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The RACGP is undergoing scheduled system maintenance: Wednesday, 17 April 2024 from 8:15PM – 10:15 PM AEST. During the maintenance window, some RACGP services will experience disruptions.
We apologise for any inconvenience caused.


Milestone

Entry

Last updated 13 September 2022
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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.
Open all sections

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.
Open all sections

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
Open all sections

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).
Open all sections

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).
Open all sections

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.
Open all sections

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.
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