Академический Документы
Профессиональный Документы
Культура Документы
1
2
Acknowledgements
A number of Fellows, trainees and College staff have contributed extensively of their time and professional expertise in
the design and development of this curriculum document.
The College would specifically like to thank those Fellows and trainees who have generously contributed to the
development of these curriculum documents, through critical comment drawn from their knowledge and experience
and the donation of their time and professional expertise.
The following Fellows, in particular, deserve specific mention for their contribution:
Leonie Callaway
Mary-Ann Ryall
Phillippa Poole
Susan Moloney
Ian Scott
Ann Gillett
Stephen Judd
Andrew Bowers
Karina Kennedy.
The process was managed by the Colleges Curriculum Development Unit, who designed the document, drafted content
material, organised and facilitated writing workshops and developed resource materials.
Copyright
1st edition 2007 (revised 2010, 2013).
Please note: No Domains, Themes or Learning Objectives have been updated for this edition; design changes ONLY.
Copyright 2013. The Royal Australasian College of Physicians (RACP). All rights reserved. Published
20 December 2013.
This work is copyright. Apart from any fair use, for the purposes of study or research, it may not be reproduced in whole
or in part, by any means, electronic or mechanical, without written permission from The Royal Australasian College of
Physicians.
3
Contact details
THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS
Tel: (+61) (2) 9256 5444 Tel: (+64) (4) 472 6713
Fax: (+61) (2) 9252 3310 Fax: (+64) (4) 472 6718
4
Contents
RACP Fellowship Training Pathways and the Continuum of Learning 6
Assessment 9
5
RACP FELLOWSHIP TRAINING PATHWAYS AND THE CONTINUUM OF LEARNING
Foundation RACP PREP Training Professional
medical practice
Basic Training Advanced Training Programs Qualification
studies and Programs
workplace Division Training Programs
experience Cardiology
Clinical Genetics
Clinical Haematology
Clinical Immunology & Allergy
Clinical Pharmacology FRACP
Community Child Health P
Dermatology (NZ only)
Endocrinology
Initial Basic Training Continuing
Gastroenterology
Medical in Adult Professional
General & Acute Care Medicine A
Qualification Medicine Development
General Paediatrics P
Geriatric Medicine A
Infectious Diseases
Medical Oncology
Neonatal/Perinatal Medicine P
Nephrology
Neurology
Nuclear Medicine
Palliative Medicine 1
Respiratory Medicine
Rheumatology
Sleep Medicine
P Trainees must complete Basic Training in Paediatrics & Child Health to enter this program.
A Trainees must complete Basic Training in Adult Medicine to enter this program.
1 Trainees who have entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will be awarded FRACP upon
completion and may subsequently be awarded FAChPM. Trainees who have NOT entered Advanced Training in Palliative Medicine via a RACP
Basic Training Program will only be awarded FAChPM upon completion.
2 The Child & Adolescent Psychiatry Joint Training Program with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is
currently under review by the RACP and RANZCP and closed to new entrants at present.
3 Alternative entry requirements exist for these training programs; please see the corresponding PREP Program Requirements Handbook for
further information.
NB1: This diagram only depicts training programs that lead to Fellowship. Please see the RACP website for additional RACP training programs.
NB2: For further information on any of the above listed training programs, please see the corresponding PREP Program Requirements Handbook.
6
THE CONTEXT OF BASIC TRAINING LINK TO PROFESSIONAL
The medical profession is currently operating within QUALITIES CURRICULUM
a context of rapidly increasing change in terms of the The Professional Qualities Curriculum outlines the range
various professional, societal, economic, political and of concepts and specific learning objectives required and
technological aspects which impact upon its practice utilised by all physicians, regardless of their specialty or
and the society within which it operates. trainees will area of expertise.
need to be cognisant of these various situations and
Each of these concepts and objectives will be taught,
incorporate the relevant aspects into the context of their
learnt and assessed within the context of everyday
overall training program.
clinical practice. It is important, therefore, that they
be aligned with, and fully integrated into, the learning
Some of these key impacts include:
objectives within this curriculum.
changing views of the profession towards training and
assessment
EXPECTED OUTCOMES AT THE
increased community expectations of health care COMPLETION OF TRAINING
providers
At the completion of Basic Training, it is expected that
exponential growth in the scope and depth of medical trainees will have:
knowledge
rapid introduction of new medical technology and built on the knowledge and skills acquired during
procedures medical school and the pre-vocational post-graduate
certification and continuing education years
7
COMMON ATTITUDES AND ATTITUDES AND BEHAVIOURS WITH
BEHAVIOURS PATIENTS AND FAMILIES
The range of desirable personal and professional use of a positive, compassionate, caring and empathic
behavioural attitudes required of, and commonly attitude towards patients and their family/carers
utilised by, all consultant physicians and paediatricians involvement of patients as equals in identification of
in the course of their daily clinical practice and in their treatment priorities and in the development of the
relationship with others are listed below. These will care plan
facilitate appropriate patient care and management
ensuring patient confidentiality, particularly where
associated with professional practice when working
others are involved in the development of a care plan
with patients, their families, professional colleagues, and
imparting of bad news in a compassionate and
allied medical and administrative personnel. Depending
positive manner
upon the clinical context, each of these may be utilised
individually or, more commonly, in combination with use of a clinical approach that models and reinforces
others. preventive and prophylactic approaches to health care
encouragement of patient mastery, including
PERSONAL ATTITUDES participation in self-awareness and rehabilitation
programs
fostering of a patient-centred approach to health care use of a non-judgemental approach to the assessment
maintenance of a balanced and broad perspective on of all determinants of illness
health care delivery willingness to accede to requests for a second opinion
preparedness to learn and adopt new and validated provision of constructive and evidence-based advice
approaches to diagnosis and management, despite on complementary and alternative management
logistical difficulties, and to change work practices approaches, when patients wish this.
when appropriate
willingness to reflect on, and learn from, mistakes
ATTITUDES AND BEHAVIOURS WITH
preparedness to change management plans COLLEAGUES
tolerance of uncertainty preparedness to collaborate with primary carers, other
ability to cope with unexpected disappointments referrers and sub-specialists in the care of patients
equanimity, resilience and calmness in the face of by providing consultative advice, sharing of care, or
challenging clinical demands accepting ongoing care in the best interests of the
patient
desire to contribute to improvements in the health
system willingness to work in a multidisciplinary team
desire to foster clinical practice, research and teaching use of an independent, assertive, inquiring but
in general internal medicine nonetheless professionally courteous manner in
interactions with subspecialty colleagues
preparedness to acknowledge doubt and uncertainty
in clinical practice. willingness to share knowledge and skills with
colleagues
fostering of a peer network and collaborative
relationships in the health care system
provision of reassurance and support to colleagues
zero tolerance in the workplace of sexual harassment
and discrimination
respect for, and acknowledgement of, professional
contributions of all others in the workplace, including
office staff and employees.
8
ASSESSMENT
Below is an overview of the assessment tools used during Basic Training. A variety
of tools will be used, with the emphasis on provision of constructive feedback
to trainees, to aid their learning. The assessment tools will require the trainee to
provide good patient care and act as quality assurance towards this goal. Thus, the
better a person performs on the job, the better they will perform within the formal
assessment program.
The new assessment system links more closely with service provision, reducing the
need to spend time away from the job studying books and examination technique.
Rather, the centralised examinations are linked with the curriculum and are
complemented with on-the-job assessment.
9
CURRICULUM DOMAINS, THEMES AND LEARNING OBJECTIVES
Each of the curriculum documents has been developed using a common format,
thereby ensuring a degree of consistency and approach across the spectrum of training.
Domains
The Domains are the broad fields which group common or related areas of learning.
Themes
The Themes identify and link more specific aspects of learning into logical or related groups.
Learning Objectives
The Learning Objectives outline the specific requirements of learning. They provide a
focus for identifying and detailing the required knowledge, skills and attitudes. They
also provide a context for specifying assessment standards and criteria as well as
providing a context for identifying a range of teaching and learning strategies.
* Note: Refer also to Appendix 1 for a list of assumed Procedural Skills relevant to General Medicine
10
Domain 2: Medical Expertise
11
LEARNING OBJECTIVE TABLES
The following tables indicate the range of underpinning knowledge and skills associated
with each of the specific learning objectives.
12
Domain 1: Clinical Process
LEARNING OBJECTIVE 1.1.1: Elicit the history and obtain other relevant data
KNOWLEDGE SKILLS
Structured approach to patient history, including Establishes a rapport and professional relationship
systems review. with patients of all ages, their carers and relatives.
Different approaches to history taking as needed Obtains a focussed, efficient and accurate history.
in various clinical settings such as acute inpatient,
Gives appropriate emphasis to functional and
emergency, ambulatory care and telephone/
social history.
videoconference consultation settings (Link to
2.1.1). Uses a range of strategies to corroborate
information given by patient.
Other potential sources of data (e.g. personal
health records, medical records, general Evaluates critically the history in light of the
practitioner, family, carers, pharmacy records). degree of functional impairment, physical
findings, and other data.
13
Domain 1: Clinical Process
KNOWLEDGE SKILLS
14
Domain 1: Clinical Process
LEARNING OBJECTIVE 1.1.3: Synthesise findings from history and physical examination to
develop a differential diagnosis and management plan
LINKS: Clinical decision making (PQC); organ systems; undifferentiated presentations (for
differential diagnoses, provisional diagnoses); communication regarding illness
severity; presenting a patient on a ward round; discharge planning (PQC); patient
care and therapeutics; identifying learning needs (PQC teaching and learning)
KNOWLEDGE SKILLS
Refer to knowledge as listed in objectives 1.1.1 Interprets and integrates the history and physical
and 1.1.2. examination.
15
Domain 1: Clinical Process
KNOWLEDGE SKILLS
Clinical indications and contra-indications of Rationally and efficiently plans and arranges
investigations. investigations based on findings from history and
physical examination.
Relative cost of investigations.
Adapts approach to investigations taking into
Risks of performing investigations.
account patient factors and comorbidities.
Impact of false negatives and false positives on
Weighs the costs and benefits of investigations in
patient care.
each clinical situation.
Sensitivity, specificity, positive and negative
Chooses the most cost-effective investigative path.
predictive value, likelihood ratio of investigations.
Applies diagnostic reasoning to minimise the
number of investigations used and minimise harm
from false positives.
16
Domain 1: Clinical Process
KNOWLEDGE SKILLS
Fluid and electrolyte requirements in well and Identifies and prescribes appropriate replacement
unwell patients. or maintenance fluids with respect to patients
current fluid/electrolyte status, age and
Principles of fluid/electrolyte replacement and
comorbidities.
maintenance.
Appropriately monitors ongoing fluid and
Content of commonly available replacement
electrolyte status and responds to changes in
fluids.
status.
Risk factors for poor glycemic control. Commences intensive control regimens when
indicated and monitors use.
Evidence base for tight glycemic control.
17
KNOWLEDGE (Cont.) SKILLS (Cont.)
Pressure sore prevention and management Identifies patients at increased risk, ensures
adequate preventive measures are in place and
Factors contributing to increased risk of pressure
monitors for development of pressure areas in
sores.
immobile patients.
Strategies for prevention.
Manages established pressure sores including
Principles of management of established identification of need for surgical referral.
pressure sores wound management,
antimicrobial therapy.
Hospital practices to reduce risk. Complies with hand washing guidelines and other
guidelines to limit nosocomial infection
Isolation procedures.
(Link 2.4.3).
Hand washing.
18
KNOWLEDGE (Cont.) SKILLS (Cont.)
Pathophysiology of pain (links to palliative care). Identifies source (or potential sources) of pain.
Classes of commonly available analgesics with Prescribes appropriate analgesia with reference to
respect to mode of action, pharmacokinetics, cause, severity, comorbidities and comedications.
potency and efficacy in various pain syndromes.
Monitors efficacy of treatment and adjusts
Common adverse effects and drug interactions for regimen appropriately.
drug class.
Prescribes adjuvant therapy where appropriate.
Principles of acute and chronic pain management.
Refers to pain team when appropriate.
Principles of adjuvant therapy in pain
management.
19
Domain 1: Clinical Process
KNOWLEDGE SKILLS
Mechanism of drugs at the receptor and Prescribes appropriately with reference to specific
intracellular level. patient factors including organ dysfunction,
allergies and adverse effects.
Principles of absorption, distribution, metabolism
and excretion of drugs. Calculates loading doses and maintenance doses.
Effect of ageing, pregnancy and lactation on Calculates GFR, body surface area.
pharmacokinetics.
Adverse drug reactions and interactions Identifies presence of, or potential for, adverse
drug reaction and drug interactions and treats
Common and life-threatening drug interactions
appropriately.
and common presentations of drug-induced
disease, adverse drug reactions. Monitors for development of common adverse
drug reactions, including selection of appropriate
Common interactions between prescription and
laboratory investigations (e.g. monitoring of renal
non-prescription and complementary therapies.
or hepatic function).
Therapeutic drug monitoring Monitors drug levels and effects when appropriate
Indications for monitoring plasma concentrations and responds accordingly to results.
or pharmacological effects of specific drugs.
20
KNOWLEDGE (Cont.) SKILLS (Cont.)
Delivery techniques for specific medicines. Assesses patient uses of delivery devices.
Links to addiction (Mental health 2.3.6). Checks interactions to avoid the serotonergic
syndrome (Link to toxicology, 2.1.2).
21
Domain 1: Clinical Process
KNOWLEDGE SKILLS
Causes of obesity in adolescence and adults and Communicates importance of lifestyle measures to
impact on health. patients and refers appropriately for assistance.
Strategies to attain a healthy weight. Identifies reasons for obesity in an individual and
develops strategies to manage weight.
Principles of physical activity in disease
prevention, maintenance of healthy weight in all Uses available written literature, diet and exercise
age groups, and prevention of frailty in old age. prescriptions to assist in patient education and
compliance.
Techniques of proven value in smoking cessation
and health benefits of smoking cessation. Reinforces principles and monitors compliance at
subsequent visits.
Accepted healthy alcohol intake in both sexes and
all age groups including pregnant women. Uses brief interventions for hazardous drinkers and
smokers at every opportunity.
Importance of preventive strategies for
psychosocial wellbeing.
22
KNOWLEDGE (Cont.) SKILLS (Cont.)
KNOWLEDGE SKILLS
Causes of delirium in the peri-operative period. Investigates and manages patients with
common peri-operative problems sepsis,
Indications for endocarditis prophylaxis.
delirium, thromboembolism, glycemic
management, fluid balance, atrial fibrillation,
unresolved pain (Link to 1.2.1).
23
Domain 1: Clinical Process
KNOWLEDGE SKILLS
Evidence based coordination of care and disease Simplifies ongoing care where possible.
monitoring.
Refers appropriately to other subspecialty, allied
Psychological impact of chronic condition. health and community based services.
24
Domain 1: Clinical Process
KNOWLEDGE SKILLS
25
Domain 1: Clinical Process
Potential complications.
Pleural and ascitic fluid Anatomical landmarks. Punctures pleural/ascitic Safe and successful
aspiration. space. aspiration of pleural/
Safe approach.
ascitic fluid.
Withdraws fluid.
26
PROCEDURE KNOWLEDGE SKILLS ASSESSMENT
(Cont.) (Cont.) (Cont.) CRITERIA (Cont.)
Intercostal drain Anatomical landmarks. Performs safe blunt Safe and successful
insertion and dissection to pleural insertion of drain.
How an underwater seal
management. space and inserts
(UWS) functions. Drain maintained in
intercostal tube.
Needle thoracentesis. good working condition
Connects UWS and until removal.
secures in place.
Knee joint aspiration. Anatomical landmarks. Safely punctures the Safe and successful
joint. aspiration of knee joint.
Patient discomfort
minimised.
27
Domain 1: Clinical Process
KNOWLEDGE SKILLS
28
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.1.1: Recognise and manage the critically ill patient
LINKS: Procedural skills intubation, venous access , NIV; Patient care oxygen therapy,
NIV; Respiratory, CVS, Infectious Disease
KNOWLEDGE SKILLS
Signs and symptoms of impending Recognises emergency situations and the critically
cardiorespiratory arrest. ill adult.
Clinical features of serious illness. Determines rapidly the clinical context and
sequence of events leading to the emergency.
Causes of acute airway obstruction, respiratory
failure, shock and coma. Conducts a rapid, focussed clinical examination.
Principles of oxygen delivery and assisted Establishes a provisional diagnosis and orders
ventilation. appropriate initial investigations.
29
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
30
KNOWLEDGE (Cont.) SKILLS (Cont.)
The trainee describes the related pharmacology, For each of these poisonings the trainee identifies
clinical presentation and initial acute management symptoms and signs of common poisonings
of the following common and serious poisonings/ and toxic syndromes, assesses and monitors for
overdoses: other serious consequences of poisoning, initiates
paracetamol emergency management including specific
antidepressants antidotes.
antipsychotic drugs
Seeks specialist and ICU advice in a timely
alcohol
manner.
amphetamines
opioid drugs Uses information databases and the poisons
benzodiazepines centre.
anticholinesterases Assesses suicidality.
carbon monoxide
iron
venom (Australia snakes, spiders, jellyfish etc).
KNOWLEDGE SKILLS
(Refer to following aspects of the Professional Conveys to families/carers the progress to date,
Qualities Curriculum: likely cause for situation, immediate therapeutic
communication skills goals, expected outcome, and any limits on
communication with patients family escalation of care.
ethical dimensions of the workplace
Discusses the current situation within the broader
informed consent and competence
context of the trajectory of patient illness and
cultural competence).
quality of life, including areas of uncertainty.
31
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
32
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and can independently
principles of ongoing management, potential initiate appropriate medical (non-procedural)
complications of the disease and its management, management for uncomplicated disease.
preventive strategies:
If there are complications, or procedural
acute coronary syndromes
intervention is required, the trainee recognises
chronic coronary artery disease
this, provides initial emergency management and
heart failure
refers appropriately.
arrhythmias
endocarditis
hypertension
DVT/PE
stroke
peripheral vascular disease.
33
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the trainee describes For these conditions, the trainee recognises the
the clinical presentation, initial investigations, presentation, establishes a provisional diagnosis,
initial management, potential complications, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initiates symptomatic therapy,
valvular heart disease discusses broad therapeutic options, and refers
pericardial disease. appropriately.
34
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.3.2: Manage patients with endocrine and metabolic disorders
KNOWLEDGE SKILLS
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, orders appropriate investigations, and
investigations, detailed initial management, independently initiates appropriate management
principles of ongoing management, potential for uncomplicated disease.
complications of the disease and its management,
If there are complications, the trainee recognises
primary and secondary preventive strategies:
these, and refers appropriately.
diabetes mellitus Type I and II
osteoporosis Monitor for complications.
obesity.
35
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications and disease plans and arranges appropriate initial
associations, therapeutic options, adverse effects investigations, initiates symptomatic therapy,
of disease management and indications for discusses broad therapeutic options, and refers
referral: appropriately.
hypothyroidism
hyperthyroidism
Addisons disease
Cushings syndrome
benign prostatic disease
hypogonadism
polycystic ovarian syndrome
endocrine causes of hypertension
vitamin D deficiency (Link 2.3.7).
36
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, orders appropriate investigations, and
investigations, detailed initial management, can independently initiate appropriate medical
principles of ongoing management, potential (non-procedural) management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications or procedural
gastrointestinal bleeding
intervention is required, the trainee recognises
gastro-esophageal reflux disease
this, provides initial emergency management and
peptic ulcer disease
refers appropriately.
acute and chronic liver disease
obesity.
37
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initiates symptomatic therapy,
biliary obstruction discusses broad therapeutic options, and refers
allstones appropriately.
cute pancreatitis
inflammatory bowel disease
irritable bowel syndrome
coeliac disease
malabsorption
gastrointestinal malignancy (see also
management of solid organ malignancy 1.1.6,
screening in 2.4.3)
oesophageal motility disorders.
38
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
Genetics of thalassemia.
Haemolysis.
For the following common and important For this condition, the trainee recognises the
condition, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, the trainee recognises
anaemia.
these, and refers appropriately.
39
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initiates symptomatic therapy,
lymphadenopathy discusses broad therapeutic options, and refers
bleeding disorders appropriately.
thrombophilia
haemophilia
disseminated intravascular coagulopathy
neutropenia
pancytopenia
thrombocytopenia (including immune)
aplastic anaemia/bone marrow failure
plasma cell dyscrasias/myeloma
myelodysplasia
myeloproliferative disease
haemolytic disorders.
40
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.3.5: Manage patients with disorders of the immune system
KNOWLEDGE SKILLS
For the following conditions, the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications and disease plans and arranges appropriate initial
associations, therapeutic options, adverse effects investigations, initiates symptomatic therapy,
of disease management and indications for discusses broad therapeutic options, and refers
referral: appropriately.
allergic disorders anaphylaxis (Link Acute
care), food allergy, adverse drug reactions (Link
1.2.2), allergic rhinitis/sinusitis/conjunctivitis,
atopic dermatitis (Link 2.2.11), urticaria (Link
2.2.11).
autoimmune diseases SLE, PSS,
dermatomyositis, polymyositis (Link to
musculoskeletal).
acquired immunodeficiency syndromes HIV
(Link 2.4.3), immunosuppressive drugs (Link
1.2.2), post transplantation.
vasculitis.
41
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
For the following conditions, the clinical For each condition the trainee recognises the
presentation, initial investigations, initial clinical presentation, establishes a provisional
management, potential complications and disease diagnosis, plans and arranges appropriate initial
associations, therapeutic options, adverse effects investigations to rule out organic causes, discusses
of disease management and indications for broad therapeutic options (including non-
referral: pharmacological), initiates appropriate emergency
management and involves other members
mood disorders
of the team wherever appropriate and refers
psychosis
appropriately.
anxiety disorders
grief reaction If there are complications, the trainee recognises
eating disorders these, and refers appropriately.
substance abuse
For any presentation the trainee recognises
unsuccessful suicide attempt
the possible contribution of mental illness or
parasuicide
personality disorder to the clinical presentation.
somatoform disorder.
Evaluates suicide risk.
42
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following commonly abused drugs, the For each of these the trainee acquires adequate
pattern of use, relevant pharmacology, clinical history of drug use, recognises signs of drug use
presentation, differential diagnosis, detailed and abuse on general history and examination,
management of acute intoxication, complications recognises impact of drug use on presentation,
and secondary preventive strategies: institutes appropriate emergency management of
alcohol overdose/toxic effects of illicit drug use.
opioids
For the following conditions, the trainee
benzodiazepines
recognises the withdrawal state and safely
amphetamines
manages acute withdrawal on the ward:
cocaine
alcohol
cannabis
opioids
ecstasy
benzodiazepines
solvents
nicotine.
GHB
nicotine. The trainee uses a validated tool for assessing level
of alcohol use.
Mental health manifestations of systemic disease. The trainee conducts brief interventions to reduce
Link to 1.2.1 and 1.2.3 Healthy lifestyle. harm from drug use.
KNOWLEDGE SKILLS
43
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, the trainee recognises
osteoarthritis
these, and refers appropriately.
osteoporosis.
Monitors for complications.
For the following conditions the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications and disease plans and arranges appropriate initial investiga-
associations, therapeutic options, adverse effects tions, initiates symptomatic therapy, discusses
of disease management and indications for broad therapeutic options, and refers appropri-
referral: ately.
gout and pseudogout
rheumatoid arthritis
seronegative arthritidis
fibromyalgia
polymyalgia rheumatica/temporal
arteritis
dermatomyositis/polymyositis
osteomalacia
common fractures.
Osteoporosis.
44
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.3.8: Manage patients with disorders of the neurological system
KNOWLEDGE SKILLS
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, or special intervention
stroke is indicated (e.g. thrombolysis for stroke), the
trainee recognises these, and refers appropriately.
meningitis/encephalitis.
Monitors for complications.
45
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises the
presentation, initial investigations, initial presentation, establishes a provisional diagnosis,
management, potential complications, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initiates symptomatic therapy,
epilepsy discusses broad therapeutic options, and refers
migraine appropriately.
peripheral neuropathy acquired and
hereditary
Bells palsy
temporal arteritis
cerebral neoplasia
Parkinsons disease
Guillain Barre syndrome
spinal cord compression
multiple sclerosis
motor neurone disease
cerebellar disorders.
46
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.3.9: Manage patients with disorders of the renal and
genitourinary systems
KNOWLEDGE SKILLS
For the following common and important For this condition, the trainee recognises the
condition, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and can independently initiate
principles of ongoing management, potential appropriate medical (non-procedural)
complications of the disease and its management, management for uncomplicated disease.
preventive strategies:
If there are complications or procedural
urosepsis.
intervention is required, the trainee recognises
this, provides initial emergency management and
refers appropriately.
47
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises
presentation, initial investigations, initial the presentation, establishes a provisional
management, potential complications, diagnosis, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initiates symptomatic therapy,
acute and chronic renal failure discusses broad therapeutic options, and refers
complications of renal replacement therapy appropriately.
acute tubular necrosis
renovascular disease
diabetic nephropathy
obstructive uropathy
drug-related nephrotoxicity
renal hypertension
glomerulonephritis
interstitial kidney disease
renal carcinoma
genitourinary malignancies (prostate, testicular
bladder, uterine/cervical/ovarian).
48
Domain 2: Medical Expertise
LEARNING OBJECTIVE 2.3.10: Manage patients with disorders of the respiratory and
sleep system
LINKS: Patient care and therapeutics oxygen therapy, indications for ICU, drugs;
procedural skills ventilation, placement of ICC, pleural tap; acute emergencies
(put in ICU indications)
Immunology issues of immunosuppression in lung transplantation
KNOWLEDGE SKILLS
Inflammation of airways.
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, the trainee recognises
pneumonia these, and refers appropriately.
acute and chronic respiratory failure
Monitors for complications.
asthma
pulmonary embolus
chronic obstructive pulmonary disease
pleural effusion.
49
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following conditions, the clinical For these conditions, the trainee recognises
presentation, initial investigations, initial the presentation, establishes a provisional
management, potential complications, diagnosis, plans and arranges appropriate initial
therapeutic options and indications for referral: investigations, initial symptomatic therapy,
discusses broad therapeutic options, and refers
pneumothorax
appropriately.
pulmonary hypertension
sleep apnoea
cystic fibrosis
bronchiectasis
KNOWLEDGE SKILLS
50
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, the trainee recognises
drug eruptions
these, and refers appropriately.
cellulitis.
Monitors for complications.
For the following conditions, the clinical For these conditions, the trainee recognises
presentation, initial investigations, initial the presentation, establishes a provisional
management, potential complications and disease diagnosis, plans and arranges appropriate initial
associations, therapeutic options, adverse effects investigations, initiates symptomatic therapy,
of disease management and indications for discusses broad therapeutic options, and refers
referral: appropriately.
skin cancer
dermatitis
psoriasis
skin manifestations of systemic diseases
arterial and venous ulcers
non-healing ulcers and wounds
nodular skin lesions
vasculitis
naevi
fungal infections
viral exanthema
scabies, head lice.
51
Domain 2: Medical Expertise
LINKS: Palliative care and symptom control; blood transfusion; end of life; procedures
central lines; acute emergencies; haematology; clinical decision making; disease
trajectory; population in PQC; preventive health in Foundation Curriculum
KNOWLEDGE SKILLS
For the following malignancies, the risk factors, For these conditions, the trainee recognises the
clinical presentation, natural history, broad presentation of illness, establishes a provisional
therapeutic options and preventive strategies diagnosis, plans and arranges appropriate
including screening: investigations, and independently initiates
lung appropriate management of presenting
breast symptoms.
gastrointestinal
If a diagnosis of cancer is considered, the trainee
prostate
develops an appropriate management plan in
skin
consultation with their supervisor.
brain
carcinoma of unknown primary If there are complications and/or procedural
lymphoma intervention is required, the trainee recognises
multiple myeloma this, provides initial emergency management and
leukaemia refers appropriately.
potentially curable cancers.
52
KNOWLEDGE (Cont.) SKILLS (Cont.)
KNOWLEDGE SKILLS
53
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following common genetic diseases, the If a genetic disease is present, or considered, the
inheritance, phenotype(s), clinical presentation, trainee develops an appropriate management
natural history, complications and comorbidities plan in consultation with their supervisor (Link to
principles of ongoing management and clinical decision making, disease trajectory).
appropriate referral:
trisomy 21
Turners
cystic fibrosis
haemochromatosis
Marfans
Klinefelters
Huntingtons
familial cancers.
KNOWLEDGE SKILLS
54
KNOWLEDGE (Cont.) SKILLS (Cont.)
For the following common and important For these conditions, the trainee recognises the
conditions, the epidemiology, pathophysiology, presentation of illness, establishes a provisional
clinical presentation, differential diagnosis, diagnosis, plans and arranges appropriate
investigations, detailed initial management, investigations, and independently initiates
principles of ongoing management, potential appropriate management for uncomplicated
complications of the disease and its management, disease.
preventive strategies:
If there are complications, the trainee recognises
pneumonia/lower respiratory tract infections
these, and refers appropriately.
meningitis/encephalitis
upper respiratory tract infections including otitis Monitors for complications.
media and tonsillitis
conjunctivitis
UTI
infective endocarditis
cellulitis
diarrhoeal illness
septicaemia/bacteremia.
For the following conditions, the clinical For these conditions, the trainee recognises
presentation, initial investigations, initial the presentation, establishes a provisional
management, potential complications and disease diagnosis, plans and arranges appropriate
associations, therapeutic options, adverse effects initial investigations, initiates empiric therapy,
of disease management and indications for discusses broad therapeutic options, and refers
referral: appropriately.
osteomyelitis, septic arthritis
TB
HIV
hepatitis viruses
EBV/CMV/Toxo
meningococcaemia
common STDs
infections in the immunocompromised host
fever in the returning traveller including
malaria, dengue fever, parasitic infections.
55
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
Law and ethical principles in dealing with Assesses the cognitive ability for understanding
adolescents. choices and ability to make choices and provide
informed consent.
Eating disorders in adolescence.
Identifies risk behaviours and counsels and
Issues of body perception and self-awareness in
educates the young person regarding these.
adolescents.
Psychosocial assessment including HEADSS.
Substance use and abuse in adolescents and their
onset. Appropriate use of chaperone for physical
examination.
Mental health disorders in adolescence and their
various presentations. Assessment of pubertal status.
Risk behaviours and self-harm in adolescence. Assessment of risk and protective factors.
Issues relating to transition of care. Capacity for liaison and communication with
community, health, drug and alcohol,
education and welfare practitioners.
56
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
Risk factors for common pregnancy Manages common medical problems in the
associated diseases hypertension, diabetes, pregnant woman (e.g. asthma).
thromboembolism.
Diagnoses and manages common conditions
Natural history, presentations, differential encountered more frequently in pregnancy
diagnosis, initial investigations, diagnostic criteria, urinary tract infection, thromboembolism.
emergency management of pre-eclampsia/
Uses available pharmacopeia to identify safest
eclampsia.
drugs for use in pregnancy and lactation.
Risks associated with various investigative
Recognises the presentation of pre-eclampsia/
procedures, particularly imaging, during
eclampsia, orders appropriate initial investigations,
pregnancy.
provides emergency management, and calls for
assistance.
57
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
58
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
Medicolegal aspects of care of the older person: Recognises when a patient may be incompetent
competence, duty of care, guardianship, medical to make a decision, and initiates appropriate
futility. referral.
For the following common and important For these conditions, the trainee recognises the
problems in older people the trainee describes the presentation of illness, establishes a provisional
epidemiology, clinical presentation, differential diagnosis, plans and arranges appropriate
diagnosis, investigations, detailed initial investigations, and independently initiates
management, principles of ongoing management, appropriate management for uncomplicated
preventive strategies: disease.
polypharmacy and adverse drug reactions
If there are complications, the trainee recognises
falls
these, and refers appropriately.
delirium
cognitive decline Monitors for complications.
incontinence
constipation
functional decline
psychiatric presentations including depression,
anxiety, mania.
59
Domain 2: Medical Expertise
KNOWLEDGE SKILLS
60
APPENDIX 1
Assumed Skills
(to be read in conjunction with Theme 1.3 Procedural Skills)
It is assumed that trainees will have the following skills if not, appropriate remedial action
will need to undertaken.
By the end of PGY2, trainees should be competent and confident to perform the following procedures relevant to
general medicine:
At the end of Basic Training, in addition to the PGY2 skills, the trainee should be competent and confident to perform:
Other procedures that may be performed during Basic Training but will require further experience under supervision
during advanced specialist training:
61
APPENDIX 2
Cellular pathology (cell growth and ageing, cell injury and death) BTC 2.5.4
In each of the above, emphasis will be placed on: All integrated within Basic
nomenclature and definitions of disease Training Curriculum
classifications of diseases
disease processes/pathogenesis
causation/aetiology
scientific methodology and new diagnostic methods
Ethics, social and political aspects of pathology and disease PQC domains 5, 9
62