Curriculum standards
Curriculum standards
Advanced Training in Addiction Medicine
Entrustable Professional Activities
LG 8: Prescribing
Prescribing
Prescribe therapies and develop management plans tailored to patients’ needs
This activity requires the ability to:
- take an addiction medicine history
- determine the level of risk associated with the patients’ current substance use
- develop a management plan with the patient based on risks, and patient goals and preferences
- address other health issues which are identified at the start of or during treatment, such as concurrent mental health and physical health conditions
- collaborate with pharmacists, general practitioners, and other health professionals
- monitor progress and assess risks on an ongoing basis, and modify plans accordingly with the patient
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- use a comprehensive addiction medicine assessment as a framework to assess and manage patients
- evaluate interrelationships between chronic pain, past treatments, and the current opioid dependence
- determine the presence of substance dependence and associated risks
- assess the severity of substance and/or related health problems, the likelihood of complications, and clinical outcomes
- develop management plans based on assessments of patients, concurrent medical problems, treatments, and relevant guidelines
- manage patient comorbidities, or broker required treatment through general practice or specialist services
- comply with legislation concerning prescription and supply of drugs of dependence
- discuss psychological strategies that may be used alongside medication
- prescribe off-label, if indicated, considering the risks and benefits, as far as they are known and with full disclosure
- use current ongoing monitoring systems to evaluate progress, or to detect emerging risks
- interpret toxicology results
- discuss the nature of opioid agonist treatment, its risks and benefits and costs with patients
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- elicit 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
Communication
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
- provide information to patients, family or carers (if relevant), to enable them to make a fully informed decision from various diagnostic, therapeutic, and management options
- communicate clearly, effectively, respectfully, and promptly with other health professionals involved in patients’ care, including GPs and pharmacists
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- anticipate, read, and respond to patients’ questions and comments
- demonstrate active listening skills
- communicate patients’ situations to colleagues, including senior clinicians
- understand how to assess communication skills and effectiveness, evaluating patient feedback
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- determine what reasonable risk mitigation strategies need to be in place
- document management plans clearly
- communicate clearly when prescribing for opioid dependence
- demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
- recognise and de-escalate challenging behaviours
- obtain informed consent before undertaking any investigation or providing treatment, except in an emergency
- inform patients of the material risks associated with any part of the proposed management plans
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 by patients
Teaching and learning
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
- reflect regularly and self-evaluate professional development
- obtain informed consent before involving patients in teaching activities
- use clinical activities as an opportunity to teach, appropriate to the setting
- collaborate with primary care and pharmacy colleagues to increase understanding and adoption of opioid agonist treatment (OAT)
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- set vague goals and objectives for self-learning
- deliver teaching considering learners’ level of training
- participate in specialty journal clubs and available advanced training tutorials
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- compile, analyse, interpret, and evaluate information relevant to the research subject
- use relevant resources to assist with resolving clinical problems, including practice guidelines and current literature
- consider treatment decisions, including evidence from clinical trials and their applicability to older patients
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 problemse
Cultural safety
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 safe communication and care for Māori and Aboriginal and Torres Strait Islander peoples, and members of other cultural groups
- use culturally safe settings for service provision
- 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
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
- access interpretive or culturally focused services
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- 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
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, where possible, patients’ wishes and preferences about care
- contribute to building a productive culture within teams
- outline management strategies for resolving high-conflict situations
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- determine risks associated with treatment and manage accordingly, taking into account the impact on patients
- identify high-risk presentations while in treatment, and respond accordingly
- collaborate with colleagues, including medical nursing and allied health, and at times regulatory authorities, in determining management of complex high-risk situations
- integrate evidence related to questions of diagnosis, therapy, prognosis, risks, and causes into clinical decision making
- reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- involve additional staff to assist in a timely fashion when required
- recognise situations in which to ask for help
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- collaborate with medical, pharmacy, nursing, and allied health professionals to ensure safe and effective medicine use
- collaborate with colleagues in other specialties about common risks, side effects, and drug interactions
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
- outline the meaning of clinical governance and lines of accountability
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- choose medicines based on evidence underpinning comparative efficacy, safety, and cost-effectiveness
- collaborate with other health professionals and community members to better understand the risks associated with opioid dependence and the role of opioid agonist treatment
- manage clear guidelines in place for management of opioid dependence prescribing
- manage adequate processes for transfers between specialist services and custodial services and primary care to ensure continuity
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