Patients seen during general medicine rotations often present with undifferentiated illness, multiple comorbidities, and complex psychosocial needs. Trainees will see common presentations leading to diagnoses across multiple specialty areas.
The General Medicine Knowledge Guide captures the presentations and conditions trainees are most likely to encounter during general medicine rotations, and the approach required to assess and manage patients with these presentations and conditions. The more in-depth knowledge required to manage these conditions is contained within the relevant specialty knowledge guides.
Key presentations and conditions
Basic Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Presentations
- Constipation
- Undifferentiated presentations, including, but not limited to:
- abdominal pain
- acute red eye
- anaemia
- chest pain
- confusion
- delirium
- diarrhoea
- fatigue
- fever and sepsis
- pain and swelling
- reduced level of consciousness
- seizure
- shortness of breath
- syncope or pre-syncope
- visual disturbance
- vomiting
- weakness
- weight loss
Conditions
- Autonomic dysfunction, including but not limited to:
- diabetes
- erectile dysfunction
- gastroparesis
- neurogenic bladder
- Parkinson disease
- postural hypotension
- Cellulitis
- Family dysfunction
- abuse
- elder
- financial
- physical
- psychological or emotional
- sexual
- neglect
- abuse
- Hypertension, acute and chronic
- Hypotension or shock, including but not limited to:
- anaphylactic
- cardiogenic
- hypovolaemic
- neurogenic
- septic
- Metabolic emergencies, including but not limited to:
- acidosis
- alkalosis
- hypo- and hyperglycaemia
- hypo- and hyperkalaemia
- hyponatraemia
- Obesity
- Ophthalmology
- infections, such as:
- blepharitis
- conjunctivitis
- periorbital cellulitis
- ophthalmological manifestations of chronic and systemic diseases, including but not limited to:
- corticosteroid use
- diabetes mellitus
- hypertension
- inflammatory bowel disease
- rheumatoid arthritis
- seronegative spondyloarthropathies
- systemic lupus erythematosus
- Peripheral vascular disease
- Psychiatry
- anxiety disorders
- mood disorders
- overdose or toxic effects of illicit drug use
- psychotic disorders
- self-harm and suicidal behaviour
- substance use disorders, such as overdose and withdrawal
- Significant behavioural issues, such as aggressive, challenging, non-compliant, or violent behaviours
- Urinary tract infection, urosepsis or pyelonephritis
- Venous thromboembolism
- infections, such as:
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Less common or more complex presentations and conditions
Basic Trainees will understand these presentations and conditions. Basic Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Conditions
- Psychiatry:
- eating disorders
- gender dysphoria
- personality disorders
- anxious or fearful
- dramatic, emotional, or erratic
- odd or eccentric
- somatoform disorder
- trauma and stressor-related disorders
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Epidemiology, pathophysiology and clinical sciences
Basic Trainees will describe the principles of the foundational sciences.
Clinical Sciences
- Basic statistical tests:
- inter-quartile range
- mean
- median
- normal distribution
- parametric versus non-parametric tests
- standard deviation
- standard error of the mean
- summary measures
- Diagnostic and screening tests:
- likelihood ratios
- negative predictive value
- positive predictive value
- sensitivity
- specificity
- Epidemiology of disease – concepts used in describing the disease effects on a population:
- attack rate
- case fatality
- crude versus specific rates
- direct and indirect standardisation of incidence and mortality rates
- incidence
- population attributable risk
- prevalence
- Measures of effect:
- absolute and relative risk
- absolute and relative risk reduction
- confidence intervals
- hazard ratio
- number needed to harm
- number needed to treat
- odds ratio
- p-values
- type 1 and type 2 errors
- Basic statistical concepts:
- bias
- confounding
- precision
- validity
- Key features of clinical trial design:
- blinding versus concealment
- clinical relevance
- crossover and factorial design
- power and sample size calculation
- randomisation
- statistical significance
- trial endpoints and the role of composite endpoints
- Strengths and weaknesses of different epidemiological study designs:
- case control
- cohort, prospective, and retrospective
- cross sectional
- ecological
- randomised controlled trial
- systematic review and meta-analyses
Investigations, procedures and clinical assessment tools
Basic Trainees will know the indications for, and how to interpret the results of these investigations, procedures, and clinical assessments tools. Basic Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Clinical assessment tools
- Family violence and trauma
- screening tools for domestic violence
- Psychiatry
- mental status examination
- tests of cognitive function
Important specific issues
Basic Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
- Approaches to clinical problem solving, such as:
- effect of cognitive biases on decision making
- formulation of differential diagnoses
- intuition and pattern recognition
- Chronic and complex care:
- access to care and cost
- coordination of care
- health system resourcing and patient insurance status
- impact of physical, cognitive, and intellectual disabilities in management of chronic disorders
- management of complex or multiple comorbidities
- primary, emergency, and after hours care
- Collaborative goal setting and decision making when working as part of a multidisciplinary team, and respect for the professional skills of all team members
- Determinants of health:
- environmental factors
- individual characteristics and behaviours
- prevalent medical conditions:
- in certain age groups
- leading to hospital admissions
- leading to death
- socioeconomic impacts
- Holistic nature of care
- Psychological and social factors:
- impact of physical health on psychological conditions
- impact of psychological and social factors on physical health and health behaviours, such as management of chronic medical illness
- role of social services in providing community support
- Patient-centred care:
- impact of patients’ background on their health or health behaviours, such as:
- Māori and Aboriginal and Torres Strait Islander patients
- adolescent and young adult patients
- patients from culturally and linguistically diverse backgrounds
- patients with disability, including cognitive, intellectual, and physical impairment
- patients with diverse socioeconomic backgrounds
- patients with mental health issues
- vulnerable patients
- principles of patient-centred care
- impact of patients’ background on their health or health behaviours, such as:
- Prevalence and impact of obesity across the life course and associated prevention measures, such as:
- awareness of potential obesity prejudice and weight bias amongst health professionals and methods for reducing bias
- clinical practice guidelines and management options for adult obesity
- health impacts of obesity
- education, support, health promotion, and advocacy options for working with patients to manage obesity
- socio-cultural factors and their impact on obesity, including incidence, outcome, and management
- Psychiatry:
- basic suicide risk assessment and its limitations
- drug and alcohol services
- indications for use of the Mental Health Act
- medical complications relating to mental health
- mental health manifestations of systemic disease
- protocols for liaison with psychiatric services
- signs of drug use and abuse on general history and examination and impact on presentation
- Services available to patients experiencing family violence and trauma
- Transitions in care
- transitions between practitioners
- transitions between settings:
- acute settings
- community care
- inpatient settings
- metropolitan hospital care
- outpatient settings
- rural or remote healthcare settings
- subacute and rehabilitation settings
- transitions from paediatric and adolescent services to adult medicine, including but not limited to patients with:
- congenital cardiac diseases
- developmental disorders
- endocrinological diseases
- inflammatory bowel disease
- psychological disorders
- respiratory diseases
- rheumatological diseases
- transitions throughout the lifespan, such as paediatric to adult medicine services and adult medicine to geriatric medicine services
- Use of risk registers and identification of complications that need to be remediated at a health system level
- References to patients in the remainder of this document may include their families or carers.