Co-ordinate & lead open disclosure

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently co-ordinate & lead open disclosure.

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 & seek the support of his/her supervisor for feedback on performance.

  • Serious complication/missed diagnosis
  • Communicate openly with empathy
  • Listen to patient and family
  • Clarify as requested Involve consultant early in process
  • Follow hospital guidelines and advice
  • PGY 1
  • PGY 2
  • PGY 3
  • Collaboration and teamwork
    • Inform the presence or availability of team members to patients
  • 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
    • Has knowledge of the principles of open disclosure:
    • Comply with organisational policies regarding comprehensive and accurate documentation
  • Health advocacy
    • Demonstrate awareness of the cultural diversity and requirements of patients
  • Judgement and clinical decision making
    • Following any error in clinical reasoning, reflect on own clinical reasoning process and learn from mistakes
    • Recognise personal limitations and ensure appropriate supervision
  • Leadership and management
    • Know the requirements of mandatory reporting as required by the Medical Board of Australia and the Medical Council New Zealand
    • Use local protocols to respond to patient complaints of a simple nature
  • Medical expertise
    • Seek help when unsure
  • Professionalism
    • Comply with the legal requirements of being a doctor
    • Adhere to medical codes of practice and model professional behaviours including honesty, integrity, commitment, compassion, respect and altruism

  • Scholarship and teaching

    • Reflect on and learn from own observations of clinical practice
  • Collaboration and teamwork
    • Recognise expertise and roles of other health team members and staff
    • Participate in shared decision-making activity involving patients, families and relevant health professionals, such as development of a care plan noting reference to open disclosure in ‘Communication’ section
  • Communication
    • Use appropriate techniques and support when responding to patients and families in distress, and facilitate consultant involvement early in the process; to include participation in open disclosure discussions
    • Identify potential areas for communication breakdown and take action to avoid problems of miscommunication
    • Communicate effectively with administrative bodies and support organisations
  • Health advocacy
    • Recognise own cultural values/biases that may impact on role as a doctor and in interactions with others
    • Take into account the impact of history and experience of Indigenous Australians/Māori people, and their spirituality and relationship with the land
  • Judgement and clinical decision making
    • Has awareness and acknowledges errors or omissions in own decision making
  • Leadership and management
    • Document and report adverse events in accordance with local incident reporting systems
    • Articulate the reporting requirements for complaints and adverse events within the hospital
  • Medical expertise
    • Identify medical errors or adverse events and implement the appropriate clinical protocols to manage them
  • Professionalism
    • Comply with legal requirements in patient care, e.g. Mental Health Act, death certification

  • Scholarship and teaching

    • Contribute to unit morbidity/mortality meetings
  • Collaboration and teamwork
    • Collaborate effectively with other specialist teams involved in the patient’s care
  • Communication
    • Conform to principles of open disclosure, noting the hospital’s policy if involved in an adverse event.
    • Able to co-ordinate and lead open disclosure discussions
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
  • 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
    • Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan
    • Discuss imperfect management and reflect on one’s own clinical reasoning process
  • Leadership and management
    • Manage patient complaints as advised by the hospital system, and lead a team-based review into complaints and adverse outcomes
  • Medical expertise
    • Present complex cases effectively to senior medical staff and other health professionals
    • Audit own and team performance in relation to patient progress and outcome
  • Professionalism

  • Scholarship and teaching

    • Chair/facilitate morbidity/mortality meetings, and identify desirable changes to processes and systems of care