The clinical competencies for the CCE

This competency focuses on communication with patients and appropriate general practice consultation techniques.

Communication skills enable a consultation to proceed. Effective communication, especially in difficult consultations, is a core skill in general practice.

• Communication and consultation are patient-centred, and the candidate engages the patient to understand their ideas, concerns and expectations.
• Developing respectful therapeutic relationships involves empathy and sensitivity, with the candidate trying to see things from the perspective of the patient.
• Explanations provided to the patient about the diagnosis or management are appropriate to the patient, their health literacy and their health beliefs.
• The candidate checks for understanding and agreement at various times during the consultation.

This competency is about the gathering, interpreting and using information for clinical judgement.

• It includes information gathered from the history, clinical records, physical exam and investigations.
• History-taking includes gathering information from other sources, such as family members and carers, when appropriate.
• Information gathering is hypothesis-driven and used to confirm or exclude likely diagnoses, as well as red flags.
• The physical exam, and the selection of appropriate and evidence-based investigations, are appropriate to the patient and presentation and are evidence-based.

This competency is about a conscious, structured approach to making a diagnosis and the decision-making process.

• The focus is on the content and includes all the steps leading up to formulating a diagnosis or problem list.
• The candidate demonstrates appropriate and accurate reasoning in working towards the diagnosis. The candidate isn’t necessarily required to make the correct diagnosis in the first instance.
• The candidate demonstrates the ability to think about and reflect on their reasoning.

This competency is closely aligned with information gathering; however, it can also be assessed in different ways.

This competency concerns the management of common, serious, urgent and chronic medical conditions encountered in general practice.

• It includes aspects of care beyond managing simple consultations (including management of comorbidity and uncertainty).
• The management plan is patient-centred at all times.
• Therapeutic reasoning includes the steps taken based on the problem list, or the likely diagnosis, and is a part of the clinical reasoning process.

• Issues related to public health are identified and managed.
• The determinants of health and disease are identified both on the individual and community level.
• This competency includes disease prevention and health-promotion activities.

This competency requires knowledge of ethical principles, duty of care and maintaining appropriate therapeutic boundaries.

• The candidate is able to appropriately review potential and actual critical incidents, manage consequences and reduce future risk.
• The candidate is able to scrutinise their own professional behaviour and is open to feedback, demonstrating a willingness to change.

This competency is about understanding general practice systems, including appropriate use of administration and IT systems and the importance of effective record keeping, clinical handover and recall systems.

• The candidate understands how primary care is organised in Australia, including statutory and regulatory requirements and guidelines.
• The candidate understands the importance of patient consent and maintaining confidentiality.

Appropriate procedures are those likely to most benefit a patient’s health and wellbeing from a diagnostic and/or management perspective.

• Assessment of appropriate procedures is related to the practice setting, individual sociocultural context and consequent availability of access to more specialised services.
• Recommendations for procedures consider the potential benefits, the evidence basis, and the possible risks and costs in the context of any relevant sociocultural beliefs of the patient.
• The candidate is able to demonstrate a range of procedures appropriate for general practice.
• The candidate considers skills that need to be developed and considers the local community or practice population needs.

Ongoing undifferentiated conditions can cause considerable anxiety for patients, their families and the GP. A structured, evidence-based approach is needed to minimise risk from the perspectives of a patient’s health and economic situation.

• Undifferentiated conditions are often associated with uncertainty and ambiguity, and present management challenges.
• The candidate makes rational and balanced choices of investigations, avoiding over-investigation, under-investigation and management that would not benefit the individual.

A significantly ill patient is an individual at any life stage who is at risk of actual or acute potentially life-threatening health problems.

Candidates identify significant illness early and manage this in line with accepted guidelines.

This competency requires culturally appropriate and non-judgemental communication, acknowledging the impacts of intergenerational trauma on the patient’s ability to trust and build therapeutic relationships with health professionals; awareness and respect for differences in social structure, culture and impacts of intergenerational trauma; and, in this context, the way that these affect perceptions of health, wellness and approach to health.

• The candidate communicates with social and cultural competency to develop effective therapeutic relationships with Aboriginal and Torres Strait Islander patients.
• The candidate demonstrates how they would optimise health outcomes by early identification and effective management of all health conditions.

This competency is about understanding general practice in the rural and remote setting.

• The candidate demonstrates an understanding of referral pathways, including transfer, evacuation and retrieval procedures.
• The candidate identifies and ethically manages therapeutic boundaries.