Entrustable Professional Activities

LG 5: Clinical assessment and management

Learning Goal 5

Clinical assessment and management

Clinically assess and manage the palliative care needs of patients across different stages of life-limiting illnesses

This activity requires the ability to:

  • identify and access sources of relevant information about patients
  • locate patient histories
  • examine patients
  • synthesise findings to develop differential diagnoses
  • assess where patients are in their illness trajectory
  • formulate management plans, including physical, psychosocial, and spiritual needs
  • discuss findings and plans with patients
  • generate a symptom management plan
  • communicate findings 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:

  • elicit accurate, organised, and problem-focused medical histories, considering physical, psychosocial, and spiritual factors
  • perform focused physical examinations appropriate to patients’ ages, stages of illness, and presenting problem
  • synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnosis and reasonable differential diagnoses
  • assess the severity of problems, the likelihood of complications, and clinical outcomes
  • develop management plans based on relevant guidelines and evidence, as well as patients’ stages of illness, goals of care, and any advance care planning discussions that have been conducted
  • plan for and anticipate future complications based on knowledge of the likely disease trajectory
  • develop symptom management plans for potential or current physical and emotional symptoms, both for other health professionals and for families
  • consult with other team members in grief and bereavement risk assessments, both before and after the death of a child
  • participate in team conversations about appropriate bereavement follow-up

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
  • seek supervisor input to develop appropriate management plans, including for symptom 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:

  • explain diagnosis, investigation, and management options using language appropriate to patients’ understanding and desire for information
  • address questions, misunderstandings, and concerns
  • explore the concerns and goals of patients and their families, whānau, and/or carers, and plan management in partnership
  • respond to verbal and nonverbal cues and emotions while providing medical information
  • include significant others in conversations when appropriate, recognising that in paediatrics this will commonly but not always be patients’ parents
  • communicate with other health professionals and members of relevant multidisciplinary teams as needed
  • document relevant and detailed medical record entries, including clinical assessments and management plans
  • share summaries of care and management plans with other professionals involved in a child’s care
  • address prognosis if required, acknowledging the limits of prognostication in paediatric palliative care

direction
Requires some supervision

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

The trainee may:

  • explain diagnosis, investigation, and management options using basic communication skills
  • seek supervisor input for complex or highly emotional conversations

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:

  • incorporate infection control into clinical practice
  • participate in effective clinical handover
  • recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
  • obtain informed consent before undertaking any investigations or providing treatment (except in emergencies)
  • contribute to monitoring and evaluation strategies around clinical assessment and management, including clinical audits
  • evaluate and explain the benefits and risks of clinical interventions based on the specific circumstances of individual patients
  • report and analyse adverse incidents and sentinel events to identify system failures and contributing factors
  • identify evidence-based practice gaps using clinical indicators, and implement changes to improve patient outcomes

direction
Requires some supervision

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

The trainee may:

  • take precautions against potential assaults from patients or their families, whānau, and/or carers

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:

  • reflect regularly upon and self-evaluate professional development and clinical practice
  • seek feedback from colleagues on own clinical practice
  • address gaps in knowledge and skills through self-directed learning and continuing professional development
  • supervise junior colleagues in the provision of clinical care
  • use clinical encounters to educate patients and junior colleagues on relevant aspects of health and disease
  • obtain informed consent before involving patients in teaching activities

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
  • initiate self-reflection practice
  • 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:

  • apply evidence-based guidelines to clinical practice
  • analyse and apply relevant research literature to clinical practice
  • support or engage in research to build the paediatric palliative care evidence base

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 an understanding 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 linguistical sensitivity
  • demonstrate effective and culturally competent communication and care for Māori and Aboriginal and Torres Strait Islander peoples, and members of other cultural groups
  • use professional interpreters, health advocates, or family or community members to assist in communication with patients, and understand the potential limitations of each
  • acknowledge patients’ and families’ 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
  • 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, integrity, and honesty to all patients
  • maintain patient privacy and confidentiality according to legal guidelines
  • 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 clinical expertise to diagnose and manage patients’ problems and make logical and rational decisions
  • use a holistic approach to health considering comorbidity, uncertainty, and risk when formulating differential diagnoses and management plans
  • 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 team member to achieve the best health outcome for patients when working with:
    • multidisciplinary teams
    • subspecialty units in paediatric teams
    • teams in community palliative care
  • identify colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety
  • ensure patients are referred to other teams as appropriate, either within or external to the palliative care team

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 health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

  • aim to achieve optimal cost-effective patient care to allow maximum benefit from the available resources
  • advocate for children with paediatric palliative care needs in the health system

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