Entrustable Professional Activities

EPA 4: Clinical assessment and management of function

EPA 4

Clinical assessment and management of function

Clinically assess and manage the ongoing care of patients

This activity requires the ability to:

  • identify and access relevant information about patients, including obtaining patient collateral histories
  • examine patients, including their medical, physical, functional, and psychosocial health
  • evaluate psychosocial, personal, and environmental factors that influence independence
  • select, plan, and use evidence-based clinically appropriate investigations
  • develop and implement management plans and goals of care
  • discuss findings with patients, their families and/or carers
  • work in partnership with patients, their families and/or carers to facilitate choices that are right for them
  • collaborate and communicate with health professionals.

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:

  • perform a full physical examination to establish the nature and extent of problems
  • assess a range of factors, including:
    • medical history
    • patients' mental state and cognitive function
    • personal and contextual factors influencing severity and nature of patients' disabilities
    • psychological history
    • social, environmental, and attitudinal factors that contribute to disability
  • assess the contextual aspects of patients' lifestyle to maximise function
  • recognise and manage issues of function, including changes to function over time, or patient goals
  • outline the natural history of common diseases and conditions, and the prognosis of these conditions
  • describe the relationship between disease and functioning using the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF)
  • use objective outcome measures in patients' assessments
  • choose appropriate diagnostic tools to assess function
  • assess the severity of problems, preventative strategies, and the likelihood of complications and clinical outcomes
  • develop management plans based on relevant guidelines, and consider the balance of benefit and harm by taking patients' personal sets of circumstances into account
  • recognise different models of care
  • work with the patients' limitations and participation restrictions
  • identify short- and long-term consequences of disability
  • identify areas where patients and families may require further support and advocacy
  • choose and interpret evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessments
  • identify the patients' disorder requiring pharmacotherapy, therapies and/or prescriptions
  • recognise the risk of opioid dependence for chronic pain management, and provide intervention for de-escalation of use
  • consider age, chronic disease status, lifestyle factors, allergies, potential drug interactions, and patients' preferences prior to prescribing new medications
  • plan for follow-up and monitoring

direction
Requires some supervision

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

The trainee may:

  • 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
  • not be able to articulate potential risks of day-to-day clinical decisions, such as prescription errors or falls risks
  • assess patients using a biomedical approach, rather than a holistic rehabilitation approach
  • provide rationale for investigations
  • understand the significance of abnormal test results, and act on these
  • consider patient factors and comorbidities
  • consider age-specific reference ranges
  • be aware of potential side effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
  • prescribe inappropriate drugs to patients without considering patient context or demographic

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 question
  • use sensitive language when introducing tests and/or the assessment process to patients and their families or carers
  • support patients with cognitive impairment in decision making, including using an interpreter or speaking in simpler language, using pictures or photos, and putting explanations in writing
  • communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients' care
  • use clear and simple language, checking that patients understand the terms used and that they agree to proceed with proposed investigations
  • discuss and evaluate the risks and benefits of treatment options, making decisions in partnership with patients

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
  • communicate patients' situations to colleagues, including senior clinicians
  • take control of patients' decisions and tasks of daily living to save time, leading to further functional decline
  • explain the results of investigations to patients
  • arrange investigations, providing accurate and informative referrals, and liaising with other services where appropriate
  • discuss and explain the rationale for treatment options with patients, their families or carers
  • explain the benefits and burdens of therapies, considering patients' individual circumstances

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 patients are informed of the material risks associated with any part of proposed management plans
  • identify and document risk prevention strategies
  • identify high-risk patients, such as those with cognitive impairment or at risk of falls, and those with reduced insight into their conditions
  • outline risk prevention strategies, including home environment and medications
  • review medicines regularly to reduce non-adherence, monitoring treatment effectiveness, possible side effects, and drug interactions, and ceasing unnecessary medicines

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 confused or agitated patients, ensuring appropriate care of patients
  • document history and physical examination findings, and synthesise with clarity and completeness
  • demonstrate uncertainty as to when a risk assessment is required
  • monitor side effects of medicines prescribed
  • identify medication errors and institute appropriate measures

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 the ICF/ICD framework as a tool to guide teaching sessions
  • 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
  • use appropriate guidelines, evidence sources, and decision support tools
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines and other non-pharmacological treatment options, and keep up to date on new treatments and therapies

direction
Requires some supervision

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

The trainee may:

  • set unclear goals and objectives for self-learning
  • self-reflect infrequently
  • deliver teaching considering learners' level of training
  • display limited engagement in teaching other team members, or fail to include functional issues in teaching sessions
  • undertake professional development to maintain currency with investigation guidelines
  • reflect on prescribing, and seek feedback from supervisors

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
  • obtain written consent from patients if the investigation is part of a research program
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines or therapies
  • select suitable research and quality assurance projects available at the training location, such as Australasian Rehabilitation Outcomes Centre (AROC) data and Functional Independence Measure (FIM) assessments

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 evidence, and the challenges of applying research in daily practice
  • consult current research on investigations, and make therapeutic decisions according to the best evidence
  • insufficiently engage with available research opportunities regarding assessment of function

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 professional interpreters, health advocates or family or community members to assist in communication with patients
  • use plain language education materials while demonstrating cultural and linguistic sensitivity to patients

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:

  • document patient assessments using a legal format, where required
  • apply laws governing practice on consent, capacity, and elder abuse and neglect
  • 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' capacity for decision making, involving a proxy decision maker appropriately
  • balance the rights of patients with the wishes and expectations of families or carers
  • discuss with patients how decisions will be made once the investigation has started and the patient is not able to participate in decision making
  • advise patients there may be additional costs, which patients may wish to clarify before proceeding
  • make prescribing decisions based on good safety data when benefits outweigh the risks involved

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
  • assume there is always functional impairment in certain patient groups, such as older patients or patients with amputations
  • display a lack of awareness for the management of an impairment to ensure function
  • identify appropriate proxy decision makers when required
  • involve patients in decision making regarding investigations and obtaining the appropriate informed consent, including financial consent if necessary
  • consider the efficacy of medicines in treating illnesses, including the relative merits of different pharmacological and non-pharmacological options
  • follow regulatory and legal requirements and limitations regarding prescribing

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:

  • select the most appropriate care setting for rehabilitation, such as inpatient, day hospital, outpatient, home based, or outreach
  • apply knowledge and experience to identify patients' problems, making logical, rational decisions, and acting 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
  • identify social determinants of health that may impact on patients' care
  • implement tailored approaches to promote functional independence through shared decision making using the ICF framework
  • assess the urgency, complexity, and related risks of situations
  • conduct a capacity assessment when an appropriate trigger is identified, such as health, financial, legal, or lifestyle
  • use a systematic approach to select treatment options
  • use medicines safely and effectively to get the best possible results

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, seeking help when required in an appropriate way
  • lack awareness of facilities, therapies, and environmental changes that can be made to improve function in health conditions and impairments
  • lack awareness of how to promote independence and quality of life
  • 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

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:

  • produce clear plans, including discharge plans and equipment required
  • collaborate with patients' health care teams to perform comprehensive capacity assessments, as needed
  • provide information to clinicians and other staff on the need for patient mobilisation and involvement in activities of daily living, including how to assess risks to patients
  • provide clinicians with expertise and advice to recognise the needs of carers and mechanisms for taking action
  • 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 patients' safety

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
  • show limited awareness of rehabilitation team structures and processes used to improve function and environmental access

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:

  • work with patients and families to identify opportunities for disease prevention, health promotion, and health protection
  • participate in health promotion and protection, disease prevention, control, and screening, and reporting notifiable diseases
  • aim to achieve optimal cost-effective patients' care to allow maximum benefit from the available resources
  • facilitate timely access to resources, including the public guardian and/or trustee, legal advice, appeal mechanisms, and family education and support
  • provide information on services such as support groups, respite services, and other carer support 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 patients' care
  • show limited knowledge of local and national health policy systems and need for advocacy on function and community access