Admit/consult the new patient

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently admit/consult the new patient.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3. The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance.

  • Able to see new patient in Outpatient Clinic
  • Emergency Department or on the ward
  • Perform history/examination
  • Assimilate tests/define working diagnosis
  • Propose management plan
  • Discuss – present with consultant
  • Describe plan/timelines to patient
  • Achieve understanding/agreement
  • Document all of this
  • PGY1
  • PGY 2
  • PGY 3
  • Communication
    • Provide clear and accurate information to patients for common procedures in the unit and most commonly prescribed medications.
      • Build rapport with the patient’s family and/or carer(s).
      • Show  respect for diversity, confidentiality and autonomy when communicating with patients e.g. adapt language, use of interpreter services.
      • Actively listen to patients and families using techniques such as appropriate eye contact, attending to verbal and non-verbal cues and clarifying information provided by patient.
    • Identify and overcome communication barriers that may occur due to a patient’s age, physical impairment, cognitive ability or literacy level.
    • Comply with organisational policies regarding comprehensive and accurate documentation.
    • Demonstrate high-quality written skills to communicate clinical reasoning, e.g. write case notes legibly, concisely and informatively.
  • Health advocacy
    • Is courteous and compassionate to all patients, without discrimination, regardless of a patient’s chosen lifestyle, e.g. discuss options, offer choices.
    • Consider, and allow for, the impact of social, economic and political factors, as well as culture, ethnicity, sexuality, disability and spirituality, on patient illness and health.
    • Show respect for patient treatment choices.
  • Judgement and clinical decision making
    • Identify significant clinical issues from history and examination.
    • Make well-reasoned diagnosis for common problems with assistance from senior clinician.
    • Synthesise clinical information to generate a graded problem list, containing appropriate provisional diagnoses as part of the clinical reasoning process.
  • Leadership and management
    • Take responsibility for any task delegated.
  • Medical expertise
    • Practise hand hygiene, noting standard precautions, transmission-based precautions, personal protective equipment and aseptic technique
    • Undertake a comprehensive and focussed history, eliciting symptoms and signs relevant to the presenting problem or condition. Note medication history, including medicine allergies and previous adverse drug reactions
    • Identify and provide relevant and succinct information when ordering investigations. Ensure tests and results are documented
    • Recognise common symptoms and signs
  • Professionalism
    • Adhere to medical codes of practice and model professional behaviours including honesty, integrity, commitment, compassion, respect and altruism.
    • Treat colleagues and other health care workers with respect.
  • Technical Expertise
  • Communication
    • Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions
    • Communicate effectively within multidisciplinary teams, reflecting an understanding of, and respect for, different health professional perspectives.
    • Demonstrate high-quality written skills to communicate clinical actions, e.g. discharge summaries and completion of tasks before discharge.
  • Health advocacy
    • Identify key issues on which to advocate for the patient to ensure their immediate clinical care and requirements are achieved.
    • Take into account the impact of history and experience of Indigenous Australians/Maori people, and their spirituality and relationship with the land.
  • Judgement and clinical decision making
    • Able to explain processes of diagnostic reasoning.
    • Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same.
    • Able to succinctly present the patient scenario and discuss management plan.
  • Leadership and management
    • Accept opportunities for increased autonomy and patient responsibility under direction of supervisor.
  • Medical expertise
    • Perform a comprehensive examination of all systems.
    • Follow-up and interpret investigation results appropriately to guide patient management.
    • Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:
      • apply medical knowledge to clinical practice
      • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
      • identify when patient transfer is required, and manage risks prior to and during patient transfer
      • recognise indications for, and risks of, fluid and electrolyte therapy and blood products
      • provide appropriate aftercare and arrange follow up for common procedures 
      • safely manage anti-coagulant therapy and manage diabetes
      • recognise acute cardiac events and use relevant resuscitation/drug protocols
      • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
      • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
      • recognise and manage fluid and electrolyte imbalances in a patient
      • effectively use semi-automatic and automatic defibrillators
      • provide appropriate aftercare and arrange follow up for more complex procedures
      • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge.
    • Specify peri-operative management of anticoagulants and antiplatelet agents and recognise prescription and/or administration errors.
  • Professionalism

  • Technical expertise

  • Communication
    • Obtain fully informed consent for common elective and emergency conditions
    • Communicate effectively with complex patients to take clinical history, identifying key comorbidities, e.g. use open and closed questions to elicit information
  • Health advocacy
    • Adapt communication strategy according to the culture, values and beliefs of each patient
    • Work with the patient/family/carers to develop a management plan that addresses the needs and preferences of the patient
  • Judgement and clinical decision making
    • Direct/oversee the request of diagnostic tests for common conditions
    • Use investigation findings to refine diagnoses for common conditions
    • Discuss imperfect management and reflect on one’s own clinical reasoning proces
  • Medical expertise
    • Present complex cases effectively to senior medical staff and other health professionals
    • Be aware of risks associated with common conditions and procedures and implement steps to predict or mitigate them
    • Have ongoing awareness of gaps in own knowledge and address these
  • Professionalism
    • Respond positively to suggestions for performance improvement
  • Technical expertise
    • Able to assess advanced Essential Surgical Skills constructs (competent with basic and intermediate) both for use in current position as well as for surgical education and training (SET) application – career pathway
    • Competent with intermediate and many of the advanced Essential Surgical Skills constructs