Clinical Competency Rubric 2022

4. Clinical management and therapeutic reasoning

This competency concerns the management of common, serious, urgent and chronic medical conditions encountered in general practice. Aspects of care beyond managing simple consultations, including management of comorbidity and uncertainty, are incorporated. The management plan is patient-centred at all times.
Therapeutic reasoning includes the steps taken based on the problem list, or likely diagnosis that has been developed and is a part of the clinical reasoning process.

Required knowledge

  • Australian healthcare system
  • Preventive health, health promotion theory and practice
  • Community and patient resources
  • Safe management of common and important presentations in general practice
  • Professional resources and guidelines

Required attitudes

  • Ability to deal with uncertainty and ambiguity
  • Professionalism
  • Respect for patient autonomy

Required skills

  • High-level problem solving
  • Negotiation
  • Identifying relevant evidence
  • Integrating evidence into decisions and actions
  • Developing management plans with patients, their family/carers and other providers
  • Patient-centred and safe clinical decision making
  • Safe and appropriate prescribing
  • Networking
  • Multidisciplinary teamwork

Skills focus: Evidence-based management

This includes: pharmacological, no active intervention, lifestyle modification, nutrition, physical therapies, psychological approaches, surgical procedures and return-towork planning. A patient-centred management plan is developed.

Criteria

  1. Demonstrates knowledge of common therapeutic agents, uses, dosages, adverse effects and potential drug interactions and ability to prescribe safely
  2. Rational prescribing is undertaken
  3. Monitors for medication side-effects and risks of polypharmacy
  4. Outlines and justifies the therapeutic options selected, basing this on the patient’s needs and the problem list identified
  5. Safely prescribes restricted medications using appropriate permits
  6. Non-pharmacological therapies are offered and discussed
  7. A patient-centred and comprehensive management plan is developed
  8. Provides effective explanations, education and choices to the patient


Performance lists

Criteria (competent at level of Fellowship) Performs consistently at the standard expected
  1. Demonstrates knowledge of common therapeutic agents, uses, dosages, adverse effects and potential drug interactions and ability to prescribe safely
  • Has extensive knowledge of commonly prescribed medications
  • Appropriately refers to prescribing guidelines
  1. Rational prescribing is undertaken
  • Makes safe prescribing decisions, routinely checking on drug interactions and side effects
  • Considers patients age when prescribing
  • Considers co-morbidities
  • Considers drug interactions
  1. Monitors for medication side-effects and risks of polypharmacy
  • Plans medication reviews
  • Checks for acute and chronic side-effects
  • Has confidence in stopping or stepping down medication where this is appropriate
  1. Outlines and justifies the therapeutic options selected, basing this on the patient’s needs and the problem list identified
  • Discusses the therapeutic options and provides sound reasoning for this
  1. Safely prescribes restricted medications using appropriate permits
  • Prescribes restricted medication within the appropriate legal frameworks
  • Keeps clear and accurate records regarding rationale for prescribing
  • Has pain management plans for patients prescribed opioids in place
  • Refers appropriately to a pain management specialist
  1. Non-pharmacological therapies are offered and discussed
  • Discusses:
  • Lifestyle modification (SNAP)
  • Physical therapies
  • Psychological approaches
  • Surgical procedures (eg hip replacement surgery)
  • Return-to-work planning
  1. A patient-centred and comprehensive management plan is developed
  • Appropriate safety netting is arranged
  • Takes into consideration patient’s health literacy
  • Takes into consideration patient’s social circumstances
  • Takes into consideration patient expectations
  • Negotiates an agreement on the management plan with the patient
  1. Provides effective explanations, education and choices to the patient
  • Discusses possible outcomes
  • Discusses uncertainties of treatment options
  • Balanced communication regarding risks vs benefits
Aboriginal and Torres Strait Islander health context
  1. Collaborate effectively with multidisciplinary teams to develop meaningful and holistic management plans
  2. Identify and use professional resources to assist with delivery of best practice care to Aboriginal and Torres Strait Islander patients 
  3. Identify and incorporate social and cultural determinants of health into management plans
 
Rural health context
  1. Link into existing networks of health professionals in rural and remote settings
 
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Related documents

  Clinical-Competency-Rubric (PDF 0.39 MB)

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