Manage the sick patient

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently manage the sick 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.

  • Acutely, seriously ill patient on ward or in Emergency Department
  • Recognise this; initiate management; judgement and decision making in uncertain situations
  • Support patient in locality; tests sent
  • Ask for help – delegation of tasks
  • Communicate with senior doctors
  • Plan transfer, if required (ICU, operating theatre)
  • Communicate with patient/family
  • Relevance of Care of the Critically Ill Surgical Patient (CCrISP) course
  • PGY 1
  • PGY 2
  • PGY 3

  • Collaboration and teamwork

    • Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient
    • Respond positively to requests for help from team, as needed
  • Communication
    • Provide updates to the current health team, e.g. new critical issues or changes in a patient’s condition
    • Participate in clinical handover in a manner that ensures patient safety and continuity of care
  • Health advocacy
    • Demonstrate awareness of the cultural diversity and requirements of patients

  • Judgement and clinical decision making

    • Recognise personal limitations and ensure appropriate supervision
  • Medical expertise
    • Recognise and effectively assess acutely ill, deteriorating and dying patients
    • Perform basic emergency and life support procedures while continuing full assessment of the patient to include:
      • Apply principles of triage and medical prioritisation
      • Identify patients requiring immediate resuscitation and when to call for help, e.g. Code Blue, MET calls
      • Implement basic airway management, ventilatory and circulatory support
      • Identify indications for advanced airway management
      • Participate in decision making, and debriefing, about cessation of resuscitation
  • Professionalism
    • Demonstrate empathy, caring and compassion for patients, their families and carers and treat them with dignity and respect
    • Demonstrate flexibility and ability to adapt to change

  • Scholarship and teaching

    • Reflect on and learn from own observations of clinical practice

  • Collaboration and teamwork

    • 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
    • Explain clinical reasoning to current health team using concise language and a structured approach
  • Health advocacy
    • Identify key issues on which to advocate for the patient to ensure their immediate clinical care and requirements are achieved
    • Arrange appropriate support for a dying patient

  • Judgement and clinical decision making

    • Able to succinctly present the patient scenario and discuss management plan
    • Implement the ISBAR approach of identification, description of case, clinical background, assessment and recommendation for discussion
    • Recognise when advice and guidance is required in development of management plans
  • Leadership and management
    • Recognise stressful situations and know when to ask for help
    • Contribute fully in handover of patients within unit
  • Professionalism
    • Comply with legal requirements in patient care, e.g. Mental Health Act, death certification

  • Scholarship and teaching

    • Use current evidence-based resources in own learning, in communicating with patients and in making decisions about the care of patients

  • Collaboration and teamwork

    • Encourage participation of all team members and allocate appropriate tasks to junior members
  • Communication
    • Communicate clearly and compassionately when breaking bad news or discussing difficult topics (deterioration, poor prognosis, resuscitation and end-of-life issues)
    • Collect and collate relevant information from other team members or specialist teams pertinent to decision making or patient management
  • Health advocacy
    • Adapt communication strategy according to the culture, values and beliefs of each patient

  • Judgement and clinical decision making

    • Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan
  • Leadership and management
    • Remain calm under pressure
  • Medical expertise
    • Present complex cases effectively to senior medical staff and other health professionals
    • Understand the actions and interactions, indications, monitoring requirements, contraindications and potential adverse effects of each medication used
    • Apply the criteria for referral or consultation relevant to a particular problem or condition
  • Professionalism
    • Act as a role model of professional behaviour in the workplace

  • Scholarship and teaching

    • Provide effective supervision using recognised techniques and skills (availability, orientation, learning opportunities, role modelling, delegation)

  • 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