Clinical Competency Rubric 2022

3. Making a diagnosis, decision making and reasoning

This is about a conscious, structured approach to making diagnoses and decision-making. This focuses on all the steps leading up to formulating a diagnosis or problem list. This also includes diagnostic accuracy that does not necessarily require the correct diagnosis, but that the direction of reasoning was appropriate and accurate. The doctor’s ability to think about and reflect on their reasoning is another aspect of this assessment domain. This WBA competency is closely aligned with information gathering but can be assessed in different ways.

Required knowledge

  • Human body and disease
  • Safe management of common and important presentations in general practice

Required attitudes

  • Empathy
  • Ability to deal with uncertainty and ambiguity
  • Curiosity
  • Professionalism
  • Commitment to learning and development

Required skills

  • High-level problem solving
  • Critical thinking
  • Comprehensive diagnostic skills
  • Patient-centred and safe clinical decision making

Skills focus: Problem solving, decision-making, dealing with uncertainty

Criteria

  1. Integrates and synthesises knowledge to make decisions in complex clinical situations
  2. Modifies differential diagnoses based on clinical course and other data as appropriate
  3. Demonstrates diagnostic accuracy: This does not require the correct diagnosis, but that the direction of reasoning was appropriate and accurate
  4. Collects/reports clinical information in a hypothesis driven manner
  5. Articulates an appropriate problem definition
  6. Formulates a rational list of differential diagnoses including most likely, less likely, unlikely and can’t miss diagnoses
  7. Directs evaluation and treatment towards high priority diagnoses
  8. Demonstrates metacognition (thinking about own thinking)


Performance lists

Criteria (competent at level of Fellowship) Performs consistently at the standard expected
  1. Integrates and synthesises knowledge to make decisions in complex clinical situations
  • Is comfortable with the range of patients who present to the practice
  • Discusses key and differentiating features of symptoms and uses this to sort them into likely diagnoses
  • Discusses epidemiology of symptoms (who gets the disease) including demographics, risk factors
  • Considers the temporal course including the duration of the symptoms and pattern of symptoms
  • Outlines the pathophysiology of the disease
  1. Modifies differential diagnoses based on clinical course and other data as appropriate
  • Reviews history, progress and current status at follow up
  • Reviews discharge summaries, specialist reports
  • Reflects on feedback from the patient or others and incorporates this
  1. Demonstrates diagnostic accuracy - this does not require the correct diagnosis, but that the direction of reasoning was appropriate and accurate
  • Discusses patterns of disease presentation and how the pattern recognition enabled diagnostic accuracy
  • Gathers information appropriately targeted to the most likely diagnosis
  1. Collects/reports clinical information in a hypothesis driven manner
  • Follows a clear line of enquiry, directing questioning and examination to specific findings likely to
  • increase or decrease the likelihood of a specific diagnosis
  1. Articulates an appropriate problem definition
  • Provides a clear synopsis of the clinical problem
  • Emphasises important positive and negative findings
  1. Formulates a rational list of differential diagnoses (including most likely, less likely, unlikely and can’t miss diagnoses)
  • Provides an accurately ranked differential diagnosis
  • Demonstrates the use of a safe diagnostic strategy
  1. Directs evaluation and treatment towards high priority diagnoses
  • Defers investigations that are directed to less likely/less important diagnoses
  • Efficiently directs evaluation and treatment towards more likely and can’t miss diagnoses
  1. Demonstrates metacognition (thinking about own thinking)
  • Can discuss factors that influenced decision-making, including any emotional or situational factors

Aboriginal and Torres Strait Islander health context

  1. Demonstrate effective diagnostic and management strategies that enhance health outcomes for Aboriginal and Torres Strait Islander patients
 
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Related documents

  Clinical-Competency-Rubric (PDF 0.39 MB)

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