- mental health
- minimising risks
- substance use
- supportive environments
Normal fetal and placental physiology and pathology
Pathophysiology of pregnancy complications related to high-risk / premature births
Role of magnesium sulphate for neuroprotection
Role of steroids in predicted premature birth
Understand fetal cardiological, endocrinological, and respiratory responses to birth
Umbilical cord pathology, including abnormal and normal variants
Umbilical gas significance:
- arterial
- venous
Understanding of the placenta and the role it plays in fetal wellbeing

Investigations

Amniocentesis
Antenatal infection tests:
- bacterial
- viral
Carrier screening
Chorionic villus sampling (CVS)
Fetal:
- echocardiogram
- MRI
- ultrasound
First trimester combined ultrasound and serum screening test
Genetic testing, such as:
- karyotype
- microarray
- whole exome sequencing
- whole genome sequencing
Maternal serum screening first trimester (MSS1)
Non-invasive prenatal testing (NIPT)
Routine pregnancy screening tests and monitoring

Procedures – know about but not perform

Cerebral doppler studies
Intrauterine fetal surgery
Laser ablation for twin-to-twin transfusion syndrome
Umbilical doppler monitoring

Impacts of climate and environmental hazards on fetal, maternal, and neonatal health:
- changing epidemiology of infectious diseases and pollution-related disorders, including impact on fetal brain and lung development
- heat-related risk of neonatal mortality, stillbirth, and preterm birth
- impact of displacement / reduced health care access due to natural disasters
- psychological effects of climate hazards, such as:
  - acute and chronic heat stress
  - natural disasters
Knowledge and application of antenatal counselling
Management of periviable births
Parental expectation and planning for birth
Role of maternal fetal medicine specialists

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

Printed by:	Guest user
Date:	Saturday, 29 November 2025, 12:37 AM

Description

Advanced Training in Neonatal and Perinatal Medicine

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

11

12

13

14

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care and longitudinal care

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety