Clinical Competency Rubric

9. Managing uncertainty

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Table of contents

Ongoing undifferentiated conditions can cause considerable anxiety for patients, their families and the GP. There is a need for a structured, evidence-based approach in order to minimise risk from health and economic perspectives. Undifferentiated conditions are often associated with uncertainty and ambiguity, and present management challenges for the clinician. Clinical decision-making around choices of investigations need to be rational and balance the potential risks of both over and under investigating and management, against the benefits in the context of the individual

Criteria

Manages the uncertainty of ongoing undifferentiated conditions
Addresses problems that present early and/or in an undifferentiated way by integrating all the available information to help generate differential diagnoses
Recognises when to act and when to defer doing so and uses time as a diagnostic tool

Performance lists

Criteria (competent at level of Fellowship)	Performs consistently at the standard expected
Manages the uncertainty of ongoing undifferentiated conditions	Excludes serious or red flag conditions Formulates a management plan in the absence of a diagnosis Refrains from treatment whenever this is applicable (watchful waiting) Makes rational and evidence-based choices of investigations Arranges appropriate review
Addresses problems that present early and/or in an undifferentiated way by integrating all the available information to help generate differential diagnoses	Discusses key and differentiating features of symptoms and uses this to sort them into likely diagnoses Gathers information appropriately targeted to the most likely diagnosis Considers the temporal course including the duration of the symptoms and pattern of symptoms Demonstrates the use of a safe diagnostic strategy
Recognises when to act and when to defer doing so and uses time as a diagnostic tool	Avoids intervention when no clinical justification Arranges appropriate review Aware of normal course of disease

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