Milestone

Foundation

Page last updated 13 September 2022

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

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