Curriculum standards

Ready to perform without supervision

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

The trainee will:

• explore preferred location of care and preferred location of death with patients and their families, whānau, and/or carers
• communicate with patients and their families, whānau, and/or carers about options and plans for transitions in care settings, including the reasons and/or risks associated with such transitions
• communicate and consult with other health professionals and members of the multidisciplinary team regarding transitions of care
• provide handover to receiving health professionals
• write comprehensive and accurate summaries of care, including transfer documentation

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

Ready to perform without supervision

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

The trainee will:

• identify patients at risk of adverse outcomes, including death during transition of care, and mitigate this risk or conduct appropriate conversations with families and health professionals to ensure the risks are understood and incorporated into decision making
• ensure appropriate infection control measures during transitions in care
• analyse adverse incidents and sentinel events during transitions of care to identify system failures and contributing factors
• use consent processes, including written consent if required, for the release and exchange of information

Requires some supervision

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

The trainee may:

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

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 clinical practice around transitions of care
• supervise junior colleagues in managing transitions of care
• use teaching opportunities arising from transitions of care, including handover sessions
• use opportunities from transitions of care to learn about and enhance the skills and resources available to support end-of-life care for children in different settings and communities

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 handovers, as necessary

Ready to perform without supervision

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

The trainee will:

• communicate in a culturally appropriate way by considering health literacy, language barriers, culture, religion, and belief systems when discussing transition of care with patients and their families, whānau, and/or carers
• use culturally appropriate services to support patients in care transitions, such as Māori and Aboriginal or Torres Strait Islander peoples’ health workers or community-controlled organisations

Requires some supervision

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

The trainee may:

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

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 during transitions of care in line with clinical, ethical, and legal requirements
• maintain patient privacy and confidentiality according to legal guidelines during transitions of care
• consider the additional complexity related to some types of information, including genetic information, and seek appropriate advice about disclosure of such information

Requires some supervision

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

The trainee may:

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

Ready to perform without supervision

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

The trainee will:

• use medical expertise and knowledge of patients and their families, whānau, and/or carers’ wishes and priorities to ensure that care is provided in the most appropriate facility and setting

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

Ready to perform without supervision

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

The trainee will:

• delegate appropriately during transitions of care
• demonstrate understanding of the medical governance of patient care, and the differing roles of team members
• respect the roles and expertise of health professionals across various institutions and settings, and collaborate with these professionals to ensure smooth transitions of care

Requires some supervision

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

The trainee may:

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

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, including formal surveys or follow-up phone calls

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