Entrustable Professional Activities

LG5: Clinical assessment and management, including prescribing radioisotopes

Learning Goal 5

Clinical assessment and management, including prescribing

Clinically assess and manage the ongoing care of patients, including prescribing radioisotopes

This activity requires the ability to:

  • identify and access sources of relevant information about patients
  • obtain patient histories, including medication histories
  • gather and interpret prior investigations, including the results of relevant laboratory and imaging investigations
  • perform and interpret physical examinations
  • assess the patient’s suitability to proceed with diagnostic or therapeutic nuclear medicine interventions
  • generate patient-centric management plans
  • establish goals of care in collaboration with referring clinicians and/or multidisciplinary teams, patients, and their families to ensure that only appropriate diagnostic and therapeutic procedures are performed
  • discuss management plans with referring clinicians, patients, families, and/or carers
  • communicate information with 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:

  • identify high-risk patients who may require additional supportive or acute care during nuclear medicine studies and Theranostic procedures
  • elicit accurate, organised, and problem-focused medical histories (including collateral histories), considering relevant risk factors where appropriate
  • perform targeted physical examinations to establish the nature and extent of problems
  • ensure adequate patient preparation
  • synthesise and interpret findings from patients’ histories and examinations to devise the most likely provisional diagnoses
  • assess the severity of problems, including the likelihood of complications, and identifying patients who may require supportive / acute care and clinical outcomes
  • develop proficiency in identifying patients attending the nuclear medicine department who may need urgent care
  • consider the radiation protection factors which may impact the management of patients in acute care settings
  • identify and evaluate information relevant to the provisional and differential diagnosis
  • develop management plans based on relevant information, integrate guidelines, and consider the balance of benefit and harm by taking patients’ personal circumstances into account
  • consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patient preference prior to implementing new management plans
  • follow ALARA principles when prescribing radioisotopes
  • demonstrate an awareness of potential side effects and practical prescription points when prescribing radioisotopes or other medications required for patients undergoing nuclear medicine studies or therapies
  • recognise and manage anaphylaxis

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 during examinations and evaluation of laboratory / other imaging results
  • follow guidelines to ensure adequate patient preparation
  • synthesise pertinent information to direct the clinical encounter and diagnostic categories
  • demonstrate the ability to identify patients who may require supportive / acute care
  • 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’, families’, or carers’ concerns seriously, giving them adequate opportunity to ask questions
  • provide information to patients, family members, or carers to enable them to make fully informed decisions from various diagnostic, therapeutic, and management options
  • communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
  • discuss and evaluate the risks and benefits of treatment options, making decisions in partnership with patients

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 professional safety skills, including infection control, adverse event reporting, and effective clinical handover
  • observe existing departmental procedures and policies for management of patients in the acute care setting, from medical and radiation perspectives
  • follow existing departmental procedures and policies for management of patients in the acute care setting, from medical and radiation safety perspectives
  • recognise and effectively manage aggressive and violent patient behaviours
  • obtain informed consent before undertaking any investigations or providing treatment, except in emergencies
  • ensure patients are informed of the material risks associated with any part of proposed management plans
  • evaluate the contraindications, indications, safety aspects, and potential advantages of prescribing radioisotopes especially in relation to Theranostics
  • perform hand hygiene, and take infection control precautions at appropriate moments
  • apply principles of radiation safety during all aspects of patient care
  • maintain up-to-date certification and licence requirements

direction
Requires some supervision

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

The trainee may:

  • know where to access existing departmental policies for management of patients in the acute care setting, from medical and radiation safety perspectives
  • take precaution against assaults from confused or agitated patients, and ensure 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
  • use clinical activities as teaching moments when appropriate

direction
Requires some supervision

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

The trainee may:

  • set goals and objectives for self-learning
  • develop an understanding of the importance of self-reflection, and develop strategies for the development thereof
  • learn to process and implement feedback from supervisors to ensure positive learning outcomes
  • 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
  • adhere to ethical research practice, including informed consent, for all diagnostic and therapeutic procedures

direction
Requires some supervision

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

The trainee may:

  • demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice
  • demonstrate a good understanding of ethical research practice, including informed consent
  • refer to guidelines and medical literature to assist in clinical assessments when required

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 and care for Aboriginal and Torres Strait Islander and Māori peoples, and members of other cultural groups
  • acknowledge patients’ beliefs and values, and how these might impact on health
  • use a professional interpreter, a health advocate, or a family or community member to assist in communication with patients
  • use plain language patient education resources, and demonstrate cultural awareness
  • consider and reflect on the role of unconscious bias, diversity, equity, and inclusion plays in health service provision

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

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

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
  • appropriately prioritise patient wellbeing and care in relation to personal and professional needs
  • consider the efficacy of prescribed Theranostics in treating illnesses, including the relative merits of alternate treatment options

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 informed clinical judgement to identify patients' issues
  • make logical, rational decisions, and act to achieve positive patients’ outcomes
  • use a comprehensive approach to health, considering comorbidities, uncertainty, and risk
  • use the best available evidence for the most effective therapies and interventions to ensure quality care
  • evaluate new management options in relation to their possible efficacy and safety profile for individual patients, including the economic impact on the patient and their family

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
  • consider the following factors for all proposed management options:
    • alternate treatments
    • contraindications
    • cost to patients, families, and the community
    • funding and regulatory considerations
    • interactions
    • risk-benefit analysis, including long-term consequences of radiation exposure / dose

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 patients’ best health outcomes
  • advocate for patients if conflict occurs between interprofessional teams
  • demonstrate an awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety

direction
Requires some supervision

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

The trainee may:

  • understand the importance of and show the ability to work effectively within a team
  • share relevant information with members of the health care team
  • show compassion and support colleagues in difficulty
  • develop skills for managing conflict / diversity within interprofessional 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:

  • 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
  • recognise the difference between publicly funded and non-funded management options

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
  • prescribe radioisotopes in accordance with the organisational policy