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
13. Engage in reflective practice and ongoing learning
Know
- Know that reflective practice is a core aspect of personal and professional development and learning, and includes developing the capacity to reflect on personal attitudes, beliefs, values, learning style and clinical skills and knowledge to engage in a process of continuous learning and improvement.
- Ensure insight into areas of concern and areas for improvement to optimise likelihood of strategies being implemented to support sustainable practice and improved wellbeing.
Do
- Incorporate reflective practice and intellectual humility into daily work.
- Actively seek formal or informal feedback from patients, peers, senior GP colleagues, mentors and non-GP specialist colleagues.
- Use reflective practice and evaluative judgement to identify:
- if own practice is ethical and professional (capability 11)
- if personal attitudes, values and beliefs may be impacting quality of care provided. For example, identifying if a heartsink response to patients (individuals perceived to be placing an unreasonable burden on the treating doctor) is impacting effective therapy; it can be helpful to recognise that these patients often have complex health issues and comprehensive care needs and require adequate time for consultations and/or a team-based approach to care (capability 12)
- if clinical practice is evidence-based, and if not, determine whether it is in line with peers (capability 14)
- whether there is justification and rationale for clinical choices (capability 14)
- if effective communication, both verbal and non-verbal (including written), is being used with patients and within healthcare teams (capabilities 3 and 4)
- if care provided is culturally safe (capability 1)
- any near misses and reflect on critical incidents (capability 15).
Do
- Reflect on gaps in clinical skills and knowledge to engage in a process of continuous learning.
- Develop learning plans to meet these needs.
- Consider strategies to stimulate learning and encourage reflection, such as role plays, observation of consultations, case presentations at practice meetings and critical case discussions.
Know
- Understand limits of own skills and knowledge.
Do
- Identify when supervisor assistance and support or referral is required and access this in a timely fashion, understanding that the safety of the patient is a paramount consideration.
- Undertake reflective practice .
- Consider common clinical situations that would require access to a senior colleague for an opinion or other assistance; for example:
- prescribing of Schedule 8 or unfamiliar medications
- undertaking unfamiliar procedures
- assessing individuals with complex presentations; for example, multimorbidity, prescribed multiple medications, cluster B personality traits, previous trauma
- assessing individuals who are significantly unwell or at risk of clinical deterioration (eg have red flags symptoms or signs [competency 5.1.1])
- patients with a new serious diagnosis where the doctor needs to ‘break bad news’ (eg malignancy)
- patients with unfamiliar symptoms (eg skin rashes)
- challenging consultations (eg ‘heartsink’ response to patients, nursing home visits, home visits, aggressive patients, medicolegal documentation requests)
- patients from demographic groups with which the doctor has had limited clinical experience (eg neonates and young children, pregnant women, adolescents with mental health issues, returned travellers, Aboriginal and Torres Strait Islander peoples, people of refugee background).
Know
- Understand that feedback is an essential component of reflective practice that supports learning and professional development.
Do
- Seek feedback from others who have observed or participated in consultations and/or observed professional practice, including peers, colleagues in healthcare teams, patients and their families and carers, and professional organisations.
- Seek feedback on various aspects of clinical practice and professionalism, including:
- culturally safe care (from Aboriginal and Torres Strait Islander peoples and from individuals in cross-cultural consultations)
- communication skills
- clinical documentation, including adequacy of referral letters
- prescribing patterns
- clinical problem-solving
- compliance with investigation and disease management guidelines.
- Obtain feedback through, for example:
- clinical audits
- formal feedback surveys
- ad hoc conversations.
- Demonstrate intellectual humility.
Be
- Be engaged in and enthusiastic about learning.
Know
- Know the benefits of mentoring for professional development and self care, including:
- improved social and emotional wellbeing
- enhanced connection and collegiality with colleagues
- confidence in communication and leadership skills
- increased motivation, job satisfaction and sense of self-worth
- improved relationships with patients and colleagues
- career progression
- stronger clinical knowledge and skills.
- Understand the structures required for an effective mentor–mentee relationship and what is required of a mentee, including:
- understanding the role of mentoring
- acknowledging boundaries and respecting mentor time constraints
- setting short-, medium- and long-term goals
- having a capacity for insight into own needs and for self-reflection
- establishing trust.
- Consider the characteristics of a mentor that would be helpful for own career development and interests.
Do
- Identify and reflect on a range of issues that would be useful to discuss with a mentor.
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
14. Integrate best available scientific evidence, teaching and research into practice
Know
- Know commonly used guidelines for assessment and management of common conditions and how to access these.
- Know how to undertake a literature review to find answers to identified clinical problems not covered in guidelines.
Do
- Think critically and assess the relevance and validity of a guideline or research paper to a particular individual or condition and:
- consider the design and type of the guideline, research or analysis, and thus the level of evidence for the findings
- consider whether the study design addressed potential sources of bias, confounding factors and/or conflicts of interest
- consider whether the data analyses were correct
- consider whether the data justified the conclusions drawn
- compare the similarities and differences of the patient population studied to the individual(s) to whom the practitioner wishes to apply the findings.
Know
- Demonstrate:
- a willingness to consider clinical questions
- insight into limitations of own knowledge
- curiosity and a willingness to learn.
- Frame clinical questions concisely and accurately.
- Access appropriate guidelines and/or seek out assistance from senior colleagues and/or undertake literature reviews to find answers to these questions.
Know
- Know that hypothetical deductive reasoning is an important skill to be learnt in problem-based learning. This involves the ability to explore causes of a patient’s problem and make decisions about the management of the problem, applying basic science and clinical knowledge. Multiple hypotheses are generated to explain the presentation, which are then tested using enquiry and diagnostic decisions and may be used to identify the most appropriate management plan.
Do
- Clearly articulate clinical problems and hypotheses to explain presentations.
- Consider strategies that could be used to identify the most likely diagnosis, including additional history-taking, consideration of risk factors, examination, investigations and/or procedures.
- Demonstrate effective use of hypothetical deductive reasoning for a variety of common clinical presentations identified in practice.
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
15. Display commitment to practice quality and safety
Know
- Understand what is meant by ‘near miss’, ‘adverse event’ and ‘critical incident’.
Do
- Use reflective practice to identify near misses, adverse events and critical incidents, and engage in discussion with peers and senior colleagues to debrief and identify potential contributing factors and quality improvement strategies.
Be
- Be collaborative and engaged.
- Be willing to discuss and consider strategies with colleagues to minimise risk of future incidents.
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
13. Engage in reflective practice and ongoing learning
Do
- Engage in reflective practice to support own learning, personal and professional development.
- Actively seek formal and/or informal feedback from patients, peers , senior GP colleagues, mentors and non-GP specialist colleagues to whom you refer on important aspects of clinical practice, including:
- communication with patients, family members and carers, and colleagues
- provision of culturally safe care
- quality of clinical care provided
- standard of clinical decision-making
- whether requests for help are delivered in a timely fashion
- verbal and written clinical handover
- quality of clinical notes, health summaries and referral letters.
- Regularly reflect on own feelings after consultations, particularly challenging ones, and more generally on workload and work–life balance. Identify signs of fatigue, including compassion fatigue, burnout and vicarious trauma, and access support to manage these.
- Integrate feedback into learning plan and reflect on effective strategies to address identified gaps or areas for improvement, including focusing on own wellbeing and self care.
Be
- Be engaged in ongoing learning and open to conversations about improving practice.
Do
- Identify a variety of strategies that suit own learning style to address areas of need identified in learning plan.
- Access support from supervisor to address learning needs; for example, observed consultations, case-based discussions, clinical audits (referral letters, clinical notes) and random case analyses.
- Consider learning activities and strategies; for example:
- cultural awareness training
- small group learning with peers and colleagues (eg journal clubs, case-based discussions, role plays, random case analysis, Balint groups)
- participation in external data extraction/research projects
- online learning modules.
Do
- Plan meaningful learning and use reflective practice to identify strengths and gaps in knowledge, skills and attitudes and use this to inform development of a learning plan to address these, including formal professional development activities.
- Identify specific health needs in the local community that require development of extended skills through specific training. Community needs may include high prevalence conditions or important public health issues; or specialised support that cannot be met due to a lack of secondary or tertiary public health services, as can occur in rural and remote communities (eg anaesthetics, obstetrics, emergency medicine).
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
14. Integrate best available scientific evidence, teaching and research into practice
Do
- Base clinical decision making on:
- presentation
- existing evidence and guidelines
- risks and benefits of the various options
- values, beliefs and sociocultural context of the individual
- ability of patient to access treatment (financially and physically).
- Identify:
- diagnostic and therapeutic guidelines to assist with management of the acute and chronic conditions outlined in competencies 5.2.1 and 6.2.1 (also refer to competencies 6.2.2 and 6.2.3)
- factors that help in assessing if a guideline is applicable to a specific patient; for example, recognising comorbidities and diversity from the populations included in the research or on which guidelines are based.
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
15. Display commitment to practice quality and safety
Know
- Understand the role of reflective practice and quality improvement strategies in reducing the incidence and impact of near misses, adverse events and critical incidents.
Do
- Identify near misses, adverse events and critical incidents, including:
- a missed diagnosis leading to a poor clinical outcome
- a communication problem or difficult interaction between a health professional and a patient or family member
- situations that cause individuals to feel inadequate, unsupported or confronted, etc.
- Reflect on near misses in own and others’ practice. With peers and colleagues, discuss strategies to minimise risk of future events. Strategies may apply either to individuals or practice processes and may include identifying gaps in knowledge or resources. Include in learning plan, where relevant.
Know
- Know the hazards and health and safety risks that arise in a practice as they affect personal and patient safety (refer to competencies 15.4.1 and 15.4.2).
- Understand the importance of practices having policies and procedures that relate to discrimination, equal opportunity, harassment and bullying.
- Describe cultural safety as it applies to practice staff as well as patients.
- Understand the process for reporting injuries or concerns in the practice.
Do
- Reflect on what support should be offered to staff in the practice; for example, vaccinations, ongoing training and development appropriate to their role and the practice population, and training in cultural awareness and Aboriginal and Torres Strait Islander health.
- Become familiar with the practice policies and procedures that relate to the workplace, especially in relation to equal opportunity, anti-discrimination, harassment and bullying.
Be
- Be reflective of self and the environment.
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
13. Engage in reflective practice and ongoing learning
Know
- Understand the concept of evaluative judgement and its important role in learning.
- Know that procedural skills can change with time according to context and practice, requiring ongoing maintenance and review to maintain a specific skill level.
Do
- Regularly reflect on the criteria for quality care and critically appraise own practice against expected ‘best or good practice’ and/or performance of peers and colleagues.
- Identify strengths and areas for improvement and integrate these into learning plan.
- Regularly reflect on procedural skill levels and participate in ongoing professional development activities, such as audit or performance review, to ensure skill levels are maintained.
Do
- Use reflective practice to identify strengths and gaps in knowledge, skills, attitudes and values, and use this to inform development of a learning plan to address these, including formal professional development opportunities.
- Identify own learning style and specific learning needs and identify appropriate professional development activities based on this. Activities may include:
- small group learning and journal clubs
- RACGP gplearning modules
- Balint groups
- clinical audit and e-audit tools
- participation in external data extraction/research projects
- active learning modules
- cultural awareness training
- peer review of journal articles
- graduate certificate or diploma courses, master’s degree.
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
14. Integrate best available scientific evidence, teaching and research into practice
Know
- Know that understanding of, and ability to interpret, clinical research evidence is an important part of provision of quality care when integrated with clinical expertise and the individual patient context.
- Understand grades of quality of evidence related to type of study design (eg qualitative and quantitative design, case study, case series, cohort study, randomised controlled trial, systematic review, meta-analyses).
- Understand basic epidemiological and statistical terms and interpret research findings, including:
- relevance and validity
- types of bias
- confounding factors
- prevalence and incidence
- confidence interval and P value
- relative risk/odds ratio.
Do
- Interpret research findings using understanding of clinical research frameworks.
Know
- Identify modifiable risk factors and ensure early recognition of physical and psychological conditions to provide effective health education, promotion and appropriate management. Management may include a broad range of therapeutic options:
- from no active intervention to lifestyle modification (including changes to diet, stress modification and exercise regimens)
- medical therapies (eg pharmaceuticals and/or herbal and nutritional supplements)
- physical therapies (eg physiotherapy, osteopathy, hand therapy)
- psychological approaches (eg meditation, psychological and trauma counselling)
- surgical procedures
- return-to-work planning.
- Make the decision to pursue one or multiple treatment options (following provision of education and advice about options to the individual to enable informed consent) after consideration of:
- the presentation
- existing evidence and guidelines and determination of applicability of these to the individual, considering comorbidities and other important personal factors
- risks and benefits of the assorted options
- values, beliefs and sociocultural context of the individual and participation in the shared decision-making process
- the individual’s ability to access treatment from a financial or physical point of view.
- Identify and clearly explain the evidence gained from the pre-existing knowledge of the patient and current clinical assessment, including relevant positive and negative findings, that support your working diagnosis or differential diagnoses.
- Use diagnostic and therapeutic guidelines to assist with management of acute and chronic conditions.
- Identify factors that assist assessment of whether a guideline or research paper is applicable to a specific patient. For example:
- the design and type of research or analysis, and thus the level of evidence for the findings (using a common hierarchy such as National Health and Medical Research Council criteria)
- whether the study design addressed potential sources of bias, confounding factors and/or conflicts of interest
- whether the data analyses were correct
- whether the data justified the conclusions drawn
- the similarities and differences of the patient population studied (eg age, ethnicity, comorbidities) or the population to which the guideline is intended to be applied.
Do
- Demonstrate evaluative judgement by assessing the quality of skills and knowledge demonstrated by self and colleagues, relative to accepted standards.
- Create structures to enable honest and fair provision of feedback, respectfully discussing strengths and weaknesses regarding clinical care to maintain quality improvement.
Do
- Develop effective teaching and mentoring skills, including:
- use effective communication skills (eg recognise the learning needs of peers and colleagues
- develop rapport with learner/mentee
- reflect and provide respectful feedback to help learners develop knowledge and skills
- provide clear explanations as to reasoning behind use of clinical strategies
- formulate appropriate questions to encourage learners to develop problem-solving skills
- assist learners to use reflective practice to encourage them to ‘learn’, rather than be ‘taught’
- cater to individual learning styles and facilitate learning with an appropriate level of autonomy.
- Demonstrate accountability when assisting in the development of clinical skills and knowledge (eg be mindful of the level of supervision required after assessment of the potential risks, taking into account your colleague's experience and knowledge).
- Ensure that an evaluation process is in place that includes requests for provision of formal/informal and structured/unstructured feedback on quality of leadership, quality and content of education and mentoring, and development of effective ways to manage this information, and any subsequent communication and changes to the way in which team-based learning is carried out in the future.
Do
- Participate in research opportunities, such as designing, coordinating and/or contributing to research through assisting with patient recruitment, participating in clinical audits or taking an active role in research design and implementation.
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
15. Display commitment to practice quality and safety
Know
- Understand that identification of contributing factors to near misses and critical incidents is important for reducing risk in the future.
Do
- Consider a broad array of factors that can contribute to these events, from the individual (eg fatigue, knowledge gaps, poor communication, time pressure) to systems (eg clinical notes, IT systems not working effectively, clinical handover not occurring consistently).
Know
- Understand risk management strategies for responding to complaints from patients, family members or carers, and useful structures to respond to adverse events (competency 3.3.2).
- Recognise broad categories of complaints, including:
- patient perceptions of poor communication and interpersonal skills
- near misses or adverse events related to inappropriate or inadequate treatment
- inadequate quality of care, such as incorrect or missed diagnoses
- inappropriate referrals for diagnostic or management procedures
- issues raised by family members or carers regarding quality of care provided
- concerns about waiting times.
Do
- Manage complaints. This may include complaints about self, a colleague within the practice, or a practitioner to whom a patient has been referred. Complaints may be made by patients, family members, health professionals or other staff within or external to the clinic.
- Effectively communicate and problem-solve approaches to complaints, near misses and adverse events, including:
- responding to and managing any complaint in a timely way
- use of active listening, acknowledgement, and if appropriate, validating the complaint and the impact on the individual and/or family (including for issues that may appear trivial but may have caused distress for an individual)
- offering an apology if appropriate, recognising that this is not an admission of guilt but a sign of empathy and recognition of the impacts and distress that has been caused (eg ‘I’m sorry that this has happened to you’).
- Identify the expectations and needs of the individual making the complaint or who experienced the near miss or adverse event.
- Explain how the complaint will be addressed, including future prevention strategies and, if appropriate, organise a follow-up to discuss the outcome of the complaint investigation.
Be
- Be respectful and empathic.
Know
- Understand the importance of a continuous process of quality improvement for individual clinicians and practices (eg Plan, Do, Study and Act; refer to Appendix C in RACGP Green Book), and the use and tracking of clinical indicators and strategies to address identified issues.
Do
- Identify useful clinical indicators as markers of quality care.
- Identify and track these to assist in development of quality improvement strategies.
- Use clinical indicators; for example:
- patient experience surveys
- proportion of clinical files with health summaries and up-to-date adverse drug reaction warnings
- provision of care that adheres to clinical guidelines
- use of interpreter service for patients of linguistically diverse backgrounds
- quality of referral letters
- currency of medication lists, evidence of timely review of test results and maintenance of infection control standards
- proportion of files with appropriate recalls.
- Adopt quality improvement practices; for example:
- clinical audits
- patient experience surveys and complaints
- development of structures that support regular tracking of useful clinical indicators
- accessing relevant professional development
- regular clinic team meetings to discuss progress against quality improvement goals
- robust complaint management processes.
Know
- Know the costs associated with delivering quality health services and the sources of income for practices.
- Discuss the financial models used in practices, such as bulk billing.
- Describe why it is important for the operation of the practice to bill correctly.
Do
- Ensure correct billing.
- Determine how the various team roles in the practice contribute to the business model as well as to the provision of quality patient care.
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
13. Engage in reflective practice and ongoing learning
Know
- Understand prevalent and priority health conditions in the local community and emerging health issues.
Do
- Consider ways to address inequity and emerging health issues in the local community.
- Participate in ongoing professional development relevant to learning style and needs; this may include:
- the use of small group learning and journal clubs
- Balint groups
- clinical audit and e-audit tools
- participation in external data extraction/research projects
- active learning modules
- cultural awareness training
- peer review of journal articles
- graduate certificate or diploma courses, master’s degree
Do
- Engage in reflective practice during and after consultations with Aboriginal and Torres Strait Islander peoples and in all cross-cultural consultations, with a focus on:
- strengths and weaknesses of communication skills
- effectiveness of cultural assessment
- gaining feedback from individuals as to whether they perceived that their cultural beliefs and practices were heard and integrated into management plans
- addressing barriers to follow-up or access to other health services.
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
14. Integrate best available scientific evidence, teaching and research into practice
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
15. Display commitment to practice quality and safety
Know
- Understand common clinical indicators and the governance structures in own practice – including relevant practice policies and processes – for identifying and managing near misses and critical incidents.
Do
- Manage consequences and reduce risk of future critical incidents by, for example:
- identifying any near misses and critical incidents and assuming responsibility for understanding contributing factors, and driving strategies to address these
- identifying barriers to quality improvement and addressing these
- considering clinical indicators that could be used to track progress against quality improvement strategies, and participating in establishing these within the practice or participating in clinical audits in relevant areas.
Know
- Ensure that practice processes are followed and are robust for:
- handover when leave is taken
- checking patient results and incoming correspondence and taking appropriate actions as a result
- following up on recall communication (letters or SMS) that has not been actioned by the patient
- checking that referrals to non-GP specialists for serious health issues have been actioned by the receiving clinic and that the patient has an appointment booked.
- Identify any potential strategies for improvement in practice systems to reduce risks.
- Inform patients of their responsibilities and the practice processes for being informed of their results.
Know
- Describe the importance of practice policies and procedures that relate to discrimination, equal opportunity, harassment and bullying.
Do
- Manage identified hazards and health and safety risks in the practice as they affect:
- personal safety; for example, the use of personal alarms, how to manage violence in the workplace
- patient safety; including recall and follow-up, and management of environmental hazards, such as sharps, spills or infection risks.
- Reflect on what support should be offered to staff in the practice; for example, vaccinations, ongoing training and development appropriate to their role and the practice population, and training in cultural awareness and Aboriginal and Torres Strait Islander health.
- Participate in review of practice policies and procedures that relate to discrimination, equal opportunity, harassment and bullying, where possible.
- Be involved in reviewing injuries or concerns in the practice.
Be
- Be collaborative and involved, especially in performance and incident reviews.
Know
- Consider the various employment options and contracts, including business owner, contractor or employee.
- Know the principles of ethical business practices.
- Know the essentials to manage a successful business and the issues that affect the sustainability of general practice, including practice factors and personal factors.
- Explain the role of practice accreditation standards.
- Describe the practice accreditation process.
Do
- Reflect on personal approaches to billing and business.
- Acknowledge personal approaches and preferences to employment in general practice and how these may influence work–life balance.
- Identify resources that can assist in the business management of practices.
Be
- Be ethical in the business management of general practice.