Entrustable Professional Activities

LG 10: Undertaking consultation-liaison work

Learning Goal 10

Consultation-liaison

Advising other health professionals who are providing care for people using substances or with addictive disorders

Addiction medicine frequently involves consultation-liaison practice, including advising and supporting other health professionals in their management of people with substance use and addictive disorders.

In settings such as hospital consultation-liaison, the patient is directly seen and assessed by the addiction medicine specialist while under the care of another team or clinician.

Sometimes advice is given based on the clinical picture from other health professionals, with the patient not being directly seen.

Consultations are also undertaken in clinics and in private consulting rooms when the patient has been referred by a GP. In this situation, a report (usually a letter) is sent back to the referring practitioner. There may also be telephone or online communication.

The treating health professional may also be a community pharmacist, a clinical nurse, or nurse practitioner.

This activity requires the ability to:

  • assess the clinical situation either directly with the patient, or through structured discussions with the referring health professional
  • assess the risks associated to the patient, and their treatment options
  • develop a clear agreed management plan
  • demonstrate understanding and give due consideration to the principles of medical confidentiality in line with relevant legislation
  • create detailed medical records, and when the patient has been seen directly, provide a written report to other 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:

  • use a targeted framework to assess scenarios, determining the main clinical issues
  • define the issues treating clinicians want advice on
  • seek corroborative information where appropriate, such as clinical databases and past case notes
  • consider whether patients may have impaired capacity due to delirium or cognitive impairment
  • develop management plans with principal treating clinicians or teams, in collaboration with patients where possible, based on patients’:
    • context in the community, such as the geographical setting
    • legal capacity
    • mental health and social circumstances
    • concurrent medical problems
    • pattern of substance use
    • readiness for change
    • various risks present
  • use brief interventions or more extensive motivational interview techniques to influence patients’ readiness for change, with direct patient contact
  • adopt harm reduction approaches to minimise harm from continuing substance use, be this unchanged or reduced
  • plan for timely follow-up of progress where required

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 clinical encounters and diagnostic categories
  • develop appropriate management plans

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 with patients and family, if appropriate, in a way that encourages engagement, increases motivation to change, and reflects educational level and cognitive status
  • communicate with other health professionals, including providing written reports to ensure sharing of information and collaboration
  • involve patients in the development of management plans, considering their preferences and social circumstances
  • communicate the responsibilities of the treating team or health professionals

direction
Requires some supervision

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

The trainee may:

  • adopt a patient-centred communication style
  • not adequately communicate or seek to engage other professionals involved in patients’ care
  • develop management plans which do not necessarily consider patients’ preferences and 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:

  • document assessment and management plans clearly
  • demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
  • describe the criteria for seeking further advice and escalation of care

direction
Requires some supervision

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

The trainee may:

  • undertake infection control measures
  • document management plans
  • conduct adequate handovers

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 opportunities to educate referring practitioners about substance use and addictive disorders
  • model respectful patient-centred care and a focus on harm minimisation
  • 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
  • use opportunities to teach using clinical activities

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

Research

confident
Ready to perform without supervision

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

The trainee will:

  • collect relevant information with due consideration of ethical requirements when research or quality improvement work is being undertaken
  • use relevant resources to assist with resolving clinical problems, including practice guidelines and current literature
  • consider treatment decisions, including evidence from clinical research

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
  • refer to colleagues to assist with research or finding resources to resolve clinical problems

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:

  • demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander people and Māori, and members of other cultural groups
  • work with Aboriginal and Torres Strait Islander and Māori services and professionals in ensuring responses are culturally safe
  • acknowledge patients’ beliefs and values, and how these might impact on health
  • use professional interpreters, health advocates, or family or community members to assist in communication with patients
  • use plain language patient education materials, demonstrating cultural and linguistic sensitivity

direction
Requires some supervision

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

The trainee may:

  • respect patients’ cultures, and attentiveness to social determinants of health
  • demonstrate understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
  • 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:

  • communicate with patients regarding the choices they have regarding treatment and non-treatment
  • explain access options for treatments now and in the future
  • facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
  • demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy

direction
Requires some supervision

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

The trainee may:

  • communicate medical management plans as part of multidisciplinary plans
  • establish patients’ wishes and preferences about care
  • contribute to building a productive culture within teams

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:

  • respect the need for patients’ autonomy, even in the setting of what appears to be poor decision making
  • have awareness of when compulsory treatments and mandatory reporting need to be used, per the jurisdiction
  • assess the risks present in clinical scenarios, taking into consideration the context of referrals, such as community-based GPs with patients in the community with high levels of uncertainty versus senior registrars or consultants with an inpatient in a much more controlled environment
  • recognise the need for escalation of care, and escalate to appropriate services or agencies or advise such accordingly
  • balance conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
  • seek advice from colleagues in high-stakes difficult clinical situations

direction
Requires some supervision

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

The trainee may:

  • have difficulty reconciling poor decision making by patients
  • not be able to match advice regarding management with the setting of the referring health professional
  • recognise situations in which to ask for help
  • have difficulty with conflicting advice from specialties and arriving at agreed plans
  • seek advice at lower thresholds than at expert level

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:

  • collaborate respectfully with nursing, pharmacy, and other health professionals to optimise outcomes through care planning
  • provide leadership and advocacy regarding issues around substance use and addictive disorders

direction
Requires some supervision

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

The trainee may:

  • collaborate with the other relevant health professionals
  • participate in multi-department meetings

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:

  • advocate for appropriate guidelines and pathways to assist people with substance use and addiction disorders, both in primary and tertiary care settings
  • adequately resource support services for addiction medicine specialty practice
  • verify that treatment escalation protocols are in place
  • collaborate Aboriginal and Torres Strait Islander and Māori communities to improve access and appropriateness of addiction services

direction
Requires some supervision

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

The trainee may:

  • practice in accordance with guidelines and organisational policies for perinatal care