Nephrology curriculum standards

Ready to perform without supervision

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

The trainee will:

• discuss and evaluate the risk and benefits of treatment options, making decisions in partnership with patients
• provide clear and legible prescriptions in plain language, and include specific indications for the anticipated duration of therapy
• educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication, addressing the common and rare but serious side effects at the time of prescribing to improve patients’ adherence to pharmacotherapy
• describe, using patient-appropriate language, how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
• ensure patients’ understanding by repeating back pertinent information, such as when to return for monitoring and whether therapy continues after this single prescription
• identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives

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 and families and/or carers
• explain the benefits and burdens of therapies, considering patients’ individual circumstances
• provide clearly legible scripts or charts using generic names of the required medication in full, including mg/kg/dose information and all legally required information
• seek further advice from experienced clinicians or pharmacists when appropriate

Ready to perform without supervision

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

The trainee will:

• review medicines regularly to reduce non-adherence, monitoring treatment effectiveness, possible side effects, and drug interactions, ceasing unnecessary medicines
• use electronic prescribing tools where available, and access electronic drug references to prevent errors caused by drug interactions and poor handwriting Quality and safety
• prescribe new medicines when they have been demonstrated to be safer or more effective at improving patient-oriented outcomes than existing medicines
• participate in clinical audits to improve prescribing behaviour, including an approach to polypharmacy and prescribing cascade
• report suspected adverse events to the Advisory Committee on Medicines and record it in patients’ medical records appropriately

Requires some supervision

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

The trainee may:

• check medication doses before prescribing
• monitor side effects of medicines prescribed
• identify medication errors and institute appropriate measures
• use electronic prescribing systems safely where applicable
• rationalise medicines to avoid polypharmacy

Ready to perform without supervision

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

The trainee will:

• use continuously updated software for computers and electronic prescribing programs
• ensure patients understand management plans, including adherence issues
• use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines

Requires some supervision

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

The trainee may:

• undertake continuing professional development to maintain currency with prescribing guidelines
• reflect on prescribing and seek feedback from a supervisor

Ready to perform without supervision

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

The trainee will:

• critically appraise research material to ensure that any new medicine improves patient-oriented outcomes more than older medicines, and not just more than placebo
• use sources of independent information about medicines that provide accurate summaries of available evidence on new medicines

Requires some supervision

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

The trainee may:

• make therapeutic decisions according to the best evidence
• recognise where evidence is limited, compromised, or subject to bias or conflict of interest

Ready to perform without supervision

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

The trainee will:

• demonstrate effective understanding and explore patients’ understanding of and preferences for pharmacological and nonpharmacological management
• offer patients effective choices based on their expectations of treatment, health beliefs, and cost
• interpret and explain information to patients at the appropriate level of their health literacy
• anticipate queries to help enhance the likelihood of medicines being taken as advised
• ensure appropriate information is available at all steps of the medicine management pathway

Requires some supervision

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

The trainee may:

• appreciate patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of pharmacological and nonpharmacological management approaches

Ready to perform without supervision

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

The trainee will:

• provide information to patients about:
  • what the medicine is for
  • what it does
  • potential side effects
  • how to take it
  • when it should be stopped
• make prescribing decisions based on good safety data when the benefits outweigh the risks involved
• demonstrate understanding of the ethical implications of pharmaceutical industry marketing and funded research

Requires some supervision

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

The trainee may:

• consider the efficacy of medicines in treating illnesses, including the relative merits of different pharmacological and nonpharmacological options
• follow regulatory and legal requirements and limitations regarding prescribing
• follow organisational policies on pharmaceutical representative visits and drug marketing

Ready to perform without supervision

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

The trainee will:

• use a systematic approach to select treatment options
• use medicines safely and effectively to get the best possible results
• choose suitable medicines only if medicines are considered necessary and benefit patients
• prescribe medicines appropriately to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost to them
• evaluate new medicines in relation to their possible efficacy and safety profile for individual patients

Requires some supervision

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

The trainee may:

• consider the following factors for all medicines:
  • contraindications
  • cost to patients, families, and the community
  • funding and regulatory considerations
  • generic versus brand medicines
  • interactions
  • risk-benefit analysis
• recognise personal limitations, and seek help in an appropriate way when required

Ready to perform without supervision

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

The trainee will:

• interact with medical, pharmacy and nursing staff to ensure safe and effective medicine use

Requires some supervision

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

The trainee may:

• work collaboratively with pharmacists
• participate in medication safety and morbidity and mortality meetings

Ready to perform without supervision

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

The trainee will:

• choose medicines in relation to comparative efficacy, safety, and cost effectiveness against medicines already on the market
• prescribe for individual patients, considering history, current medicines, allergies, and preferences, ensuring resources are used wisely for the benefit of patients

Requires some supervision

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

The trainee may:

• prescribe in accordance with the organisational policy