Role

Clinician

Milestone: Entry

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

1. Deliver culturally safe care

Know

  • Know the meaning of cultural lens and cultural bias
  • Understand the impacts of these on a range of different consultations. 

Do

Be

  • Be self-reflective, self-aware and open-minded.

Know

  • Understand the importance of identifying an individual as an Aboriginal or Torres Strait Islander person.
  • ​Understand the barriers to self-identification, including the historical context.

Do

  • Engage in respectful dialogue with individuals as to whether they identify as Aboriginal or Torres Strait Islander people.

Be

  • Be respectful and empathic to minimise barriers. 

Know and Do

  • Be aware of and respect the diversity of Aboriginal and Torres Strait Islander cultures.
  • ​​Be aware of and respect differences in Aboriginal and Torres Strait Islander social structure and culture and the impacts of intergenerational trauma on perceptions of health, wellness and approach to healthcare.

Do

  • Be interested in and willing to learn about Aboriginal and Torres Strait Islander culture in consultations and demonstrate intellectual humility.
  • Be respectful of Aboriginal and Torres Strait Islander people and avoid assumptions and stereotypes.
Note: determination of whether this competency has been attained, should be undertaken by patients who are Aboriginal and Torres Strait Islander people. 

Know

  • Describe the importance of the roles of Aboriginal and Torres Strait Islander health workers, health liaison officers, and cultural educators and mentors in improving communication with and providing culturally safe and appropriate healthcare to Aboriginal and Torres Strait Islander people.
  • ​Understand the value and importance of developing effective relationships with Aboriginal and Torres Strait Islander health workers and health liaison officers.

Do

  • In identifying a patient as being an Aboriginal or Torres Strait Islander, routinely offer involvement of an Aboriginal or Torres Strait Islander health worker or liaison officer in consultations or as part of the care team. 
  • ​Engage with the local Aboriginal and Torres Strait Islander community, including Aboriginal and Torres Strait Islander health workers, health liaison officers, and cultural educators and mentors, to help develop your understanding of local health issues and to develop effective partnerships.

Be

  • Be interested, respectful and engaged.

Know

Do

  • Consider the impacts of culture on access to healthcare. 
  • Avoid cultural assumptions and stereotypes.

Be

  • Be respectful and demonstrate interest about the culture, perceptions of health, and potential barriers to accessing healthcare in patients from culturally and linguistically diverse communities.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Identify the many dimensions of each individual patient and place the needs and safety of patients at the centre of care by:
    • taking a comprehensive biopsychosocial-cultural history
    • understanding the patient’s agenda for the consultation.
  • Consider sociocultural context during assessment and management (including consideration of appropriate referrals), including:
    • Aboriginal and Torres Strait Islander status
    • race, ethnicity, language and migration experience
    • gender identity and sexuality
    • religious beliefs
    • socioeconomic status, financial and social stressors
    • family connections and traditions
    • peer groups
    • occupation
    • age
    • disability
    • hobbies and interests
    • health literacy.
  • Consider psychological factors and how they may impact the consultation and/or consequent management, including the patient’s capacity to implement self-management and/or ability to access care in the future.

Do

  • Consider whether the gender of the treating clinician may create barriers for individual patients.
  • Ask respectfully about cultural protocols and personal preferences regarding gender.
  • Ask patients about their preferences; for example, having a family member or chaperone present for intimate examinations.
  • Check with Aboriginal and Torres Strait Islander patients whether they would prefer to see a gender-concordant clinician with respect to ‘men’s business’ or ‘women’s business’.

Be

  • Be non-judgemental, understanding and engaged.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Do

  • Introduce self and clarify role.
  • Use attentive listening.
  • Effectively use silence and open and closed questions.
  • Acknowledge the patient’s level of health literacy and modify language to match.
  • Use nonverbal communication, such as body language, eye contact and appropriate touch to establish rapport.
  • Use concise and easily understood questions when taking a history.
  • Clearly outline management plans for each defined problem.
  • Avoid use of medical jargon.
  • Obtain informed consent before discussions with a patient's family and/or carers.
  • Effectively use a range of modes of communication, including:
    • face-to-face consultations
    • telehealth consultations
    • electronic, such as email
    • written, such as recall letters or care agreements.
  • Demonstrate intellectual humility.

Be

  • Be respectful and empathic of the patient’s needs and concerns.

Know

  • Understand that an individual who speaks a language other than English as their primary language, while being able to converse in English, may have difficulty expressing themselves and fully understanding the discussion in a consultation.
  • Recognise impacts of cognitive and/or sensory impairments on ability to communicate and process information, and understand how to adapt communication, as needed.

Do

  • Identify social, language and cultural factors that may impact communication in consultations, including:
    • perceptions of power imbalance in the therapeutic relationship
    • fear and mistrust of mainstream health services due to past mistreatment or other negative experiences
    • inadequate time for consultations
    • inappropriate stereotyping or labelling, including ‘non-compliance’.
  • Identify patients who speak languages other than English and recognise the need to engage professional interpreters (either onsite or by phone).
  • Identify individuals with sensory and/or cognitive impairments and recognise the need to engage appropriate support to meet the communication preferences and/or needs of the individual; for example, accessing Auslan interpreters or using communication boards.
  • Allow adequate time for consultations.

Do

  • Use verbal and nonverbal communication to convey understanding of the patient’s feelings. 
  • Demonstrate understanding of and compassion for people’s experiences.
  • Consider what an individual patient may be thinking or feeling based on understanding of their personality, previous experiences, sociocultural context and belief systems.        
  • Acknowledge and, if appropriate, validate an individual’s belief systems and their impact on the patient’s perceptions of health and access to healthcare.

Be

  • Be compassionate, empathic, open and non-judgemental in consultations

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

Know

  • Understand the roles of key members of the patient's care team.

Do

  • Effectively collaborate with a range of healthcare professionals to minimise fragmentation of care and reduce risks and unnecessary duplication of care.
  • Provide concise and relevant information regarding an individual’s health status and therapies, demonstrating understanding of the patient’s needs and wishes.
  • Effectively use a range of modes of communication, including:
    • videoconferencing
    • email (encrypted)
    • web services and e-care planning tools
    • electronic referrals systems (with use of appropriate encryption)
    • electronic prescribing
    • electronic patient health records (including My Health Record).
  • Communicate effectively, providing clear and concise information and/or requests for information or responses to clinical questions from other team members.

Be

  • Be respectful and collaborative when working in healthcare teams.

Know

  • Understand common barriers to accessing healthcare and strategies to advocate for individuals to access appropriate care.

Do

  • Identify the diversity of the local community population, including:
    • Aboriginal and Torres Strait Islander peoples
    • cultural and linguistic diversity
    • occupational diversity
    • gender and sexual diversity
    • people with disability
    • socioeconomic diversity, considering social determinants and prevalence of poverty.
  • Identify frequently encountered barriers to healthcare access and reasons for these. Examples of barriers include:
    • lack of access to interpreters or appropriate health resources (eg not culturally appropriate or in primary language)
    • non–culturally safe care
    • physical access difficulties or other barriers for people with disability (eg challenging environment from a sensory perspective for people with autism spectrum disorders)
    • geographical and financial
    • access to public transport.
  • Ask patients about potential barriers to accessing care and consider strategies to manage these, which may include advocating for:
    • colleagues to use interpreters for individuals who speak languages other than English
    • strategies to minimise out-of-pocket costs for individuals with low income (eg through informed prescribing, use of Medicare items to optimise access to allied health and/or specialist care, reduced fees, bulk-billed services)
    • provision of culturally safe care
    • access to support workers, where feasible, to maximise potential of individuals to attend appointments
    • access to assistance (eg transport, physical access to facilities, mobility aids).

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Do

  • Identify common presenting symptoms and acute conditions, including red flags, by undertaking a structured assessment that identifies relevant positive and negative findings and which includes:
    • a structured history that is accurate, concise and records information such as:
      • presenting symptoms
      • possible associated risk factors, including lifestyle risk factors
      • family history
      • allergies
      • current medications
      • previous experiences that may adversely impact consultations (eg medical trauma)
    • appropriate and respectful physical examination appropriate to the presenting complaint, age and gender of the patient, demonstrating consideration of patient comfort and privacy
    • preliminary available point-of-care or ‘bedside’ investigations relevant to context (eg pregnancy test, urinalysis, glucometer, spirometry, blood gas analysis, peak flow meter).
  • Use high-level clinical problem-solving skills, integrating information gained from the structured assessment to:
    • develop a rational list of differential diagnoses
    • identify and prioritise the key investigations or further information required to identify the most likely diagnosis to inform safe management.
  • Identify and undertake preliminary assessment of common acute and red flag conditions across the lifespan and appropriate to context.

Do

  • Develop initial evidence-based management plans across the lifespan and appropriate to context, using appropriate resources, such as clinical guidelines.
  • Seek assistance from colleagues in a timely way if significant illness or clinical deterioration is identified. Provide a concise and accurate clinical summary of assessment findings, differential diagnoses and management plan to discuss the best course of management, including facilitating access to appropriate tertiary or non-GP specialist care.

Know

  • Understand standards for infection control and relevant clinical practice standards.

Do

  • Demonstrate competency in undertaking a range of procedures, across the lifespan and appropriate to context.
  • Follow guidelines for the prevention and control of infection in healthcare.
  • Demonstrate the implementation of infection control standards, including:
    • hand hygiene
    • environmental hygiene
    • body fluid spills management
    • aseptic technique and sterilisation
    • ensuring adequate immunisation of self
    • standard and transmission-based precautions.

Know

  • Demonstrate knowledge of prescribing of common medications and of resources used to support safe prescribing for drugs, intravenous fluids, blood products, inhalational therapies (including oxygen), tailored to patients’ needs and conditions, either in response to a request by the treating team or self-initiated.
  • Be familiar with commonly prescribed medications, including their common side effects, interactions and contraindications.
  • Understand the different categories of drug schedules and consequent impacts on prescribing processes and procedures (eg Schedule 8 drugs).
  • Understand safe prescribing principles for blood products and fluid and electrolyte therapy, including:
    • identifying indications for blood products or fluid and electrolyte therapies
    • identifying and managing consequences of fluid and/or electrolyte imbalance.

Do

  • Routinely check for allergies, contraindications and adverse reactions prior to prescribing.
  • Obtain and interpret medication histories, including over-the-counter medications and vitamin, herbal and dietary supplements.
  • Obtain and interpret medication histories.
  • Consider whether a prescription is appropriate.
  • Consider relevant drug interactions.
  • Choose appropriate medications based on guidelines.
  • Clarify prescription with supervisor, colleagues or pharmacist, if unsure.
  • Monitor use of medication and for side effects and cease when indicated.

Know

  • Demonstrate knowledge of the key indications for acute resuscitation across the lifespan, including identification of signs of clinical deterioration to enable rapid intervention. These include:
    • signs of shock, including tachycardia, tachypnoea, hypotension, confusion, agitation and reduced peripheral circulation
    • decreased or loss of consciousness
    • lack of normal breathing and/or loss of palpable pulses
    • absence of a not-for-resuscitation order (eg advance care directive documenting patient’s wish to not be resuscitated).

Know

  • Develop and maintain skills and confidence in basic life support protocols according to the most current version of the Australian Resuscitation Council guidelines. 

Know

  • Be familiar with:
    • standard and transmission-based precautions (eg outbreak control, including identifying individuals who may have communicable diseases and implementing appropriate procedures to minimise risk of spread)
    • healthcare-associated infection surveillance, including notifiable diseases.

Do

  • Identify common transmissible conditions where there is a risk of transmission to others:
    • vaccine-preventable diseases
    • gastroenteritis (eg rotavirus)
    • pulmonary tuberculosis
    • respiratory infections, including pandemic influenza
    • blood-borne viruses (eg hepatitis B and C, HIV)
    • STIs (eg chlamydia, gonorrhoea, syphilis).
  • Identify other issues which may impact public health:
    • environmental hazards (eg impacts of climate change, thunderstorm asthma, water quality issues, respiratory effects of pollution)
    • occupational hazards (eg asbestos exposure).

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Know and do

  • Understand, and apply as indicated, holistic therapeutic options for common chronic conditions to optimise wellbeing and reduce risk of complications, including:
    • lifestyle changes
    • pharmaceutical management
    • allied health therapies
    • surgical options.
  • Identify, assess and manage common chronic conditions and associated complications across the lifespan and appropriate to context.

Know

  • Understand the importance of engaging individuals and, where relevant and with consent, their families and/or carers in developing management plans.
  • Understand the need for follow-up and monitoring, including:
    • patient concordance with medication and/or other therapeutic management, and recognise potential barriers to this
    • development of complications or deterioration in condition
    • routine screening and monitoring
    • provision of health education and preventive care.

Do

  • Document the management plan clearly in the clinical record to facilitate continuity of care.

Know

  • Describe common factors that impact disease presentation and progression, including:
    • sociocultural factors
    • health literacy
    • lifestyle factors
    • comorbidities
    • psychological factors.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

Do

  • Identify at-risk patients and screen for common diseases.
  • Effectively discuss healthy behaviours and other therapeutic early intervention options with patients and their families and/or carers.
  • Consider risks related to:
    • age
    • family history (eg haemochromatosis, coeliac disease, Down’s syndrome, familial hypercholesterolemia, Factor V Leiden, haemophilia, polycystic kidney disease, thalassemia)
    • ethnicity/race; for example:
      • Aboriginal and Torres Strait Islander peoples (diabetes, renal disease, ischaemic heart disease – younger age with higher risk of complications and mortality than non-Indigenous Australians)
      • breast cancer in people of Ashkenazi Jewish descent
      • oesophageal cancer in southern Chinese population
      • glaucoma risk in individuals of African descent at younger age
    • modifiable lifestyle risk factors that increase risk of common chronic diseases and/or infections (eg STIs, hepatitis B and C)
    • comorbidities (eg metabolic syndrome, polycystic ovarian syndrome, psoriasis, obstructive sleep apnoea, increased cardiovascular risk)
    • occupation (eg need for immunisation, workplace ergonomic modification, prevention of musculoskeletal and stress-related injuries)
    • substance use and dependency-related issues.
  • Identify individuals at risk of substance use or with dependency-related issues and provide harm minimisation education.
  • Identify modifiable risk factors (eg elevated blood pressure, lipids, smoking, alcohol use) and recommend preventive measures, such as lifestyle modification or commencement of treatment.

Do

  • Provide information appropriate to sociocultural context, language and health literacy regarding:
    • exercise regimens
    • dietary improvements
    • sleep routine
    • adequate sun exposure
    • avoidance of chemicals, pollutants, alcohol, smoking and other addictive substances.

Milestone: Foundation

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

1. Deliver culturally safe care

Do

  • Demonstrate capacity to reflect on own cultural lens.
  • Discuss the impact of cultural lens and cultural bias on consultations with Aboriginal and Torres Strait Islander peoples and other cross-cultural consultations (where the patient has a different cultural background to self).
  • Identify own and others’ assumptions and stereotyping.
  • Discuss strategies to continue to identify impacts of assumptions and stereotyping and to manage these.

Know and Be

  • Have awareness and respect for the diversity of Aboriginal and Torres Strait Islander cultures.
  • Have awareness of and respect for differences in social structure and culture and the impacts of intergenerational trauma on perceptions of health, wellness and approach to healthcare.

Be

  • Be interested in and willing to learn about Aboriginal and Torres Strait Islander cultures in consultations.
  • Be respectful towards Aboriginal and Torres Strait Islander peoples and avoid assumptions and stereotypes.

Know

Do

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Identify the agenda for the consultation through respectful, effective communication with each patient, which may include:
    • asking about ideas, concerns and expectations for the consultation to enable both the patient and doctor to identify key priorities
    • confirm the list of issues to be discussed in the consultation and screen for further problems.
  • Consider the broader priorities of each patient during assessment and discussions about management to identify any ‘hidden agendas’ or issues that may impact ability to attend for follow-up, concordance with recommended treatment, and/or to address risk factors.
  • Organise appropriate follow-up if the patient’s agenda is not able to be fully addressed in the consultation.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Know

  • Acknowledge that a foundation of trust is paramount and allow time to build rapport.

Do

  • Introduce self and clarify role.
  • Effectively use communication skills, including:
    • communication appropriate to a patient’s linguistic, social and cultural background and health literacy
    • listening attentively to the patient’s opening statement without interrupting
    • demonstrating interest and respect for privacy, ensuring attention to the patient’s physical comfort
    • respecting patient autonomy – the individual’s right to make decisions about their own health
    • accepting legitimacy of the patient’s concerns
    • using concise, easy-to-understand questions and avoiding jargon
    • appropriately using open and closed questions
    • using appropriate non-verbal behaviour, including body posture, position and eye contact
    • providing health education and information appropriate to the individual to enable an informed decision.

Be

  • Be non-judgemental, compassionate and empathic (competencies 2.2.1 and 5.2.5).

Know

  • Understand the variety of communication barriers that may exist in general practice consultations, including for individuals:
    • with cognitive and/or sensory impairments, where different communication styles or strategies may be required
    • whose primary language is a language other than English
    • in cross-cultural consultations
    • who perceive significant power imbalances in the therapeutic relationship.

Do

  • Allow adequate time for consultations.
  • Assess a patient’s health literacy and present information in a way that will be readily understood to enable effective engagement and a collaborative approach to care.
  • Acknowledge own cultural lens and cultural bias and use empathy and sensitivity to deliver culturally safe, person-centred care.
  • Avoid assumptions about English proficiency of any patient who is an Aboriginal or Torres Strait Islander or from a culturally and linguistically diverse community and who speaks languages other than English.
  • Routinely offer a professional interpreter if English is not the first or the preferred language, and allow adequate time for the consultation.
  • Identify individuals with sensory and/or cognitive impairments and engage appropriate support to meet the communication preferences and/or needs of the individual; for example, accessing Auslan interpreters or using communication boards.

Be

  • Be respectful, self-reflective, empathic and interested.
  • Adopt a non-judgemental approach to gender, cultural and sexual diversity.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

No additional competencies at this milestone

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Do

  • Assess and initiate management of serious and potentially serious health conditions safely by:
    • establishing a rational management plan with a focus on patient safety, including, as appropriate:
      • initiating resuscitation and stabilisation of the patient
      • organising appropriate investigations and referral or follow-up
      • seeking help from a senior colleague with appropriate urgency if limits of own knowledge and skills may impact the safety or wellbeing of the patient
    • prioritising comfort and emotional wellbeing of the patient by providing explanation, support and relief from acutely distressing symptoms (eg pain and nausea).
  • Identify red flag presenting symptoms and conditions and develop a structured approach to assessing and initiating safe management of these.

Do

  • Clearly define problems and articulate hypotheses and/or clinical questions in consultations with patients.
  • Enquire about and understand patient preferences and perspectives to guide further enquiry and problem definition.
  • Identify best available evidence to guide problem definition and management.
  • Join patients in the task of defining their clinical problem and preferred approach to management.
  • Use the PICO framework to build clinical questions that are directly relevant to the problem at hand to assist in reviewing guidelines and/or the broader literature to guide evidence-based care.

Do

  • Use strategies that ensure patient comfort; for example:
    • clear communication about the purpose of the examination, investigation or procedure
    • offer a gender-concordant clinician, chaperone or family member to be present for intimate examinations
    • obtain informed consent prior to undertaking any examination, investigation or procedure
    • ensure patient privacy and dignity; for example, provide a private space for them to change and only expose the body part being examined
    • regularly check with the patient during examination to ensure that they are comfortable
    • optimise the patient’s sense of empowerment by ensuring that they can stop the examination at any time
    • prioritise relief of physical pain in acute presentations with appropriate use of analgesia and treatment of other distressing symptoms, such as nausea and vomiting
    • in chronic pain management, provide holistic care that addresses biopsychosocial-cultural factors.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Know

  • For high prevalence chronic diseases, know:
    • the risk factors and diagnostic criteria
    • early treatment guidelines
    • team-based approach and routes to escalation of care.
  • Know the key features of common chronic conditions.

Do

  • Identify chronic disease by conducting a thorough assessment, including use of investigations and/or procedures.
  • Consider early intervention strategies and management options.
  • Identify limits to knowledge and skills, and determine when to ask for help and/or refer for review by non-GP specialists and/or allied health professionals.

Know and do

Know

  • Know the available prescribing guidelines and how to access these.
  • Understand safe prescribing principles:
    • use of evidence-based prescribing
    • benefit versus risk
    • the impact of the placebo response.

Do

  • Consider a range of factors when prescribing, including:
    • contraindications or warnings, such as allergies or individual capacity to safely metabolise medication (eg patients with renal or hepatic impairment, or who are pregnant or breastfeeding)
    • contraindications or interactions with concomitant medications (eg other pharmaceuticals, herbal and nutritional supplements), including risk of withdrawal symptoms when changing from one medication to another
    • financial cost
    • patient factors:
      • age: especially children and elderly (eg metabolism, effectiveness of medication)
      • cognitive capacity of individual (eg impacting ability to adhere to medication instructions, capacity to manage complex dosing regimens)
      • patient’s occupation and other responsibilities (eg potentially sedative medication, individuals who are elite athletes)
      • comorbidities
      • pregnancy and lactation
      • hepatic and renal impairment
      • risk for dependency.
  • Educate patients to empower and enhance shared decision-making and safe medication use:
    • provide verbal and/or written information about the medication(s) prescribed, appropriate to sociocultural context of patient; include common side effects, important drug and/or food interactions, and/or the need for therapeutic monitoring or screening (eg pelvic ultrasound with tamoxifen use) to enable informed consent
    • clearly explain how to use commonly prescribed medication devices, including inhalers and spacers, adrenalin auto-injector, insulin pens
    • ensure adequate follow-up to monitor for concordance, side effects or complications; adhere to therapeutic monitoring if required (eg warfarin, phenytoin, lithium)
    • comply with state or territory-based legislative frameworks for prescribing of drugs of dependency, including applications for permits, and monitoring of frequency of scripts and for signs of dependency.
  • Provide counselling about use of commonly prescribed medications.
  • Use evidence-based guidelines and resources to assist with prescribing, including:
    • unbiased resources to assist with rational antimicrobial prescribing (eg antibiotic guidelines)
    • appropriate and judicious use of chemical (and physical) restraints in patients with impaired cognition as a last resort (eg psychotropic guidelines)
    • appropriate analgesic prescribing (eg analgesic guidelines)
    • other therapeutic guidelines
    • Australian medicines handbook
    • PBS criteria, including authority criteria
    • drugs in sport guidelines regarding banned substances.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

No additional competencies at this milestone

Milestone: Consolidation

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

1. Deliver culturally safe care

Know

  • Understand the importance of the role played by Aboriginal and Torres Strait Islander health workers, health liaison officers and cultural educators and mentors in improving communication with, and in providing culturally safe and appropriate healthcare to, Aboriginal and Torres Strait Islander peoples.
  • Understand the value and importance of developing effective relationships with Aboriginal and Torres Strait Islander health workers and health liaison officers.

Do

  • In identifying a patient as being an Aboriginal or Torres Strait Islander, routinely offer involvement of an Aboriginal or Torres Strait Islander health worker or liaison officer in consultations or as part of the care team.
  • Engage with the local Aboriginal and Torres Strait Islander community, including Aboriginal and Torres Strait Islander health workers, health liaison officers and cultural educators and mentors, to develop understanding of local health issues and develop effective partnerships.
Note: If there are no Aboriginal and Torres Strait Islander health practitioners/workers or liaison officers in the local community, it is still important to understand local referral pathways for Aboriginal and Torres Strait Islander peoples and to work effectively with services (even if done remotely) by using effective communication and providing continuity of culturally safe care. It is important for all GPs to attain this competency, to understand the roles of these health professionals and to access education from cultural educators and mentors to better understand how to work effectively in teams to improve health outcomes for Aboriginal and Torres Strait Islander peoples.

Do

  • Routinely ask Aboriginal and Torres Strait Islander patients about their preferences for services that cater specifically to Aboriginal and Torres Strait Islander peoples. These may include:
    • social and emotional wellbeing workers
    • Aboriginal and Torres Strait Islander liaison officers
    • Aboriginal and Torres Strait Islander health workers
    • Aboriginal and Torres Strait Islander health practitioners
    • Aboriginal and Torres Strait Islander mental health workers
    • Aboriginal and Torres Strait Islander–specific health clinics.
  • Routinely ask patients in cross-cultural consultations about their preferences for services that deliver culturally safe and/or gender-concordant care.
  • Improve the quality of culturally safe healthcare by:
    • including language preference and need for interpreter in referral letters
    • including cultural considerations and practices in referral letters
    • where possible, providing health information to patients that is in their main language and/or culturally appropriate to ensure that they are informed prior to attending appointments with other healthcare providers.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Integrate an understanding of the factors that may impact the quality and effectiveness of therapeutic relationships, including:
    • psychological factors, such as transference and countertransference
    • the power imbalance between doctor and patient
    • the importance of setting and maintaining clear personal and professional boundaries, especially in small communities
    • cultural and linguistic diversity (capabilities 1 and 2)
    • history of trauma and/or negative past experiences with healthcare
    • socioeconomic disadvantage, with concerns about financial cost of care.
  • Identify warning signs that a patient–doctor relationship may not be therapeutic or effective; for example:
    • feeling uncomfortable about seeing a particular patient
    • requests from patients for dishonest or unethical behaviour by the doctor (eg supplying medications that are not clinically indicated, providing incorrect information on legal documentation, taking part in an intimate relationship)
    • situations in which the doctor may be providing a level of care that is outside of their normal practice.
  • Address barriers to effective therapeutic relationships by considering options such as:
    • having open and clear communication with patients about blurring of therapeutic boundaries, unreasonable expectations or inappropriate requests
    • attempting to share responsibility to define and maintain clear boundaries
    • providing trauma-informed care
    • accessing support and advice from colleagues on how to manage any challenges
    • developing strategies to terminate therapeutic relationships if boundaries are not able to be maintained, while maintaining duty of care responsibilities by referring the patient to another doctor to maintain continuity of care.

Know and do

  • Consider the impact of social and cultural determinants of health on disease presentation, including:
    • Aboriginal and Torres Strait Islander status (particularly noting any impacts of intergenerational trauma)
    • culturally and linguistically diverse background, including refugees and asylum seekers
    • LGBTIQ+ identification
    • low health literacy
    • rural and remote location
    • social disadvantage, including people who are unemployed and/or homeless
    • use of illicit substances, including the effects on the children of people who are dependent on these substances
    • severe mental health issues
    • involvement in the justice system
    • disability
    • children living in out-of-home care
    • intimate partner/family violence
    • previous or ongoing trauma.
  • Consider psychological factors that may impact presentation and management of health conditions, such as:
    • patients with complex PTSD or borderline personality disorder may subconsciously attempt to manipulate the health team dynamics
    • patients with severe cognitive impairment or intellectual disability, or who are floridly psychotic, may not be able to easily make their wishes understood.
  • Consider other factors, such as patients who present seeking analgesics but are unwilling to be properly assessed.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Do

  • Structure consultation in a logical sequence.
  • Use nonverbal skills, such as attentive listening, use of silence and understanding visual cues, body language, eye contact, posture and facial expressions to optimise communication with patients.
  • In consultations with Aboriginal and Torres Strait Islander people, be aware of the importance of nonverbal communication and how nonverbal cues may be perceived by the patient. Seek information and support from cultural educators and mentors.
  • Use reflection, and periodically summarise patient history by ‘checking back’ to verify own understanding and inviting patient to correct interpretation.
  • Encourage patient to express how they are feeling.
  • Actively determine and appropriately explore patient’s feelings, ideas, concerns and expectations.
  • Attend to timing of consultation and ensure that history-taking and examination remain focused on presenting symptoms to optimise diagnostic accuracy.
  • Consider whether to negotiate time alone with adolescents who present with an adult guardian (eg if there are cues that they may wish to discuss sexual health issues, such as contraception, understanding of sexual consent, and/or there is a concern about their ability to recognise unwanted sexual experiences).
  • Consider whether to negotiate time alone for individuals presenting with a partner or family member if there are concerns that there may be abuse or violence being perpetrated.

Do

  • Use respectful, effective communication skills to identify priorities and negotiate an agenda; for example:
    • asking patients about their ideas, concerns and expectations
    • confirming list of presenting problems and screening for other problems
    • re-prioritising issues if other issues arise during consultations, and communicating about impacts of this on ability to cover Patient’s agenda and priorities in current consultation, with potential need for follow-up appointment to cover issues adequately
    • using reflection and regularly ‘checking back’ with patients, summarising issues discussed to clarify that information has been communicated correctly.

Know

  • Understand that confidentiality is central to an effective therapeutic relationship and that assessment of capacity to provide consent is an integral part of ensuring ethical practice. Understand limits, including ethical strategies to manage confidentiality and obtain informed consent.
  • Understand legislative requirements regarding care of individuals who are unable to provide consent, including temporary and ongoing medical power of attorney, guardianship arrangements and advance care directives.

Do

  • Identify the range of people who may expect to be consulted regarding a patient’s care, including family members, carers, staff in residential aged care facilities and interpreters.
  • Ensure that specific informed consent is received from the patient to discuss health issues with family and/or carers.
  • Advise family members of the importance of confidentiality and of not providing confidential patient information without consent.
  • Communicate effectively with family members, carers and substitute decision makers. While acknowledging that the doctor’s prime duty of care is to the patient, recognise impacts of provision of care on family members and carers and shared goals, and incorporate views of these individuals into management plans, where relevant.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

Do

  • Maintain quality clinical records, including:
    • next-of-kin contact details
    • allergies and drug reactions
    • social history, including lifestyle factors such as cigarette smoking, alcohol intake, diet and exercise
    • family history that identifies any inheritable conditions
    • contemporaneous progress notes that clearly outline information gleaned from history, examination and clinical tests combined with past history and risk factors, to inform a diagnosis or concise list of differential diagnoses, including red flag conditions that need to be further investigated
    • clinical notes that are comprehensive enough to allow another health practitioner to review the patient in the near future and understand the clinical problem-solving that has occurred to date, and the current plan
    • a concise management plan, including planned investigations, pharmacological and non-pharmacological management, and plan for follow-up
    • effective use of recalls and reminders
    • up-to-date medication summaries
    • use of My Health Record with patient consent, to optimise continuity of care.

Know and do

  • Identify and understand barriers to care and advocate for these to be addressed.

Do

  • Advocate for patients, particularly those from priority population groups who have social, cultural and/or environmental determinants that may adversely impact their ability to advocate for themselves; for example, poor health literacy, experiences of trauma, and cultural and/or language barriers.
  • Advocate for individual patients who have issues with equitable access by coordinating patient care with external health professionals using a strategic, holistic, person-centred approach, and effective communication and goalsetting.

Do

  • Consider referrals to allied health and specialist care for the most appropriate and beneficial tests, procedures or specialist opinion, taking into account what would be of the most benefit to the health and wellbeing of the patient, the balance between potential benefits, the evidence base, the possible risks and costs and the sociocultural beliefs of the patient.
  • Identify barriers to care and advocate that these be addressed, which may include providing an explanation of biopsychosocial-cultural barriers to care in referral letters to other services. Barriers may include:
    • diversity – cultural, gender, sexual or linguistic
    • disability
    • low health literacy
    • concomitant substance use
    • past trauma, which may impact ability to trust health professionals
    • psychiatric illness; for example, delusional disorders that may impair insight or judgement
    • ineligibility for Medicare or financial barriers
    • difficulties accessing transport.
  • Consider appropriateness of referrals to minimise fragmentation of care.
  • Consider appropriateness of referrals with regard to cost to the patient and timeliness of appointment, to ensure there is minimal risk of health deterioration due to long wait times.
  • Organise referrals in an efficient way, using clear communication to minimise the risk of unnecessary repetition of investigations or therapies that can be burdensome to patients and the broader community.
  • Provide timely and high-quality referral letters to professionals with the appropriate skills to meet the patient’s needs, and who fulfil any other patient needs (eg gender-concordant care).
  • Provide referral documentation that:
    • contains adequate information to accurately identify the patient, including an individual healthcare identifier, if available
    • contains sufficient information to assist the allied health or specialist professional to provide quality care (eg clear reason for the referral, current and relevant past history, family history, medication list, allergies, vaccination status, need for an interpreter)
    • is clear as to its purpose (eg opinion on diagnosis or management, request for therapy)
    • follows completion of an appropriate work-up and includes the results in the referral letter, where appropriate (eg recent liver function tests for an individual with hepatitis B being referred to a liver clinic).
  • Maintain patient confidentiality by:
    • not disclosing sensitive information that is not relevant to the referral
    • encrypting referrals sent electronically (practices must comply with standards for secure transmission of health information).
  • Provide health information to patients who request referrals to help them understand the potential risks posed by undergoing procedures prior to their specialist appointment.

Do

  • Use eHealth systems to:
    • allow another practitioner to continue the care of patients
    • help reduce patient harm and adverse events, and enhance communication between health service providers
    • enable clinical audits of medical records to evaluate the appropriateness of care and how well it aligns with recommendations
    • record key patient information, including:
      • patient demographics (name, date of birth, gender, contact details, next-of-kin details, Medicare number)
      • cultural status, including Aboriginal and Torres Strait Islander status and migration history (to assist with risk assessment and advice)
      • preferred language (and whether an interpreter is required)
      • medical information (allergies, up-to-date list of health problems)
      • medication (up-to-date list)
      • family history (particularly inheritable conditions relevant to the individual)
      • social and occupational history (relationship status, sexuality, gender identification, education level, type of occupation)
      • lifestyle risk factors (eg smoking, alcohol intake, illicit drug use)
      • health screening (whether up to date with developmental screening, blood pressure, mammograms, cervical screening tests, annual diabetes assessments, etc).
  • Competently use a range of eHealth systems; for example:
    • clinical software
    • telehealth/videoconferencing facilities
    • My Health Record
    • encrypted email to transfer patient information
    • health tools and applications available for professionals and patients (eg e-mental health interventions).

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Do

  • Conduct a structured and rational approach to assessment, including:
    • taking a concise, focused, and patient-centred history
    • completing relevant and respectful examinations using appropriate equipment
    • identifying individuals who have had a traumatic experience that may impact their capacity to trust or tolerate discomfort, or that may create a perception of loss of control in consultations
    • using available clinic tests
    • using appropriate assessment and screening tools
    • identifying patients who are significantly ill or at risk of acute clinical deterioration (competency 5.3.6)
    • accessing clinical support appropriately and as required.
  • Establish a working diagnosis or a rational list of differential diagnoses that identifies red flag conditions and high probability acute conditions.
  • Understand the limits of own skills and knowledge and seek help appropriately (competency 13.1.3) if unable to distinguish the likely diagnosis and/or if unsure how to investigate or manage the symptoms or condition.
  • If in need of advice:
    • logically and concisely present assessment findings and explain approach to clinical problem-solving to a senior supervising doctor
    • explain plan for investigation and/or procedures required and initial safe management of the presenting problem, to enable advice and feedback to be provided.
  • Use examination skills to identify relevant positive or negative findings, including:
    • cardiovascular, respiratory, gastrointestinal, cranial nerve and limb neurological examination
    • eye, ear, nose and throat examination
    • joint examination, including cervical, thoracic, lumbar spine, knee, hip, shoulder, elbow, wrist, ankles, hand and foot
    • thyroid, breast, pelvic and genital examination in men and women.
  • Use relevant equipment for examination, including:
    • visual acuity charts
    • ophthalmoscope +/– panophthalmoscope +/– slit lamp
    • Amsler grid and Ishihara chart
    • auroscope (including visualisation of tympanic membrane in uncooperative children)
    • tuning fork for Rinne and Weber tests
    • monofilament
    • magnifying instrument to examine skin lesions +/– dermatoscope
    • peak flow meter and spirometer
    • ECG (and interpret for atrial fibrillation; atrial flutter; supraventricular tachycardia; ventricular fibrillation; atrial and ventricular ectopics and ischaemia; first-, second- and third-degree heart block).
  • Use relevant assessment tools.
  • Identify and ascertain impact on differential diagnoses of positive and negative physical signs.
  • Identify common acute symptoms (typically not severe or life-threatening).
  • Practise rational safe prescribing using clinical guidelines as appropriate (competencies 6.3.4 and 14.3.1).

Do

  • Effectively triage and manage time to assist in prioritising patients to be assessed.
  • Consider:
    • current symptoms and severity
    • how long symptoms have been present
    • whether the individual recently travelled to an area at high risk for communicable diseases
    • existing vulnerabilities and thus a risk of acute deterioration (eg age and existence of concomitant illness).
  • Stratify and prioritise differential diagnoses according to level of risk by assessing the patient’s risk of having a disease state based on the information available and consideration of the potential severity of this condition. In taking a history, elicit clinical flags and other risk factors, particularly family history and mode of inheritance of the condition, as well as lifestyle factors, concomitant disease and medication history.
  • Use clinical flags to assist in prioritisation. Clinical flags include:
    • red (possibility of serious pathology)
    • yellow (psychosocial pointers that may indicate risk of progression to long-term distress, disability and/or pain)
    • orange (psychological equivalent of red flags: suggest need for mental health review)
    • blue (perceptions about the relationship between work and health that may inhibit recovery)
    • black (systemic or contextual obstacles related to particular people, systems or policies).
  • Consider all relevant factors to assist in recognising the multidimensional aspects of conditions, particularly pain, and to assist in risk stratification and developing a meaningful management plan.
  • Consider referral for appropriate tests and procedures and/or for specialist opinion.
  • Provide a rational approach to ordering investigations and/or diagnostic procedures based on:
    • the key purpose of the investigation(s)
    • likely benefits versus any risks to the individual
    • evaluation of the validity, sensitivity and specificity
    • relevant guidelines
    • MBS criteria, where relevant
    • costs to the individual and/or broader population.

Do

  • Demonstrate rational decision making and correct processes for procedures, including:
    • choosing the appropriate procedure
    • communicating clearly with the patient
    • obtaining and documenting informed consent
    • safely performing the procedure using strict infection control standards, including safe management of sharps and body fluids
    • accurately documenting what took place
    • organising appropriate aftercare, including advice on when to return for review.
  • Understand the limits of own procedural skills and practice requirements prior to undertaking a procedure, and organise appropriate supervision to optimise patient safety.
  • Safely undertake common procedures.

Know

  • Use competencies 5.3.1, 5.3.2 and 5.3.3 to gather adequate clinical data to inform and prioritise a rational list of differential diagnoses. Use guidelines, as appropriate, and experiential knowledge to generate a high probability diagnosis, if possible.
  • Interpret investigation results in the context of the patient’s history and examination findings, identify likely causes of any abnormal findings and explain significance to the patient in the context of their current symptoms, health status and any comorbidities.
  • Clearly explain and manage common abnormal pathology and radiology results, including:
    • anaemia: micro, macro and normocytic
    • iron, B12 and folate deficiency
    • elevated creatinine, including acceptable levels in individuals with chronic renal impairment
    • abnormal liver function tests
    • low platelets
    • proteinuria
    • haematuria
    • electrolyte abnormalities (eg high or low potassium, high or low sodium)
    • elevated or reduced thyroid-stimulating hormone with normal or abnormal T3, T4
    • disc prolapse on CT spine scan of individual with no back pain.
  • Manage uncertainty by developing a safe management plan, including continuity of care, and explore other differential diagnoses (including possible biopsychosocial-cultural contributing factors) if it is not possible to define the final diagnosis (refer to competency 5.3.8 for further criteria regarding management of uncertainty, safety netting and use of time as a diagnostic aid).

Know

  • Understand importance of adequate follow-up, including an assessment of the urgency and importance of the reason for follow-up.
  • Describe the factors that may affect either the patient’s or the doctor’s ability to follow up appropriately, such as barriers to follow-up or where errors may occur that lead to lack of follow-up.  
  • Know the practice systems that facilitate timely follow-up, including recalls, reminders, handover and clinical notes. 

Do

  • Prioritise the urgency of follow-up and proactively follow up patients appropriately.
  • Make appropriate plans for follow-up and ensure the patient understands the plan.
  • Use practice systems to ensure follow-up occurs.

Know

  • Know the signs and symptoms of severe illness in different age groups and patient cohorts, including:
    • indicators of a ‘sick child’, including signs of dehydration, hypovolemia, and respiratory distress in children of different ages:
      • in infants – reduced feeding and looking ‘floppy’ when unwell, signs of dehydration and increased respiratory effort and decompensation (eg cool peripheries, greater respiratory rate with increased work of breathing, poor skin turgor, sunken fontanelle)
      • in toddlers – uninterested in playing or engaging with surroundings, tachycardia (usually the first physical sign of decompensation)
    • in fit young adults – drop in blood pressure, severe tachycardia, etc
    • in older people or those with chronic conditions – hypotension and tachycardia (may be masked by pre-existing conditions; eg heart block or use of medications such as calcium channel or beta blockers), etc.

Do

  • Put in place an efficient treatment plan to optimise outcomes; for example, rapidly prioritise issues to manage, including the DRSABCD action plan (Danger, Response, Send for help, Breathing, CPR, Defibrillation), in line with Australian Resuscitation Council guidelines.
  • Ensure effective clinical handover (either verbal or written) in emergency situations. The ISBAR framework is a useful structure for efficient clinical handover:
    • Introduction (describe role and purpose of communication)
    • Situation (current status of the patient)
    • Background (concise summary of issues that led to the presentation, including past history, medications, allergies and relevant risk factors)
    • Assessment (outline of the problem with key clinical signs, working diagnosis and management instituted)
    • Recommendation (what is needed).

Know

  • Demonstrate skills in advanced life support, including:
    • airway management skills, bag and mask ventilation, insertion of oropharyngeal airway, including laryngeal mask airway
    • emergency scene management and safety
    • establishing venous access
    • defibrillation and cardioversion.

Know

  • The psychological causes of undifferentiated symptoms, particularly repeat presentations; for example:
    • causes of non-accidental injury (including concerns about intimate partner or family violence)
    • individuals at risk of intentional self-harm (eg misuse of medication, disordered eating, cutting) such as occurs in borderline personality disorder or complex PTSD, or recurrent somatic complaints that remain undifferentiated despite investigation where there is a suspicion that there may be a psychological basis
    • stress related to being a carer, recent bereavement, work/career or financial difficulties or potential for secondary gain
    • Munchausen syndrome or Munchausen by proxy.

Do

  • Identify patients with acute undifferentiated conditions who are significantly unwell or at risk of acute clinical deterioration as per competency 5.3.6.
  • Access support from a senior colleague in a timely way if unsure how to investigate or manage a presentation.
  • Rationally choose investigations and management and balance the potential risks (of both under- and over-investigating and management) against the benefits to the individual.
  • Use the ‘diagnostic pause’ appropriately.
  • Be familiar with serious conditions that must not be missed, conditions commonly missed, and conditions that may present with unusual or elusive symptoms.
  • Reduce risk by organising follow-up and review.
  • If appropriate, inform the patient of the signs of deterioration and provide options for them to access medical review in a timely way.
  • Acknowledge that some symptoms and presentations may never be attributed to specific conditions.
  • Develop strategies for delineating the physical and psychological components when psychological conditions present as physical symptoms.
  • Deliver trauma-informed care.
  • Use a multidisciplinary approach and professional support to ensure that diagnoses are not missed.
  • Be clear about decisions and refer to evidence during history-taking, examination and investigations, to maximise diagnostic effectiveness and patient safety and minimise over-investigation.
  • Use evidence-based approaches to assessment and management to clarify and strengthen decision-making.
  • Use effective communication skills to manage patient anxiety when there is uncertainty and/or when managing undifferentiated conditions of a psychogenic origin, and to communicate management options and expected outcomes.

Know

  • Be informed about public health risks, including:
    • notifiable communicable diseases (eg hepatitis A, giardia, rotavirus, salmonella)
    • STIs (eg chlamydia, gonorrhoea, syphilis, human papillomavirus [HPV])
    • vector-borne diseases (eg malaria, dengue fever)
    • airborne viruses (eg influenza, tuberculosis), including pandemic influenzas, novel coronavirus
    • vaccine-preventable diseases (eg hepatitis B, measles, mumps, varicella, tetanus, polio, meningococcus, haemophilus)
    • blood-borne viruses (eg HIV, hepatitis C)
    • infections spread by contact (eg chlamydial eye infections)
    • potential environmental hazards (eg water quality, respiratory effects of pollution)
    • occupation-related hazards (eg asbestos exposure).
  • Understand own state or territory requirements for reporting of notifiable conditions and relevant time limits.

Do

  • Make notifications to own state or territory department of health and assist with contact tracing once informed consent has been provided regarding STIs and communicable diseases (eg active pulmonary tuberculosis, pandemic management).
  • Implement vaccination programs with appropriate education.
  • Identify health concerns in the local community (eg related to occupational or environmental risk factors) and manage these through advocacy and professional support.
  • Stay informed of disease trends and guidelines regarding screening and prevention.
  • Improve health outcomes by identifying vulnerable groups and detecting or preventing disease.
  • Use a team approach within practice setting to identify and manage individuals with communicable diseases.
  • Manage communicable disease outbreaks, including by:
    • effectively triaging febrile patients
    • using infection control procedures
    • using medical isolation appropriately
    • vaccinating vulnerable members of the population
    • using the communicable disease notification framework
    • contact tracing after diagnosis
    • educating patients, family members and/or carers on effective minimisation of transmission
    • communicating efficiently with hospitals prior to patient transfer.
  • Participate as required in public health initiatives; for example, health education and promotion campaigns, implementation of vaccination programs and advocacy regarding issues of public health concern.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Do

  • Develop management plans for common chronic conditions that take into consideration:
    • evidence-based pharmacological and non-pharmacological approaches
    • physical, social and psychological therapeutic modalities
    • which options will be of most benefit to the health and wellbeing of the patient
    • the patient’s sociocultural beliefs
    • the balance between risk of side effects, interactions and costs.
  • Consider management options such as physical, social and psychological therapeutic modalities that are likely to be of most benefit to the health and wellbeing of the individual, considering sociocultural beliefs and balancing the risk of side effects, interactions and costs. These may include:
    • advice on exercise regimens, dietary improvements and sleep routine
    • adequate sun exposure
    • involvement in community activities
    • stress management techniques
    • communication strategies
    • conflict resolution with significant others
    • avoidance or minimisation of exposure to risk factors (eg smoking, alcohol, illicit substances, environmental pollutants)
    • pharmaceuticals
    • herbal or nutritional supplements
    • referrals for physical or psychological therapy, or to other non-GP specialists for different forms of intervention or management
    • addressing impacts of social determinants of health that may be contributing to the condition, or any potential for development of complications due to barriers to care access.
  • Provide continuity of care and appropriate follow-up.

Do

  • Provide effective counselling, in language appropriate to the individual and their sociocultural context, regarding management options and models of care to enable informed consent and shared decision-making and to develop collaborative goals of care.
  • Consider using therapies and recommendations for lifestyle interventions to improve quality of life, reduce risk of complications and prolong life.
  • Consider and discuss with patients and their families or carers, where appropriate, care versus cure management (eg palliation versus active treatment for advanced cancer, severe ischaemic heart disease, incurable chronic condition).
  • Consider a variety of models of care, including:
    • cure
    • rehabilitation
    • palliation and voluntary assisted dying (in states and territories where legislation is in place to support this)
    • health promotion and prevention with focus on lifestyle modification
    • delivery of care to priority population groups
    • specialised general practice (eg sports medicine, military medicine, sexual health)
    • care for specific populations (eg options for obstetric care and delivery).

Do

  • Provide patient-centred, collaborative care.
  • Discuss impacts of the condition on the individual patient, their relationships, their ability to work and/or study and to undertake their activities of daily living, as well as their psychological wellbeing and financial situation.
  • Recognise the impacts of burden of care on family members and carers; for example:
    • identify signs of stress in carers (particularly in instances of chronic mental health issues, older patients with intensive needs, individuals with sensory, physical or intellectual disabilities, individuals who are receiving end-of-life care, etc.)
    • discuss and organise respite, as required
    • identify grief reactions, distress and fatigue
    • identify signs that carers are not coping with their workload and provide support and advice regarding management
    • support family and carers with bereavement.
  • Provide support and education to optimise wellbeing and promote self care; for example:
    • provide socioculturally appropriate verbal and written information on health promotion activities
    • use psychological techniques, such as motivational counselling, cognitive behavioural therapy and mindfulness to encourage and sustain behavioural change.

Know

  • Be aware of statutory requirements; for example:
    • definition of drug-dependent person
    • Schedule 8 medication prescribing, including criteria for permit
    • requirements for additional training prior to prescribing some restricted medications (eg opioid substitution therapy).
  • Understand availability of most appropriate guidelines for different classes of medication and how to access current versions of these.
  • Know the local resources that are available to assist with safe prescribing and optimising patient concordance; for example:

Do

  • Prescribe medication according to indications and in line with guidelines.
  • Use unbiased evidence-based resources to guide prescribing; for example, for antibiotics, analgesics, psychotropics and other common acute and chronic conditions (competencies 6.2.3 and 14.2.1).
  • Select the most appropriate medication for the individual patient, considering factors such as:
    • ability to metabolise and tolerate medication (eg age, renal and hepatic impairment, other comorbidities)
    • age – especially children, elderly
    • comorbidities
    • pregnancy and lactation
    • interactions with other medications, including over-the-counter medications or contraindications (eg oral contraceptives, hormone replacement therapy, beta blockers, drug sensitivities, anticoagulants and antidepressants)
    • capacity for patient to manage complex dosing and access appropriate monitoring, if required
    • the need to balance potential benefits against potential risks, and discuss these with the patient.
  • Educate patients on use of commonly prescribed medication devices, including:
    • different types of inhalers and spacers
    • adrenaline auto-injectors
    • insulin pens.
  • Follow up to monitor for side effects, assess effectiveness and concordance.
  • Facilitate concordance by:
    • providing socially, culturally and language-appropriate resources (eg multilingual patient information, Easidose prescribing aid)
    • effectively communicating with patients about the role of medications, including discussion about patient concerns or reticence
    • ensuring patients are aware of how and when to make contact if they have concerns about a medication or side effects
    • provide counselling regarding use, benefits and common side effects of common medications
    • referring to other services, including pharmacist for home medicine review or provision of packaged medication (eg medication packs), or the district nursing service; enlist family help to assist with medication management if there are safety or concordance concerns.
  • Conduct appropriate therapeutic monitoring, including for:
    • medications with a narrow therapeutic range to minimise risk of toxicity (eg warfarin, lithium, digoxin and phenytoin)
    • individuals at risk of, or who experience specific side effects from, prescribed medications; for example, kidney function tests (UEC) after commencement of angiotensin-converting enzyme inhibitors in individuals at risk; indications for creatine kinase monitoring with statins.
  • Manage drug withdrawal symptoms, including for individuals with prescription drug dependence (eg benzodiazepines, opioid and other analgesic medications and antidepressants).
  • Undertake safe and rational private and off-label prescribing and provide appropriate counselling to patients (eg about review or follow-up processes required to ensure that adverse effects are detected early).
  • Appropriately report adverse side effects to relevant authorities.
  • Undertake prescribing of common medications and counsel patients regarding their use.
  • Understand clinical uses of and, where appropriate, provide advice on safe use of commonly used integrative therapies.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

Know

  • Understand the principles of good screening tests.
  • Understand the types of health promotion and education that are typically required at different life stages and the engagement strategies that are most effective for priority population groups.
  • Understand the breadth of social and epidemiological, non-modifiable and modifiable risk factors for common acute and chronic conditions to assist in identification of individuals who may benefit from preventive care to improve outcomes. These include:
    • gender and age
    • ethnicity/country of origin
    • if sexually active
    • lifestyle risk factors (eg diet, exercise, smoking, alcohol intake, substance use)
    • biometrics (eg BMI, neck and waist circumference)
    • family history (of inheritable conditions)
    • occupational history (eg asbestos and dust exposure)
    • comorbidities
    • socioeconomic status
    • previous trauma experiences.

Do

  • Use recall systems and flags in patient records for reminders regarding vaccinations, age- and risk-based screening, and where appropriate, prophylactic treatment for those at risk, as well as opportunistic screening when risk factors are identified based on established guidelines.
  • Identify patients, particularly those with low health literacy, who would benefit from opportunistic or planned health promotion education to prevent injury and/or disease.
  • Identify and notify individuals in need of follow-up; for example, for further investigation or specialist referral after routine screening or abnormal results.
  • Undertake opportunistic screening of priority population groups.
  • Prior to screening, counsel individuals appropriately of potential outcomes if result is positive or negative to ensure that they are adequately informed.
  • Use screening and prevention strategies appropriately.
  • Provide life stage–based screening, preventive health assessments and opportunistic counselling.

Milestone: Fellowship

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

1. Deliver culturally safe care

Do

  • Undertake respectful cultural assessments.
  • Routinely offer access to an interpreter or Aboriginal and Torres Strait Islander health worker, community health worker or liaison officer in consultations.
  • Be aware of and respectfully enquire about sociocultural beliefs and obligations, such as ‘Sorry Business’, segregation of men’s and women’s business and issues regarding spirituality (eg in some communities it is common to hear the voices of departed loved ones, which could be misdiagnosed as auditory hallucinations and raise concerns about mental illness).
  • Be willing to work effectively with cultural educators and mentors to increase awareness and understanding of the depth and diversity of Aboriginal and Torres Strait Islander culture.
  • Be humble, engaged, aware and respectful of differences in social structure, culture and impacts of intergenerational trauma and the way that these impact perceptions of health, wellness and approach to healthcare.

Do

  • Undertake respectful cultural assessments in cross-cultural consultations.
  • Routinely offer access to an interpreter for consultations.
  • Use interpreters effectively (competency 3.4.2).
  • Respectfully enquire about an individual’s history, cultural beliefs and practices and how these affect perceptions of health and access to health services. For example, experience with health services in country of origin, cultural dietary restrictions or practices (eg fasting, avoidance of animal products) and cultural beliefs (eg regarding mental illness).

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

2. Provide person-centred and comprehensive care, using a biopsychosocial approach

Do

  • Incorporate consideration of preferences and health beliefs into management plans to support appropriate referrals, clinical handover and provision of care.
  • Consider:
    • the patient’s language and level of health literacy
    • the patient’s values, preferences and health beliefs
    • the patient’s previous experiences, including interactions with health services and experiences of trauma that may impact ability to access care
    • tailoring information to engage the patient in their care
    • barriers to care, including financial, geographical, resource limitations, etc.
  • Incorporate consideration of preferences and health beliefs into management plans to support appropriate referrals, clinical handover and provision of care.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

3. Manage consultations and communicate effectively with patients, families and carers

Do

  • Identify the range of challenging patient encounters that can occur with patients who may:
    • have experienced trauma, including adverse childhood experiences
    • be distressed or agitated and/or present as physically or verbally aggressive
    • be about to be given bad news
    • have made a complaint about a doctor or other colleague
    • have unreasonable expectations about the consultation or the care to be provided, including blurring of therapeutic boundaries
    • present with symptoms of an STI.
  • Understand types and causes of trauma, including that trauma may be caused by exposure to family violence, sexual, physical and/or emotional abuse, and/or neglect in childhood.
  • Understand the potential impacts of trauma on the therapeutic relationship, including:
    • barriers to establishing rapport, trust and open communication
    • reticence to be examined or undergo procedures.
  • Establish a therapeutic relationship by:
    • practising trauma-informed care, including using sensitive and empathic communication when caring for patients who may have experienced trauma
    • using communication techniques, such as active listening and validation of a patient’s experience
    • conducting safety assessments for patients who are in situations in which they are continuing to experience trauma
    • conducting mental health and risk assessments
    • providing emotional support, psychoeducation, and encouragement of active use of social support and self-care strategies
    • considering referral for trauma-focused cognitive behavioural therapy, dialectical behaviour therapy for complex PTSD, or eye movement desensitisation and reprocessing, etc.
  • Identify early signs of behaviour that may lead to aggression (eg individuals who are noticeably affected by substances such as alcohol or methamphetamines, signs of physical agitation such as pacing or responding to auditory hallucinations).
  • Use simple de-escalation techniques and implement safety net strategies if these are not effective, such as ensuring there is an escape route if confronted, considering safety of other staff, use of duress alarm or calling emergency services.

Do

  • Acknowledge barriers to communication, including:
    • social (including gender, sexuality, socioeconomic status)
    • psychological
    • language
    • health condition (eg sensory, intellectual and physical disabilities)
    • cultural.
  • Proactively address these barriers through use of skills and knowledge, specifically:
    • ensuring adequate time for consultations
    • acknowledging perceptions of power imbalances in the therapeutic relationship and discussing these with the patient to address impacts
    • acknowledging fear and mistrust of mainstream health services due to past mistreatment or other negative experiences, and working with the patient to manage these
    • acknowledging Aboriginal and Torres Strait Islander peoples and respectfully enquiring about their land and community or ‘mob’
    • considering displaying Aboriginal and Torres Strait Islander flags in the clinic room, and including an acknowledgement of country in correspondence signature
    • engaging with Aboriginal cultural mentors and educators to support culturally safe care for Aboriginal and Torres Strait Islander patients
    • identifying the need for interpreters and using them effectively; for example, maintaining eye contact with the patient, speaking slowly and concisely, breaking speech up into short phrases and pausing so that the interpreter can translate. Request that the interpreter identify any cultural misunderstandings, trust their judgement, and rephrase questions or statements where misunderstandings have occurred
    • using LGBTIQ+ inclusive language, avoiding assumptions (eg asking about partner or parents rather than boyfriend/girlfriend, husband/wife, mother/father) and acknowledging diversity. For example, respectfully ask how a patient describes themselves or what pronoun they use, rather than asking what they prefer. Consider having a visual identifier in the clinic room, such as a rainbow sticker, to communicate being an LGBTIQ+ inclusive practitioner
    • identifying the most effective way to communicate and collaborate with people with disability by working with them and their family/carers, if appropriate, as a team to optimise outcomes, including avoiding using a deficit model when providing care, maintaining a focus on strengths and understanding the sociocultural context to maximise effectiveness of communication
    • recognising that some individuals with disability may have impaired capacity to consent to some decisions; however, they should remain at the centre of the decision-making process, with assistance from a guardian if required.

Do

  • Demonstrate effective time management and use respectful, effective communication and clinical problem-solving skills to:
    • consider patient’s agenda for consultations and balance this against other outstanding clinical issues
    • prioritise issues to be covered in the consultation (eg assess high-risk issues and defer less urgent issues)
    • set reasonable expectations for what can be achieved, provide a clear explanation and suggest a rational follow-up plan if all of the outstanding issues cannot be addressed in the current consultation
    • communicate rationale for the plan to demonstrate commitment to follow-up and continuity of care
    • address any concerns that arise about deferred issues and organise follow-up appointments in an appropriate timeframe.

Do

  • Demonstrate effective shared decision making, including:
    • provision of accurate and comprehensive information to the individual, tailored to their sociocultural context (particularly the level of health literacy and appropriate language) about the options available, and the risks and benefits of these options
    • acknowledging and managing any conflicts between the patient and their family or carers when setting goals or preferences for management (eg request for contraceptive script for an adolescent less than16 years of age, mental illness that threatens safety of individual, eating disorder management)
    • effectively assessing capacity of patient to provide consent
    • ethically and appropriately involving family and/or carers (including ensuring privacy and confidentiality of patient and seeking consent prior to sharing information) and identifying and managing impacts of burden of care responsibilities.
  • Develop personalised management plans, considering:
    • model of care (eg care, cure, rehabilitation, palliation and advance care planning)
    • investigation and/or treatment options, including consideration of barriers to accessing these (eg financial, geographical, cultural)
    • impacts of burden of care on family and carers and identifying signs of stress in carers; providing support and advice about management, and discussing and organising respite, as required.

Do

  • Clearly communicate relevance of research or application of a guideline to patients, considering relevant biopsychosocial approach -cultural factors.
  • Avoid jargon and communicate evidence effectively, taking into consideration the patient’s level of health literacy, values, preferences and health belief system, and tailor how information is conveyed to assist in collaboration, shared decision-making and to achieve person-centred care.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

4. Collaborate and coordinate care (within healthcare teams and with other professional stakeholders)

Know

  • Recognise the importance of the GP’s role in providing holistic person-centred care to efficiently identify and manage acute and chronic conditions and minimise fragmentation of care.
  • Understand the roles of each member of a patient’s healthcare team, to minimise fragmentation and reduce risks, as well as to avoid unnecessary duplication of care.
  • Understand the value of the complementary skills of other clinic staff (eg practice nurse), non-GP specialists and allied health professionals in optimising quality of care and improving patient outcomes (particularly for patients with complex, chronic health conditions and/or those who have psychosocial risk factors, such as unstable accommodation, substance dependency issues, problems with medication concordance, etc).

Do

  • Coordinate and, where appropriate, lead care to avoid duplication and fragmentation:
    • as part of the general practice team with GP colleagues , practice manager, practice nurse, administrative staff and allied health colleagues
    • as part of the multidisciplinary team with external practitioners, such as non-GP specialists, allied health professionals (eg Aboriginal health workers, liaison officers, cultural mentors and educators, physiotherapists, dentists, podiatrists, optometrists, exercise physiologists, psychologists, audiologists, naturopaths, osteopaths, Chinese medicine and Ayurvedic practitioners, social workers and residential healthcare staff).
  • During the peri-operative period, work with patients, particularly those with chronic diseases, to optimise their health prior to, during and after surgery.
  • Provide continuity and effectively collaborate, lead and coordinate patient care by:
    • undertaking appropriate assessment, investigation, clinical problem-solving and management prior to referring individuals to other services
    • facilitating appropriate referrals and verbal and written clinical handover by:
      • efficiently organising appropriate referrals and management plans for allied health and non-GP specialist care, using effective communication to minimise the risk of unnecessary repetition of investigations or therapies, which can be burdensome to patients and the broader community, and containing all relevant information on current and past medical history, family history, current medications, allergies, risk factors and sociocultural factors
      • using case conferencing with documentation of opinions and agreement on management plan and actions/roles of individual practitioners
    • ongoing use of effective communication to ensure the care team is kept informed of relevant information about a patient’s health status and therapies, and understands the patient’s needs and wishes.
  • Optimise continuity through effective use of practice quality and safety systems, including recall systems to optimise access to screening, monitoring of medication, and follow-up of abnormal urgent and non-urgent pathology and radiology results. Recall systems should be considered for patients who have been referred to other services for serious health conditions that require intervention, to inform and prompt for follow-up if reviews do not occur in an acceptable time frame.
  • Provide education and support to improve concordance and health outcomes.
  • Maintain privacy and confidentiality and safely use eHealth strategies to collaborate and coordinate care, such as:
    • video conferencing
    • internet telephone services (eg Zoom)
    • email
    • SMS
    • web services and e-care planning tools
    • electronic referrals systems (with use of appropriate encryption)
    • electronic prescribing
    • electronic patient health records (including PCEHR)
    • electronic communication with Medicare, pathology and medical imaging providers
    • electronic or tele-based recall systems.
  • Address barriers to effective communication with other health professionals, such as:
    • difficulties communicating during consulting hours
    • delays in creating and handing over documentation (eg referral letters and discharge summaries)
    • incomplete or difficult-to-read documentation resulting from time pressures or inadequate medical record systems, etc
    • conflict about patient management or personality conflicts or bullying; minimise conflict within a care team by:
      • recognising and addressing signs of dysfunctional interactions
      • avoiding judgement or blame
      • behaving respectfully and empathically with all members of the team
      • identifying situations where health professionals may be breaching their professional code of ethics in how they interact with others.

Be

  • Be collaborative and respectful.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

5. Identify and manage uncertainty and acute and undifferentiated presentations (across the lifespan and appropriate to context)

Know

  • Know the limits of own knowledge and skills and when to ask for assistance from supervisor and/or colleagues to manage common acute and emergency conditions as outlined in competencies 5.3.1 and 5.3.2.

Do

  • Undertake a structured and rational assessment of the presenting symptoms by taking a concise, focused, patient-centred history, doing a relevant and respectful physical examination using appropriate equipment, and using clinic tests and/or screening tools.
  • Establish a working diagnosis or a rational list of differential diagnoses that identifies any red flag conditions and high probability acute conditions, and do so largely independently without assistance from supervisor or colleagues.
  • Identify patients who are significantly ill or at risk of acute clinical deterioration, stabilise (competency 5.3.5) and access clinical support appropriately.
  • Initiate management of patients who are significantly unwell, including stabilisation and appropriate urgent referral to tertiary facility for the following conditions, appropriate to context, in both children and adults:
    • hypovolaemia and septic shock
    • acute anaphylaxis
    • acute coronary syndromes, including cardiac arrest, ventricular fibrillation, asystole
    • collapse, altered conscious state and loss of consciousness
    • acute abdomen
    • respiratory failure
    • physical trauma, including cervical spine protection.
  • Establish a rational and safe management plan, including investigation or procedures, and/or initial therapy, and/or review and safety-netting, and/or referral.
  • Logically and concisely present assessment findings, verbally or written, to enable another clinician to understand clinical problem-solving and management plan to continue management.
  • Interpret results of investigations in the context of the patient (identify the significance of abnormal or, in some cases, normal investigation results for the individual in the context of their relevant past and family history, current symptoms and medications). This includes understanding the physiological impacts of ageing and disease processes, such as:
    • the significance of low normal platelets and low-level elevation of transaminases in individuals with hepatitis B
    • the ideal ferritin targets for individuals with haemochromatosis
    • the HbA1C targets for individuals with type 1 and type 2 diabetes
    • acceptable creatinine levels in an individual with chronic renal impairment
    • mildly elevated bilirubin in patients with Gilbert’s syndrome.
  • Use reflective practice.

Do

  • Demonstrate continuity of care and awareness of the need for follow-up and reassessment of patients, as appropriate, to minimise risk of clinical reasoning errors and consequent risk to patients by:
    • reviewing following investigations, and/or practising watchful waiting, and/or conducting initial therapeutic trial to determine status and whether another assessment is required
    • willingness to consider other differential diagnoses and investigating or referring appropriately
    • following evidence-based guidelines and recommendations for diagnosis and investigation of common acute conditions, complex acute conditions (competency 5.4.3) and ongoing undifferentiated conditions (competency 5.4.4).

Do

  • Identify and manage patients who are at risk of deterioration and/or who are at risk of delayed recovery, including those who present with:
    • evidence of being acutely unwell (competencies 5.3.1 and 5.3.6)
    • complex presentations that are undifferentiated (competency 5.4.4)
    • complex comorbidities
    • psychosocial prognostic indicator flags for delayed recovery.
  • Be familiar with categorisation of psychosocial prognostic indicator flags (particularly relevant for chronic pain) for delayed recovery in complex acute conditions:
    • yellow flags (psychological factors such as prominent distress and high perceived disability, low resilience and low belief in self-management, passive approach to recovery)
    • orange flags (mental health equivalent of red flags, including existing mental health diagnosis, such as personality disorder); consider need for mental health review
    • blue flags (perceptions about the relationship between work and health that may inhibit recovery)
    • black flags (systemic or contextual obstacles related to particular people, systems or policies; eg compensation claims with need to prove validity of symptoms).
  • Identify and manage complex comorbidities in acute presentations, including:
    • renal or hepatic impairment
    • diabetes with complications
    • severe disability that may impact communication
    • cancer (undertaking chemotherapy and/or radiotherapy)
    • patient taking multiple medications to manage chronic disease, which may interact with new medications.

Know

  • Understand types of uncertainty that may occur in general practice, including diagnostic, management and prognostic, and have structures to manage these safely, while avoiding over-investigation and inappropriate referrals.
  • Know the natural history of common undifferentiated conditions.
  • Be familiar with serious conditions that must not be missed, conditions commonly missed, and conditions that may present with unusual or elusive symptoms.

Do

  • Undertake an adequate assessment and:
    • explore the ideas, concerns and expectations of the patient
    • identify physical and psychological components of the presenting condition that may be contributing factors to presenting symptoms (eg borderline personality disorder with recurrent self-harming, Munchausen syndrome or Munchausen by proxy, trichotillomania, compulsive skin-picking causing unusual rashes, and weight changes related to eating disorders)
    • identify impacts of ongoing undifferentiated symptoms on psychological and social wellbeing
    • understand the use of time as a diagnostic tool.
  • Identify types of clinical uncertainty, including:
    • diagnostic – patients presenting with undifferentiated conditions that are acute, subacute or chronic (medically unexplained symptoms)
    • management – chronic pain with requests for analgesics, or off-label prescribing or other situations where evidence is limited or lacking; for example, patient use of complementary therapies in combination with conventional therapies
    • prognostic – for example, an individual with a new cancer diagnosis who wants to understand likelihood of survival and benefits of treatment.
  • Use effective and empathic communication to:
    • acknowledge and validate the person’s experience, concerns and frustration with uncertainty
    • assess and support patients to identify a possible psychogenic origin of symptoms through assessment of anxiety or other mental health symptoms
    • characterise undifferentiated conditions and explain management outcomes to patients.
  • Adopt a structured and safe approach to managing patients with undifferentiated conditions, including regular review, and recognise that some symptoms and presentations may never be attributed to specific conditions.
  • Access evidence-based resources and use sound clinical reasoning to assist shared decision-making to manage undifferentiated conditions and minimise health and economic risks, including presentations such as:
    • fatigue
    • insomnia
    • cough
    • dizziness
    • anorexia
    • nausea
    • sexual difficulty
    • weight and appetite loss
    • chronic pain (including headache, chest, back, pelvic, and abdominal pain, which has been explored clinically and investigated with no precise diagnosis).
  • Use follow-up, safety-netting and continuity of care to avoid duplication of investigations and risk of causing iatrogenic harm.
  • Focus on symptom relief.
  • Involve the multidisciplinary team, if indicated, to support recovery and assist with symptom management.
  • Consider psychological factors contributing to, or the consequence of, physical symptoms:
    • somatic dysfunction, such as chronic pain or irritable bowel syndrome
    • compulsive skin picking
    • trichotillomania
    • weight changes secondary to eating disorders
    • Munchausen syndrome or Munchausen by proxy
    • borderline personality disorder.
  • Consider mental health diagnoses that may present as, or compound, presentations of undifferentiated conditions, including:
    • anxiety (generalised anxiety and obsessive-compulsive disorders) and depressive symptoms, somatoform disorders, psychotic disorders, complex PTSD, substance use disorders, etc
    • other psychological contributing factors, such as fear related to past experiences, obsessional thinking, anxiety related to concomitant mental health diagnosis, style of thinking that is pertinent to the individual’s personality type or disorder, etc.
  • Manage diagnostic uncertainty in cases of somatisation, when psychological conditions present as physical symptoms, considering:
    • treatment versus non-treatment
    • referral versus non-referral
    • serious versus non-serious.
  • Use a range of strategies to manage clinical scenarios where evidence is lacking or may not be known by, or be readily available to, the doctor, such as:
    • the use of off-label prescribing
    • enquiring about the patient’s use of over-the-counter and complementary therapies and considering the potential benefits and risks of potential interactions or side effects
    • enquiring about use of alternative or non-conventional treatments.

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

6. Manage individuals with chronic and complex conditions, providing continuity of care (across the lifespan and appropriate to context)

Do

  • Identify common chronic conditions that are likely to present with multisystem impacts and comorbidities, including:
    • chronic back pain and mental health issues
    • type 1 and type 2 diabetes with complications, particularly neuropathy, retinopathy, nephropathy, microvascular and macrovascular disease
    • obesity, metabolic syndrome, ischaemic heart disease, hypertension, hepatic steatosis, obstructive sleep apnoea, gout and psoriasis
    • obesity and osteoarthritis (knees and hips).
  • Identify appropriate surveillance strategies and time intervals for common chronic conditions. These may include:
    • regular pathology screening to identify deterioration or complications (eg HbA1c, ACR, fasting lipids in type 2 diabetes, LFTs, FBE viral load in hepatitis B, thyroid-stimulating hormone in hypothyroidism to assess adequacy of thyroid hormone replacement)
    • regular radiology screening to identify deterioration or complications (eg liver ultrasound in hepatic steatosis, fibro scan +/– liver ultrasound in hepatitis)
    • monitoring medication side effects
    • regular assessment for development of deterioration, recurrence or complications.
  • Use processes to help with documentation, sharing of information and follow-up of essential aspects of a patient’s care over time (eg chronic disease management plans).

Know

  • Know useful techniques for motivational interviewing and brief interventions and strategies to help improve health literacy and set goals.
  • Know how to access useful resources, including online resources that support behaviour change and/or concordance with treatment.
  • Understand local community resources that can support individuals with treatment concordance; for example, pharmacy medication reviews and use of blister packs for medication.

Do

  • Identify barriers to behaviour change and/or concordance with management, and work with the patient to address these.
  • Provide clear information to patients and families to educate about a chronic condition, improve health literacy and optimise collaborative goal setting.
  • Promote self-efficacy.
  • Identify the patient’s stage of change (competency 7.4.1) to support this process.
  • Identify patients who may benefit from motivational interviewing and other strategies to improve health literacy and collaboratively set goals to optimise health; for example, patients who:
    • demonstrate signs of substance dependence, with psychological, social and/or cultural contributing factors (competency 7.4.1)
    • maintain unhealthy lifestyle choices, particularly risk factors for preventable chronic conditions, such as poor diet, sedentary behaviour, smoking or binge drinking.
  • Use brief interventions, effective communication and motivational counselling to establish a collaborative therapeutic relationship and, if relevant, to minimise risk of harm to the individual.
  • Provide follow-up and continuity of care.

Be

  • Empathic, patient and non-judgemental.

Do

  • Provide continuity of care to ensure that acute, undifferentiated and chronic conditions and abnormal results are followed up promptly to minimise risks and improve health outcomes, and to ensure that preventive care is delivered opportunistically.
  • Use effective communication strategies to establish trust, rapport and a sound therapeutic relationship that supports shared decision-making and collaboration (competencies 3.4.2 and 3.4.4).
  • Consider and discuss a range of models of care to allow patients and families to make informed choices; for example:
    • when palliation may be an alternative to active treatment, such as in the case of advanced cancer, severe ischaemic heart disease or an incurable chronic condition (eg COPD, Alzheimer’s disease)
    • when there are options for curative treatment or rehabilitation
    • regarding voluntary assisted dying in jurisdictions where there are legislative frameworks available.
  • Use therapies and lifestyle interventions to improve quality of life, reduce risk of complications and prolong life.
  • Discuss and document advance care directives with patients and their families and carers, as appropriate.
  • Formulate safe strategies to provide care for patients who decline evidence-based management options (eg individuals who opt to access non–evidence-based treatment as an alternative to, or in combination with, no treatment), taking a non-judgemental approach and offering ongoing support for monitoring, review, education and health promotion (competency 10.4.2).

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

7. Promote health and deliver preventive care (across the lifespan and appropriate to context)

Know

  • Understand the concept of harm minimisation and the stages of change model and how this informs effective motivational interviewing and support for behaviour change for individuals with lifestyle risk factors.

Do

  • Identify patients for whom application of the stages of change model, brief interventions and/or motivational counselling may be useful, including individuals who:
    • demonstrate signs of substance dependence, when it can be useful to also identify possible psychological, social and cultural contributing factors
    • are struggling with concordance with management or with making important lifestyle changes, which impacts their risk of chronic disease or development of complications (competency 6.4.2).
  • Identify opportunities in consultations for person-centred health education to empower patients and promote behaviour change to reduce future disease risks. This may include:
    • provision of accurate, timely and evidence-based quality health information and decision aids to patients in the most appropriate way considering their individual context (taking into account sociocultural factors and level of health literacy)
    • verbal and written information on diagnoses and/or management options
    • electronic or paper-based health promotion resources to educate and empower, as well as assist in developing rapport with patients.
  • Avoid blame and acknowledge that substance dependence is a treatable disease and that behaviour change for healthier lifestyle choices can be challenging.
  • Identify mutual goals to minimise risk of harm and align with stages of change, from pre-contemplative through action to maintenance.
  • Collaboratively develop a management plan that may include:
    • education (eg safe injecting techniques for patients who use intravenous drugs)
    • options for therapeutic intervention programs, including behavioural treatments or referral for non-GP specialist or allied health support to address behaviour change or substance dependence
    • prescribing medications or providing referrals to access appropriate medications to enable cessation or reduction in use of addictive substances; for example: methadone, naltrexone or buprenorphine for opiate addiction; use of naltrexone, acamprosate and disulfiram in individuals who are alcohol-dependant; benzodiazepine withdrawal regimens using diazepam.

Know

  • Understand normal psychology, physiology and anatomy at different life stages and provide clear explanations, education and reassurance, as appropriate, to patients to distinguish variations from normal and to promote good health.

Do

  • Identify useful resources, in different formats, about normal life stage topics and maintaining good health that cater to the needs of a diverse range of individuals to support education provided in consultations (competencies 7.4.1 and 6.4.2.)
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