Choose, organise, and interpret investigations
This activity requires the ability to:
- plan, rationalise, and arrange investigations
- discuss investigative plans with patients, their families, or carers, and support them to make informed choices
- follow-up the results of investigations and interpret the results independently
- follow-up investigations that have been ordered but not performed
- communicate results of investigations with patients
- modify management plans based on new information
- 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:
- plans appropriate investigations based on clinical assessment
- provides rationales for investigations
- understands the significance of abnormal test results and acts on these as appropriate and in a timely manner
- modifies patients’ management plans based on the results of investigations in a timely manner
- estimates pre-test probability and applies this concept appropriately when ordering investigations
- considers patient factors and comorbidities
- considers age-specific reference ranges
- understands the implications of genetic testing for patients and families
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 a lack of awareness of the significance of abnormal test results and the appropriate response
- inadequately modify management plans when results of investigations would indicate that a change in management is appropriate
- order or intend to order inappropriate investigations
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:
- discusses the indications, risks, benefits, and complications of investigations with patients prior to ordering the investigation, in order to obtain informed consent and conduct investigation
- communicates and explains the results of investigations to patients
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:
- have difficulty in clearly explaining investigations to patients, such as excessive use of medical jargon
- inadequately complete required documentation or investigation request forms
- provide inadequate information on referrals for investigations or inadequately convey the indication for ordering particular tests
- have difficulty communicating clearly with other services regarding timing or prioritisation of investigations
- inadequately communicate significant results to appropriate health professionals
- inadequately explain the implication of results to 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:
- seeks help with interpretation of test results for less common tests or indications, or unexpected results
- considers safety aspects of investigations when planning to order them, such as radiation exposure, taking large volumes of blood from small infants, or sedation required to perform the investigation
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:
- order potentially dangerous investigations, such as CT scan of a pregnant patient or MRI in a patient with a pacemaker
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:
- undertakes continuing professional development to maintain currency with investigation guidelines
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:
- consults current research on investigations
- refer to evidence-based clinical guidelines
- 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:
- appreciates patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations
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:
- consistently involves patients in decision-making regarding investigations, and obtains the appropriate informed consent, including financial consent if necessary
- identifies appropriate proxy decision makers when required
- chooses not to investigate in situations where it is not appropriate to investigate for ethical reasons
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 follow-up on results of investigations or not handover to colleagues to review investigations
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:
- chooses the most appropriate investigation for the clinical scenario in discussion with patients
- minimises the number of investigations for effective clinical care
- adjusts the investigative path depending on the test results received
- evaluates the costs, benefits, and potential risks of each investigation in a clinical 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:
- have difficulty deciding on appropriate investigations
- under- or over-investigate
- inadequately consult with senior colleagues
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 responsibility for following up on results and ensures results are checked in a timely manner, or provides appropriate and thorough handover to other staff to do so
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:
- arranges investigations efficiently, including providing an accurate, informative referral, liaising with other services where appropriate, and advocating on behalf of patients
- factors the costs to patients and the community into decisions to order investigations
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:
- order investigations injudiciously and be unaware of the impact at a health system level