Milestone

Consolidation

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

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.
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

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.

Know

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.
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

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.
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