Entrustable Professional Activities

LG8: Occupational and environmental screening, surveillance, and investigations

Learning Goal 8

Occupational and environmental screening, surveillance, and investigations

Select, organise, and interpret screening, surveillance, and diagnostic investigations

This activity requires the ability to:

  • develop a risk management approach, including health prevention activities
  • select, plan, and use evidence-based clinically and occupationally appropriate screening, surveillance, and diagnostic investigations with the aim of preventing disease or identifying early disease
  • prioritise workers/patients receiving investigations by using a risk-based approach and evaluating the anticipated value of investigations
  • work in partnership with workers/patients to facilitate choices that are right for them
  • work in partnership with employers and other stakeholders to ensure preventive activities, including evidence-based occupational screening, surveillance, and investigations, including assisting in meeting their statutory requirements
  • provide aftercare for workers/patients as needed
  • interpret the results and outcomes of investigations at both worker/patient and worker population levels as needed
  • communicate the outcome of investigations to workers/patients and other key stakeholders, such as employers and regulators
  • compose comprehensive medical and scientific reports outlining the results of occupational exposure for workers/patients, employers, regulator and insurance organisations, and medicolegal purposes

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 screening tools used in occupational medicine, including those used in determining fitness to work and disease prevention
  • develop, implement, assess, and evaluate evidence-based health surveillance programs, including legislated programs for hazardous substances
  • choose evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessments
  • assess workers’/patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
  • develop plans for investigations, identifying exposure patterns and timing of surveillance
  • recognise and correctly interpret abnormal findings, considering workers’/patients’ specific circumstances, and act accordingly

direction
Requires some supervision

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

The trainee may:

  • demonstrate the principles around biological monitoring and biological effect monitoring
  • outline the principles of medical surveillance, including toxicodynamic and toxicokinetic
  • describe legislative requirements around occupational health surveillance
  • provide rationale for investigations
  • understand the significance of abnormal test results and act on these
  • consider worker/patient factors and comorbidities
  • consider age-specific reference ranges

Communication

confident
Ready to perform without supervision

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

The trainee will:

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

direction
Requires some supervision

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

The trainee may:

  • discuss the benefits, complications, indications, and risks of investigations with workers/patients before ordering investigations
  • explain the results of investigations to workers/patients
  • arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate
  • complete medical certificates and legislated documents appropriately

Quality and safety

confident
Ready to perform without supervision

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

The trainee will:

  • identify adverse outcomes that may result from a proposed investigation, focusing on workers’/patients’ individual situations

direction
Requires some supervision

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

The trainee may:

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

Teaching and learning

confident
Ready to perform without supervision

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

The trainee will:

  • use appropriate guidelines, evidence sources, and decision-support tools
  • 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

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 workers/patients with relevant information if a proposed investigation is part of a research program
  • obtain written consent from workers/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 and procedures

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:

  • respect workers’/patients’ views and preferences about any proposed investigation and the adverse outcomes they are most concerned about

direction
Requires some supervision

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

The trainee may:

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

Ethics and professional behaviour

confident
Ready to perform without supervision

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

The trainee will:

  • remain within the scope of authority given by workers/patients (except for emergencies)
  • discuss with workers/patients how decisions will be made once the investigation has started and the worker/patient is not able to participate in decision making
  • respect workers’/patients’ decisions to refuse diagnostic investigations, 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 investigation before obtaining informed consent or other valid authority
  • demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information
  • maintain individual worker/patient confidentiality when reporting results to employers or others

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 workers/patients in decision making regarding investigations and obtaining the appropriate informed consent, including financial consent, if necessary

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

direction
Requires some supervision

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

The trainee may:

  • choose the most appropriate investigation for the clinical scenario in discussion with workers/patients
  • recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

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

The trainee will:

  • consider the role other members of the health care team might play, and what other sources of information and support are available
  • consider the role that other stakeholders such as employers, unions, and other medical specialists might play, and what other sources of information and support are available
  • check results in a timely manner, taking responsibility for following-up results

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 an investigation are provided by different doctors or health professionals

Health policy, systems, and advocacy

confident
Ready to perform without supervision

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

The trainee will:

  • develop a risk management framework supported by preventive activities relevant to the work environment, exposures, and worker population
  • select and justify investigations regarding appropriateness, cost effectiveness, safety, the pathological basis of disease, and utility
  • consider resource utilisation through peer review of testing behaviours
  • engage with unions and employers to gain support for recommended health surveillance programs