Curriculum standards

About this resource

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

This document outlines the curriculum standards for Advanced Training in Paediatric Rehabilitation Medicine for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Paediatric Rehabilitation Medicine LTA programs.

Download the curriculum standards PDF

LG1: Competencies

Competencies outline the expected professional behaviours, values and practices that trainees need to achieve by the end of training.

Competencies are grouped by the 10 domains of the professional practice framework.

Competencies will be common across all or most training programs.

Medical expertise

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

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

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

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

Communication

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

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

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

Professional standard. Physicians demonstrate a lifelong commitment to excellence in practice through continuous learning¹ and evaluating evidence.

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

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

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

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

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

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

References

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

Research

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

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

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

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

Cultural safety*

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

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

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

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

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

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

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

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

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

References

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

Ethics and professional behaviour

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

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

Sustainability. Manage the use of health care resources responsibly in everyday practice.

Entrustable Professional Activities

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

LG2: Team leadership

Learning Goal 2

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

participate in audits and other activities that affect the quality and safety of patients’ care
participate in multidisciplinary 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 knowledge and skills, 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 discussions 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 to achieve 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 and transparent decision making
make decisions when faced with multiple and conflicting perspectives
ensure medical input to organisational decision making
adopt a systematic approach to analysing information from a variety of specialties to make decisions that benefit health care delivery

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

understand the range of personal and other team members’ skills, expertise, and roles
acknowledge and respect the contribution of all health professionals involved in patient 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 health care teams to achieve organisational priorities
influence the development of organisational policies and procedures to optimise health outcomes
identify the determinants of health of the population, and mitigate barriers to access to care
remove self-interest from solutions to health advocacy issues

direction
Requires some supervision

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

The trainee may:

communicate with stakeholders within the organisation about healthcare 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/or different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication
listen and convey information clearly and considerately

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address challenges in health care delivery

This activity requires the ability to:

identify and report actual and potential (‘near miss’) errors
conduct and evaluate system improvement activities
adhere to best practice guidelines
audit clinical guidelines and outcomes
contribute to the development of policies and protocols designed to protect patients and enhance health care
monitor one’s own practice and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use population health outcomes to identify opportunities for improvement in delivering appropriate care
review patients’ or population health outcomes regularly to identify health care delivery improvement opportunities
evaluate health, environmental, and lifestyle risks
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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

use a systematic approach to improve the quality and safety of health care

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

use only protocols for human research approved by a human research ethics committee, in accordance with the national statement on ethical conduct in human research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively, demonstrating cultural awareness

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG5: 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 patients’ histories
examine patients
perform appropriate standardised assessments, such as:
- American Spinal Injury Association (ASIA) Impairment scale (AIS)
- Functional Independence Measure for Children (WeeFIM)
- manual muscle testing
- musculoskeletal assessment, including goniometer joint ranges
- post-traumatic amnesia testing
- standardised hypertonicity scales
- Westmead post-traumatic amnesia (PTA) testing
synthesise findings to develop diagnoses and identify impairments, activity limitations, and participation restrictions
discuss findings and goals with patients, families, and/or carers
generate multidisciplinary management plans
discuss findings and plan with other professionals, such as allied health clinicians, general practitioners, and school staff

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 and developmental histories, considering physical, psychosocial, and risk factors
perform full physical examinations to establish the nature and extent of problems
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses, impairments, activity limitations, and participation restrictions
assess the severity of problems, the likelihood of complications, and impact on function and clinical outcomes
develop goal-directed multidisciplinary management plans based on relevant guidelines, considering the harm / benefit balance by taking patients’ personal circumstances into account

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients, families, whānau, and/or carers to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other professionals involved in patients’ care

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 nonspeaking 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 challenging behaviours
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
inform patients of the risks associated with any part of the proposed management plans

direction
Requires some supervision

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

The trainee may:

perform hand hygiene, and take infection control precautions at appropriate moments
take precaution against patients displaying challenging behaviours, ensuring appropriate care of patients and safety of staff
document histories and physical examination findings, and synthesise with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

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 and management when required
recognise the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

use plain-language education materials, and demonstrate cultural and linguistical sensitivity
demonstrate effective and culturally safe communication and care for all groups, including Aboriginal and Torres Strait Islander peoples and Māori
use a professional interpreter, health advocate, or community member to assist in communication with families
understand patients’ beliefs and values, and how these might impact on health and function

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

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
prioritise patients and/or social welfare above personal interest or professional agendas

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate clinical reasoning by gathering focused information relevant to patients’ care
recognise personal limitations, seeking 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:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the multidisciplinary care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
provide optimal cost-effective care to allow maximum benefit from the available resources

direction
Requires some supervision

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

The trainee may:

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:

transfer care at any transition point, including:
- acute to sub-acute care
- inpatient / outpatient rehabilitation care to community care
- paediatric to adult care
- sub-acute to acute care
manage the transition of patients’ care to ensure the optimal continuation of care between providers
identify the appropriate health care providers and other stakeholders with whom to share patients’ 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, and in the community

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them
manage adolescent patients, including transition to adult services

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

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 an effective transition between settings, and continuity and quality of care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

check that handover is complete, or work to mitigate risks if incomplete
request follow-up of outstanding results or procedures 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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate respectfully with patients about their choices and preferences, discussing whether they are realistic and achievable, with careful consideration of health literacy, language barriers, and culture
recognise the timing, location, privacy, and appropriateness of sharing information with patients, families, whānau, and/or carers

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information
recognise the clinical, ethical, and legal rationale for information disclosure
share information about patients’ care in a manner consistent with privacy law and professional guidelines on confidentiality
recognise 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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

organise patients’ care delivery in the most appropriate setting, with the most appropriate provider

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

share the workload of transitions of care appropriately, including delegation
demonstrate understanding of the medical governance of patients’ care, and the differing roles of team members
show respect for the roles and expertise of other health professionals, and work effectively as a member of professional teams
provide the opportunity for patients’ engagement and participation across multidisciplinary teams

direction
Requires some supervision

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

The trainee may:

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
support processes for adolescents transitioning to adult health services

direction
Requires some supervision

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

The trainee may:

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

LG7: Longitudinal care

Learning Goal 7

Longitudinal care

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

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

formulate management goals and strategies collaboratively with patients, their families, and/or carers
work in partnership with patients, and motivate them to comply with agreed care plans, exploring and acknowledging the impact of any barriers to engagement with care plans
provide healthy lifestyle advice and information to patients on the importance of self-management

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management based on current clinical guidelines
educate patients in self-management, including recognising and monitoring their symptoms, undertaking self-management strategies, and seeking health advice appropriately

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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:

encourage patients to access culturally safe local networks to receive the support needed for long-term self-management

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

select suitable contexts, and include patients, their families, whānau, and/or carers, and other team members
adopt a patient-centred perspective, including adjusting for developmental stage and disabilities
select and use appropriate modalities and communication strategies
structure conversations intentionally
facilitate and guide discussion, encouraging participation from patients and families
integrate information from the multidisciplinary team to outline care considerations and identify shared goals
negotiate mutually agreed management plans
manage conflict as it arises
verify patients’, their families’, whānau, and/or carers’ understanding of information conveyed
develop and implement plans to ensure actions occur
document conversations

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and correct any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, giving adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
factor in diverse views from patients, families, carers, and medical teams into goals and planning
explore and facilitate realistic goals, wishes, and ways of successfully managing patients’ functional activities on a day-to-day basis

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use an appropriate communication strategy and modalities for communication, such face-to-face, videoconferencing, phone calls, and email
elicit patients’ views, concerns, and preferences, promoting rapport
provide information to patients in plain language, avoiding jargon, acronyms, and complex medical terms
encourage questions, and answer them thoroughly
ask patients to share their thoughts or explain their management plans in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
respond to patients’, families’, whānau, and/or carers’ emotions regarding discussions
treat children (tamariki) and young people respectfully, and listen to their views
use communication aids, such as interpreters, to enable patients to partake in discussions
communicate the outcomes of family meetings to wider team members who were absent from meetings
debrief after difficult and/or emotionally charged meetings

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, without 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 and/or advocacy team members as required

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

create a safe and supportive environment to enable patients to explore and discuss plans or goals during family meetings
discuss with patients their condition and available management options, including potential benefits and harms
consider young people’s capacity for decision making and consent
provide patients with clear information, checking their understanding before asking for their consent
recognise and take precautions where patients may be vulnerable, such as issues of child protection or self-harm
participate in processes to manage adverse events and patient complaints

direction
Requires some supervision

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

The trainee may:

inform patients of the 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 and management to be conducted
obtain informed consent or other valid authority before involving patients in teaching

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients that is based on evidence-based guidelines
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain informed consent or other valid authority before involving patients in research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally safe communication with all groups, including Aboriginal and Torres Strait Islander peoples and Māori
effectively communicate by meeting patients’ specific language, cultural, and communication needs
provide plain language and culturally safe written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

promote health literacy for patients and their families and carers
encourage and support patients, their families, whānau, and/or carers in caring for themselves and managing their health
demonstrate respectful professional relationships with patients
prioritise 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
recognise that the values, biases, or perspectives of patients, physicians, and other health professionals may have an impact on patient care, and modify the approach to patients accordingly

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
demonstrate a caring attitude towards patients
respect patients, including protecting their rights to privacy and confidentiality
use social media ethically and according to legal obligations to protect patients’ confidentiality and privacy
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours, or the illness itself

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

address questions from team members, and participate in conflict resolution within the team
summarise, clarify, and communicate responsibilities of healthcare team members
keep healthcare team members focused on patient goals and outcomes

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other services to help patients navigate the health, education, and disability systems

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 professionals and agencies as appropriate

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe medications tailored to patients’ needs and conditions

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ medical issues requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, allergies, chronic disease status, comorbidities, lifestyle factors, patient preference, and potential drug interactions prior to prescribing new medications
plan for follow-up and monitoring
administer medication appropriately, taking into consideration any important relationships to food, time of day, and other medicines being taken
provide written plans for medication commencement, up-titration, or weaning plans as 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 accurately, appropriately, and safely
demonstrate understanding of the benefits, contraindications, dosage, drug interactions, mechanism of action, rationale, risks, and side effects
identify and manage adverse events

Communication

confident
Ready to perform without supervision

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

The trainee will:

discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
write clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common, rare, and serious effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
check patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after a single prescription
identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives
communicate and collaborate with other clinicians involved in patients’ care
interpret and explain information to patients at the appropriate level of their health literacy

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

review medicines regularly to reduce non‑adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
prescribe new medicines only when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
report suspected adverse events to the relevant governing advisory body on drugs or medications in the jurisdiction, and record it in patients’ medical records
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
make prescribing decisions based on good safety data when the benefits outweigh the risks involved

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use continuously updated software for computers and electronic prescribing programs
check patients understand management plans, including adherence issues

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

demonstrate understanding of the ethical implications of pharmaceutical industry-funded research and marketing

direction
Requires some supervision

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

The trainee may:

consider the efficacy of medicines in treating illnesses, including the relative merits of different non-pharmacological and pharmacological approaches
follow regulatory and legal requirements and limitations regarding prescribing
follow organisational policies regarding pharmaceutical representative visits and drug marketing
acknowledge and discuss benefits and risks of alternative and complementary therapies that patients may wish to explore

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

prescribe in accordance with the organisational policy

LG10: Procedures

Learning Goal 10

Procedures

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

This activity requires the ability to:

select patient appropriate procedures in partnership with patients, their families, whānau, and/or carers
obtain informed consent
set up the equipment, maintaining an aseptic field where appropriate
perform procedures, including appropriate analgesia and sedation
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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

select procedures by assessing patient-specific factors, including risks, benefits, and alternatives
confidently and consistently perform a range of common procedures
communicate all identified allergies / adverse reactions to team members, and take precautions to avoid reactions during procedures
select appropriate patients, including muscle selection for botulinum toxin A dosing
select and use appropriate modalities for muscle localisation, including, but not limited to, musculoskeletal ultrasound
select appropriate analgesia and/or sedation for procedures in children (tamariki)
check that patients have complied with preprocedural 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
test dosing of intrathecal baclofen, including dosage and administration of lumbar punctures
perform routine management of intrathecal baclofen pumps, including management of dosage adjustment and pump refilling
investigate and manage intrathecal baclofen adverse events, including pump programming and side port catheter access

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide information in a manner so that patients, families, whānau, and/or carers are fully informed when consenting to any procedures
demonstrate an inconsistent application of aseptic technique
identify patients using approved patients’ identifiers before any treatment or intervention is initiated
attempt to perform 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 be familiar with relevant published procedural guidelines prior to undertaking procedures
organise or participate in in-service training on new technology
provide specific and constructive feedback and comments to junior colleagues
initiate and conduct skills training for junior staff

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures when adequately supervised
follow procedures to ensure safe practice

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

perform procedures in accordance with the organisational guidelines and policies

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

Yes

Not applicable n/a

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

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

Set up the equipment, maintaining an aseptic field where appropriate

Perform procedures, including appropriate analgesia and sedation

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

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

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

Set up the equipment, maintaining an aseptic field where appropriate

Perform procedures, including appropriate analgesia and sedation

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

LG11: Investigations

Learning Goal 11

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

identify adverse outcomes that may result from proposed investigations, focusing on patients’ individual situations
participate in clinical audits to improve test ordering strategies for diagnoses and screening

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

use appropriate guidelines, evidence sources, and decision support tools

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

LG12: Clinic management

Learning Goal 12

Clinic management

Manage an outpatient clinic

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify and effectively 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 an ambulatory care review
update documentation in a time frame appropriate to the clinical situation of patients

direction
Requires some supervision

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

The trainee may:

recognise the importance of prevention, early detection, and health maintenance

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 and disability system to improve access to care by collaboration with other services, such as community healthcare and therapy providers
link patients to specific community-based programs

direction
Requires some supervision

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

The trainee may:

meet patients’ specific language and communication needs
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
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
inform patients about billing 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 their own professional practice
demonstrate learning behaviour and skills in educating junior colleagues
maintain professional continuing education standards

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

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:

acknowledge the cultural needs of patients, families, and the community
mitigate the influence of one’s own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement, health, and rehabilitation outcomes

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

recognise the appropriate use of diagnostic interventions, therapeutic modalities, and specialised clinical services

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

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 and disability agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs

direction
Requires some supervision

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

The trainee may:

recognise common population health screening and prevention approaches

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.

LG13: Foundations of paediatric rehabilitation medicine

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 tinterpret the reported results of each investigation or procedure.

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

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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 intcare.

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Clinical sciences

Biomechanics of human movement, to assist in differentiating normal from pathological patterns, such as:
- functional electrical stimulation and its uses in paediatric rehabilitation
- phases of the gait cycle
- principles of balance and mobility
- principles of upper and lower limb orthotics to assist with function, prevention, care, and comfort, including resting and functional upper limb splints, supports, and gait orthoses
Bladder and bowel health, including:
- management of bladder and bowel dysfunction, including its medical and surgical options and how this varies depending on the patient’s developmental level and function
- methods of assessment of bladder and bowel health and function, such as urodynamics
- neurogenic dysfunction
- non-neurogenic dysfunction, such as:
  - constipation
  - enuresis
- physiology and pathophysiology of bladder and bowel function and dysfunction as related to conditions encountered in paediatric rehabilitation
Bone and musculoskeletal health, including:
- factors that lead to low bone mineral density and osteoporosis in the paediatric rehabilitation patient population
- management strategies for prevention and treatment, such as:
  - orthotic prescription
  - pharmacological
  - surgical
  - therapy
- monitoring guidelines and assessment tools for musculoskeletal complications
- pathophysiology of musculoskeletal complications commonly encountered in the paediatric rehabilitation population
Cardiovascular and respiratory health, including:
- exercise, fitness, and long-term cardiovascular health in people with a disability
- knowledge of the principles of assessment and management of respiratory health in children (tamariki) with disability
Child growth and development:
- assessment tools:
  - behavioural
  - cognitive
  - developmental
  - growth
- education, health, and support needs and implications for home, school, and community for children (tamariki) with disability and developmental differences
- impact of:
  - current level of development on the rehabilitation process
  - early intervention on disability trajectory and development
  - illness and injury on a child’s physical and cognitive development, and how the developmental stage of the child affects resulting disability
- intellectual disabilities associated with paediatric rehabilitation conditions
- management of puberty, reproductive health, and sexuality in young people with disability
- typical stages and ranges of development and growth across childhood and adolescence
Feeding and nutrition:
- assessment and management of drooling
- assessment and methods for feeding, including supplemental feeding for children (tamariki) with disability
- assessment of:
  - nutritional status
  - wwallow safety
- impact of nutrition and growth on disability
- nutritional requirements for children (tamariki) with illness, injury, and disability
Pain management:
- anatomy, pathophysiology, and physiology of pain perception and pathways
- assessment tools for pain
- management options:
  - environmental
  - pharmacological
  - physical
  - psychological
- multidisciplinary approach to pain management
Skin health and wound management:
- factors that lead to pressure injuries and skin breakdown, and prevention strategies
- knowledge of principles of assessment of pressure injury, including appropriate assessment tools
- principles of:
  - management of pressure injuries, including:
    - care of the wound
    - pressure relieving equipment
  - skin surveillance and skin breakdown
Vision and hearing:
- principles of assessment and management of vision and hearing impairments

Epidemiology

Concepts of primary, secondary, and tertiary prevention in the context of paediatric rehabilitation medicine
Epidemiology and natural history of diseases and injuries in childhood and adolescence that may result in disability
Major preventive health programs at state and national levels, with relevance to paediatric rehabilitation medicine
Preventative strategies regarding illness and injuries that may cause significant disability

Clinical assessment

Clinical surveillance tools for medical management
Functional measures in rehabilitation planning, management, and outcomes
Goal setting tools, such as:
- Canadian Occupational Performance Measure (COPM)
- Goal Attainment Scaling (GAS)
Patient measures:
- patient reported:
  - experience measures
  - outcome measures
Tools for assessment of activity, impairment, participation, and quality of life

Investigations

Appropriate investigations required to diagnose and treat common rehabilitation conditions, as well as prevention and management of complications
Application of knowledge of appropriate investigations to less common conditions
Investigations may include, but are not limited to:
- medical imaging, such as:
  - CT
  - MRI
  - nuclear medicine
  - ultrasound
- other investigations, such as:
  - genetic testing
  - neurophysiological testing
- pathology tests, such as:
  - blood
  - urine

Procedures

Administration of botulinum toxin A for hypertonicity and sialorrhea
Procedures as required for the assessment of and ongoing management of patients with intrathecal baclofen pumps, including:
- pump refill
- test dosing
- troubleshooting

Child safety

Emotional or behavioural presentation as a consequence of current or previous maltreatment, and the impact of neglect over time
Health needs of children (tamariki) and young people in the care and protection systems, including:
- in-home care
- out-of-home care
- under care of the justice system
patterns of inflicted and accidental injury

Community disability supports

Funding systems to support people with disability
Post-discharge and community care, including:
- community support services
- equipment and modifications to allow maximal independence at home and in the community
- formal and informal personal care and participation supports
- leisure and sports activities
- patient support organisations
- vocational rehabilitation

Educational support

Alternative schooling pathways
Assessment and verification of disability, including intellectual disability and learning disorders
Modification of curriculum and assessment to allow access
Special educational settings
Supports available for children (tamariki) to access curriculum

Family

Alternative and complimentary therapies commonly encountered in rehabilitation care
Caregivers’ health, both psychological and physical, and support services
Impact of disablement on the child or adolescent's family, including:
- changes to family function
- influence of family dynamics on rehabilitation outcomes
- need for support of the family during rehabilitation

Medicolegal

Knowledge of the process of guardianship in the setting of children (tamariki) and young people with a disability
Principles of report writing for medicolegal processes

Orthoses and equipment

Adaptive devices and mobility aids, and their indications and precautions for use, including, but not limited to:
- scooters
- standing frames
- walking frames
- walking sticks
- wheelchairs
Australasian and Aotearoa New Zealand standards for home modifications to accommodate disabilities and access to a built environment
Constraints, indications, and training required for use of adaptations and devices that improve function in the home, including, but not limited to:
- adaptive seating
- bathing
- hoists
- Sleeping equipment
Electrical stimulation
Prosthetics, orthotics, and adaptive equipment in the management of impairment and disability

Psychosocial health

assessment tools used to identify mood, behaviour, and adjustment conditions in the setting of disability
development of independence across childhood and adolescence in the setting of disability, including factors that may influence independence and promotion strategies
management options for behaviour and mood disorders, including how to access these and their indications:
- non-pharmacological
- pharmacological
- psychological therapies
Psychological and psychiatric issues:
- associated with familial adjustment, grief, and loss, and living with disability
- in the setting of disability, including:
  - adjustment disorders
  - anxiety
  - cognitive / behavioural disorders
  - depression
  - grief and loss
  - post-traumatic stress symptoms / disorder (PTSD)
  - typical psychological reactions to disablement

Rehabilitation assessment – disability and function

Concepts of impairment, disability, activity, and participation in reference to the International Classification of Functioning, Disability, and Health (ICF)
Early and effective rehabilitation / treatment to limit the disabling consequences of illness and injury
Early identification and treatment of disability, including secondary physical and psychological disabilities
Environmental factors that contribute to illness and injury, including psychological factors, and ethnic and cultural issues
Influence of cultural, educational, ethnic, gender, medical, physical, psychological, sexuality, and social issues on the determination of disability, and their possible effects on the outcome of rehabilitation

Rehabilitation implementation

Appropriate orthoses and assistive equipment for commonly encountered impairments in patients, and the limitations and training required to implement these
Core principles of the implementation and review of a realistic and appropriate rehabilitation program that specifies appropriate modalities of treatment
Impact of transitions of care in a patient's journey, and the implications for rehabilitation management and strategies to optimise these transitions
Principles of organisation and management of multidisciplinary rehabilitation, including the use of care plans and critical pathways
Role the family context plays in supporting the patient, and the influence of family dynamics on the rehabilitation plan

Rehabilitation planning

Roles and skills of rehabilitation team members
Roles of:
- government agencies, private organisations, and volunteer groups in community care and advocacy of people with disability
- hospital rehabilitation units, both inpatient and outpatient, and community systems
Standardised outcome measurement tools for the purpose of improving patient and service outcomes

LG14: Acquired brain injury

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

Sequelae of acquired brain injury (ABI), such as:
- behavioural
- cognitive
- medical
- physical
- psychosocial
- sensory

Conditions

Non-traumatic brain injury, such as:
- arteriovenous malformation
- hemispherectomy
- hypoxic brain injury
- immune conditions
- infections
- metabolic disorders
- stroke
- tumour
Traumatic brain injury (TBI), such as:
- concussion
- mild
- moderate
- severe

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Sequelae of acquired brain injury, such as prolonged disorders of consciousness

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

Synthesise

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

Manage

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

Consider other factors

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

Definitions of ABI and TBI, including measures of severity
Epidemiology and pathophysiology of ABI and TBI
Factors that affect the trajectory of recovery and disability after brain injury
Outcomes of ABI versus TBI
Post-traumatic amnesia, such as:
- clinical management
- methods of measurement
- significance regarding rehabilitation management and outcome

Clinical assessment tools

Assessment of post-traumatic amnesia, such as Westmead post-traumatic amnesia (PTA) scale
Clinical psychology assessments
Common neuropsychological tests of domains, such as:
- adaptive function
- attention and concentration
- executive function
- intellectual function
Glasgow Coma Scale
Rancho Los Amigos Scale
Speech and language assessments
Vestibular tests
Vision / Visual perception / Visuomotor integration tests

Investigations

Cerebral imaging, such as:
- angiogram
- CT
- magnetic resonance angiography (MRA)
- MRI
Medical imaging to assess sequelae of brain injury, such as video fluoroscopic swallow assessment

Procedures

Common neurosurgical procedures, such as:
- craniectomy
- external ventricular drain
- intracranial pressure monitoring
- ventriculoperitoneal (VP) shunt
Spasticity and movement disorder management

Acute management

Acute monitoring in acute neurosurgical care, emergency, and intensive care
Pharmacotherapy, including prophylactic anticonvulsant medication
PTA
Role of diagnostic investigations in management and prognosis
Role of paediatric rehabilitation medicine physician in acute neurosurgical and intensive care units

Complications of brain injuries – diagnosis and management

Aspiration pneumonia
Associated neuroendocrine disorders / pituitary dysfunction
Autonomic dysfunction syndrome, including paroxysmal sympathetic hyperactivity
Behavioural disturbance
Contractures
Fatigue and sleep disorders – altered sleep
Headache
Heterotopic ossification
Hypertonicity and movement disorders
Pain syndrome:
- central
- neuropathic
Post-traumatic hydrocephalus and VP shunting
Pressure areas
Psychiatric disorders, such as:
- alcohol and substance issues
- mood disorders
- post-traumatic stress disorder (PTSD)
- psychosis
- suicidality
Repeat brain injury during recovery phase
Seizures and epilepsy
Venous thromboembolism
Visual disturbances, such as:
- changes in visual acuity and fields
- cortical visual impairment (CVI)

Concussion

Acute management
Management of persistent symptoms, such as:
- behavioural and emotional challenges
- headaches
- sleep and fatigue
- vestibular and visual disturbance
Return to school and sport

Longer term management

Activities of daily living
Adjustment and grief
Assessment and management of symptoms, such as:
- attention
- concentration
- executive function
- intellectual disability
- memory
Behaviour
Cognitive disorders
Communication disorders
Community reintegration
Driving
Fatigue and sleep
Growth and nutrition, such as obesity
Pharmacotherapy
Physical function and impact of:
- balance
- contracture
- movement disorders
- spasticity
- vestibular
- weakness
Play and leisure
School reintegration and long-term educational support
Sexuality and relationships
Social skills
Vocational guidance

Prevention of brain injuries

pool fencing
road laws, including those relating to car seats and bicycle helmets
sporting guidelines

LG15: Cerebral palsy

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

Disorders of movement and posture identified in early life

Conditions

Cerebral palsy

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Other conditions presenting like cerebral palsy

Conditions

Genetic conditions, such as hereditary spastic paraparesis
Structural brain abnormalities

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

Synthesise

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

Manage

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

Consider other factors

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

Aetiology, pathogenesis and pathophysiology of cerebral palsy
Antenatal and postnatal strategies to prevent cerebral palsy
Common comorbidities seen in children (tamariki) with cerebral palsy
Epidemiology of cerebral palsy, including:
- incidence
- morbidity
- mortality
- prevalence
- probability:
  - infant
  - perinatal
Motor types and distribution of motor impairments in children (tamariki) with cerebral palsy
Natural history and musculoskeletal complications of cerebral palsy

Clinical assessment tools

Assessments of upper limb function, such as assisting hand assessment
Classification systems used to describe function in children (tamariki) with cerebral palsy, such as:
- Communication Function Classification System (CFCS)
- Eating and Drinking Ability Classification System (EDACS)
- Gross Motor Function Classification System (GMFCS)
- Manual Abilities Classification System (MACS)
Clinical gait assessment:
- 2D
- 3D
Musculoskeletal assessment, such as:
- range of motion
- selective motor control
- strength
- tone assessment
- tools, such as:
  - Assessment in SpondyloArthritis international Society (ASAS)
  - Modified Ashworth Scale (MAS)
  - Modified Tardieu Scale (MTS)
Scales describing motor function, such as:
- functional Mobility Scale (FMS)
- gross Motor Function Measure (GMFM)
Tools for identifying infants (pēpi) with a likelihood of cerebral palsy, such as:
- general Movements Assessment (GMA)
- hammersmith Infant Neurological Examination (HINE)

Investigations

Diagnostic tests for other aetiologies of motor delay, such as:
- chemical pathology
- genetic tests
- metabolic tests
Interpretation of medical imaging used in diagnosis of cerebral palsy
Interpretation of x-rays for musculoskeletal complications, such as:
- hip subluxation
- scoliosis

Procedures

botulinum toxin A
deep brain stimulation
intrathecal baclofen pumps
orthopaedic surgery
phenol injections
selective dorsal rhizotomy (SDR)

Early diagnosis and early intervention
Treatments and therapeutic interventions for cerebral palsy and evidence for their use, including:
- assessment, prescribing, and procedures for hypertonicity and movement disorders
- awareness of experimental and emerging treatments
- postoperative rehabilitation following orthopaedic surgery
- surveillance and management of common comorbidities, such as drooling and bone health
- surveillance for musculoskeletal complications, particularly hip subluxation and scoliosis:
  - knowledge of common orthopaedic procedures used to address musculoskeletal complications of cerebral palsy
  - knowledge of when to refer for orthopaedic intervention

LG16: Spinal cord injury and disease

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

Acquired spinal cord dysfunction

Conditions

Non-traumatic acquired spinal cord dysfunction with causes, such as:
- autoimmune
- infectious
- inflammatory
- neoplastic
- vascular
Traumatic spinal cord injury (SCI)

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Ventilator-dependent tetraplegia

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

Synthesise

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

Manage

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

Consider other factors

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

Anatomy of the spinal cord and column, including:
- blood supply and topography of motor
- motor and sensory levels, with corresponding myotomes and dermatomes
- sensory and autonomic pathways within the spinal cord
Autonomic dysfunction, including autonomic dysreflexia:
- management
- pathophysiology
- symptoms and signs
Factors influencing outcomes after SCI
Level and severity of injury:
- expected functional independence
- International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) classification
Pathophysiology of SCI, including:
- incomplete spinal cord injury syndromes
- mechanisms of SCI, including spinal cord injury without radiological signs (SCIWORA)
- Spinal shock
Physiology of the spinal cord, including effects on:
- bladder function
- bowel function
- cardiac function
- respiratory function
- sexual function
Skin integrity and pressure injuries

Clinical assessment tools

ISNCSCI
Musculoskeletal assessment
Neurologic exam

Investigations

Diagnostic medical imaging, such as:
- CT
- MRI
Investigation for sequelae, such as:
- bone densitometry
- polysomnography
- urodynamics
Investigation for surveillance following spinal cord injury, such as kidney ultrasound

Procedures

Bladder management strategies, such as:
- clean intermittent catheters
- indwelling catheter
- Mitrofanoff procedure
- suprapubic catheter
- vesicostomy
Bowel management strategies, such as:
- aperients
- enemas
Spasticity management
Surgical management for stabilisation after spinal cord injury

Prevention strategies for traumatic spinal cord injury

Acute management

Acute pressure care
Bladder management
Deep vein thrombosis (DVT) / Pulmonary embolism (PE) prophylaxis
Gastrointestinal dysfunction
Haemodynamics, including blood pressure
Neuroprotection strategies
Respiratory insufficiency, including:
- indications for mechanical ventilation and basic principles of noninvasive positive pressure ventilation and respiratory function in tetraplegia
- indications for mechanical ventilation
Spinal shock
Thermoregulation

Bladder and bowel management

Neurogenic bladder:
- assessment of bladder function
- monitoring for kidney complications of bladder dysfunction
- types of bladder dysfunction
Neurogenic bladder interventions, such as:
- bladder emptying, including clean intermittent catheterisation
- pharmacological management of neurogenic bladder
- surgical interventions, such as:
  - electrical nerve stimulators
  - external sphincterotomy
  - suprapubic catheter
  - vesicostomy
Neurogenic bowel:
- bowel management programs
- dietary management
- pharmacological management

Community reintegration

Adaptive techniques and assistive devices for activities for daily living (ADLs)
Available funding supports
Carer training
Community support services
Disability support options
Driving:
- assessment
- modification
- training
Housing, including:
- environmental controls
- equipment
- home modifications
Leisure and sports activities
Mobility
Peer support organisations
Return to education
Technology for:
- environmental control
- recreation
- vocation
Vocational rehabilitation

Long-term monitoring

ADLs and equipment
Bladder management and kidney surveillance
Bone health and fracture prevention
Growth and nutrition
Musculoskeletal surveillance of contracture, hips, and spine
Psychosocial support
Puberty and menarche management
Recreation and leisure
Respiratory and sleep health
School and vocation
Sexuality and reproductive health
Skin integrity

Management of common complications

Autonomic dysfunction, such as:
- autonomic dysreflexia
- impaired temperature control
- orthostatic hypotension
Heterotopic ossification
Pain
Respiratory insufficiency
Skin integrity and pressure issues
Spasticity and contractures
Spinal deformity
Syrinx
Venous thromboembolism

LG17: Congenital spinal 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

Congenital defects of spinal cord development

Conditions

Associated central nervous system pathology, such as:
- Chiari malformation type II
- obstructive hydrocephalus
Congenital spinal dysraphism conditions, such as:
- closed spinal bifida, including:
  - lipomyelomeningocoele
  - myelocoele
  - spinal lipoma
- open spina bifida myelomeningocoele
- sacral agenesis
- spinal dysraphism associated with VACTERL sequence and other syndromic diagnoses
- tethered cord

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Anencephaly
Encephalocoele

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

Synthesise

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

Manage

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

Consider other factors

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

Embryologic principles of spinal cord development
Public health interventions, such as folate
Risk factors for congenital spinal dysraphism

Clinical assessment tools

Cognitive assessment
Gait analysis:
- 2D
- 3D
Manual muscle testing (MMT)
Vision assessment

Investigations

Biochemistry:
- kidney function
Genetic investigations
Medical imaging, such as:
- antenatal:
  - MRI
  - ultrasound
- kidney ultrasound
- micturating cystourethrogram (MCUG)
- MRI
- urodynamics
Microbiology, such as urine microscopy and culture
Respiratory function testing
Sleep studies

Procedures

Antenatal surgery
Post natal surgery to close lesions and treat hydrocephalus
Surgery for lower limbs and spine
Surgical bladder and bowel management

Antenatal management

Antenatal counselling
Methods of prevention of neural tube defects, and antenatal care
Understanding grief and loss

Management of the infant

Bladder and kidney investigations and management:
- ladder catheterisation / alternative emptying
- imaging, including:
  - MCUG
  - ultrasound
- urodynamics
Bowel management
Handling and equipment
Hydrocephalus detection and management:
- cranial ultrasound / MRI
- head circumference measurement
- referral for treatment
- symptom identification
Long-term clinical considerations:
- Complications of neurogenic bladder:
  - management strategies to reduce risk
  - routine investigations
- growth and nutrition monitoring and support
- hydrocephalus:
  - cognitive assessment and support
  - monitoring for progression or signs of shunt malfunction
- mood and behaviour assessment and support
- musculoskeletal complications:
  - contracture prevention and management
  - prevention and management of foot deformity
  - spasticity management
  - spinal deformity monitoring, prevention, and management
- progressive spinal cord pathology – cord tethering and syrinx:
  - clinical monitoring
  - referral for investigation and management
- Skin care:
  - assessment and guidance regarding sensory deficits
  - pressure injury:
    - management
    - prevention
Orthopaedic management:
- hip ultrasound, and management of dysplasia
- management of congenital foot deformity

Supporting activity and participation

Community support:
- home modifications and equipment
- mobility
- recreation and leisure
- relationships
- reproduction
- sexuality
- support for personal cares and transport
- therapy
Educational support:
- personal care assistance
- physical access
- role and timing of neuropsychological assessments
- support and equipment to access the curriculum
Family and whānau supports
Funding supports
Peer supports
Vocational support

LG18: Limb differences and prosthetics

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

Short or absent limbs or digits
Traumatic limb loss

Conditions

Congenital upper and lower limb differences
Non-traumatic amputations, such as:
- infection
- ischemia
- tumour
Traumatic amputations

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Multiple amputations, such as those occurring from meningococcal disease
Multiple comorbidities, such as traumatic brain injury (TBI)

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

Synthesise

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

Manage

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

Consider other factors

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

Acquired amputation

Aetiology and pathologies leading to amputation
Incidence and prevalence, and mortality and morbidity, of limb injuries and amputation
Prevention of traumatic limb injury and amputation

Congenital limb difference

Aetiology, nomenclature, and pathogenesis of congenital limb differences
Antenatal diagnosis
Genetic and syndromic associations with limb differences
Incidence of congenital limb differences

Clinical assessment tools

Functional classification (K level)

Investigations

Postnatal investigations, including:
- genetic tests
- medical imaging

Procedures

Stump revision
Surgical treatment options for congenital limb differences
Types of surgical amputation

Complications of amputation

Skin infections and breakdown
Stump pain, such as:
- bony overgrowth and neuroma
- phantom pain and phantom sensation
- psychological impact, such as body image issues

Congenital upper and lower limb differences

Antenatal and early family counselling
Appropriate prosthetic management for:
- comorbidities
- the stage of development
- the underlying condition
Liaison with orthopaedic team for surgical considerations

Education, sport, and recreation

Liaison with school regarding activities in school curriculum
Recreational prostheses
Unique prosthetic needs and mobility goals for athletes

Post-amputation care

Dressings and wound management
Liaison with school and community providers
Pain management
Pre-prosthetic rehabilitation, such as prevention of contracture, and strengthening

Pre-amputation management

Developmental considerations
Pre-amputation pain, and prevention of postoperative pain
Psychosocial assessment and support

Prosthetic management

Early fitting and training with interim prostheses
Longitudinal care, and transition to adult service
Monitoring of wound and residual limb
Prescription of appropriate prosthesis and prosthetic components, considering child’s developmental stage and psychosocial considerations
Problems commonly seen in prosthetic ambulation
Prosthetic alignment and adjustment
Replacement of prosthetic components with growth and development

Prosthetic training

Application of prosthesis and suspension
Care and maintenance of prostheses
Muscle strength and conditioning exercise
Newer techniques to improve prosthesis control, such as osseointegration
Patient expectations of prosthetic use
Special needs of the bilateral amputee
Training in prosthesis operational use, such as myoelectric hands

LG19: Hypertonicity and movement disorders

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

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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.

View

Presentations

Ataxia
Dyskinesia, such as:
- athetosis
- chorea
- dystonia
Movement or posture disorders
Spasticity

Conditions

Acquired brain injuries
Cerebral palsy
Hereditary spastic paraplegia
Spinal cord injury

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

Synthesise

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

Manage

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

Consider other factors

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

Conditions

Genetic conditions, such as:
- Aicardi–Goutières syndrome
Genetic dystonias
Leucodystrophies
Metabolic conditions
Multiple sclerosis (MS)

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

Synthesise

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

Manage

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

Consider other factors

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

Epidemiology of conditions leading to hypertonicity and movement disorders in children (tamariki) and young people, such as:
- incidence
- morbidity
- mortality
- prevalence
Neuromuscular impairments, such as:
- contracture
- dystonia
- muscle weakness
- spasticity
- tremor
Neurophysiology of hypertonicity and movement disorders
Pharmacological treatments for dystonia, movement disorders, and spasticity, such as:
- alpha-2 (α2) adrenergic agonists, such as clonidine
- baclofen
- benzodiazepines, such as diazepam
- botulinum toxin A
- gabapentin / pregabalin
- tetrabenazine
- trihexyphenidyl HCL (Artane)

Clinical assessment tools

Goal setting and outcome measurement tools
Hypertonicity and dystonia assessment tools
Muscle strength
Musculoskeletal examination
Specific assessment for activity, impairment, participation, and quality of life
Specific spasticity scale measures, such as:
- Australian Spasticity Assessment Scale (ASAS)
- Modified Ashworth Scale (MAS)
- Tardieu Scale

Investigations

Biochemical tests, such as neurotransmitters in cerebrospinal fluid (CSF)
Genetic tests
Hip surveillance
Medical imaging, such as:
- CT
- MRI
Scoliosis monitoring

Procedures

Botulinum toxin type A, including:
- dosing
- rvidence for use
- mechanism of action
- risks
Deep brain stimulation, intrathecal baclofen, and selective dorsal rhizotomy, and their:
- benefits
- evidence for use
- mMechanisms of action
- risks
Muscle anatomy and function, and injection guidance techniques, including:
- muscle stimulation
- surface anatomy
- use of ultrasound
Neurosurgical procedures used in movement disorder management, such as:
- neurectomy
- pallidotomy
Orthopaedic procedures for musculoskeletal complications of hypertonicity and movement disorders, such as:
- bone surgery
- spine surgery
- tendon surgery

Physical therapy modalities

Electrical stimulation, such as functional electrical stimulation (FES)
Muscle strengthening
Stretch and positioning, such as:
- casting
- orthoses
- seating
- splints
- standing
Task-specific training

Prevention / Reduction of noxious stimuli

Bladder infections
Bowel constipation
Fatigue
Fractures
GORD
Hip dislocation / subluxation
Oral health
Pain
Scoliosis
Skin problems, such as:
- infections
- pressure wounds

LG20: Musculoskeletal, neuromuscular and other specific conditions requiring rehabilitation

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Presentations

Autonomic dysfunction
Functional sequelae:
- associated with common acquired neuromuscular conditions
- of weakness associated with congenital neuromuscular conditions
Impairment associated with congenital musculoskeletal disorders, such as short stature
Pain

Conditions

Acquired neuromuscular conditions such as Guillain Barre syndrome
Congenital musculoskeletal disorders such as skeletal dysplasia
Congenital neuromuscular conditions such as muscular dystrophy

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations

Functional decline unrelated to neurological injury or disease (deconditioning)
Physical impairment associated with acquired musculoskeletal disorders

Conditions

Acquired medical and surgical conditions impacting on function and independence, such as:
- burns
- chronic fatigue syndrome
- functional neurological disorders
- persistent pain syndromes
Acquired musculoskeletal disorders such as slipped upper femoral epiphysis
Complex congenital behavioural, developmental, or other medical disorders and comorbidities that may impact participation and outcomes of rehabilitation programs, such as complex congenital heart disease

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

Synthesise

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

Manage

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

Consider other factors

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

Clinical sciences

Impact of conditions on:
- activity
- development
- function
- growth

Epidemiology

Prevalence and probability of common musculoskeletal and neuromuscular conditions

Pathophysiology

Cellular, molecular, and structural pathology for common musculoskeletal and neuromuscular conditions
Genetics of hereditary musculoskeletal conditions
Musculoskeletal anatomy
Principles of healing, plasticity, and regeneration

Clinical assessment tools

Common assessments used for surveillance and outcome measurement across International Classification of Functioning, Disability, and Health (ICF) domains for common conditions

Investigations

Interpretation of investigations to assess sequelae of neuromuscular disease, such as:
- bone densitometry
- polysomnography
- videofluoroscopic swallow study (VFSS)
Investigations for antenatal and/or early diagnosis of congenital musculoskeletal conditions, such as:
- antenatal ultrasound
- genetic testing
- MRI
Investigations for screening and diagnosis of congenital neuromuscular conditions, such as:
- creatine kinase (CK)
- genetic testing
- muscle biopsy
Investigations required for:
- diagnosis of common acquired musculoskeletal conditions, such as:
  - bone scan
  - hip x-ray
- surveillance for specific congenital musculoskeletal conditions, such as craniocervical MRI for skeletal dysplasia

Procedures

Common orthopaedic procedures for musculoskeletal conditions, such as slipped upper femoral epiphysis
Common procedures required for management of sequelae of above conditions, such as home ventilation
Common surgical procedures for neuromuscular conditions, such as nerve grafting for brachial plexus injury

Surveillance, identification, and management of common sequelae of childhood disabilities, including:
- accounting for the effects of developmental age and stage on resulting disability
- the impact of the illness or injury on the child’s physical and cognitive development
Treatments used for disease modification or symptomatic management of:
- common congenital:
  - musculoskeletal conditions
  - neuromuscular disorders
- Duchenne muscular dystrophy
- short stature in achondroplasia
- spinal muscular atrophy

Management of congenital musculoskeletal disorders

Specific handling and surveillance protocols, such as achondroplasia management guidelines

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

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

Description

Advanced Training in Paediatric Rehabilitation 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

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork