Entrustable Professional Activities

EPA 6: Acute paediatric cardiac care

EPA 6

Acute paediatric cardiac care

Assess and manage the care of acutely unwell paediatric cardiology patients

This activity requires the ability to:

  • recognise instability and medical acuity in clinical presentations
  • provide assessment and initial stabilisation of airways, breathing, and circulation
  • elicit a history, including relevant past history, and perform relevant physical examinations
  • select and/or interpret appropriate investigations
  • develop and implement management plans

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:

  • recognise and manage typical and atypical cardiac presentations
  • use emergency monitoring equipment to timely identify cardiovascular abnormalities requiring urgent intervention
  • integrate and synthesise clinical information, haemodynamics, and results of investigations to assess clinical status
  • manage hemodynamic support and monitoring, including inotropes, anti-arrhythmics, and/or mechanical support

direction
Requires some supervision

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

The trainee may:

  • recognise deterioration, and know how to escalate treatment
  • perform the sequence of cardiac resuscitation as per established protocols
  • use echocardiography to look for and/or provisionally diagnose abnormalities in cardiac structure or function
  • select and use diagnostic techniques to differentiate the underlying causes and precipitating factors of heart disease, and to evaluate cardiac function and pulmonary pressures

Communication

confident
Ready to perform without supervision

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

The trainee will:

  • convey information to other medical professionals involved in patients’ care, including ICU, retrieval services, and other teams (e.g. neurology, general paediatrics)
  • support health professionals in remote settings to manage acutely unwell patients
  • support multidisciplinary teams to achieve the best health outcomes for acutely unwell patients

direction
Requires some supervision

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

The trainee may:

  • support health professionals in remote settings to manage acutely unwell patients • support multidisciplinary teams to achieve the best health outcomes for acutely unwell 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:

  • consider alternative strategies if complications arise or treatment is ineffective
  • participate in organisational quality and safety activities, including morbidity and mortality reviews and clinical incident reviews

direction
Requires some supervision

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

The trainee may:

  • review and re-assess acute management plans

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:

  • demonstrate learning behaviour and skills in educating junior colleagues
  • regularly reflect and self-evaluate professional development
  • obtain informed consent before turning clinical activities into teaching opportunities, ensuring patients are aware of the risks

direction
Requires some supervision

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

The trainee may:

  • self-reflect infrequently
  • set unclear goals and objectives for self-learning

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 and critically appraise the evidence to resolve clinical areas of uncertainty

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
  • demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

direction
Requires some supervision

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

The trainee may:

  • understand the impact of cultural and psychosocial perspectives of the family

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:

  • engage appropriate colleagues in decision making (e.g. when withdrawing care or continuing to provide care despite patient/parent wishes)

direction
Requires some supervision

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

The trainee may:

  • consider discrepancies between parents' or carers’ wishes and decisions around what is best for patients based on their personal comfort and life expectancy

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:

  • consider discrepancies between parents' or carers’ wishes and decisions around what is best for patients based on their personal comfort and life expectancy
  • balance risk, effectiveness, and priority of intervention in the presence of multiple comorbidities and/or other features of case complexity

direction
Requires some supervision

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

The trainee may:

  • integrate best evidence and clinical expertise into decision making
  • participate in decisions to admit, discharge, or transfer patients from the ICU

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:

  • participate in joint cardiac conferences to decide and agree on treatment approaches and appropriate locations for provisions of care across the network
  • integrate the skills of other health professionals in the acute care as relevant
  • determine the need and timing of referrals to other physicians

direction
Requires some supervision

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

The trainee may:

  • present patient cases to health care teams, and understand the cardiac management plans
  • determine the need and timing of referrals to other specialists

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:

  • apply knowledge of local protocols and resources
  • apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs

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