Curriculum standards

About this resource

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

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

Download the curriculum standards PDF

LG1: Competencies

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

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

Competencies will be common across training programs.

Medical expertise

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

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

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

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

Communication

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

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

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

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

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

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

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

Quality and safety

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

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

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

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

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

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

Teaching and learning

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

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

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

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

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

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

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

References

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

Research

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

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

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

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

Cultural safety*

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

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

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

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

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

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

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

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

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

References

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

Ethics and professional behaviour

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

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

Physicians demonstrate high standards of personal behaviour.

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

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

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

Accountability. Be personally and socially accountable.

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

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

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

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

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

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

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

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

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

Judgement and decision making

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

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

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

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

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

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

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

Leadership, management, and teamwork

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

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

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

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

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

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

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

Health policy, systems, and advocacy

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

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

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

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

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

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

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

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

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

Entrustable Professional Activities

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

LG2: Team leadership

Learning Goal 2

Team leadership

Lead a team of health professionals

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address failures in health care delivery

This activity requires the ability to:

identify and report actual and potential (‘near miss’) errors
conduct and evaluate system improvement activities
adhere to best practice guidelines
audit clinical guidelines and outcomes
contribute to the development of policies and protocols designed to protect patients, reduce bias, achieve equity, and enhance health care for all
monitor one’s own practice with critical self-reflection, and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

use population health outcomes to identify opportunities for improvement in delivering appropriate care
regularly review patients’ or population health outcomes to identify opportunities for improvement in delivering appropriate care
regularly monitor personal professional performance
represent needs of specific priority populations at local levels and appreciate roles and importance of advocacy at a national level

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
use standardised protocols to adhere to best practice and prevent the occurrence of procedural errors

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

communicate effectively with patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

LG5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

elicit accurate, organised, and problem-focused medical histories, including sexual history, considering physical, psychosocial, and other risk factors
perform focused genitourinary examinations with view to full physical examinations, where relevant and required, to establish the nature and extent of symptoms
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses via reasonable differential diagnoses
assess the severity of problems, likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients’ personal sets of circumstances into account

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 clinical encounters and diagnostic categories
develop appropriate management plans

Communication

confident
Ready to perform without supervision

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

The trainee will:

communicate openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to patients to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
communicate clearly, effectively, respectfully, and promptly with other health 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 nonverbal cues
demonstrate active listening skills
communicate patients’ situations to colleagues, including senior clinicians

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
recognise aggressive and violent patient behaviours, and have strategies for de-escalation and management of these behaviours to the extent possible through appropriate training
obtain informed consent before undertaking any investigation or providing treatment (except in an emergency)
ensure patients are informed of the material risks associated with any part of proposed treatment or 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 assaults from confused or agitated patients, ensuring appropriate care of patients
document history and physical examination findings, and synthesise with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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 when required
demonstrate awareness of the limitations of evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

share relevant information with members of the healthcare team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
demonstrate awareness of local and national strategies in relation to sexually transmitted infections (STIs) and blood-borne viruses (BBVs)

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 patient care
access public health acts and privacy legislation relevant to location

LG6: Management of transitions in care

Learning Goal 6

Management of transitions in care

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

This activity requires the ability to:

manage transitions of patient care to ensure the optimal continuation of care between providers
identify the appropriate care providers and other stakeholders with whom to share patient information
exchange pertinent, contextually appropriate, and relevant patient information
perform this activity in settings appropriate to sexual health medicine

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

facilitate optimal transitions of care for patients
identify and manage key risks for patients during transition
anticipate possible changes in patients’ conditions, and provide recommendations on how to manage them

direction
Requires some supervision

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

The trainee may:

understand the details of patients’ conditions, illness severity, 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
initiate and maintain verbal communication with other health professionals, when required
communicate with patients, families, and/or carers about transitions of care, and engage and support these parties in decision making

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

ensure that handover is complete, or work to mitigate risks if incomplete
ensure results are received and actioned
keep patients’ information secure, adhering to relevant legislation regarding personal information and privacy
ensure the safety and wellbeing of children and young people by providing information to others for the purpose of ensuring safety, according to relevant legislation

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

take opportunities to teach junior colleagues during handover, as necessary

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

communicate with careful consideration to health literacy, language barriers, and culture about patient preferences, and whether they are realistic and possible, respecting patient choices
recognise the timing, location, privacy, and appropriateness of sharing information with patients and their families or carers
collaborate with health promotion officers, Indigenous health workers, and non-government organisations to achieve positive outcomes with specific communities

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 backgrounds, and whether an interpreter is required

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

disclose and share only contextually appropriate medical and personal information
demonstrate understanding of the clinical, ethical, and legal rationale for information disclosure
share information about patients’ care in a manner consistent with privacy laws and professional guidelines on confidentiality
respect patients’ rights to privacy, and develop systems to ensure patients’ personal information remains confidential where appropriate
demonstrate strategies to maintain enhanced confidentiality through clinic and systems measures
manage unexpected or unanticipated disclosure of confidential information
interact in a collegiate and collaborative way with professional

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
demonstrate understanding of legislation and policies related to some types of patient information, such as BBV status, and seek appropriate advice about disclosure of such information

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

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 transition of care
engage in organisational processes to improve transitions of care, such as formal surveys or follow-up phone calls after hospital discharge

direction
Requires some supervision

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

The trainee may:

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

LG7: Emergency and longitudinal care

Learning Goal 7

Emergency and longitudinal care

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

This activity requires the ability to:

recognise and assess patients requiring urgent care that may be seen in the sexual health setting, and facilitate patients’ care in a timely manner
recognise and manage anaphylaxis, and perform basic life support according to resuscitation council guidelines
manage chronic and advanced conditions, complications, disabilities, and comorbidities
develop management plans and goals in consultation with patients, families, and/or carers
facilitate patients’ and/or families’ and/or carers’ self-management and self-monitoring
collaborate with other care providers
ensure continuity of care
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, including people living and aging with HIV
ensure patients contribute to their needs assessments and care planning
monitor treatment outcomes, effectiveness, and adverse events
coordinate patients’ management in a multidisciplinary team environment, including collaborating with other specialties as required
systematically identify causes of acute deterioration in health status and levels of physical and cognitive functioning
ensure appropriate initial management of emergencies, such as anaphylaxis
ensure appropriate referral for emergency ongoing care
provide urgent care when required and appropriate

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
provide documentation on patients’ presentation, management, and progress, including key points of diagnosis and decision making, to inform coordination of care
recognise seriously unwell patients requiring immediate care
identify potential causes of current deterioration, and comply with escalation protocols
facilitate initial tests to assist in diagnosis and develop management plans for immediate treatment

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
negotiate realistic treatment goals, and determine and explain the expected prognoses and outcomes
employ communication strategies appropriate for younger patients or those with cognitive difficulties
explain the situation to patients in a sensitive and supportive manner, avoiding jargon and confirming their understanding
determine the level of health literacy of individual patients and their level of understanding of agreed care decisions

direction
Requires some supervision

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

The trainee may:

provide healthy lifestyle advice and information to patients on the importance of self-management
work in partnership with patients, and motivate them to comply with agreed care plans
demonstrate communication skills to sufficiently support the function of multidisciplinary teams
if possible, determine patients’ understanding of their diseases and what they perceive as the most desirable goals of care
triage patients requiring urgent care

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

use 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 patients to become more independent
participate in quality improvement processes impacting on patients’ abilities to undertake normal activities of daily living
identify evidence-based practice gaps using clinical indicators, and implement changes to improve patients’ outcomes
coordinate and encourage innovation, and objectively evaluate improvement initiatives for outcomes and sustainability
analyse adverse incidents and sentinel events to identify system failures and contributing factors

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

contribute to the development of clinical pathways for chronic diseases management and comorbidities, including people living and aging with HIV, based on current clinical guidelines
educate patients to recognise and monitor their symptoms, and undertake strategies to assist their recovery
mentor and train others to enhance team effectiveness
provide constructive feedback to junior colleagues to contribute to improvements in individuals’ skills
seek guidance and feedback from healthcare teams to reflect on encounters and improve future patients’ care

direction
Requires some supervision

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

The trainee may:

use clinical practice guidelines for chronic diseases management
contribute to team education, including education for junior colleagues

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
evaluate the value of treatments in terms of relative and absolute benefits, cost, potential patient harm, and feasibility
evaluate the applicability of the results of clinical studies to the circumstances of individual patients, especially those with multiple comorbidities
specify research evidence to the needs of individual patients

direction
Requires some supervision

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

The trainee may:

search literature using problem / intervention / comparison / outcome (PICO) format
recognise appropriate use of review articles
use information from credible sources to aid in decision making
refer to evidence-based clinical guidelines and protocols on acutely unwell patients
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

encourage patients from culturally and linguistically diverse backgrounds to join local networks to receive the support needed for long-term self-management
negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems, particularly in the priority groups seen in sexual health medicine
integrate culturally appropriate care of Aboriginal and Torres Strait Islander peoples and Māori into patients’ management
consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams

direction
Requires some supervision

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

The trainee may:

provide culturally safe chronic disease management
practise cultural competency appropriate for the community serviced
proactively identify barriers to care access

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

share information about patients’ health care, consistent with privacy laws and confidentiality and professional guidelines
use consent processes for the release and exchange of health information
assess patients’ decision-making capacity, and appropriately identify and use alternative decision makers
consider the consequences of delivering treatment that is deemed futile, directing to other care as appropriate
facilitate interactions within multidisciplinary teams respecting values, encouraging involvement, and engaging all participants in decision making
demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy

direction
Requires some supervision

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

The trainee may:

share information between relevant service providers
acknowledge and respect the contribution of health professionals involved in patients’ care
communicate medical management plans as part of multidisciplinary plans
establish, where possible, patients’ wishes and preferences about care
contribute to building a productive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

implement stepped care pathways in the management of chronic diseases and disabilities
recognise patients’ needs in terms of both internal resources and external support on long-term health care journeys
recognise the need for escalation of care, and escalate to appropriate staff or services
integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and cause into clinical decision making

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
involve additional staff to assist in a timely fashion 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
work collaboratively with staff in the emergency department, intensive care, and other subspecialty inpatient units when relevant

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
encourage an environment of openness and respect to lead effective teams

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

use health screening for early intervention and chronic diseases management
assess alternative models of care delivery to patients with chronic diseases and disabilities
participate in government initiatives for chronic disease management to reduce hospital admissions and improve patients’ quality of life
help patients access initiatives and services for patients with chronic diseases and disabilities
use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
prioritise patients’ care based on need, and consider available resources
demonstrate understanding of the social determinants of sexual health and wellbeing, such as financial impact, stable housing, education and literacy, transport, and accessibility
collaborate with other specialist colleagues to develop policies and protocols for areas of need

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

LG8: Communication with patients

Learning Goal 8

Communication with patients

Discuss diagnoses and management plans with patients

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

anticipate and be able to correct any misunderstandings patients may have about their conditions and/or risk factors
inform patients of all aspects of their clinical management, including assessments and investigations, and give them adequate opportunity to question or refuse interventions and treatments
seek to understand the concerns and goals of patients, and plan management in partnership with them
provide information to patients to enable them to make informed decisions about diagnostic, therapeutic, and management options
apply public health, ethical, and legal principles to achieve a high level of patient participation in processes of partner notification, by patient or provider

direction
Requires some supervision

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

The trainee may:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

use appropriate and confidential communication strategies and modalities for communication, such as emails, face-to-face, or phone calls
elicit patients’ views, concerns, and preferences, promoting rapport
establish supportive relationships with patients, families, and/or carers based on understanding, trust, empathy, and confidentiality
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 plan in their own words, to verify understanding
convey information considerately and sensitively to patients, seeking clarification if unsure of how best to proceed
treat all people respectfully, including adolescents, and young and older people, and listen to their views
recognise the role of family or carers and, when appropriate, encourage patients to involve their family or carers in decisions about their care
discuss new clinical diagnoses with patients, with empathy and understanding

direction
Requires some supervision

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

The trainee may:

select appropriate and confidential modes of communication
engage patients in discussions, avoiding the use of jargon
check patients’ understanding of information
adapt communication style in response to patients’ age, developmental level, and cognitive, physical, cultural, socioeconomic, and situational factors
collaborate with patient liaison officers as required
ensure consistent messages are given to patients, families, and/or carers about treatment options, their likelihood of success, risks, and prognosis

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

obtain informed consent or other valid authority before involving patients in teaching
teach others about patient communication, particularly regarding sexual health, such as communicating a harm minimisation approach related to sexual activity, sex positive communication, and communicating with people of diverse genders and sexualities

direction
Requires some supervision

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

The trainee may:

participate in ongoing learning regarding patient communication, particularly regarding sexual health, such as communicating a harm minimisation approach related to sexual activity, sex positive communication, and communicating with people of diverse genders and sexualities

Research

confident
Ready to perform without supervision

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

The trainee will:

provide information to patients that is based on guidelines issued by the National Health and Medical Research Council and/or Health Research Council of New Zealand
provide information to patients in a way they can understand before asking for their consent to participate in research
obtain an informed consent or other valid authority before involving patients in research

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

demonstrate effective and culturally competent communication with Aboriginal and Torres Strait Islander peoples and Māori
effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
use qualified language or cultural interpreters to help meet patients’ communication needs
provide plain language and culturally appropriate written materials to patients when possible

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

encourage and support patients to be well informed about their health, and to use this information wisely when they make decisions
encourage and support patients and, when relevant, their families or carers, in caring for themselves and managing their health
demonstrate respectful, professional relationships with patients
prioritise honesty, patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
support patients’ rights to seek second opinions

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
set boundaries to avoid developing any sexual, intimate, and/or financial relationships with patients
demonstrate a caring attitude towards patients
demonstrate awareness of resource persons available to assist in resolving ethical issues, such as clinic counsellors and university ethicists
respect patients, including protecting their rights to privacy and confidentiality
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours, or the illness itself
use social media ethically and according to legal obligations to protect patients’ confidentiality and privacy

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other services, such as community health centres and consumer organisations, to help patients navigate the healthcare system
discuss principles of ethical behaviour outlined by organisations such as the World Medical Association, the Australian Medical Association, and in the Hippocratic Oath
recognise primacy of one law over another, such as child protection over confidentiality of personal information where a child is either at risk or potentially at risk, or in the case of public health notifications
provide expert evidence for court in matters relating to sexual health, including sexual assault

direction
Requires some supervision

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

The trainee may:

communicate with and involve other health professionals as appropriate

LG9: Prescribing

Learning Goal 9

Prescribing

Prescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

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

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

identify the patients’ needs requiring pharmacotherapy
consider non-pharmacologic therapies
consider age, allergies, chronic disease status, lifestyle factors, patient preference, potential drug interactions, and pregnancy prior to prescribing a new medication
consider past treatment history and resistance profile (if relevant) prior to commencing or changing medication
demonstrate awareness of the special access scheme
plan for follow-ups and monitoring
recognise up- and down-titration regimen in terms of dosages and rate of change

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 awareness of the benefits, contraindications, dosage, drug interactions, rationale, risks, and side effects
identify and manage adverse events

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

discuss and explain the rationale for treatment options with patients, families, or carers
explain the benefits and burdens of therapies, considering patients’ individual circumstances
write clearly legible scripts or charts using generic names of the required medication in full, including mg / kg / dose information and all legally required information
seek further advice from experienced clinicians 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 optimise therapy, provide adherence support when required, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing medicines that are no longer indicated
use continuously updated software for computers and electronic prescribing programs, where available
use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting
participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
report suspected adverse events to the Advisory Committee on Medicines (Australia) or the Centre for Adverse Reactions Monitoring (NZ) and record it in patients’ medical records

direction
Requires some supervision

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

The trainee may:

check the dose and drug-drug interaction 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:

maintain up-to-date knowledge with new medications, their indication, safety profile, and efficacy
use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

use a systematic approach to select treatment options
use medicines safely and effectively to get the best possible results
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, nursing staff, and general practitioners 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

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
be aware of stigma, and advocate on behalf of their patients if needed

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: Investigations and procedures

Learning Goal 10

Investigations and procedures

Select, organise, and interpret investigations and procedures

This activity requires the ability to:

select, plan, and interpret evidence-based, clinically appropriate investigations
ensure appropriate use of limited resources across the patient population
evaluate the anticipated value of investigations
work in partnership with patients, families, and/or carers to facilitate choices that are right for them, demonstrating patient-centred care
discuss choice of investigations with patients and their families, and obtain informed consent when required
provide aftercare for patients
accurately interpret the results and outcomes of investigations
effectively communicate the outcome of investigations to patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

provide rationale for investigations
understand the significance of abnormal test results, and act on these
consider patient factors and comorbidities
consider age-specific reference ranges
assess patients, and identify indications for procedures
check for allergies and adverse reactions
interpret results of common diagnostic procedures
organise and document post-procedure 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:

discuss potential benefits, burdens, costs, potential alternatives, risks, and side effects of each option
obtain consent before proceeding
discuss the rationale, and the possibility of false negative / false positive results, as well as incidental findings with patients and/or caregivers
specifically discuss the option of no investigation, and the risks and benefits of this, with patients
use clear and simple language, and check that patients understand the terms used
offer patients the opportunity to ask further questions and time to think about the decision
identify patients’ concerns and expectations, providing adequate explanations to address these
confirm whether patients understand the information they have been given and the need for more information before making decisions
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, and/or carers
give information that patients may find distressing in a considerate way, using best-practice techniques for breaking of bad news
discuss the likely timeframes during which investigations will occur, and the plan for communicating results when available
include sufficient clinical information to accurately convey patients’ contexts and reasons for investigations within investigation requests
discuss results using simple language, and explain how the results might affect future management
counsel patients sensitively and effectively, and support them to make informed choices
keep other relevant healthcare practitioners updated regarding planned investigations and results, including clear communication of who is responsible for reviewing these
accurately document procedures in the clinical notes, including:
- aftercare
- aseptic technique
- informed consent
- medicines given
- procedures performed
- reasons for procedures
address patients’, families’, and/or carers’ concerns relating to procedures, providing opportunities to ask questions
communicate effectively with team members, patients, families, and/or carers prior to, during, and after procedures

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 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
explain the process of procedures to patients without providing a broader context
help patients, families, and/or carers choose procedures
discuss postprocedural care with patients, families, and/or carers
complete relevant documentation, and conduct appropriate clinical handovers if needed

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

consider safety aspects of investigations when planning them
seek help with interpretation of test results for less common tests or indications or unexpected results
provide information in a manner so that patients, families, 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:

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

direction
Requires some supervision

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

The trainee may:

undertake professional development to maintain currency with investigation guidelines
participate in continued professional development

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure appropriate ethics approval when undertaking investigations as part of clinical research
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:

be cognisant of patients’ views and preferences about any proposed investigations and the adverse outcomes they are most concerned about
recognise the principles of equity as they pertain to diagnostic decision making, and apply these appropriately to advocate for patients
recognise the impact of implicit bias on diagnostic decision making, and initiate steps to address this
be aware of key legislation policies and how these relate to access to diagnostic services, such as Te Tiriti o Waitangi, the United Nations Declaration on the Rights of Indigenous Peoples, and the United Nations Refugee Agency’s 1951 Refugee Convention
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:

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:

discuss with patients how decisions will be made once the investigation has started and the patient is not able to participate in decision making
remain within the scope of the authority given by patients (except for emergencies)
respect patients’ decisions to refuse investigations and procedures, even if their decisions may not be appropriate or evidence based
explain the expected benefits as well as the potential burdens and risks of any proposed investigations or procedures
advise patients if there may be additional costs, which they may wish to clarify before proceeding
clarify who will make decisions on the patient’s behalf if they are unable to do so
show respect for the knowledge and expertise of colleagues

direction
Requires some supervision

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

The trainee may:

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

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

direction
Requires some supervision

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

The trainee may:

choose the most appropriate investigations for clinical scenarios in discussion with patients
recognise personal limitations and seek help in an appropriate way when required
assess personal skill levels, and seek help with procedures when appropriate
use tools and guidelines to support 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:

consider the role other members of the healthcare team might play, and what other sources of information and support are available
ensure clear delegation of tasks within the team, including responsibility for following up test results
ensure results are checked in a timely manner
identify relevant management options with colleagues
liaise with other healthcare professionals for expert advice when indicated

direction
Requires some supervision

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

The trainee may:

demonstrate understanding of what parts of investigations are provided by different doctors or health professionals
ensure all relevant team members are aware that a procedure is occurring

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
discuss serious incidents at appropriate clinical review meetings
support health policy and system development to improve equitable patient access to investigations
initiate local improvement strategies in response to serious incidents

direction
Requires some supervision

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

The trainee may:

perform relevant procedures in accordance with organisational guidelines and policies

LG11: Clinic management

Learning Goal 11

Clinic management

Manage an outpatient clinic or multidisciplinary sexual health service

This activity requires the ability to:

manage medical procedures and treatments
manage clinic services
oversee quality improvement activities
liaise with other health professionals and team members
demonstrate problem-solving skills
responsibly use public resources
assess policies and guidelines as they relate to sexual health service delivery, child protection, occupational health and safety, and privacy
communicate with external stakeholders and respond to media enquiries with the support of the relevant health communication team

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

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

The trainee will:

ensure clinic systems enable the identification, recording, and addressing of current clinical concerns, as well as longer-term clinical objectives, as appropriate to patients’ context
evaluate environmental and lifestyle health risks relevant to the community served by the clinic, and ensure the clinic has capacity to respond to these
ensure clinic documentation occurs 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:

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

Communication

confident
Ready to perform without supervision

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

The trainee will:

collaborate with other services, such as community health centres and consumer organisations
advocate for the needs of minority, stigmatised, and priority groups that access sexual health services
identify or support the development of specific community-based health programs and group education programs
demonstrate an understanding of information technologies and their potential use in the sexual health setting
contribute to the provision of accurate local surveillance data, and interpret local and national surveillance data regarding sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in relation to clinical care, policy development, and service planning
collaborate with a range of stakeholders, including public health units and non-government organisations, in identification of and response to emerging epidemics in relation to STIs

direction
Requires some supervision

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

The trainee may:

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

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

practice health care that maximises patient safety
adopt a systematic approach to the review and improvement of professional practice in the outpatient sexual health clinic setting
demonstrate an understanding of how to identify and implement key performance indicators and benchmarking for a sexual health service
develop, implement, and evaluate quality assurance activities
monitor and evaluate service delivery
identify aspects of service provision that may be a risk to patients’ safety
support a mix of service delivery, including primary care, public sexual health centres, outreach programs and co-located services, to maintain access to confidential testing and treatment

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Research

confident
Ready to perform without supervision

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

The trainee will:

ensure clinic research is undertaken with appropriate ethical and governance oversight
notify breaches of protocol for approved research
demonstrate an understanding of data management issues as they apply to service delivery
ensure clinic protocols are in place to inform patients about their rights, the purpose of the research, the procedures to be undergone, and the potential risks and benefits of participation, and 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:

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

Cultural safety

confident
Ready to perform without supervision

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

The trainee will:

apply knowledge of the cultural needs of the community being served, and how best to meet them
mitigate the influence of own culture and beliefs on interactions with patients and decision making
adapt practice to improve patient engagement and health outcomes

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Judgement and decision making

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

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

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

prepare for and conduct clinical encounters in a well-organised and time-efficient manner
work effectively as a member of multidisciplinary teams or other professional groups
ensure that all important discussions with colleagues, multidisciplinary team members, and patients are appropriately documented
provide supervision for clinical activities, and documentation of junior colleagues
support colleagues who raise concerns about patients’ safety
provide medical leadership that supports other team members’ ability to work effectively and efficiently

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
use databases and other information technologies to assist clinical service delivery
develop clinical and administrative policies and procedures
participate in strategic planning to meet health service objectives
maintain good relationships with health agencies and services
apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
advocate for the needs of a variety of stakeholders, including media, non-medical organisations, and other professions

direction
Requires some supervision

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

The trainee may:

understand common population health screening and prevention approaches
contribute to clinical policy and procedure development

Knowledge guides

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

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

LG12: Scientific foundations and basic principles of sexual health medicine

Epidemiology, pathophysiology, and clinical sciences

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

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Anatomy and physiology of anal, genital, neogenital, and oropharyngeal structures and skin
Behavioural, biological, and disease-related changes of ageing in relation to sexual health and sexuality
Biological and endocrinological basis of sexual development from fetus to adulthood and influencing factors, both common and less common
Epidemiology of sexually transmitted infections (STIs) and HIV locally, nationally, and globally
Immunology of HIV
Pathophysiology of STIs

Investigations

Point-of-care tests, such as:
- bench top microscopy
- pregnancy testing
- urinalysis
Relevant tests for screening, diagnosis and monitoring of STIs, including awareness of issues relating to:
- cost
- patient convenience
- predictive values:
  - negative
  - positive
- reproducibility
- sensitivity
- specificity

Procedures

Anogenital examination
Bimanual examination
Cryotherapy
Features and purpose of colposcopy and high resolution anoscopy
Genital biopsy
Proctoscopy
Vaginal speculum examination

Attitudes and beliefs of health care workers working with patients with sexual health-related issues
Concepts, possible implications, and terminology of alternative sexual lifestyles and sexuality, including:
- fetish
- kink
- non-monogamy
Confidentiality regarding sexual health, including dissemination of information to other health professionals or public health units
Evaluation of current research base and evidence on sexual health-related topics, and apply this to own personal and professional environment
Gender:
- concepts of binary and non-binary gender, development of gender expression, and variation throughout life
- concepts of social, legal, and medical gender transition, and how this may change over time for the individual and society
- gender dysphoria, and impact of medical intervention on sexual wellbeing and sexuality
- impact of cultural influences
- social and psychological factors that influence expression of gender roles in the community
- terminology of gender discourse
Impact of cultural, relationship, and social factors on patient concepts of:
- conception
- contraception
- fertility
- pregnancy
Impact of embarrassment, guilt, shame, and stigma regarding sexuality and gender and sexual expression, and how these will vary across different cultures, sub-groups, and age groups, and their relationship to sexual behaviours and health-seeking behaviours
Impact of past abuse, neglect, and trauma on:
- health-seeking behaviours
- sexual behaviours
- sexuality
Impact of sexual health and sexuality on general health and mental health
Impact of variations in ability and disability on sexual health and sexuality
Issues and management of intimacy, sexual function, and sexuality in older adults, including in the context of aged care facilities and nursing homes
Local social and subculture issues regarding priority populations, and how they relate to public health and delivery of health interventions to those populations
Range of gender, and sexual differences, sexual orientation, and sexual practices in the community, and factors affecting expression in the community
Recognition of sexual difficulties and concepts of management
Rights and dignity of index case and contacts
Role of chaperone in clinical examinations as a support person for patients
Sexual health counselling:
- common models of counselling, including acceptance and commitment therapy, cognitive behavioural therapy (CBT), and interpersonal therapy, and how these may apply to different areas of sexual health
- concepts of transference and countertransference, and how these may impact therapeutic relationships with sexual health physicians
- possible issues in counselling, such as cross-cultural and religious factors related to sexual expression
Sexuality:
- how sexuality varies throughout life
- ‘nature versus nurture’ issues in the genesis and management of sexuality
- variance of sexual diversity and sexuality
Sociocultural factors of gender, sexual development, and sexuality
Strategies for prevention of future acquisition of STIs, blood-borne viruses (BBVs), and unwanted pregnancies
Variations between management guidelines in different jurisdictions, and the rationale for these variations

LG13: Infections

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

Bacterial

Chlamydia
Gonorrhoea
Lymphogranuloma venereum (LGV)
Mycoplasma genitalium
Treponema pallidum (syphilis)

Protozoa, fungal, and other

Bacterial vaginosis
Candida
Pubic lice
Scabies
Sexually acquired enteric pathogens
Tinea
Trichomonas

Viral

Herpes simplex virus
Human papillomavirus (HPV)
Molluscum contagiosum
Mpox
Viral hepatitis:
- A
- B
- C
- D

Syndromes and clinical presentations

Anogenital ulceration
Cervicitis
Epididymo-orchitis
Pelvic inflammatory disease
Proctitis
Prostatitis (infectious)
Rectal discharge
Urethritis
Vaginal discharge
Vulvovaginitis

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

Chancroid
Donovanosis
Human T-lymphotropic virus type 1 (HTLV-1)
Sexually acquired reactive arthritis
Sexually transmitted infections (STIs) in neonates
STIs in pregnancy

Antimicrobial resistance mechanisms and issues
Epidemiology
Microbiology, including virulence factors
Pathogenesis and immunogenesis of clinical presentations and natural history:
- extra-genital manifestations
- genital manifestations
- immunosuppression, including HIV, and effect on natural history and management
- impact of age / stage of life on presentations
Treatment options:
- allergic patients
- alternatives
- breastfeeding
- complicated
- first-line
- pregnancy
- recurrent
- suppressive
Vaccinology and vaccine use

Investigations

Antimicrobial resistance testing
Cervical cytology
Cervical screening tests
Culture
HPV DNA test
Microscopy, including wet prep
Nucleic acid amplification testing
Serology

Procedures

Anoscopy
Biopsy
Cryotherapy
Role of colposcopy
Role of high resolution anoscopy

Complications and long-term sequelae, including fertility complications
Counselling on testing, diagnosis, and management
Emerging research on STI control and management
Ethics of various studies, such as the Tuskegee and Guatemalan syphilis studies and the HPV ‘Unfortunate Experiment’
Partner notification and contact tracing
Public health notification requirements
Risk assessments
Screening and testing guidelines
STI prevention and control methods in different populations
Stigma and discrimination
Transmission dynamics

LG14: HIV

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 and conditions

Ageing with HIV
All stages of HIV infection:
- acute HIV
- advanced HIV and AIDS
- chronic HIV
Chronic disease monitoring for people living with HIV:
- bone
- cancer screening
- cardiovascular
Diagnosis of HIV
Drug resistance
HIV co-infections:
- hepatitis B
- hepatitis C
- human T-lymphotropic virus type 1 (HTLV-1)
- sexually transmitted infections (STIs)
- tuberculosis (TB)
HIV prevention:
- HIV screening
- post-exposure prophylaxis (PEP) in:
  - adolescents
  - adults
  - neonates
- pre-exposure prophylaxis (PrEP) in:
  - adolescents
  - adults
Immune reconstitution inflammatory syndrome (IRIS)
Manifestations of HIV:
- cancer
- cardiovascular
- dermatological
- gastrointestinal
- haematologic
- neurological
- ocular
- renal
- respiratory
Medication-related adverse effects
Opportunistic infections (OI)
Reproductive health:
- contraception
- fertility
- menopause
- pregnancy, including neonatal management
Vaccination

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

HIV in children and adolescents, including transitioning to adult services
Mental health issues in the context of HIV infection
Substance use in the context of HIV infection

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

Antiretroviral therapy (ART) and other therapies:
- adverse drug reactions
- biomedical prevention
- drug-drug interactions
- initiation in treatment-naive people
- long-term management of antiretroviral (ARV) regimes
- managing drug resistance and treatment-experienced people
- monitoring in pregnancy and breastfeeding
- OI prophylaxis and treatment
Epidemiology:
- global
- national
Epidemiology, natural history, and pathophysiology of opportunistic infections
HIV pathophysiology
HIV virology and immunology
Natural history of HIV infection

Investigations and procedures

Anogenital human papillomavirus (HPV) screening
Baseline investigations for new HIV diagnosis
Cancer screening
Cardiovascular risk assessment
Chronic disease monitoring
Diagnosis / Screening for opportunistic infections
HIV monitoring
HIV point of care testing
HIV serology and confirmatory testing
Resistance testing, including role of proviral DNA testing

Contact tracing
Engagement in care
Legislation around duty of disclosure and risk of transmission to others
Local support services, including non-governmental organisations
Public health notification
Risk factors for HIV acquisition
Stigma and discrimination

LG15: Dermatological conditions

Key presentations and conditions

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

View

Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

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

View

Epidemiology, pathophysiology, and clinical sciences

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Presentations

Blisters
Dyspareunia
Itch or irritation
Lumps or growths
Pain
Skin discolouration / pigmentation
Ulceration

Conditions

Anogenital intraepithelial neoplasia, dysplasia, and cancer
Aphthous ulcers
Balanitis – various types
Bartholin cysts
Dermatological sequelae of sexually transmitted infections (STIs) and blood-borne viruses (BBVs):
- hepatitis C
- herpes simplex virus (HSV)
- HIV
- human papillomavirus (HPV)
- lymphogranuloma venereum (LGV)
- mpox
- syphilis
Eczema
Erythema multiforme
Erythrasma
Genital dermatology due to systemic conditions, such as Crohn disease
Impetigo
Lichen planus
Lichen sclerosis
Pruritis ani
Psoriasis
Seborrheic dermatitis
Tinea cruris
Vulval candida

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

Dermatological sequelae of opportunistic infections, such as:
- cytomegalovirus (CMV)
- Epstein–Barr virus (EBV)
- tuberculosis (TB)
Fixed drug eruption

Conditions

Behçet's disease
Kaposi sarcoma

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 and physiology of normal female and male anogenital regions
Anogenital region diseases, such as:
- dermatoses:
  - benign
  - malignant
- inflammatory diseases
- skin lesions:
  - benign
  - malignant
- STIs
Dermapathology of:
- inflammatory dermatoses
- tumours:
  - benign
  - malignant
Disorders of skin and mucous membranes
Genital dermatology and normal variation
Skin and subcutaneous anatomy and biology:
- cells:
  - Langerhans
  - mast
  - Merkel
- dermis:
  - basement membranes
  - collagen
  - elastin
  - extracellular matrix
  - glycosaminoglycans
  - proteoglycans
- epidermis:
  - epidermal differentiation
  - keratinisation
- microanatomy:
  - apocrine glands
  - eccrine glands
  - hair
  - nails
  - sebaceous glands
- mucus membranes:
  - genitalia
  - oral
Pathophysiology of dermatological conditions and immunology issues
Principles of wound healing

Investigations

Culture / Microscopy / Sensitivity testing
Cytology
Histopathology
Nucleic acid amplification tests (NAAT)
Outline specific diagnostic techniques, interpret results, and develop management plans

Procedures

Skin and anogenital biopsy
Skin scraping

LG16: Sexual function and dysfunction

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 and conditions

Chronic pelvic pain syndrome and prostatitis
Ejaculatory dysfunction, such as:
- anejaculation
- delayed ejaculation
- haematospermia
- painful ejaculation
- premature ejaculation
- retrograde ejaculation
Erectile dysfunction:
- mixed
- organic
- psychogenic
Genitopelvic pain / penetration dysfunction:
- dyspareunia
- vaginismus
- vulvodynia
Hypoactive sexual desire disorders
Orgasm / Ejaculation issues, including anorgasmia
Other specified dysfunction, such as aversion, or in the context of gender dysphoria
Penile deformity, including Peyronie disease
Priapism
Sexual arousal disorders
Sexual dysfunction related to medication or substance use

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

Problematic sexual behaviour, including in children
Specific issues of sexual dysfunction which may be experienced by:
- people with cognitive impairment
- people with drug addiction
- people with mental health conditions

Biological, psychological, relational, and sociocultural factors affecting sexual function
Coexisting medical, psychiatric, and surgical conditions contributing to sexual dysfunction
Human sexual response cycle
Physical and psychological influences on sexual pleasure and function
Range of sexual behaviours and activities that constitute normal sexual activity in consenting relationships
Relationship between asexual identity and sexual function, acknowledging that varying levels of sexual activity, arousal, attraction, desire, and function may be normal for different individuals

Develop management plans and prescribe medication
Discuss effects of prescribed and recreational drugs on sexual function
Discuss sexual behaviours and anxieties
Display sensitivity in understanding psychosocial sequelae of sexual dysfunction
Examine patients to determine any underlying organic factors contributing to sexual dysfunction
Exhibit respect for patient autonomy and informed choice
Manage sexual disorders in the context of medical conditions, including mental health conditions
Plan and arrange appropriate investigations
Recognise need to counsel individuals and partners
Recognise patients’ attitudes and values
Take sexual function history
Treat in a holistic way that recognises biopsychosocial aspects of sexual dysfunction in people
Use appropriate models, such as Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT), for brief interventions

Benefits to general health and relationships for normal sexual functioning
Impact of dysfunctional relationships on sexual function
Participate as a team member in managing patients’ dysfunction
Recognise own limitations in management of sexual function, and refer where appropriate
Recognise the length of time people can take to present with sexual difficulties and be proactive in enquiring about issues in sexual histories
Treatment strategies for psychosocial effects and drivers of pain

LG17: Reproductive health

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 and conditions

Abnormal uterine bleeding
Cervical screening
Contraception:
- barrier methods
- emergency contraception
- hormonal contraception
- intrauterine devices (IUDs)
- permanent contraception
Haematospermia
Menopause
Pelvic pain
Postcoital bleeding
Pregnancy:
- early / late
- miscarriage
- preconception care
- sexually transmitted infections (STIs) in pregnancy
- termination of pregnancy, including complications
- unwanted pregnancy
Premenstrual syndrome
Prostatitis

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations and conditions

Endometriosis
Infertility / Subfertility
Molar pregnancy
Ovarian cysts
Polycystic ovary syndrome (PCOS)
Pregnancy:
- antenatal care
- complications
- ectopic

Contraception:
- adverse effects
- contraindications
- drug interactions
- efficacy
- mechanism of action
- suitability
Fertility throughout the course of life
Human papillomavirus-related cancers
Menopause:
- associated comorbidities
- diagnostic criteria
- pharmacological versus non-pharmacological management
Menstrual cycle:
- factors or conditions that can affect menstruation
Pregnancy:
- complications, including:
  - ectopic
  - miscarriage
- pregnancy-related STIs, including:
  - management
  - screening
- trimesters
Termination of pregnancy:
- follow-up management, including:
  - failed termination
  - management of complications
- medical
- pharmacology of medications used in medical termination
- pre-termination counselling
- relevant pharmacology and pharmacotherapy
- surgical

Bimanual examination
Cervical screening
Digital anorectal examination
Long-acting reversible contraception:
- implant insertion / removal
- intrauterine device (IUD) insertion / removal
Permanent contraception:
- tubal ligation
- vasectomy
Pregnancy:
- antenatal screening
- calculation of gestation and expected date of delivery
- diagnosis
Role of ultrasound:
- abnormal uterine bleeding
- pelvic pain
- pregnancy
Termination of pregnancy:
- pre-termination screening

Legislation in relation to termination of pregnancy
Professional and legislative frameworks that apply to reproductive health areas, such as provision of contraceptives or termination of pregnancy for minors or people with a disability

LG18: Gender-affirming care

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 and conditions

Adjuncts to transition:
- binding
- hair removal
- tucking
- voice therapy
Complications of hormone therapy
Gender dysphoria
Gender incongruence
HIV / Sexually transmitted infections (STI) screening and prevention
Medical transition:
- feminising hormone therapy
- masculinising hormone therapy
Pelvic pain in people using masculinising hormone therapy
Reproductive health:
- contraception options
- fertility, including fertility preservation
- pregnancy
Sexual function and dysfunction

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

Synthesise

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

Manage

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

Consider other factors

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

Presentations and conditions

Management of gender diverse people aged under 18, and relevant laws
Mental health issues and neurodivergence in the context of gender diversity
Neophallus and neovagina:
- assessment of surgical complications
- care / maintenance
- infections
Social transition
Surgical options for transition:
- chest augmentation / reconstruction
- gender affirming genital surgery
- other surgery, such as:
  - facial
  - vocal

Embryology related to genital development, including intersex variation
Endocrinology of sexual development and puberty
Epidemiology of gender diversity in Australia / Aotearoa New Zealand and the limitations of how these statistics are determined
Pharmacology of hormone therapy:
- expected physical and psychological responses
- initiation protocols
- risks and complications
- risks regarding pregnancy
- side effects
- therapeutic options regarding drug delivery methods
Spectrum of gender variance, including binary and non-binary gender identities
Terminology of gender discourse

Assessment of conditions of the neovagina and neophallus, including:
- differing presentations of common conditions, including infections
- surgical complications
Baseline investigations prior to gender-affirming hormone therapy
Interpretation of hormone levels related to gender-affirming therapy
Monitoring of clients using gender-affirming hormone therapy

Acknowledge current evidence gaps in management
Cancer screening
Intersectionality with sexual health risks
Legislation affecting social transition
Legislation regarding transition in children and adolescents
Local support services, including non-governmental organisations and peer support networks
Models of consent to gender-affirming care
Role of mental health practitioners in supporting people accessing gender-affirming care
Stigma and discrimination

LG19: Sexual assault

Epidemiology, pathophysiology, and clinical sciences

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

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Clinical sciences

Acute management following recent sexual assault
Emergency contraception and options
Follow-up care after sexual assault, including sexually transmitted infection (STI) testing
Implications of STI transmission for legal processes
Management of common physical injuries co-occurring with sexual assault, including non-fatal strangulation
Mandatory reporting requirements for adults and children
Principles of biological sampling for:
- DNA detection
- injury documentation
- toxicology
Principles of trauma-informed care
Principles of use of post-exposure prophylaxis against HIV, hepatitis B, and other STIs after sexual assault
Role of sexual health physicians in the collection of forensic evidence and referral pathways according to jurisdiction or country of practice
Therapeutic management of historic sexual assault
Usage of non-occupational post-exposure prophylaxis (nPEP) for HIV in sexual assault setting

Epidemiology

Impacts on First Nations peoples
Population groups with higher prevalence of sexual assault
Prevalence of sexual assault and child sexual abuse
Relationship between sexual assault and other forms of abuse, neglect, and violence, including intimate partner violence and non-fatal strangulation

Forensic medicine

Legal requirements for consenting to forensic assessments, and how this differs to duty of care
Legislative requirements as a professional or expert witness in the context of sexual assault
Local legislation, including key sexual offences
Role of police and courts in prosecuting sexual offences

Pathophysiology

General physical and anogenital injuries occurring secondary to sexual assault
Physical and psychological consequences of adult and child sexual abuse
STI transmission in the context of sexual assault

Acute medical and forensic care following sexual assault

Assess and manage physical injuries, and provide referral in the case of severe injury
Assess immediate physical and emotional safety, and organise support for patients in these instances
Be aware of the range of immediate responses to sexual assault, and:
- manage acute distress
- provide appropriate emotional support
- provide immediate safety planning
Discuss the legal, medical, and psychological care options following sexual assault
Document medical history, examination, and follow-up medical care
Provide medical care, including emergency contraception, post-exposure prophylaxis (PEP) for HIV, hepatitis B, and STIs, and tetanus vaccination, where required

Follow-up care and care following delayed disclosure

Assessment of and management options for pregnancy conceived from sexual assault
Provide psychological care, including referral to counselling services
Referral for follow-up of other injuries, including non-fatal strangulation and head injuries
STI and HIV follow-up testing

Legal procedures

Provide evidence in court in accordance with expert witness guidelines

Multidisciplinary care

Operate within a multidisciplinary health team, which may include:
- forensic clinicians
- nurses
- specialist sexual assault counsellors
Work cooperatively with other services, including:
- child protection services
- family and domestic violence units
- police

Vicarious trauma

Acknowledge impact of exposure to trauma
Debrief and seek advice and support when required
Identify appropriate support person for own requirements

LG20: Public health

Epidemiology, pathophysiology, and clinical sciences

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

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

View

Investigations, procedures, and clinical assessment tools

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

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

View

Important specific issues

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

View

Clinic management

Infection control measures required to conduct clinical services in sexual health medicine
Principles of infection control in clinical practice
Rationale for provision of clinical services via specialist public sexual health clinics and in primary care

Epidemiology

Epidemiological basis for prevention strategies
Epidemiology of sexually transmitted infections (STIs) / HIV at local, national, and international levels
Epidemiology of STIs / HIV in priority populations
Priority populations:
- how and why priority populations may vary over time and location
- priority populations for different STIs in different contexts and locations
- process of community engagement with different priority populations
- rationale for why priority populations require particular attention
- use epidemiological data to develop and evaluate innovative clinical services for priority populations
Social determinants of health and how they relate to sexual behaviours, health, and risk, and the complex interplay between components
Transmission dynamics, including Rₒ = BcD

Evidence

Describe levels of evidence according to study design, and rank evidence according to consistency, freedom from bias, and methodological rigour
Differentiate expert opinion from observational evidence, and reconcile dissonant expert opinion with patient values, research evidence, and societal expectations
Make decisions based on clinical judgement in circumstances where evidence is lacking or conflicting
Reconcile evidence with contrary patient values and preferences

Health promotion

Design and implementation of population-based health promotion programs
Evaluation of health promotion activities
History and contribution of health promotion approaches to the management at population level
Importance of the advocacy role of specialists in sexual health medicine in relation to health promotion and public health interventions
Key strategies and evidence for effectiveness in health promotion interventions
Prevention frameworks for interventions at a population level:
- primary
- secondary
- tertiary

Partner notification

Ethical and legal principles
Rationale and methods of partner notification
Strategies for resolution of conflicting ethical and legal requirements

Policy

Fiscal, legislative, and other public policy measures as they relate to sexual health
Impact of health economics on health service provision, including cost-benefit and cost-effectiveness analyses of testing and treatment regimens

Screening

Methods for planning, delivery, and evaluation of programs
Principles of screening as defined by the World Health Organization:
- early detection and intervention to prevent disease progression
- ethical and economic aspects
- management of screening databases
Strategies and target populations for screening programs:
- community-wide screening and mass treatment programs to eliminate or significantly reduce infectious disease in specific communities
- importance of population prevalence in program design
- opt-out versus opt-in screening
Use of statistical tests in screening programs

Vaccination

Efficacy of vaccination for STIs
Importance of vaccination in reducing basic reproductive rate
Roll out of vaccination programs through sexual health clinics and other locations and services, including the role of community engagement in program development
Strategies for targeting priority populations

Epidemiology

Apply statistical concepts in relation to the use and interpretation of specific screening tests at the individual and population level, such as:
- likelihood ratios
- predictive value:
  - negative
  - positive
- sensitivity
- specificity

Patient management

Develop strategies for ongoing engagement with, and management of, individual clients / client groups at higher risk of acquiring and/or transmitting STIs and/or blood-borne viruses (BBVs)
Negotiate complex and conflicting clinical and contact tracing issues
Use a variety of approaches in clinical context to promote individual health and wellbeing, including:
- developing communication skills in negotiating safer sex
- harm reduction, such as:
  - condoms
  - dams
  - injecting equipment
  - non-occupational post-exposure prophylaxis (nPEP)
  - pre-exposure prophylaxis (PrEP)
  - treatment as prevention
  - vaccination
- improving health literacy
- readiness to change models
- risk assessment
- tailored information

Public health programs

Describe disease outbreak management, including identification of the outbreak, stakeholders, interventions, and evaluation
Design health promotion intervention, including the following components in relation to STIs and BBVs:
- carry out needs assessments
- develop program goals, objectives, and strategies
- evaluate programs – process, impact, and outcome
- identify and consult with stakeholders
- implement and monitor programs
- select strategies to achieve program objectives
Identify frameworks for intersectoral collaboration and community engagement, and apply to a sexual health promotion initiative
Procedures, methods, and tools used for health impact assessments
Use a range of assessment tools to determine health needs and the effect of health promotion activities

Ethical considerations

Balance individual rights with those of the population in relation to infectious disease
Consent and issues of consent to investigation and medical treatment
Consent and issues of consent to sex in local jurisdiction
Research ethics
Role of community engagement and involvement in clinic services and research
Role of human research ethics committees
Specific issues of consent in young people and people with reduced capacity

Legal considerations

Legislation in relation to discrimination, both in general and in relation to disability, gender, and sexuality
Management of individuals who may knowingly place others at risk
Notification of infectious diseases by laboratories and clinicians in local jurisdictions
Principles underpinning legislation
Public health legislation in relation to infectious diseases and STIs, with consideration of issues of discussing status, prevention of transmission, and safer sex, and as it applies to specific groups
Public health orders in management of risk behaviours
Recognise the need and role of consultation with public health authorities

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

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

Description

Advanced Training in Sexual Health 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

13

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Management of transitions in care

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy