Entrustable Professional Activities

LG6: Clinical management

Learning Goal 6

Clinical management

Clinically manage paediatric patients across multiple settings

This activity requires the ability to:

  • manage general paediatric patients across the age span from birth to young adulthood, including transition to adult care and end-of-life care
  • manage paediatric inpatients, outpatients, and across health care settings
  • develop management plans and goals in consultation with patients, families, and/or carers
  • collaborate with other health professionals and/or community agencies
  • manage patients within their family and community context, considering cultural, socioeconomic and geographical factors
  • prescribe therapies tailored to patients’ needs, conditions, and goals
  • monitor, review, and adjust management plans
  • manage and coordinate longitudinal care of patients
  • manage the transition of care between health professionals, providers, and contexts

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 and address current clinical concerns and longer-term clinical objectives, as appropriate to patients’ context
  • holistically manage paediatric and adolescent patients across the age range within their family and community context, including physical and psychological symptoms
  • effectively plan for, and manage, patients’ pain, distress, stress, or discomfort during treatment
  • refer to, and liaise with, subspecialists and other health professionals where appropriate
  • manage general paediatric inpatients to a high standard
  • manage general paediatric outpatients to a high standard
  • manage patients with common neurodevelopmental and behavioural concerns
  • manage patients with common mental health concerns in liaison with mental health support services
  • manage patients with common neonatal / perinatal concerns
  • manage adolescent patients, including transition to adult services
  • manage patients where there are concerns for child maltreatment, in conjunction with other relevant agencies
  • manage patients with complex, multisystem, or chronic conditions, such as chronic pain
  • consider and select appropriate pharmacological and non-pharmacological therapies considering patients’ age, comorbidities, adverse reactions, preparations, availability, and patients’ preference
  • plan appropriate monitoring and follow up to promote wellbeing and prevent harm
  • monitor treatment outcomes, effectiveness, and adverse events
  • regularly review the goals of care and treatment plans with patients
  • initiate opportunistic screening and management of complications and comorbid conditions
  • demonstrate knowledge of the principles of care for patients at the end of their lives, in liaison with paediatric palliative care services

direction
Requires some supervision

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

The trainee may:

  • develop appropriate management plans for current concerns
  • develop safe management plans for general paediatric inpatients and outpatients that may not consider all holistic care needs
  • select medicines for common conditions appropriately, safely, and accurately
  • identify potential side effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
  • identify neurodevelopmental and behavioural concerns for patients
  • identify mental health concerns for 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:

  • communicate with patients about the benefits, risks, and potential side effects of proposed therapies
  • provide information to patients to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
  • educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication
  • facilitate and support open family discussions or meetings to deliver bad news or prognostic information
  • educate patients to recognise and monitor symptoms and when to seek help
  • communicate effectively with other professionals involved in patients’ lives to promote wellbeing, such as those working in education, mental health, allied health, and statutory child protection services

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
  • explain the benefits and burdens of therapies, considering patients’ individual circumstances
  • 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:

  • prescribe medications in accordance with evidence, guidelines, and protocols (including schedule 8 prescribing)
  • review medicines regularly to reduce non-adherence, and monitor treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
  • report suspected adverse events to medications, 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:

  • identify medication errors, and institute appropriate measures

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 safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples
  • effectively communicate with members of other cultural groups by meeting patients’ specific language, cultural, and communication needs
  • use qualified language interpreters or cultural interpreters where appropriate
  • enquire, acknowledge, and reflect on patients’ beliefs and values, and how these might impact on health and choices
  • offer support to patients, families, and carers to include cultural or religious practices in their care

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 sensitivities
  • access interpretive or culturally focused services when appropriate

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:

  • manage and share information about patients’ health care in adherence to privacy laws, confidentiality, and professional guidelines
  • prepare for, and conduct, clinical encounters in a well-organised and time-efficient manner
  • demonstrate an understanding of the medicolegal requirements of written communications
  • recognise complexities around patient consent when there may be disputes between parents, parent and child or court orders in place

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
  • identify patients’ preferences regarding management and the role of families in decision making
  • prioritise patient and social welfare over own personal interest and professional agenda

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 appropriate guidelines, evidence sources, and decision support tools
  • plan appropriate investigations, considering risk, benefit, tolerance, resources, diagnostic yield, and contribution to management
  • identify and address patients’ concerns, expectations, and goals
  • develop management plans in consultation with patients and carers
  • develop management plans considering the balance of benefit and harm by taking patients’ personal sets of circumstances into account
  • manage patients within their family and community context, considering cultural, socioeconomic, and geographical factors
  • ensure patients’ care is in the most appropriate facility, setting, or provider make appropriate decisions regarding referring or transferring patients to other services for further management, including regional and remote patients
  • use medicines safely and effectively to get the best possible results
  • recognise professional limitations

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
  • consider and prioritise patients’ issues using a structured approach
  • 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:

  • coordinate holistic care for complex patients
  • work effectively as a member of multidisciplinary teams to achieve the best health outcome for patients
  • lead inpatient teams
  • efficiently manage outpatient clinics
  • manage, and plan follow up for, patients that live in regional or remote locations, in liaison with their local health services
  • ensure care plans are communicated to all teams involved in patients’ care, including primary care and other relevant community care providers
  • engage and facilitate multidisciplinary team meetings, family meetings, and complex case conferences
  • establish and follow clear transition plans for adolescent patients, utilising appropriate services

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
  • contribute effectively to inpatient teams
  • work effectively in outpatient clinics

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 appropriate utilisation of local, regional, and national health services and systems
  • aim to achieve the optimal cost-effective patient care to allow maximum benefit from the available resources
  • support and use innovative systems, such as telehealth and digitally integrated support services
  • contribute to processes for managing risks, and identify strategies for improvement in transition of care
  • apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs
  • follow and support processes for adolescents transitioning to adult health services

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
  • consider transport issues and costs to patients in arranging for transferring patients to other settings