Entrustable Professional Activities

LG10: Investigations and procedures

Learning Goal 10

Investigations and procedures

Select, organise, and interpret investigations and procedures

This activity requires the ability to:

  • select, plan, and use evidence-based clinically appropriate investigations
  • select, plan, and perform procedures if appropriate
  • produce informed consent, and perform procedures and post-procedure care
  • evaluate the anticipated value of the investigation or procedure
  • collaborate with patients to support the decisions that are right for them
  • interpret the results and outcomes of investigations
  • communicate the outcome of investigations and procedures to patients

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:

  • choose evidence-based investigations, using them to complement comprehensive clinical assessments
  • assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefits
  • recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
  • determine procedures by assessing patient-specific factors, risks, and alternatives, and perform if appropriate
  • avoid wasteful and morbid investigations that will not improve patient care

direction
Requires some supervision

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

The trainee may:

  • provide rationale for investigations and indications for procedures
  • recognise the significance of abnormal test results, and act on these
  • interpret results of common diagnostic investigations and procedures
  • consider 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 patients the potential benefits, risks, costs, burdens, and side effects of each option, including the option to have no investigations
  • use clear language, ensure patient understanding, and confirm their agreement to proposed investigations
  • provide explanations on the rationale for individual test ordering
  • use written, visual material, or other aids that are accurate and up to date to support discussions with patients
  • explain findings or possible outcomes of investigations to patients
  • deliver potentially distressing information to patients with care and empathy
  • address patients’ concerns relating to investigations and procedures, and provide the opportunity to ask questions

direction
Requires some supervision

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

The trainee may:

  • discuss the indications, risks, benefits, and complications of investigations and procedures with patients
  • arrange investigations and procedures, providing accurate and informative referrals, and liaise with other services where appropriate
  • explain the results of investigations to patients

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 patients’ individual situations
  • document the notification and disclosure of adverse outcomes appropriately
  • ensure appropriate informed consent is obtained before undertaking any procedures

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 and procedures 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-making support tools
  • participate in ongoing self-education to improve test ordering strategies as per evidence-based guidelines
  • provide skills training, and specific and constructive feedback to junior colleagues

direction
Requires some supervision

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

The trainee may:

  • participate in continued professional development around procedures

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

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:

  • recognise 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 how patients’ gender identity, sexual orientation, cultural and religious backgrounds, attitudes, and beliefs 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:

  • practice within the scope of authority given by patients (with the exception of emergencies)
  • recognise own limitations and seek assistance when required
  • respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
  • advise patients if there are additional costs, which patients may wish to clarify before proceeding
  • explain the expected benefits, as well as the potential risks, of any proposed investigation before obtaining informed consent or other valid authority
  • demonstrate comprehension of genetic findings from investigations, and the complexities of subsequent disclosure

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 patients in decision making regarding investigations, 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 or procedure in a clinical situation
  • adjust the investigative path depending on test results received
  • consider whether 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 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 healthcare team might play, and what other sources of information and support are available
  • ensure results are checked 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:

  • select and justify investigations regarding the pathological basis of disease, appropriateness, utility, safety, and cost effectiveness
  • consider resource utilisation through peer review