Curriculum standards

About this resource

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

This resource outlines the curriculum standards for Advanced Training in General and Acute Care Medicine for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in General and Acute Care 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 using 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
explain the roles of team members

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate health services and clarify expectations to support systematic, transparent decision making
make decisions when faced with multiple and conflicting perspectives
ensure medical input to organisational decision making
adopt a systematic approach to analysing information from a variety of specialties to make decisions that benefit health care delivery
recognise own limitations and seek help, when required, in an appropriate way

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
inadequately consult with senior colleagues

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
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
remove self-interest from solutions to health advocacy issues

direction
Requires some supervision

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

The trainee may:

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

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

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
inadequately consult with senior colleagues

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
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged 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 and service improvement

Learning Goal 4

Quality and service improvement

Identify and address improvement opportunities in health care quality, efficiency, and effectiveness

This activity requires the ability to:

identify, analyse, and report actual and potential (‘near miss’) events
conduct root cause analysis / gap analysis using appropriate tools
recognise and apply quality improvement methodology, including audit cycles
conduct and evaluate system improvement activities
recognise and interpret systems’ quality and performance indicators
adhere to best practice guidelines
contribute to the development of policies and protocols designed to protect patients and enhance sustainable health care
monitor one’s own practice and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
use standardised protocols to adhere to best practice and prevent the occurrence of wrong-site, wrong-patient procedures
regularly monitor personal professional performance
use relevant guidelines to develop clinical quality and performance indicators
use key aspects of healthcare safety, quality, and system governance
comprehend, and use, data systems that enable regular auditing and reviews of processes of care and patient outcomes
evaluate the quality of health care in practice
identify evidence-based practice gaps using clinical quality and performance indicator measurements
develop quality improvement strategies and methods to measure response
identify systemic factors that drive health system change currently and into the future, and consider approaches to address these

direction
Requires some supervision

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

The trainee may:

contribute to processes on identified opportunities for improvement
recognise the importance of prevention and early detection in clinical practice
use local guidelines to assist decision making for patient care

Communication

confident
Ready to perform without supervision

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

The trainee will:

advocate for patients in critical errors / ‘near misses’, and partner with patients in system improvement
approach patient care and the healthcare system holistically, in terms of being able to identify stakeholders to participate in multidisciplinary quality improvement discussions
discuss with patients any safety and quality concerns they have relating to their care
enable the healthcare team to effectively communicate safety and quality concerns between team members and with patients
implement the organisation’s open disclosure policy and statutory duty of candour
encourage patients and carers to take an active role in advocating for their own safety and wellbeing
verify quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
incorporate appropriate LGBTQIA+ safe language, including gender affirming language

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate an awareness of evolving concepts and approaches to quality and safety improvement, and management of risks within organisations
demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
participate in organisational quality and safety activities, including morbidity and mortality reviews, clinical incident reviews, root cause analyses, and corrective action preventative action plans
participate in systems for surveillance and monitoring of adverse events and ‘near misses’, including reporting such events
ensure that identified opportunities for improvement are raised and reported appropriately
use quality improvement methodologies (including clinical audits) and registries of data on patients’ experiences and outcomes, learnings from incidents, and complaints to improve care
demonstrate awareness of factors that influence health care quality and safety, including the measurement and interpretation of key performance and quality indicators

direction
Requires some supervision

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

The trainee may:

be cognisant of a systematic approach to improving the quality and safety of health care
demonstrate awareness of the steps required in performing quality improvement projects

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

participate in professional training in quality and safety to ensure a contemporary approach to safety system strategies
translate quality improvement methodology into practice
supervise and manage the performance of junior colleagues in the delivery of high-quality, safe care
identify opportunities to increase the education and training of multidisciplinary team members in quality and service improvement

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:

demonstrate the ability to carry out critical appraisal of the literature
identify opportunities for research, focusing on quality and service improvements
ensure that any protocol for human research is approved by a human research ethics committee, in accordance with the National Statement on Ethical Conduct in Human Research
demonstrate familiarity with quality improvement research guidelines

direction
Requires some supervision

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

The trainee may:

demonstrate awareness that patient participation in research is voluntary and based on an informed consent process regarding the purpose, methods, demands, risks, and potential benefits of the research
demonstrate awareness of the ethics application process for conducting research and the various levels of ‘risk’ associated with clinical 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:

recognise the vulnerability of marginalised patient groups involved in quality assurance or research
undertake professional development opportunities that address the impact of cultural bias on health outcomes

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use decision-making support tools, such as guidelines, protocols, pathways, and reminders
analyse and evaluate current care processes to improve care delivery
explain human factors affecting safety, and describe strategies to prevent human error
evaluate quality of processes and outcomes through well-designed quality improvement initiatives
analyse adverse incidents using appropriate root cause / gap analysis tools to identify system failures and contributing factors
evaluate improvement initiatives for outcomes and sustainability
recognise own limitations and seek help, when required, in an appropriate way

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
inadequately consult with senior colleagues

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 with the multidisciplinary team to manage the complex care needs of patients and reduce complication risk
promote and foster interprofessional education and collaborative practice to optimise the safety and quality of care
foster a critical, data driven, evidence-based, multidisciplinary, and systems-orientated approach to quality and safety issues
lead the development of project plans that identify enablers, barriers, stakeholders, and risks, and articulate implementation methods

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
identify and address equity impacts on quality of care through quality improvement
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
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
outline health policies relevant to society
evaluate the quality and safety systems implemented within the workplace, and identify gaps in the structure of these systems
devise and implement quality improvement strategies, such as clinical guidelines, reminders, academic detailing, and decision supports at a local level
consider the importance of environmental sustainability when designing health systems and policies
develop improvement plans that integrate local and system contexts
establish data systems that enable regular monitoring and evaluation of processes of care and patient outcomes for specific patient populations
develop policies informed by clinical practice
actively and constructively advocate for individuals, populations, and health services lacking power and voice to improve care delivery
seek to mitigate inequities of geographical isolation and lack of health service access on care provision
encourage a culture of reporting safety incidents with a focus on systems issues and a no-blame culture
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 organisational policies and procedures
help shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

identify and access sources of relevant information about patients
obtain thorough patient histories
systematically evaluate patients’ physical, medical, psychological, and functional status within their specific social and environmental context
synthesise findings to develop provisional and differential diagnoses
use a shared decision-making approach to develop care plans based on the findings of comprehensive assessments, and discuss with patients, families, whānau, and/or carers
manage acute and chronic multisystem health problems
develop comprehensive management plans that effectively prioritise care needs amidst competing priorities in a range of settings
work collaboratively with other health professionals as part of a multidisciplinary team to provide holistic care
actively assess patients’ response to management, and re-evaluate treatment plans regularly
identify potential risks and employ preventative strategies against adverse events where possible

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, organised, and problem-focused medical histories, considering physical, psychosocial, and risk factors
obtain collateral history from carers, relatives, and other health professionals
perform appropriate and thorough physical examinations to establish the nature and extent of problems
adapt approach to history and examination in specific situations
obtain and review relevant past results, specialist reports, and hospital summaries to facilitate accurate knowledge of patient background and avoid duplication
obtain accurate medication history, and always prescribe within the current clinical context
synthesise multisource information to form comprehensive patient assessments, including functional and cognitive capacity where appropriate
recognise and act when elements of a history or examination do not fit with expectations or an obvious pattern
assess the severity of problems, the likelihood of complications, and clinical outcomes
generate comprehensive problem lists, and appropriately prioritise management of individual problems within the current clinical context
synthesise and interpret findings to devise the most likely provisional diagnoses and reasonable differential diagnoses
recognise the significance and limitations of clinical and examination findings, and be able to interpret these in the relevant patient context
tailor and prioritise investigations and management for individual patients’ circumstances
be cognisant of the inter-relatedness of physical / medical and psychiatric illness, and the relevance of this in management
re-assess management with regards to patient progress, making appropriate changes as clinically indicated
recognise an actively deteriorating patient, and when to escalate management versus reaching medical futility

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, actively listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
engage patients in exploration of the biological, psychological, and social components of their illness
provide information to patients and their family or carers to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
assess decision-making capacity, and review patients who want to discharge against medical advice
explain and discuss the risks, benefits, and costs (monetary and adverse effects) of diagnostic and therapeutic interventions
discuss prognosis, and formulate realistic treatment goals
collaborate with other specialties to balance conflicting treatment choices with patients’ overall best interests
explain medical management plans clearly and promptly as part of a multidisciplinary team
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
demonstrate effective strategies to minimise patient risk at points of clinical handover / change in patient care providers
support patients and families in adjusting to acute and chronic illness
provide clear and concise medicolegal and administrative reports
provide timely updates to both patients and other healthcare providers in the event of a change in clinical condition or management
discuss emotive issues with sensitivity, such as futility, limits of care, patient deterioration, and impending or unexpected death

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
be aware of gender stereotypes and bias, including the importance of using correct pronouns
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
ensure patients are informed of the material risks associated with any part of proposed management plans
ensure patients’ safety while avoiding inappropriate overuse of investigations
practice open disclosure in the event of medical error
report any perceived risk to clinical safety, such as inadequate staffing levels or access blocks
demonstrate an awareness of evolving concepts and approaches to quality and safety improvement, and management of risks within organisations
demonstrate an ability to weigh the risk / benefit of proposed treatments against the risk / benefit of doing nothing

direction
Requires some supervision

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

The trainee may:

document history and physical examination findings, and synthesise with clarity and completeness
take precaution against assaults from confused or agitated patients, ensuring appropriate care of patients
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 elicit feedback on mutually agreed goals
self-evaluate clinical practice
obtain informed consent before involving patients in teaching activities
turn clinical activities into an opportunity to teach, appropriate to the setting
engage in continual professional development activities
consolidate dissonance between clinical heuristics and evidence-based medicine
demonstrate methods for updating clinical beliefs and practices as new valid evidence becomes available

direction
Requires some supervision

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

The trainee may:

set unclear goals and objectives for self-learning
self-reflect infrequently
deliver teaching considering learners’ level of training

Research

confident
Ready to perform without supervision

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

The trainee will:

demonstrate the ability to accurately interrogate available literature when required for clinical care
critically appraise literature, demonstrate awareness of limitations, and apply available evidence to the diagnosis and management of patients
formulate research questions relevant to clinical practice and health systems to address practice gaps or ongoing needs
foster enquiry and research among colleagues in response to unanswered clinical questions
be aware of active clinical trials being undertaken in the workplace
explain how to report possible adverse events for patients participating in clinical trials
characterise personal clinical reasoning style and determine its alignment with evidence-based approaches

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

explain the need for culturally safe care
recognise the specific challenges for patients from culturally diverse backgrounds
explain cultural diversity and how this affects patients’ health and interactions with the healthcare system
use culturally specific patient resources and physical spaces when available
use professional language interpreters and translated written material when available
engage specific support services when available, such as Aboriginal liaison services and Hāpai Kaimahi Hauora
ask patients about their preferences, such as name, family involvement, and same-gendered staff
be aware of gender stereotypes and bias, including the importance of using correct pronouns
demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander peoples and Māori, and members of other cultural groups
acknowledge patients’ beliefs and values, and how these might impact on health

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all patients
hold information about patients in confidence, unless the release of information is required by law or public interest
reflect on cases where clinical enquiry and judgements have led to incorrect clinical decisions

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
identify local requirements for informed consent

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:

assess patients’ capacity for decision making, involving a proxy decision maker appropriately
explain the range of certainty around diagnoses, and the benefits and risks of treatments
apply knowledge and experience to identify patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for patients
use a holistic approach to patient care, considering comorbidity, uncertainty risk, and patient preference
use the best available evidence for the most effective therapies and interventions to ensure quality care
evaluate the value of diagnostic tests in terms of sensitivity, specificity, likelihood ratios, predictive value, cost effectiveness, reproducibility, and patient convenience
implement processes to facilitate reflection and review of clinical cases that elicited doubt or uncertainty
appraise the accuracy, relevance, and ability to implement recommendations provided by other specialists
reconcile conflicting advice from other specialties, and apply judgement in making clinical decisions in the presence of uncertainty
recognise and acknowledge when the diagnosis is not clear despite appropriate investigation
identify situations where integrated care is in the best interests of individual patients
recognise own limitations and seek help, when required, in an appropriate way

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, when required, in an appropriate way

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:

determine the appropriate admitting team based on the care needs for individual patients, and be able to negotiate with other admitting teams
set clear parameters for monitoring medical illness and/or escalating medical care
demonstrate ability to recognise a colleague in difficulty, and how to evaluate and address the potential implications on their wellbeing and risk, and on patient safety
collaborate with specialty colleagues, and facilitate their input to provide optimal patient care
collaborate with allied health disciplines to ensure effective multidisciplinary teamwork
manage under-performing staff members
deal with conflict in a constructive and respectful way
demonstrate task delegation to maximise efficiency and the appropriate use of individual skill sets and teaching / learning without compromising patient safety
recognise factors required to build an effective team
demonstrate and encourage effective time management and task prioritisation while working within a team
give both positive and negative feedback to staff members under supervision

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 of notifiable diseases
contribute to the development of guidelines and protocols
explain the difficulties of balancing equitable resource allocation
recognise key equity determinants as they pertain to clinical care, and devise strategies to address them
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
communicate system-level concerns through appropriate local channels
advocate for high cost or off-label medication for individual patients when needed
work with healthcare systems to develop innovative ways to balance quality care delivery with resource limitations and cost
contribute to clinical redesign projects
advocate for all disadvantaged, unsupported, and/or vulnerable patient groups to improve access and delivery of care
consider the importance of environmental sustainability when designing health systems and policies

direction
Requires some supervision

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

The trainee may:

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

LG6: Management of transitions in care

Learning Goal 6

Management of transitions in care

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

manage referrals, including discharges to primary care, complex ambulatory care models (such as hospital in the home), in- and out-bound interhospital transfers, and handover between shifts
apply understanding of transition needs between life stages, including the role of healthcare systems
facilitate an optimal transition of care for patients, including, but not limited to, handover meetings
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them
implement measures to ensure patient care is appropriately monitored and reviewed as required

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use digital communication tools and applications to aid in safe communication at transitions of care
write relevant and detailed medical record entries, including clinical assessments and management plans
write comprehensive and accurate summaries of care, including discharge summaries, clinic letters, and transfer documentation
initiate and maintain verbal communication with other health professionals when required
communicate with patients, families, and/or carers about transitions of care, and engage and support these parties in decision making, including appropriate safety-netting advice
communicate proactively with peers and managers regarding workload and patient care issues when required
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
communicate effectively and apply understanding of the role of primary care providers
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify and mitigate risks present during transitions of care or handover
use and respect the expertise of primary care professionals in coordinating care of patients outside hospital
recognise the importance of the context of care in the environments to which patients transition
work with colleagues to ensure management plans are appropriate and sustainable in the new context
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 professional communications, including confidentiality and conflicts of interest

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

integrate clinical education in handover sessions and other transition of care meetings
tailor clinical education to the level of the professional parties involved
demonstrate and teach best practice in handover, including closed-loop communication, and written and oral communication between health professionals

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

ensure culturally safe communication, paying attention to culture and language
ensure patient-centred care by eliciting patient preferences
respect patients’ choices whenever they are realistic and possible
acknowledge and allow for differences in worldview and how this may impact on transitions in care and care planning
recognise the timing, location, privacy, and appropriateness of sharing information with patients, whānau, their families, or carers

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

ensure patients’ care is in the most appropriate facility, setting, or provider
facilitate patient care provision when disadvantage or vulnerability is present, such as lack of services or geographical isolation
make appropriate decisions regarding referring or transferring patients to other services for further assessment, including regional and remote patients

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
recognise the medical governance of patient care, and the differing roles of team members
work effectively as a member of professional teams, showing respect for the roles and expertise of other health professionals
ensure that multidisciplinary teams provide the opportunity for patients’ engagement and participation when appropriate

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

contribute to processes for managing risks, and identify strategies for improvement in transitions of care
engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital discharge
work with primary care liaison teams and networks to foster continuous improvement in safe transitions to primary care
identify and build partnerships between metropolitan and rural health services to enable optimal patient care
recognise equity barriers that may impact on safe transitions of care, and mechanisms through which these may be addressed
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

direction
Requires some supervision

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

The trainee may:

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

LG7: Acute care

Learning Goal 7

Acute care

Manage those who are acutely unwell and stabilise haemodynamic compromise

This activity requires the ability to:

assess seriously unwell patients, and initiate management
recognise clinical deterioration, and respond by following the local process for escalation of care
recognise and manage acutely unwell patients who require resuscitation (primarily in inpatient settings) and provide advanced life support
liaise with transport services and medical teams

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise immediate life-threatening conditions and deteriorating and critically unwell patients, and respond appropriately
perform advanced life support according to resuscitation council guidelines
lead a medical emergency / rapid response team
explain 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
discuss goals of care, limitations, or escalation of treatment with patients and families
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
formulate complete and reasoned problem lists
manage escalations or transitions of care in a proactive and timely manner
initiate empirical therapy aimed at stabilising patients and avoiding irreversible organ failure pending definitive diagnosis
formulate management plans that recognise treatment interactions with multisystem diseases and comorbidities
create contingency plans when initial management plans do not provide the expected outcome
develop management plans that are based on medical assessment of clinical condition and multidisciplinary assessment of functional capacity
provide clear and effective discharge summaries with recommendations for ongoing care
optimise medical management perioperatively

direction
Requires some supervision

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

The trainee may:

recognise seriously unwell patients requiring immediate care
apply basic life support as indicated
recognise general medical principles of caring for patients with undifferentiated and undiagnosed conditions
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis, and develop management plans for immediate treatment
document information to outline the rationale for clinical decisions and action plans
assess perioperative and periprocedural patients

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate clearly and in a timely manner with other team members, and coordinate efforts of multidisciplinary team members
communicate with emergency medical staff and colleagues to optimise continuity of patient care and explore alternatives to hospitalisation
use closed-loop, clear communication with other healthcare team members during resuscitation
document sufficient information to outline rationale for clinical decisions and management plans
facilitate early communication with patients, families, and healthcare team members to allow shared decision making
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain the situation 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
clearly and succinctly perform handover to the next treating team
communicate requirements for nursing care, including frequency of observations and the time of the next planned review

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

negotiate care decisions in a culturally appropriate way by considering variation in worldview, family structures, cultures, religion, or belief systems
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams
integrate culturally appropriate models of care for Aboriginal and Torres Strait Islander peoples, Māori, and Pacific peoples into clinical practice
respectfully acknowledge culturally appropriate cares that may be received in parallel, such as mirimiri

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

develop management plans based on medical assessments of the clinical conditions and multidisciplinary assessments of functional capacity
advise patients of their rights to refuse medical therapy, including life-sustaining treatment
consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
facilitate interactions within multidisciplinary teams, 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:

initiate appropriate bed management decisions
identify patients whose clinical acuity and complexity mandate inpatient management
identify patients whose clinical acuity requires intensive supervision in a relevant unit, such as the high dependency unit, intensive care unit, or coronary care unit
apply selection criteria in identifying patients presenting acutely who are candidates for admission to medical assessment and planning units
recognise when a ‘watch and wait’ approach is justified
recognise the need for escalation of care, and escalate to appropriate staff or services
select and appropriately refer patients eligible for invasive intervention during acute or subacute phases of illness
adjust approach depending on needs of the current patient, others needing acute assessment, and staff and hospital resources
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making
reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units
demonstrate timely multidisciplinary team engagement and community care delivery with clear leadership and management plan development
delegate routine tasks to others while assessing and managing patients of higher acuity
manage the transition of acute medical patients through their hospital journeys
lead a team by providing engagement while maintaining a focus on outcomes

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available healthcare resources
collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems
ensure acute care is provided in a timely fashion to disadvantaged and vulnerable patient groups through advocacy and health service development
identify equity determinants as they pertain to acute care, and devise strategies to address them
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

direction
Requires some supervision

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

The trainee may:

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

LG8: Longitudinal care

Learning Goal 8

Longitudinal care

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

This activity requires the ability to:

develop management plans and goals in consultation with patients, carers, and/or families
identify and address any barriers to meeting patients’ goals
manage chronic and advanced conditions, complications, disabilities, and comorbidities
obtain and coordinate appropriate subspecialist advice, integrating and incorporating this into management plans in a holistic and considered manner
support holistic patient-centred care through the entirety of their illness / health condition
continually reassess and revise management plans and/or goals within the context of patient progress
collaborate with other care providers
ensure continuity of care
facilitate patients’ and/or families’ and/or carers’ self-management and self-monitoring
engage with the broader health policy context

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

assess and review care plans for patients with chronic conditions and disabilities, based on short- and long-term clinical and quality of life goals
provide documentation on patients’ presentation, management, and progress, including key points of diagnosis and decision making, to inform coordination of care
make planning decisions that incorporate patients’ wishes and priorities
develop comprehensive management plans for patients with complex care needs and their carers
incorporate primary and secondary preventative approaches into care plans
integrate screening and preventive health with ongoing medical care
monitor treatment outcomes, effectiveness, and adverse events
follow up patients with complex disease post admission and referral
carefully consider patient-specific factors, conflicting medical priorities, and patients’ goals and wishes when deciding how and when to incorporate specialist management advice
identify and safely navigate necessary transitions in patients’ care
recognise the presence of life-limiting conditions, and the potential implications of this for patients and families

direction
Requires some supervision

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

The trainee may:

integrate histories and examinations to generate accurate problem lists, and independently initiate appropriate management
integrate information from and provide leadership and direction to the multidisciplinary healthcare team
assess patients’ knowledge, beliefs, concerns, and daily behaviours related to their chronic condition and/or disability and its management
accurately and succinctly contribute to medical record entries on histories, examinations, and 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:

encourage patients’ self-management through education to take greater responsibility for their care, and support problem solving
counsel patients on the impacts of the disease and/or treatment on fertility, driving, and employment
liaise with employers, education providers, and licensing authorities to safely manage illness or impairment when indicated
explain remedial risk factors and intervention strategies to patients and carers
discuss risks and benefits of proposed management plans with patients in an appropriate way
encourage patients’ access to self-monitoring devices and assistive technologies
use motivational interviewing to encourage self-care and lasting behavioural change in patients
adapt communication techniques used to build and maintain clinical rapport with patients, including interpreters where appropriate
actively listen to patients
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
communicate effectively with multidisciplinary team members, and involve patients in that dialogue
define discharge / handover endpoints during treatment planning
communicate regularly with other specialist providers who are directly involved in ongoing management
seek appropriate advice through accurate communication of the clinical question and patient-specific context when needed
synthesise and communicate all relevant specialist input into patients’ care
provide effective communication of assessments, management plans, and outcomes of care to all relevant healthcare providers
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
discuss sensitive and highly emotive issues with patients, such as poor prognosis, medical futility, and advanced care planning
demonstrate the ability to constructively navigate conflict situations with patients

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use innovative models of chronic disease care, such as 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
calibrate practise through attendance at morbidity and mortality meetings, and collegiate case discussion
ensure evidence-based care by remaining up to date with current medical literature
independently plan and undertake continuous professional development

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

independently plan and undertake continuous professional development
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
actively seek to educate junior team members during daily practice by using available opportunities for teaching and encouraging curiosity for learning

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

use information from a variety of sources to synthesise management plans
prepare reviews of literature on patients’ encounters to present at journal club meetings
maintain up-to-date knowledge of relevant medical literature, and apply evidence-based practice when formulating patient management plans
search for and critically appraise evidence to resolve clinical areas of uncertainty
seek expert advice from colleagues when medical literature is lacking
use epidemiological and public care research in the context of individual patients with chronic complex illness

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:

ensure care plans are culturally safe and feasible in local circumstances
integrate culturally safe care of Aboriginal and Torres Strait Islander peoples and Māori into care planning and patient management
encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management
reflect critically on internal and systemic bias, including how these may impact patient care, and take active steps to minimise these in practice
actively offer use of interpreters and translated resources
refer to specialised services when available
consider whether the location for patient consultation is safe, and adjust accordingly
recognise the potential for differing cultural needs, especially during discharge planning, family meetings, and discussions about advanced care planning and end-of-life care
ensure use of patients’ preferred names and terms of address

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients’ needs in terms of both internal resources and external support on long-term health care journeys
prioritise and rationalise treatment for frail patients
refer patients to appropriate supportive services
identify patients who will benefit from a rehabilitative approach
appropriately time and proactively manage escalations or transitions of care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

coordinate whole-person care through involvement in all stages of patients’ care journeys
work with community multidisciplinary teams and primary care health professionals to facilitate effective patient care
use rehabilitation resources to maximise ability to return to education, employment, and independence after illness
work with general practitioners and screening services to ensure patients with chronic disease also present for routine preventive measures
develop collaborative relationships with patients, families, carers, and a range of health professionals
identify roles within the chronic disease care team, and conduct collaborative case conferences as needed
maintain a level of supervision and task delegation to other staff members

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

be proactive in identifying and removing barriers to access health care
recognise the multifactorial inequity that exists in accessing health care, and use available and novel strategies to overcome this
advocate for patients to be able to meet their goals when feasible, within the healthcare system and the wider community
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
use health screening for early intervention and chronic disease management
assess and initiate alternative models of care delivery
participate in government initiatives for chronic diseases management to reduce hospital admissions and improve patients’ quality of life
help patients with chronic diseases and disabilities access initiatives and services
develop systems that allow regular comprehensive assessments of all patients and completion of care-related tasks

direction
Requires some supervision

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

The trainee may:

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

LG9: Shared decision making with patients and carers

Learning Goal 9

Shared decision making with patients and carers

Formulate agreed management plans with patients that fit with their medical context, goals, and values

This activity requires the ability to:

select a suitable context, and include family and/or carers and other team members
adopt a patient-centred perspective, including adjusting for cognition, disability, cultural perspectives, and language of choice
select and use appropriate modalities and communication strategies
structure conversations intentionally
negotiate mutually agreed management plans, considering the individual patient’s values, goals, and preferred level of involvement in decision-making
verify patients’, family members’, or carers’ understanding of information conveyed
develop and implement plans for ensuring actions occur
ensure conversations are documented and made available to relevant members of the treating team

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise that individual patients have different levels of engagement in their health care, and tailor approaches accordingly
determine patients’ preference for the level of involvement in medical decision-making
anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
seek to understand the concerns, values, and goals of patients, and plan management in partnership with them
negotiate initial plans and any changes with patients and colleagues
estimate and express benefit and risks of clinical interventions in individual patients
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
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
use and communicate health education resources available to the general population
recognise and work constructively with patients seeking information from additional sources
identify and manage barriers to communication, such as language, cultural background, cognitive impairment, speech and hearing problems, capacity, and health literacy issues

direction
Requires some supervision

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

The trainee may:

apply knowledge of the scientific basis of health and disease to the management of patients
demonstrate awareness of the clinical problem 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 shared-decision making strategies such as ‘ask, tell, ask’, ‘SHARE’, or ‘three-talk method’
use appropriate communication strategies and modalities for communication, such as emails, face-to-face, or phone calls
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients to share their understanding, questions, key health issues, and goals of care
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
translate measures of harm and risk into meaningful concepts for patients
employ communication strategies appropriate for younger patients
recognise the role of family or carers, and, when appropriate, encourage patients to involve family or carers in decisions about their care
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
use decision aids that assist patients to conceptualise treatment benefits and harms during informed consent
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

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
demonstrate effective consultation skills, including effective verbal and nonverbal interpersonal skills

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:

perform decision-specific capacity assessments, and be aware of local policies and procedures related to consent and substitute decision makers
discuss with patients their condition and the available management options, including potential benefits and harms
provide information to patients in a way they can understand before asking for their consent
recognise and take precautions where patients may be vulnerable, such as issues of child protection, self-harm, or elder abuse
participate in processes to manage patients’ complaints
encourage and work constructively with patient feedback

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
value the important role of patients as teachers, and prepare patients for their role 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:

communicate numeric estimates of benefit and harm to patients in a manner they can understand and act upon
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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication with Aboriginal and Torres Strait Islander peoples and Māori
demonstrate awareness of appropriate models of care for Aboriginal and Torres Strait Islander peoples, Māori, Pacific peoples and other groups, and how these may inform shared decision-making approaches
communicate effectively with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language interpreters or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible
negotiate health care decisions in a culturally safe way
interact respectfully with pastoral care workers and representatives of religion

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use information wisely when they make decisions
encourage and support patients in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
prioritise honesty, patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions
offer apologies or explanations when required
respect patient autonomy, even if a decision appears unwise or different to the medical opinion

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

determine patients’ level of understanding and commitment to agreed care decisions
determine the level of health literacy of individual patients, and their willingness to assume responsibility for care decisions
consider the consequences of decisions, including the decision to do nothing, and the impact on patients and their carers
recognise own limitations and seek help, when required, in an appropriate way

direction
Requires some supervision

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

The trainee may:

weigh up various treatment choices and explain these to patients and their carers
inadequately consult with senior colleagues

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

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:

promote healthy lifestyles for patients and the wider community
collaborate with other services, such as community health centres and consumer organisations, to help patients navigate the healthcare system
demonstrate awareness of equity determinants and how these may impact on shared decision making
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG10: Prescribing

Prescribing 10

Prescribing

Prescribe and deprescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

accurately obtain and interpret medication histories, including non-prescription medications (considering the use of native traditional treatments, such as Rongoā Māori) and herbal / natural preparations
take complete histories of allergies and prior medication adverse effects
choose appropriate medications based on an understanding of pharmacological principles, taking into consideration patients’ age, comorbidities, out-of-pocket cost, possible adverse effects, potential drug interactions, and projected benefit
communicate effectively with patients, families and/or carers about the benefits and relevant risks of prescribing proposed therapies, as well as the rationale for deprescribing, considering their beliefs, past experiences and thoughts on their medications
provide clear instructions on medication administration, desired / predicted effects, and potential adverse effects
monitor for medication efficacy and safety
review medications regularly, and assess for potential interactions
collaborate effectively with pharmacists
promote medication adherence, and work with patients to develop strategies to improve medication adherence

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’ conditions that require therapy
consider evidence-based non-pharmacologic therapies where appropriate
where robust evidence is lacking, use expert peer advice to help guide practice
consider age, allergies, chronic disease status, lifestyle factors, patients’ preference, and potential drug interactions prior to prescribing new medications
consider oral and once daily medications to improve ease of administration and adherence
consider importance of timing on medication prescription
review necessity of all medications and the evidence base for their continued use in individual patients
recognise the difference between medication effect and class effect, and the nuances of pharmacological properties of medications within a single class
recognise the prescribing cascade, and work to avoid occurrence of same in individual patients
use a recognised framework, including consideration of the culturally appropriate models of health and wellbeing, for deprescribing medications in line with patient-negotiated goals of care, expected illness trajectory, and medication safety concerns
recognise and manage toxidromes and the effects of medication overdose
use national and local guidelines on appropriate and safe prescribing
actively evaluate medication efficacy during follow-up
use therapeutic drug levels appropriately where indicated, and demonstrate the ability to interpret these results
identify clinically significant medication interactions or contraindications, and take active steps to address these, including deprescribing when appropriate

direction
Requires some supervision

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

The trainee may:

be aware of potential side effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
select medicines for common conditions appropriately, safely, and accurately
demonstrate understanding of the 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
discuss medication adherence in a non-judgemental way to identify barriers and develop strategies to overcome them in collaboration with patients
ask patients about possible medication side effects at each consultation
explore patients’ understanding of and preferences for non-pharmacological and pharmacological management
write clear and legible prescriptions, including the anticipated duration of therapy and indication, using generic medication names unless there are known brand-specific medication properties to consider
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication 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 understand prescribing details, including when to return for monitoring and whether therapy continues after a single prescription
supply specific medication instructions in legible written form using plain language
identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives
assess patients’ readiness for deprescribing and negotiate agreed deprescribing plans, including monitoring for return of symptoms and weaning where appropriate
communicate with other health professionals to ensure safe use of pharmacological therapy, particularly around transitions of care
encourage and support patient self-determination and management
offer patients effective choices based on their expectations of treatment, past experiences of pharmacological treatment, health beliefs, and cost
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
tailor information provided to patients dependent on their health literacy
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:

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

clearly document all patient allergies and the clinical manifestation using designated systems
clearly document any suspected or confirmed medication side effects, and categorise severity using designated systems
clarify and update patients’ medication lists, including accurate dosages, at each review, to minimise prescribing errors
actively assess for medication efficacy and side effects
actively assess patients’ adherence to prescribed therapies
use electronic prescribing tools where available, and access electronic drug references to minimise errors caused by drug interactions and poor handwriting
use generic medication names except in specific circumstances
substitute new medicines only when they have been demonstrated to be safer or more effective at achieving patient-oriented outcomes than existing medicines
participate in clinical audits to improve prescribing behaviour and/or equity, including an approach to polypharmacy, prescribing cascade and access to medication in varied communities
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
use a state-based registry or equivalent local systems to monitor for prescription of Section 8 medications

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 patients understand management plans and health benefits of adhering to therapeutic recommendations
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
use continuously updated software for computers and electronic prescribing programs

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 inform optimal medication prescribing, ensuring the use of the most efficacious, best tolerated therapy that achieves patient-oriented outcomes, including equitable resource use / distribution
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:

explain how cultural knowledge such as Mātauranga Māori and non-Western therapies may be used in parallel, such as Rongoā Māori and bush medicine
explain differences in health beliefs, acceptability of pharmacologic therapy, and treatment expectations
identify factors influencing adherence to treatment, such as competing family / community demands, concern about the safety of medication in the house, periods spent away from home without access, past experiences of pharmacological treatment, health beliefs, and perceived side effects
identify systemic factors that potentially affect adherence to treatments and trust, such as racism and the impact of colonisation

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 pharmacological and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients about:
- how to take the medicine
- potential side effects
- what the medicine does
- what the medicine is for
- when it should be stopped
make prescribing decisions based on robust clinical data, demonstrating the high likelihood of benefit and acceptably low risk as these relate to individual patient-oriented outcomes
recognise the ethical implications of pharmaceutical industry-funded research and marketing
communicate directly with medical colleagues when proposing changes to pharmacologic therapies that fall specifically within their area of specialty practice

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, evidence-based approach to select treatment options
implement non-pharmacological therapies when these have been proven to be safe and effective, and where this is practical / feasible
introduce medication therapy when non-pharmacological measures have failed or are not feasible
use medicines safely and effectively to get the best possible results with the lowest possible risk and cost to patients
prescribe medicines appropriately to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost to them
evaluate new medicines in relation to their demonstrated efficacy and safety profile, and how this might apply to individual patients’ care

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

work collaboratively with medical, pharmacy, nursing staff, and other health providers to ensure safe and effective medicine use
collaborate with treating specialists to best manage patient care with the most rational use of pharmacotherapy

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 based on comparative efficacy, safety, and cost-effectiveness against medicines already on the market
consider equitable use of limited resources within the healthcare system to inform judicious prescribing habits, including communities who have not had previous access to specific medications
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
identify and address equity determinants as they pertain to prescribing
apply understanding of the prescription of medications within the Pharmaceutical Benefits Scheme or PHARMAC / special authority, both within the hospital system and the non-hospital setting, including when specific criteria / prescribing permissions apply

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

LG 11: Procedures

Learning Goal 11

Procedures

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by indications, assessing patient-specific factors, risks, benefits, and alternatives
confidently and consistently perform a range of common procedures
ensure team members are aware of all identified medication allergies and adverse reactions, and take precautions to avoid allergies and adverse reactions during procedures
ensure patients have complied with pre-procedure preparation
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
identify risks arising from perioperative and anaesthetic procedures in particular patients
optimise medical management during the peri-procedure period, such as anticoagulation management

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

accurately document procedures in clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medications 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
tailor language according to individual patients’ age and capacity to understand
communicate effectively with team members and patients prior to, during, and after procedures
ensure team members are confident and competent in their assigned roles
communicate with patients, surgeons, anaesthetists, and family members regarding medical issues and risk stratification
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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
specify credentialing requirements for unsupervised practice in procedures
demonstrate open disclosure and statutory duty of candour principles when complications occur

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
seek informed consent from patients for procedures they are undertaking

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
make clinical judgements and decisions based on the available evidence
select the most appropriate and cost-effective diagnostic procedures
adapt procedures in response to assessments of risks to individual patients
select appropriate investigations on the samples obtained in diagnostic procedures
evaluate the risks and benefits of operative interventions, especially in patients with comorbidities and competing clinical priorities

direction
Requires some supervision

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

The trainee may:

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
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

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

LG 12: Diagnostic decision making

Learning Goal 12

Diagnostic decision making

Select, organise, and interpret investigations

This activity requires the ability to:

select, plan, and interpret evidence-based, clinically appropriate investigations
prioritise patients receiving investigations (if there is a waiting list)
evaluate the anticipated value and potential risks of investigations
work in partnership with patients, their families, and/or carers to facilitate choices that are right for them, demonstrating patient-centredness
discuss choice of investigations with patients, their families, and/or carers, and obtain informed consent when required
provide aftercare / counselling for patients
accurately interpret the results and outcomes of investigations
effectively communicate the outcome of investigations to patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

carefully choose evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessment
recognise the differences between diagnostic and screening investigations
recognise the performance of specific investigations that include interpretation of sensitivity, specificity, predictive values, and likelihood ratios in the context of disease prevalence and clinical epidemiology
avoid use of low-yield diagnostic strategies that may not benefit patients
use the principles of distributive justice when considering equitable resource management
consider the risk of potential harm when choosing diagnostic investigations
avoid over-investigation and over-diagnosis
assess patients’ concerns, and determine the need for specific tests that are likely to address these
tailor investigations and management for individual patients’ circumstances in an equitable way
prioritise the order and importance when multiple investigations are required
recognise and correctly interpret abnormal findings within the clinical context, and act accordingly

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
recognise the significance of abnormal test results, and act on these
demonstrate awareness on how pre-test probability, sensitivity, specificity, positive and negative predictive values, and likelihood ratios for investigations alter the interpretation of results
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:

discuss the potential benefits, risks, side effects, cost, and burden of any proposed investigation, and obtain consent before proceeding
discuss with patients the rationale and the possibility of false negative / false positive results, as well as incidental findings
discuss the option of no investigation, and the risk / benefit of this with patients
use clear and simple language, and check that patients understand the terms used
use written or visual material or other aids that are accurate and up to date to support discussions with patients
offer patients the opportunity to ask further questions, and time to think about decisions
identify patients’ concerns and expectations, providing adequate explanation to address these
give information that patients may find distressing in a considerate way, using best practice techniques for breaking bad news
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
discuss the likely timeframe during which investigations will occur, and the plan for communicating results when available
discuss results using simple language, and explain how the results might affect future management
include sufficient clinical information to accurately convey patient context and the reason for investigation within the investigation request
keep relevant healthcare practitioners updated regarding planned investigations and results, including clear communication of who is responsible for reviewing these
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

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:

select appropriate investigations using a value-based care framework, such as Choosing Wisely
identify adverse outcomes, including false positives, false negatives, and incidental findings, that may result from a proposed investigation, focusing on patients’ individual situations
consider strategies to reduce the chance of harm, and employ these if possible / practical
recognise iatrogenic harms that may result from diagnostic investigations
ensure timely follow-up of investigation results, using recall / reminder systems and other tools if appropriate
take full responsibility for reviewing the results of ordered investigations, and hand this responsibility over to a designated colleague if this is not possible

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, diagnostic algorithms, evidence sources, and decision support tools
participate in clinical and epidemiological studies 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:

ensure appropriate ethics approval is obtained when undertaking investigations as part of clinical research
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
recognise principles of equity as they pertain to diagnostic decision making, and apply these appropriately to advocate for patients
explain the impact of implicit bias on diagnostic decision making, and initiate steps to address it

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

remain within the scope of the authority given by patients (with the exception of emergencies)
clarify who will make decisions on patients’ behalf if they are unable to do so
respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
advise patients if there may be additional costs, which they may wish to clarify before proceeding
obtain written informed consent when indicated, and informal informed consent at all other times, before planning investigations
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
adjust the investigative path depending on test results received
consider whether patients’ conditions may get worse or better if no tests are selected
avoid using investigations where the results are unlikely to change clinical management
demonstrate how the range of certainty around the accuracy of diagnostic tests and the efficacy of treatments may limit their applicability in clinical practice

direction
Requires some supervision

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

The trainee may:

choose the most appropriate investigation for 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 clear delegation of tasks within the team, including responsibility for following up test results
where an investigation is time critical, ensure this is understood by the team, including an expectation of timeframe and urgency of results
liaise with other involved healthcare professionals for expert advice when indicated

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

select and justify investigations based on the likely pathological basis of disease, appropriateness, utility, safety, and cost effectiveness
consider resource use through peer review of testing behaviours
actively support transfer of patients across health services as required to progress further investigation and management
support health policy and system development to improve equitable patient access to investigations
recognise and address equity barriers that impact the diagnostic decision-making process, and legal frameworks to counter these
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

LG 13: Ambulatory care

Learning Goal 13

Ambulatory care

Provide outpatient care across diverse settings

This activity requires the ability to:

identify the needs and context of patients as individuals, such as their cultural context and geographic location
take comprehensive patient histories, including accessing information from multiple external sources
adapt work practices and management plans to the appropriate clinical setting, such as resource availability and local healthcare infrastructure
liaise with other health professionals and team members, including in the management of medical procedures and treatments
respond to changing priorities and developing obstacles if / when they arise
manage clinic services, including working closely with administrative staff to schedule patients safely and balance workload / demand
generate written patient reports for referring healthcare practitioners and any other care providers
communicate with patients regarding management plans and treatment outcomes

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 electronic patient management systems and telehealth / video consultation in healthcare delivery
consider and apply knowledge relevance of local socioeconomic and geographic factors in accessing health care
effectively identify and address current clinical concerns, as well as longer-term clinical objectives, as appropriate to patients’ context
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
create accurate and appropriately prioritised problem lists in clinical notes or as part of ambulatory care reviews
update documentation in a time frame appropriate to the clinical situation of patients
use clinical information systems within the workplace to provide effective information transfers
be proactive in contacting referring clinicians for clinically urgent cases
display flexibility in organising health care provision in the face of external change
triage clinic referrals according to patient acuity, and consider alternative methods of assessment for patients with barriers to face-to-face review
consider alternatives to hospital admission where applicable

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

help patients navigate the healthcare system to improve access to care by collaboration with other services, such as community health centres and consumer organisations
incorporate appropriate LGBTQIA+ safe language, including gender affirming language
link patients to specific community-based health programs and group education programs
set up clear reporting lines and clinical parameters with junior doctors and nursing staff
communicate goals of projects, and engage others as appropriate
facilitate communication within meetings that respects values and engages all participants in decision making
provide appropriate time frames for review, and communicate who is responsible for arranging further referrals or investigations
communicate contingency plans for referring clinicians if initial plans do not provide the desired outcome
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

direction
Requires some supervision

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

The trainee may:

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

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
provide effective rostering of team members to ensure safe patient care
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

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 own professional practice
demonstrate learning behaviour and skills in educating junior colleagues
contribute to the generation of knowledge
maintain professional continuing education standards
constructively manage performance of individuals within teams
recognise the key factors impacting successful adult education

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:

explain principles of designing and leading clinical studies
inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation before obtaining informed consent

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community served, and how to shape service to those people
mitigate the influence of bias on interactions with patients and decision making
adapt practice to improve patient engagement and health outcomes
identify and support patients’ access to clinical and non-clinical supports appropriate to the individual patient and their community, such as kaimahi hauora, Aboriginal health practitioners, and relevant non-government organisations

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
recognise 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
demonstrate knowledge of the contemporary industrial rights and responsibilities of a team leader working with a healthcare team

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

integrate chronic condition management, early detection, health maintenance, and prevention, where relevant, into clinical practice
work to achieve optimal and cost-effective patient care that allows maximum benefit from the available resources
demonstrate efficient use of time in the planning of coordinated care for individual patients
make appropriate use of sub-specialist consultation services, and integrate their advice into patient care
implement methods to ensure patient care is appropriately monitored and reviewed, particularly in cases of diagnostic uncertainty
recognise own limitations and seek guidance from other clinicians, when required, in an appropriate way

direction
Requires some supervision

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

The trainee may:

explain the appropriate use of human resources, diagnostic interventions, therapeutic modalities, and health care facilities
inadequately consult with senior colleagues

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
work autonomously but in collaboration with other local healthcare providers
be aware of the roles of other healthcare providers in the ambulatory care setting
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:

demonstrate capacity to engage in the surveillance and monitoring of the health status of populations in the outpatient setting
maintain good relationships with health agencies and services
review and develop strategies to address supply / demand mismatch and access blocks
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs, such as virtual care and satellite clinics to rural health services
support patients’ access to receiving service and care in their community setting, such as access to culturally appropriate care and telehealth
recognise the limitations of virtual care (such as telehealth) and strategies to mitigate these, and the circumstances in which it may not be an advisable alternative
discharge patients appropriately to avoid expanding clinic waiting lists
use public resources responsibly
be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations

direction
Requires some supervision

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

The trainee may:

comprehend common population health screening and prevention approaches

LG 14: End-of-life care

Learning Goal 14

End-of-life care

Manage the care of patients at the end of their lives

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

recognise and manage the terminal phase in a timely way
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
manage symptoms commonly associated with end-of-life care, such as pain, dyspnoea, nausea, constipation, and emesis
confidently manage palliative care emergencies, and consider pre-emptive management plans
provide holistic symptom management focusing on psychological and physical distress, according to patients’ wishes
avoid unnecessary investigations or treatments
review the goals of care and treatment plans with patients, families, or carers if significant changes in patients’ conditions or circumstances occur

direction
Requires some supervision

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

The trainee may:

demonstrate awareness of the principles of care for patients at the end of their lives
provide timely assessments 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

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, family, and/or carers based on understanding, trust, empathy, and confidentiality
thoughtfully explore patients’ concerns and issues associated with impending death across physical, spiritual, cultural, and psychological domains
discuss disease prognosis and end-of-life decision making with patients and carers in a sensitive and effective manner
identify opportunities to discuss end-of-life care and to align care with patients’ values and preferences
identify who else patients wish to be involved in discussions about their end-of-life care, including proxy decision makers or other care providers
identify and document lists of close family members or carers, and develop support plans for them
provide bereaved families or carers with written information about access to bereavement support
communicate effectively and in a timely manner with other health professionals involved in patients’ care
negotiate with patients, family members, and/or carers the non-initiation, and withdrawal of, life-sustaining therapy when appropriate
discuss death certificates and reportable death protocols, including the medicolegal implications, with families and other health professionals as required
check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models

direction
Requires some supervision

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

The trainee may:

discuss with patients, family, and/or carers the goals of care and treatment, and document this in patients’ clinical records
ensure consistent messages are given to patients, families, or carers about treatment options, their likelihood of success, risks, and prognosis
provide honest and clear clinical assessment summaries, using plain language and avoiding medical jargon
discuss with family or carers 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, patients, families, and carers
participate in mortality reviews to determine the safety and quality of patients’ end-of-life care and how it could be improved
review technological systems and processes that support safe and high-quality end-of-life care
submit accurate death certificates and reportable death documentation as per local protocols

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 prognosis and advance care planning to multidisciplinary teams
ensure that actual care is aligned with patients’ documented wishes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure that quality end-of-life care management processes are evidence based and outcome focused
use systematic reviews or personal reviews and appraisal of the 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, families, and carers
offer support to patients to include cultural or religious practices in their care
develop strategies for identifying culturally appropriate decision makers, and obtain their input in discussions of patients’ end-of-life care
promote and use available culturally appropriate guidelines for end-of-life care in specific groups, including Aboriginal and Torres Strait Islander peoples and Māori

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

ensure all team members discuss end-of-life care with patients, and act on expressed patient preferences
enhance the quality of life for patients before death 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
ensure that care provided to patients is not burdensome or futile
recognise feelings of moral distress and burnout in themselves and colleagues

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

identify and support patients appropriate for conservative care, using advance health directives and care plans
maximise patients’ autonomy and their best interests when making treatment decisions
liaise with other relevant services when required, such as the coroner or legal teams
recognise own limitations and seek help, when required, in an appropriate way

direction
Requires some supervision

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

The trainee may:

define and document patients’, families’ or carers’ goals and agreed outcomes
inadequately consult with senior colleagues

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:

define the responsibilities and roles of team members involved in patients’ care
achieve agreement between multidisciplinary teams about patients’ treatment options
ensure care plans are communicated to all teams involved in patients’ care, including relevant community care providers
co-ordinate care and collaborate with other teams to provide end-of-life care, including palliative care, psychiatry, nursing services, and community providers
enable care and support to be provided in patients’ preferred place of care
effectively manage personal challenges of dealing with death and grief

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

allocate scarce health care 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: General medicine presentations and 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
Abdominal mass
Abnormal speech and communication
Adverse drug reaction
Agitation, acute
Altered bowel habit
Altered conscious state
Altered gait / Difficulty walking
Altered sensation
Anorexia / Loss of appetite
Anuria / Oliguria
Bleeding:
- abdominal
- rectal
- vaginal
Cardiac murmur
Changes to vision / Visual loss
Confusion
Constipation
Cough
Diarrhoea
Discharge:
- nipple
- urethral
- vaginal
Dizziness
Dysmenorrhoea
Dyspareunia
Dysphagia
Dyspnoea
Dysuria
Erectile dysfunction
Facial droop
Falls
Fatigue / Lethargy / Malaise / Tiredness
Fever
Haematemesis
Haematuria
Haemoptysis
Headache
Hearing loss
Hyperglycaemia
Hypertension
Hypoglycaemia
Hypotension
Insomnia
Intoxication, acute
Itch / Pruritus
Jaundice
Lesions:
- breast
- skin
Loss of consciousness
Lymphadenopathy:
- in the neck
Malnutrition
Medication optimisation / rationalisation
Melaena
Menorrhagia
Muscle weakness:
- generalised
- specific
Nocturia
Oedema / Swelling:
- generalised
- joint
- lower limb
- peripheral
Pain:
- abdominal
- acute
- chest
- chronic
- facial
- joint
- musculoskeletal
Pallor
Palpitations
Polydipsia
Psychological distress
Psychosis
Pyrexia of unknown origin
Rash
Seizure
Sensory disturbance
Somnolence
Stridor
Substance misuse
Suicidal ideation
Syncope
Tinnitus
Trauma:
- head injuries
- joint injuries
- lacerations
- soft tissue injuries
Tremor
Urinary retention
Vertigo
Vomiting
Weakness
Weight change:
- gain
- loss
Wheeze

Cardiovascular conditions

Arrythmia syndromes
Heart disease:
- ischaemic
- rheumatic
- valvular
Heart failure (HF):
- HF with preserved ejection fraction (HFpEF)
- HF with reduced ejection fraction (HFrEF)
Hyperlipidaemia
Myocarditis
Pericarditis
Physiological murmurs
Supraventricular tachycardia

Dermatological conditions

Adverse drug reaction
Burns
Cellulitis
Cutaneous malignancy
Dermatophytes
Eczema
Infections:
- ectoparasite
- fungal
- scabies
- viral
Naevi
Urticaria

Endocrinological conditions

Addison disease
Cushing syndrome
Deficiency:
- vitamin D
Diabetes:
- insipidus
- mellitus
Hyperthyroidism
Hypothyroidism
Metabolic syndrome
Obesity
Osteoporosis

Gastrointestinal conditions

Abdominal pain, chronic
Coeliac disease
Constipation, chronic
Gastroenteritis
Gastro-oesophageal reflux
Hepatitis:
- viral
Inflammatory bowel disease
Liver disease:
- acute
- chronic
Liver transplant
Malignancy
Micronutrient deficiency, such as vitamins:
- B1
- B12
- C
- D
Pancreatic insufficiency

Genitourinary / Gynaecological conditions

Endometriosis
Infections:
- sexually transmitted
- urinary tract
- vulvovaginal candidiasis
Lichen sclerosus
Neurogenic bladder
Renal calculi
Testicular torsion

Haematological / Oncological conditions

Anaemias
Bleeding disorders:
- haemophilia
Deficiency:
- iron
- vitamin B12
Haemochromatosis
Haemolysis
Haemophagocytic lymphohistiocytosis (HLH)
Idiopathic thrombocytopaenic purpura (ITP)
Late effects of cancer treatment
Leukaemias
Lymphomas
Neutropenia
Solid organ tumours
Thalassaemia
Thrombosis

Immunological conditions

Adverse drug reactions
Allergy:
- allergic rhinitis
- food (immunoglobulin E-mediated)
- insect
Primary immune deficiencies

Infectious disease conditions

Cellulitis, and other skin and soft tissue
Encephalitis and meningitis
Fever in a returned traveller
Gastroenteritis
Infections:
- diabetic foot
- genitourinary
- joint and prosthetic joint
- ophthalmological
- respiratory tract
- Staphylococcus aureus
- urinary tract
- viral
Infective endocarditis
Pyrexia of unknown origin
Septicaemia
Toxic shock syndrome

Kidney conditions

Acid-base and electrolyte disturbance
Glomerulonephritis
Hypertension
Kidney failure:
- acute injury
- chronic
Nephrotic syndrome

Mental health conditions

Anxiety disorder
Complex post-traumatic stress trauma
Depression
Grief and bereavement
Medical trauma
Needle phobia

Neurological and rehabilitation conditions

Bell's palsy
Central nervous system infections
Cerebral palsy
Encephalopathy
Epilepsy
Functional neurological disorder
Guillain–Barré syndrome
Headache:
- chronic
- tension
Injury:
- spinal cord
- traumatic brain
Migraine
Motor neurone disease
Multiple sclerosis
Peripheral neuropathy
Spinal cord compression
Stroke
Transverse myelitis

Respiratory and sleep conditions

Asthma
Bronchiectasis
Lung cancer
Lung disease:
- chronic obstructive
- interstitial
- restrictive
Obstructive sleep apnoea
Pleural effusion
Pneumonia:
- community-acquired
- hospital-acquired
Pneumothorax
Respiratory tract infections

Rheumatological conditions

Arthritis:
- psoriatic
- rheumatoid
Fibromyalgia
Gout
Osteoarthritis
Scleroderma
Systemic lupus erythematosus (SLE)
Vasculitis:
- large vessel
- small vessel

Sexual health medicine conditions

Infections:
- human immunodeficiency virus (HIV)
- other sexually transmitted infections and their complications
- syphilis
Pelvic pain syndromes
Pre-conception counselling

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Cardiac conditions

Congenital cardiac disease
Long QT syndrome

Endocrinological conditions

Congenital adrenal hyperplasia
Rickets
Transgender endocrine management

Gastrointestinal conditions

Malabsorption syndromes

Haematological / Oncological conditions

Asplenia
Bone marrow failure
Cancer predisposing syndromes
Hypersplenia
Hyposplenia
Iron overload
Leucocyte disorders
Neutropenia
Rare leukaemia
Rare solid tumour
Red cell structural disorders
Sickle cell disease

Immunological conditions

Autoimmune disorders
Complement deficiencies
Immunodeficiency syndromes
Neutrophil abnormalities

Infectious diseases

Arboviruses
Dengue fever
Healthcare-associated infections
Infections:
- mycobacterial
- parasitic
- with antibiotic resistant organisms
Japanese encephalitis
Malaria
Tuberculosis
Typhoid fever
Viruses:
- emerging
- hepatitis

Kidney conditions

Diabetes insipidus, nephrogenic
Haemolytic uraemic syndrome
Interstitial nephritis
Kidney failure, chronic
Kidney tubular disorders
Nephrotic syndrome

Mental health conditions

Bipolar and related disorders
Psychosis
Schizophrenia

Musculoskeletal and rheumatalogical conditions

Dermatomyositis
Localised scleroderma
Musculoskeletal pain, chronic
Systemic lupus erythematosus

Neurological conditions

Acute disseminated encephalomyelitis (ADEM)
Autonomic dysreflexia
Central nervous system inflammatory and immune-mediated disorders
Central nervous system tumours
Central venous sinus thrombosis
Cerebellar disorders
Charcot–Marie–Tooth disease
Congenital myasthenic syndromes
Duchenne muscular dystrophy
Idiopathic intracranial hypertension
Motor neurone disease
Movement disorders
Muscular dystrophy
Myopathy
Neurocutaneous syndromes
Neurodegenerative disorders
Spina bifida
Spinal muscular atrophy

Respiratory conditions

Cystic fibrosis

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Aetiology, epidemiology, and natural history for general medical conditions listed in this knowledge guide
An understanding of how the social determinants of health impact on the conditions listed in this knowledge guide
Diagnosis, natural history, and treatment options for people with complex, multisystem, and chronic disorders
Epidemiology and determinants of diseases in the local community
Long-term effects of chronic substance use
Pain management, treatment options, and referral to appropriate healthcare specialists
Pharmacology, such as:
- medication considerations for elderly patients
- medication rationalisation
- monitoring and toxicity of immunosuppressive drugs
- pain management
- polypharmacy and drug interactions
- side effects of psychiatric medications in normal doses and in over-dosage
Population and global health considerations, such as:
- burden of disease in population groups, nationally and globally
- disease prevention
- environmental influences on health
- global emergencies and the broad impact on populations
- health indicators and priorities locally, nationally, and globally
- immunisation health
- impact of climate change on health
- outbreak and disease control
Primary preventative care, such as:
- antibiotic prophylaxis and stewardship
- cancer screening recommendations
- preventing hospital-acquired complications
- promoting healthy lifestyles
- sexual health screening
- vaccination
Specific needs for an ageing population

Clinical assessment tools

Anthropometric assessment
Blood pressure monitoring
Cognitive assessment tools
Frailty measures
Pain severity measurement
Perioperative risk screening tools
Screening for common problems among older patients
Nutritional screening tools, such as:
- Malnutrition Universal Screening Tool (MUST)
- Subjective Global Assessment (SGA)
Visual acuity

Investigations

Biopsy – skin
Bone densitometry scan (DEXA)
Cardiac investigations, such as:
- ECG
- echocardiography
- exercise testing
- Holter monitoring
Micronutrient tests, such as:
- folate
- iron
- vitamin:
  - B12
  - C
- zinc
Non-cancer screening recommendations, such as:
- bone density
Other pathology, such as:
- cerebral spinal fluid:
  - culture and antimicrobial sensitivity
  - indications for additional testing, such as autoimmune / metabolic
  - microscopy
- genetic:
  - chromosomal microarray analysis (CMA)
  - whole exome sequencing (WES)
- site swabs, from sterile and non-sterile sites:
  - culture and antimicrobial sensitivity
  - microscopy
- stool:
  - calprotectin
  - culture
  - cysts, ova, and parasites
  - faecal occult blood
  - malabsorption tests
  - microscopy
  - specific antigen, such as Helicobacter pylori
  - toxin
- sweat test
- urine:
  - biochemistry
  - culture and antimicrobial sensitivity
  - microscopy
  - toxicology screening
Pathology tests, such as:
- antimicrobial, culture, and microscopy sensitivity
- biochemistry
- blood gases
- endocrinological
- genetic investigations
- haematological
- immunological and allergen testing
- inflammatory markers
- metabolic screening tests
- polymerase chain reaction (PCR):
  - bacterial
  - viral
- serology
Radiology, such as:
- CT scan
- knowledge of indications for additional specialist radiological investigations, such as:
  - barium studies
  - nuclear medicine studies, including:
    - bone scan
    - MAG3
  - PET
  - specialist x-rays
- MRI
- plain x-ray
- ultrasound
Respiratory investigations, such as:
- bronchoalveolar lavage
- nasopharyngeal aspirate
- pulmonary function tests
- sleep studies
Skin prick testing

Procedures (required)

Airway stabilisation procedures
Blood product transfusion
Indwelling urinary catheter insertion
Intravenous cannulation
Puncture:*
- arterial (arterial blood gas sampling)
- lumbar
Ventilation:
- high-flow oxygen therapy
- manual
- non-invasive ventilation:
  - bilevel positive airway pressure (BiPAP)
  - continuous positive pressure ventilation (CPAP)

Procedures (optional)

Arterial catheter insertion*
Ascitic aspirate / paracentesis
Aspiration:*
- bone marrow
- joint
- pleurocentesis
Bedside ultrasound
Biopsy:*
- liver
- skin
Bronchoscopy
Central venous catheter insertion
Endoscopy
Endotracheal intubation
Intercostal catheter insertion
Mechanical ventilation
Nasogastric tube insertion
Percutaneous long line (PICC)
Point-of-care ultrasound (POCUS)
Procedural sedation

* Highly recommended for trainees in rural, regional, and remote settings.

General management considerations

Chronic pain management and awareness of the psychosocial consequences of chronic pain, such as depression and work loss
Complexity theory and its application in the provision of holistic health care
Consideration of appropriate secondary prevention, such as secondary stroke prevention
Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel between rural and metropolitan areas
Cost, implications, and scope of healthcare-related adverse outcomes
Family violence awareness and screening
Goals of therapy
Informed consent
Medication review and polypharmacy management
Principles of trauma-informed, patient-centred care
Role of allied health professionals in holistic care of patients and families affected by illness
Tailoring treatment and management to the setting in which care is being provided, such as clinical resources and workforce planning
The timing of decisions and risks for the individual patient

Management considerations specific to ageing patients

Correlation between frailty and vulnerability
Impacts of changing familial dynamics / roles, such as children caring for ageing or frail parents
Role of aged care services and aged care assessment teams
Transitions to supported accommodation

Management considerations specific to end-of-life care

Awareness of voluntary assisted dying (VAD) legislation and implications for discussion and management of VAD as an end-of-life option
Common problems associated with end-of-life care, such as dyspnoea, end organ failure, and pain
Medical and social factors associated with medical futility
Medicolegal aspects of decisions regarding advance health directives, capacity to consent, and resuscitation
Suitability and timing of discussions regarding ceiling of care, organ donation, and resuscitation

Management considerations specific to patients with chronic illness

Awareness and access to appropriate disability services and aids
Difference between curative, palliative, and rehabilitative approaches to disease management
Factors in rehabilitation and lifestyle management
Impact of chronic disease and medication on fertility
Impact of illness and disability on patients’ ability to care for family members
Interplay of psychosocial factors in the morbidity of chronic disease
Long-term implications of chronic disease on work
Navigation of sub-specialty advice and guidelines
Stanford model of chronic disease management

Management considerations specific to young adults

Educational and vocational resources available to adolescents with special needs, and interaction of the physician with these services
Issues of consent
Transfer of responsibility from parents to patient

LG16: Acute care presentations and conditions

Key presentations and conditions

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Acute injury

Cervical spine injury
Fracture
Haemorrhage
Oesophageal foreign body
Pain, acute
Toxidromes:
- neuroleptic malignant syndrome
- serotonin syndrome

Allergy and immunology

Adverse drug reactions
Anaphylaxis

Behavioural and psychiatric

Aggression
Agitation
Altered mental state
Anxiety
Delirium
Dementia
Depression
Overdose
Psychosis
Substance abuse and dependence
Suicidal and self-harming behaviour

Cardiovascular

Angina
Arrhythmias
Cardiac arrest
Cardiac failure
Cardiac tamponade
Cardiogenic shock
Myocardial infarction, acute
Pain, chest
Palpitations
Pulmonary oedema, acute
Syncope

Endocrinological and metabolic

Adrenal crisis
Diabetes mellitus:
- diabetic ketoacidosis (DKA)
- hyperosmolar non-ketonic hyperglycaemia
Glucocorticoid insufficiency
Hypercalcaemia
Hyperglycaemia
Hypocalcaemia
Hypoglycaemia
Hypopituitarism
Thyroid disease

Fluid and electrolyte disturbance

Acid-base disturbance
Fluid overload
Hyperkalaemia
Hypernatraemia
Hypokalaemia
Hyponatraemia
Hypovolaemia

Gastrointestinal and nutrition

Anorexia nervosa / Starvation
Bleeding – gastrointestinal
Bowel obstruction
Colitis, acute
Complications of endoscopy
Gastro-oesophageal reflux
Hepatic encephalopathy
Liver failure:
- ascites
- cholestasis
- hepatic encephalopathy
- jaundice
- portal hypertension
- spontaneous bacterial peritonitis

Genitourinary

Kidney injury, acute
Renal calculi
Urinary retention

Gynaecological / Obstetric

Dysmenorrhoea
Ectopic pregnancy
Hyperemesis
Hypertensive disorders of pregnancy
Mittelschmerz
Ovarian torsion

Haematological / Oncological

Anaemia, acute
Compression:
- inferior vena cava (IVC)
- spinal cord
- superior vena cava (SVC)
Cytopenia
Disseminated intravascular coagulation
Febrile neutropoenia
Haemophagocytic lymphohistiocytosis
Macrophage activation syndrome
Tumour lysis syndrome
Venous thromboembolic disease

Infectious disease

Encephalitis and meningitis
Pneumonia
Septic arthritis
Septic shock
Toxic shock syndrome

Inflammatory / Rheumatological

Antineutrophil cytoplasmic antibodies (ANCA) vasculidities:
- eosinophilic granulomatosis with polyangiitis (EGPA)
- granulomatosis with polyangiitis (GPA)
- microscopic polyangiitis
Antiphospholipid syndrome
Giant cell arteritis
Scleroderma renal crisis
Systemic lupus erythematosis

Neurological

Altered conscious state
Ataxia
Confusion, acute
Dystonia
Headache
Intercranial haemorrhage
Seizure
Spinal cord compromise
Stroke
Visual disturbance, acute
Weakness / Paralysis:
- focal
- generalised

Respiratory

Asthma
Chronic obstructive airways disease
Pleural collection
Pneumothorax
Respiratory distress
Respiratory failure
Upper airway obstruction

Skin

Angioedema
Blistering rashes
Petechiae
Purpura
Urticaria

Shock

Cardiogenic
Distributive, including:
- anaphylactic
- neurogenic
- septic
- systemic inflammatory response syndrome (SIRS)
Haemorrhagic
Hypovolaemic
Obstructive

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Basic toxicology
Clinical pharmacology
Nutritional requirements of critically ill patients
Oxygen delivery, including evidence-based use of humified high-flow oxygen and non-invasive ventilation
Pathophysiology of cardiovascular failure, coma, respiratory failure, and shock
Physiology of acid-base and electrolyte disturbances
Procedural anxiety, pain management, and sedation:
- non-pharmacological
- pharmacological
Resuscitation and advanced life support

Clinical assessment tools

A–E assessment
Primary, secondary, and tertiary survey

Investigations

Blood tests, such as:
- antimicrobial and culture sensitivity
- bacterial and viral PCR
- biochemistry
- endocrinological
- haematological
- inflammatory markers
- serology
Cerebral spinal fluid analysis, such as:
- culture and antimicrobial sensitivity
- microscopy
- role for additional testing (autoimmune / metabolic)
Echocardiography
Radiology, such as:
- CT
- MRI
- plain x-rays
- ultrasound
Site swabs and samples, such as:
- antimicrobial and culture sensitivity
- microscopy
Tissue biopsy analysis, such as:
- culture
- flow cytometry
- histopathology
- immunofluorescence
- specific genetic markers
Toxicology screen
Urine analysis, such as:
- albumin / creatinine ratio
- antimicrobial and culture sensitivity
- biochemistry
- microscopy

Procedures (required)

Airway stabilisation procedures
Blood product transfusion
Indwelling urinary catheter insertion
Intravenous cannulation
Puncture:*
- arterial (arterial blood gas sampling)
- lumbar
Ventilation:
- high-flow oxygen therapy
- manual
- non-invasive ventilation:
  - bilevel positive airway pressure (BiPAP)
  - continuous positive pressure ventilation (CPAP)

Procedures (optional)

Arterial catheter insertion*
Ascitic aspirate / paracentesis
Aspiration:*
- bone marrow
- joint
- pleurocentesis
Bedside ultrasound
Biopsy:*
- liver
- skin
Bronchoscopy
Central venous catheter insertion
Endoscopy
Endotracheal intubation
Intercostal catheter insertion
Mechanical ventilation
Nasogastric tube insertion
Percutaneous long line (PICC)
Point-of-care ultrasound (POCUS)
Procedural sedation

* Highly recommended for trainees in rural, regional, and remote settings.

Advanced life support algorithms
Assessment of capacity / functional limitations, such as driving
Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel from rural to metropolitan areas
Cost, implications, and scope of healthcare-related adverse outcomes
Crisis resource management principles
Ethical and legal issues, including assessing decision-making capacity and identifying proxy decision makers
Family violence awareness and screening
Grief and bereavement
Informed consent in acute and emergency care
Management of patients with cognitive impairment / delirium
Principles of trauma-informed, patient-centred care
Relationship between primary care and specialist health services
Sexual assault
Tailoring treatment and management to the setting in which care is being provided, such as clinical and workforce resources

LG17: Obstetric 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.

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Investigations, procedures, and clinical assessment tools

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

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

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Important specific issues

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

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Presentations

Abnormal blood results
Cardiac murmur
Changes to vision
Constipation
Contraception advice
Cough
Dizziness
Dysglycaemia
Dyspnoea
Excessive gestational weight gain
Facial droop
Fatigue
Fever
Haematuria
Headache
Medication safety advice
Mental health presentations:
- anxiety
- birth trauma
- depression
- grief and bereavement
- psychosis
- suicidal ideation
Nausea
Oedema
Pain:
- acute
- chest
- chronic
Palpitations
Proteinuria
Seizures
Sensory disturbance
Substance misuse
Syncope
Thrombocytopenia
Vomiting
Weakness
Weight loss

Conditions

Amniotic fluid embolism
Anaemia
Bell's palsy
Carpal tunnel syndrome
Diabetes:
- gestational
- type 1
- type 2
Gastro-oesophageal reflux
Hypertensive disorders:
- chronic
- eclampsia
- gestational
- haemolysis, elevated liver enzymes and low platelets (HELLP)
- pre-eclampsia
Infections:
- genitourinary tract
- skin and soft tissue
- upper and lower respiratory tract
Intrahepatic cholestasis of pregnancy
Pre-conception counselling
Sepsis
Thromboembolic disease
Varicosities

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Pruritus

Conditions

Autoimmune disease
Cardiac disease
Epidural complications
Epilepsy
Hyperemesis gravidarum
Infections:
- chorioamnionitis
- cytomegalovirus (CMV)
- human immunodeficiency virus (HIV)
- listeria
- syphilis
- viral hepatitis
Kidney failure
Liver disease – gestational
Medical complications of tocolytic therapy
Mental health disorders:
- generalised anxiety disorder
- major depressive disorder
- postpartum psychosis
- post-traumatic stress disorder
Meralgia paraesthetica
Nausea and vomiting of pregnancy
Ovarian hyperstimulation syndrome
Thyroid disorders

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

Synthesise

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

Manage

provide evidence-based management
for less common or more complex presentations and conditions the trainee must also seek expert opinions
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

Contraception:
- alternatives to oestrogen-containing contraception, in the context of:
  - hypertension
  - liver disease
  - thrombophilia
  - thrombosis
- effects of contraception on medical disorders, such as:
  - cardiac disease
  - hypertension
  - liver disease
  - migraine
  - previous thrombosis
  - thrombophilia
- interactions between the oral contraceptive pill and other drugs, such as:
  - antibiotics
  - anticonvulsants
Difference between normal altered physiology and disease states
Pharmacology, such as:
- altered pharmacokinetics in pregnancy
- fetal effects of drugs
- risks of medications in pregnancy and lactation
Physiology of a normal pregnancy, including changes and adaptations to:
- cardiovascular system
- electrolyte maintenance
- endocrine function
- hepatic function
- immunology of pregnancy
- kidney function
- other physiological factors
- respiratory function
Range of normal symptoms experienced during pregnancy
Widened range of normality for findings of physical examinations due to pregnancy

Alterations in laboratory normal values imparted by pregnancy and the interpretation of the significance of abnormal tests:
- blood gases
- coagulation
- D-dimer
- electrocardiogram
- haemoglobin
- liver function tests (LFTs)
- platelets
- serology, such as:
  - CMV
  - HIV
  - listeria
  - rubella
  - syphilis
  - toxoplasmosis
  - varicella
  - viral hepatitis
- thrombophilia bloods
- thyroid function tests (TFTs)
- urinalysis
Impact of pregnancy on radiographic findings, such as kidney ultrasound
Risks and benefits of radiological imaging in pregnancy and lactation to patients and other healthcare professionals

Fetal implications of disease, such as thyroid disorders
Impact of pregnancy on pre-existing medical disorders
Long-term effects on maternal and paternal health following pregnancy complications
Medical contributors to infertility
Potential intrapartum and postpartum complications
Pre-existing maternal and paternal medical disorders and their impact on pregnancy

General management considerations

Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel from rural to metropolitan areas
Cost, implications, and scope of healthcare-related adverse outcomes
Family violence awareness and screening
Goals of therapy
Individual patient clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approaches to investigations and care
Informed consent
Medication review and polypharmacy management
Principles of trauma-informed, patient-centred care
Relationship between primary care and specialist health services
Role of allied health professionals in holistic care of patients and families affected by illness
Tailoring treatment and management to the setting in which care is being provided, such as clinical and workforce resources

LG18: Perioperative medicine

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

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

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Less common or more complex patient considerations

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

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Undertaking therapy

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

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Post therapy

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

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

Assessment of physiological reserve
Indications for common surgical procedures and their urgency
Perioperative medication management
Preoperative risk assessment, risk scores, and their interpretation
Principles of anaesthetic care
Principles of preoperative medical optimisation
Relevant society guidelines regarding perioperative management of adult patients
Risk factors for postoperative adverse outcomes and their prevention / management

Comprehensive preoperative assessment

Advanced care planning
Anaemia and optimising haemoglobin
Assessment of:
- cardiovascular risk
- complex comorbidities
- delirium and its prevention
- fall risk
- frailty
- functional capacity
- nutrition, such as malnutrition and obesity nutritional assessment tools, such as:
  - Malnutrition Universal Screening Tool (MUST)
  - Subjective Global Assessment (SGA)
Comprehensive geriatric assessment
Consideration of surgical indication and urgency
Fluid and electrolyte status and acid-base disturbance
Management of common high-risk medications, such as:
- anticoagulants
- diabetic medications, including insulin
- immunosuppressants, including steroids
Medication review and assessment, including medications to be discontinued or dosage-modified perioperatively
Medications with high risk of withdrawal syndromes, such as alcohol and opioids
Pain management
Previous anaesthetic history and complications
Principles of informed consent
Risk assessment tools, including:
- Duke Activity Status Index (DASI)
- National Surgical Quality Improvement Program (NSQIP)
Shared decision-making processes and support, including risks and benefits of surgical and non-surgical management
Utility of preoperative investigations

Adrenal crisis
Assessment prior to emergency surgery
Autonomic instability
Blood loss conservation, and indications for transfusion
Elective surgical planning
High-risk bleeding and thrombosis
High-risk cardiovascular disease
Marginal surgical candidates
Patients who would benefit from prehabilitation and rehabilitation
Phaeochromocytoma
Pituitary surgery
Pulmonary hypertension
Thyroid storm

Intraoperative considerations

Types of anaesthesia, such as:
- general anaesthetic, including:
  - inhalation
  - intravenous
- local
- regional
- sedation
Types of intraoperative monitoring
Types of vascular access, including:
- arterial lines
- central venous catheters
- peripheral

Postoperative considerations

Common postoperative complications, including:
- anaemia
- arrhythmias
- constipation
- delirium and/or other cognitive dysfunctions
- exacerbations of underlying comorbidities
- functional decline
- hypothermia
- kidney injury, acute
- malnutrition, such as:
  - micronutrient deficiency, including:
    - vitamin C
    - zinc
  - protein-calorie
- myocardial arrhythmias and injury
- nausea
- respiratory failure, such as:
  - aspiration
  - atelectasis
  - obstructive sleep apnoea
- sepsis
- urinary retention
- venous thromboembolism:
  - management
  - prevention
- vomiting
- withdrawal syndromes
Discharge planning considerations, including rehabilitation
Enhanced recovery after surgery (ERAS) protocols
Glycaemic control
Leading a rapid response call for a deteriorating patient

General management considerations

Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel from rural to metropolitan areas
Cost, implications, and scope of healthcare-related adverse outcomes
Family violence awareness and screening
Goals of therapy
Individual patient clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approaches to investigations and care
Informed consent
Medication review and polypharmacy management
Multidisciplinary collaboration throughout patients’ perioperative journeys
Principles of trauma-informed, patient-centred care
Relationship between primary care and specialist health services
Role of allied health professionals in holistic care of patients and families affected by illness
Tailoring treatment and management to the setting in which care is being provided, such as clinical and workforce resources

LG19: Health equity

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 and management and integrate these into care.

View

Disease prevalence in Indigenous, rural, and remote populations
Diseases with a higher prevalence in Aboriginal and Torres Strait Islander peoples and Māori, such as:
- acute rheumatic fever
- cardiovascular disease
- chronic kidney disease
- diseases associated with socioeconomic disadvantage:
  - hepatitis B
  - methicillin-resistant Staphylococcus aureus
  - scabies
  - smoking-related illnesses
- post-infectious glomerulonephritis
- rheumatic heart disease
- type 2 diabetes mellitus
Epidemiology of health equity and the factors which influence this, including:
- geography
- historical context, including:
  - colonisation
  - racism in all its forms
- social determinants of health
Population groups most likely to experience health inequity, such as:
- Aboriginal and Torres Strait Islander peoples
- LGBTQIA+ individuals
- Māori
- Pacific peoples
- migrant groups
- refugees

Clinical assessment tools

Socioeconomic indexes systemic bias (SES index)

Investigations

Malnutrition, such as vitamin C deficiency and scurvy as conditions related to social inequity / disability

Definitions of:
- ethical guidelines relating to advocacy
- healthcare equity – both generic and more contextually nuanced
- legislative frameworks
Frameworks for assessing health equity and pro-equity health service development, such as:
- common models of Indigenous health, such as Ngaa-bi-nya
- health equity assessment tools, including World Health Organization’s Health Equity Assessment Toolkit (HEAT)
- Tanahashi
Frameworks to aid self-reflective practice
Groups at risk of inequity, such as people who are:
- experiencing intimate partner and/or family violence
- living in geographically remote areas
- living in poverty
- living with housing insecurity
How a singular approach to equity may not be applicable across all contexts encountered
Importance of malnutrition testing, specifically vitamin C deficiency and scurvy, as conditions related to social inequity / disability
Statement of commitment to Indigenous health and wellbeing
Strategies for providing healthcare to people who are ineligible for subsidised care
Strategies to address inequities commonly encountered in clinical practice

Definitions of healthcare equity and legislative frameworks

Healthcare outcomes and priorities within Australia, Aotearoa New Zealand, and globally
Healthcare policy to address inequity, such as:
- National Agreement on Closing the Gap
- strategies to improve health equity, such as:
  - co-governance and co-design
  - community-controlled organisations
  - Kaupapa Māori health services
  - Pasifika healthcare organisation
Legislative frameworks that inform or mandate healthcare equity, such as:
- anti-discrimination legislation
- International Covenant on Economic, Social and Cultural Rights
- Pae Ora (Healthy Futures) Act 2022
- Te Tiriti o Waitangi
- United Nations’ Declaration of the Rights of Indigenous Peoples
- United Nations’ Universal Declaration of Human Rights

Health considerations for Aboriginal and Torres Strait Islander peoples

Importance of Country and community, such as:
- connection to new Country, and how this might impact on access to health care
- cultural obligations and practices, and spiritual beliefs
- health care delivery as close to home as possible
- health care-related decisions within the context of the individual’s family and community group
Knowledge of strategies to enhance health care interactions, such as:
- Aboriginal healthcare workers and nursing and medical staff
- Indigenous liaison officers and their role
- interpreters
- physical environment
- supporting shared decision-making processes, such as:
  - decision making by family groups
  - inpatient family ‘escorts’
The historical context of Aboriginal and Torres Strait Islander peoples’ status and health care provision, including:
- awareness of practical resources to mitigate risks of institutional racism and unconscious bias
- colonisation, history of discrimination, and inter-generational trauma
- consequent lack of trust in government-run services
- disempowerment and structural inequity
- institutional racism and unconscious bias

Health consideration for Māori

Common models of Māori health, such as:
- Te Pae Mahutonga
- Te Whare Tapa Whā
- Te Wheke
Culturally safe and competent consultations, including professional interactions with Pou Hāpai tiaki and kaimahi hauora
Initiatives that improve Māori health outcomes
Māori health practices, such as Rongoā Māori and mirimiri
Te Tiriti o Waitangi and the application of its five principles in health care
The role of racism and colonisation, including:
- determinants of health
- policy or system design
- quality healthcare
- socioeconomic deprivation and restricted access to decision making
The varied determinants that affect Māori health outcomes

Health equity in non-metropolitan areas

Differences in resource allocation and model of care between metropolitan and non-metropolitan areas
Environmental health issues for regional areas
Health priorities for rural and remote populations
Rural health inequity as an intersectional issue
Social determinants of health and wellbeing for rural and remote patients
The benefits, limitations, and role of telehealth / telemedicine

Health equity in the rural and remote context

Access to, availability, and functions of patient retrieval services
Barriers to health for people and Indigenous whānau living in rural and remote areas, including the impact of having to receive complex care away from home
Basic principles of retrieval medicine
Broad knowledge and the ability to manage (either on-site or remotely) a wide variety of conditions across a range of diverse settings while waiting for support or tertiary transfer
Disparities in health status and access to care for people living in rural and remote areas
Geographical distances between rural and remote communities and the nearest hospital, and the nearest metropolitan centre
Management planning that balances a multitude of factors to result in the desired health outcome, as defined by the clinician and patient in collaboration, with an acceptable degree of informed risk
Person- and culture-centred decision making about care, made in collaboration with the patient and local healthcare providers
Regional health service structures and referral pathways
Service availability in regions within jurisdiction of practice, such as:
- aged care, disability, and other support services
- allied health
- emergency care
- pathology
- primary care
- radiology
- specialist and subspecialist care
The level and type of clinical care that can be safely provided within the regional / remote context for patients with uncommon or particularly complex conditions, with remote guidance from subspecialists
The nuances of providing safe and effective care with reduced access to on-site resources, such as:
- collaboration with primary care / on-site healthcare providers
- flexible approaches
- independent practice
- resource use
- the use of technology, including telehealth
The sociodemographic and cultural profile of rural and remote communities and regions within the jurisdiction of practice and more broadly

Strategies to address inequities commonly encountered in clinical practice

Advocating for patients to overcome bias
Approaches to providing pro-equity care in a mana motuhake (self-determination)-enhancing fashion
Structural causes of health inequities in each clinical setting
The existing disparity in health-related outcomes for different populations, and the ongoing impact of all forms of systemic racism and bias
The importance of culturally safe communication for effective health care delivery with people of all cultures and backgrounds, with a strong commitment to Indigenous peoples
The importance of fostering culturally diverse teams and cross-cultural partnerships
The potential impact of one’s own culture and bias on one’s own practice

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

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

Description

Advanced Training in General and Acute Care 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 and service improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour