Entrustable Professional Activities

EPA 4: Clinical assessment and management

EPA 4

Clinical assessment and management

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

  • identify and access sources of relevant information about patients 
  • obtain patient histories
  • examine patients
  • synthesise findings to develop provisional and differential diagnoses
  • discuss findings with patients, families and/or carers
  • generate a management plan
  • present findings to other health professionals
  • identify and manage complications arising from medication or comorbidities.

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 an accurate, organised and problem-focused history considering physical and psychosocial risk factors, and anticipating future needs
  • perform a full physical examination to establish the nature and extent of problems
  • synthesise and interpret findings from the history and examination to devise the most likely provisional diagnoses via reasonable differential diagnoses
  • recognise the risk of complications from nephrotoxic medications and inappropriate drug dosing in patients with chronic kidney disease (CKD)
  • identify complications such as anaemia, hypervolemia, and electrolyte imbalances, along with comorbid conditions such as diabetes, hypertension, and heart disease, which increase risk of adverse events
  • develop management plans based on relevant guidelines, considering the balance of benefit and harm by taking patients’ personal circumstances into account, and modifying medications, including immunosuppressive drugs, appropriately during pregnancy or for women planning pregnancy
  • identify patients with secondary hypertension who are suitable for specific and targeted treatments
  • recognise and counsel patients about the limitations of interventions
  • identify patients at high risk of acute kidney injury
  • differentiate acute kidney injury from chronic kidney disease (CKD)
  • recognise when a kidney biopsy is required

direction
Requires some supervision

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

The trainee may:

  • identify clinical emergencies and prioritise care
  • take patient-centred histories, considering psychosocial factors
  • perform accurate physical examinations
  • recognise and correctly interpret abnormal findings
  • synthesise pertinent information to direct the clinical encounter and diagnostic categories
  • develop appropriate management plans
  • recognise the effects of kidney disease on fertility, sexual function, pregnancy, and outcomes
  • perform clinical assessments that address all relevant issues
  • identify indications for investigating for secondary hypertension
  • identify patients who require a kidney biopsy

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 openly, listen, and take patients’ concerns seriously, giving them adequate opportunity to ask questions and explain their goals of care
  • provide balanced information to patients, family and/or carers to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options Communication
  • communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care
  • discuss sensitively the risk and implications of pregnancy to patients and their partner/family to enable the patient to make an informed choice
  • negotiate patient lifestyle measures and a suitable anti-hypertensive drug regimen

direction
Requires some supervision

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

The trainee may:

  • anticipate, read, and respond to verbal and nonspeaking cues
  • demonstrate active listening skills and communicate patients’ conditions to colleagues, including senior clinicians
  • document clinical encounters to convey clinical reasoning and the rationale for decisions
  • counsel patients with kidney disease who are on dialysis or with a kidney transplant about the risks and implications of pregnancy, and act to minimise the risks to mother and fetus in accordance with the mother’s informed choice

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:

  • demonstrate safety skills including infection control, adverse event reporting, and effective clinical handover
  • recognise and effectively deal with aggressive and violent patient behaviours through appropriate training
  • obtain informed consent before undertaking any investigation or providing treatment, except in an emergency
  • ensure that patients are informed of the material risks associated with any part of the proposed management plans

direction
Requires some supervision

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

The trainee may:

  • perform hand hygiene and take infection control precautions at appropriate moments
  • take precaution against assaults from agitated patients, and ensure appropriate care of patients
  • document history and physical examination findings, and synthesise with clarity and completeness

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:

  • set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
  • regularly reflect and self-evaluate professional development
  • obtain informed consent before involving patients in teaching activities
  • turn clinical activities into an opportunity to teach, appropriate to the setting

direction
Requires some supervision

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

The trainee may:

  • set some goals and objectives for self-learning
  • self-reflect infrequently
  • 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:

  • search for, find, compile, analyse, interpret, and evaluate information relevant to the research subject
  • refer to current best practice guidelines

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 the 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:

  • acknowledge patients’ beliefs and values, and how these might impact on health
  • demonstrate effective and culturally competent communication and care for Aboriginal and Torres Strait Islander and Māori peoples, and members of other cultural groups
  • use a professional interpreter, a health advocate, family member or community member to assist in communication with patients
  • use plain-language patient education materials, and be culturally and linguistically sensitive

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
  • 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 for diversity, integrity, honesty, and partnership to all patients
  • hold information about patients in confidence, unless the release of information is required by law or public interest
  • assess patients’ capacities for decision making, and involve a substitute 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 experience to identify patients’ problems
  • use logical, rational decisions and act to achieve positive outcomes for patients
  • use a holistic approach to health, considering comorbidity, uncertainty, and risk
  • 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 when required in an appropriate way

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 member of multidisciplinary teams to achieve the best health outcomes for patients
  • demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining patient safety

direction
Requires some supervision

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

The trainee may:

  • share relevant information about the patient and their case with members of the healthcare 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:

  • participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
  • aim to achieve optimal, cost-effective patient care to allow maximum benefit from the available resources

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 health system relevant to patients’ care
  • identify and access relevant community resources to support patient care