Entrustable Professional Activities

LG11: Investigations

Learning Goal 11

Investigations

Select, organise, and interpret investigations

This activity requires the ability to:

  • select, plan, and use clinically and microbiologically appropriate investigations, incorporating evidence-based practice
  • prioritise patients receiving investigations (if there is a waiting list)
  • evaluate the anticipated value of investigations
  • work in partnership with patients to facilitate choices that are right for them, and undertake pre-test counselling where required
  • provide aftercare for patients (if needed)
  • interpret the results and outcomes of investigations
  • communicate the outcome of investigations 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 as an adjunct to comprehensive clinical assessments, including in response to potential pathogen exposure
  • assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
  • interpret microbial tests, using principles of pathology stewardship, including in the context of time elapsed since disease onset, and modify patients’ management accordingly
  • anticipate likely breakthrough organisms based on the spectrum of antimicrobial coverage
  • consider diagnostic issues in relation to patients’ fears, and recognise the need for patients’, family members’, and/or carers’ understanding of procedures, investigation results, and disease management

direction
Requires some supervision

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

The trainee may:

  • provide rationale for investigations
  • be cognisant of the significance of abnormal test results, and act on these
  • 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, burdens, costs, risks, and side effects of each option, including the option to have no investigations
  • use clear and simple language, and check that patients understand the terms used and agree to proceed with proposed investigations
  • identify patients’ concerns and expectations, providing adequate explanations on the rationale for individual test ordering
  • confirm whether patients understand the information they have been given, and whether they need more information before they make decisions
  • use written or 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
  • give information that 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 patients before ordering investigations
  • explain the results of investigations to patients
  • arrange investigations, providing accurate and informative referrals, and liaise with other services where 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:

  • identify adverse outcomes that may result from proposed investigations, focusing on patients’ individual situations
  • weigh patients’ benefits, costs, and risks of investigations in each clinical situation, and counsel patients regarding these
  • interpret test results considering their limitations, including false negatives and false positives

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 diagnosis and screening
  • work effectively and provide clinical leadership in a multidisciplinary team

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 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
  • review clinical trials for peers, such as journal club, interpreting findings with reference to general epidemiological principles

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:

  • appreciate patients’ views and preferences about any proposed investigations 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 patients’ cultural and religious backgrounds, attitudes, and beliefs, 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 the authority given by patients (with the exception of emergencies)
  • discuss with patients how decisions will be made once the investigation has started and the patient is not able to participate in decision making
  • respect patients’ decisions to refuse investigations, even if their decisions may not be appropriate or evidence based
  • explain the expected benefits as well as the potential risks of any proposed investigations before obtaining informed consent or other valid authority

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 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
  • apply diagnostic reasoning to minimise the number of investigations used and potential harm from false positives
  • interpret laboratory resistance testing based on knowledge of resistance mechanisms, cross-resistance, and inducible resistance
  • interpret and communicate antibiograms
  • interpret clinical signs and read radiological investigation reports
  • interpret pathology results and read reports

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 clinical scenarios in discussion with patients
  • recognise personal limitations and seek help in an appropriate way when required
  • recognise a local or nearby disease outbreak

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 awareness of what parts of investigations 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, cost effectiveness, safety, and utility
  • consider resource use through peer review of testing behaviours
  • advocate for marginalised and underserved communities
  • outline reporting procedures for patients with newly diagnosed notifiable infections