Clinical Competency Rubric

4. Clinical management and therapeutic reasoning

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Table of contents

Last revised: 04 Mar 2024

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

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

Performance lists

Criteria (competent at level of Fellowship)	Performs consistently at the standard expected
Demonstrates knowledge of common therapeutic agents, uses, dosages, adverse effects and potential drug interactions, and the ability to prescribe safely	Has extensive knowledge of commonly prescribed medications Appropriately refers to prescribing guidelines
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
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
Outlines and justifies the therapeutic options selected based on the patient’s needs and the problem list identified	Discusses the therapeutic options and provides sound reasoning for this
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
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
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
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 Collaborates effectively with multidisciplinary teams to develop meaningful and holistic management plans Identifies and uses professional resources to assist with delivery of best-practice care to Aboriginal and Torres Strait Islander patients Identifies and incorporates social and cultural determinants of health into management plans
Rural health context Links into existing networks of health professionals in rural and remote settings

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