Clinically assess patients, incorporating interview, examination, and formulation of a differential diagnosis and management plan
This activity requires the ability to:
- obtain histories
- examine patients
- integrate information from assessments into comprehensive formulations
- develop provisional and differential diagnoses and problem lists
- discuss findings with patients, families, or carers1
- present findings to colleagues, including senior clinicians
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments.
Behaviours
Each EPA has lists of behaviours. The behaviours help trainees understand how they can improve, and help supervisors to make decisions about whether trainees can be trusted to do the task with supervision at a distance
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- takes patient-centred histories using appropriate lay terms and avoiding medical jargon
- tailors the history taking and physical examination to the clinical situation and the specific patient encounter
- incorporates psychosocial considerations into assessment
- identifies and uses alternative sources of information to obtain history when needed, such as family members, carers, and other health professionals and professional bodies
- recognises and takes precautions where the patient may be vulnerable, such as issues of child protection, self- harm or elder abuse
- performs accurate physical examinations
- demonstrates patient-centred examination techniques that respect patient privacy, comfort, and safety
- consistently uses a developmentally appropriate approach to the physical examination2
- recognises and correctly interprets abnormal findings
- filters, prioritises, and synthesises pertinent information to direct the clinical encounter and broad diagnostic categories
- formulates appropriate differential diagnoses
- seeks to understand the concerns and goals of patients and their families or carers
- develops appropriate management plans
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance3.
The trainee may:
- gather too little information, or exhaustively gather information following a template regardless of the chief complaint
- perform inadequate physical examinations
- inadequately alter their approach to the physical examination to meet the developmental level, behavioural needs, or the competency level of patients
- develop an overly inclusive list of potential diagnoses
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- anticipates, reads, and responds to verbal and non-verbal cues
- demonstrates active listening skills
- accurately communicates the situation of patients to colleagues, including senior clinicians
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- inadequately interpret verbal and nonverbal cues
- inadequately communicate with patients during the assessment, particularly when explaining the process of physical examination
- inadequately engage families or carers in the discussion
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- performs hand hygiene and takes infection control precautions at appropriate moments
- documents history, physical examination findings, and synthesis with clarity and completeness
- recognises and takes precautions against assault from confused or agitated patients, and ensures appropriate care of patients
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- refers to guidelines and medical literature to assist in their clinical assessments when required
- demonstrates understanding of the limitations of evidence and the challenges of applying research in daily practice
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- is respectful of patients’ cultures, and attentive to social determinants of health
- displays an understanding of at least the most prevalent cultures in society and an appreciation of their sensitivities
- appropriately accesses interpretive or culturally-focused services
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- demonstrate an inadequate awareness of, or difficulty accepting and understanding, the cultures of others
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- demonstrates professional conduct, honesty and integrity
- maintains patient privacy and confidentiality
- displays respect and sensitivity towards patients
- assesses patients’ decision-making capacity
- maximises patient autonomy and supports patients’ decision making
- identifies patients’ preferences regarding management and assesses the role of families in decision making
- identifies the decision maker, including whether a substitute decision maker must be involved
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- display lapses in professional conduct, such as acting disrespectfully or providing inaccurate or incomplete information
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- demonstrates clinical reasoning by gathering focused information relevant to patients’ care and according to the presenting situation
- recognises their own limitations and seeks help when required in an appropriate way
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- make intuitive leaps to conclusions that are often unsupported by pattern recognition, data, or evidence
- inadequately consult with senior colleagues
- References to patients in the remainder of this document may include their families or carers.
- This behaviour is particularly relevant to Paediatrics & Child Health.
- Trainees not yet ready to perform this activity with supervision at a distance may not yet display behaviours displayed by a trainee ready to perform with supervision at a distance. Therefore, not all of these opposing behaviours are listed here. In the remainder of the document lists in this column capture behaviours supervisors and trainees should be particularly aware of when considering entrustment.