Judgement and clinical decision making | Best Practice, Better Practitioners

Other Core Competencies:

To make informed and timely decisions regarding assessment, diagnosis, surgical management, follow-up, health maintenance and promotion by:

considering options
planning ahead
implementing and reviewing decisions.

Select the PGY (1–3) tabs below to view the progression of the expected skills, knowledge and behaviours across the early postgraduate years

Key clinical tasks and the workplace

The related key clinical tasks (KCT) have been designed to help you apply the Framework to your job. You can use these to obtain feedback on, and/or assessment of, your level of performance.

Select the check box next to a KCT for guidance on developing your judgement and clinical decision making skills and knowledge for this task

Select the KCT title to see the complete task, related competencies and downloadable assessment form

Identify significant clinical issues from history and examination

Identify the common clinical conditions managed by the clinical unit and be fully conversant with the clinical knowledge, key decision-making points and issues that influence decisions within these conditions

Make well-reasoned diagnosis for common problems with assistance from senior clinician

Can explain indications, contraindications and risks involved in decision making regarding common procedures

Can differentiate between available investigations by identifying their risks and benefits

Use available evidence effectively and efficiently to inform clinical decision making

Use basic algorithms and decision trees to manage common problems

Following any error in clinical reasoning, reflect on own clinical reasoning process and learn from mistake

Synthesise clinical information to generate a graded problem list, containing appropriate provisional diagnoses as part of the clinical reasoning process

Recognise personal limitations and ensure appropriate supervision

Identify and justify patient management options for common problems and conditions

Able to explain processes of diagnostic reasoning

Use mechanisms that minimise error, e.g. clinical checklists, Surgical Safety Checklist, handover protocols, unit protocols

Review patients on a regular basis and make decisions based on their response to treatment

Retrieve and use high-quality information from electronic sources for clinical decision making. Document decisions and reasons for same

Select appropriate procedures, with involvement of senior clinicians and the patient

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

Has awareness and acknowledges errors or omissions in own decision making

Direct/oversee the request of diagnostic tests for common conditions

Use investigation findings to refine diagnoses for common conditions

Undertake continued timely reviews of patient progress and respond appropriately to any changes of condition

Recognise when a management plan is failing and, where appropriate, seek senior input to devise an alternative plan

Retrieve, comprehend and apply results of systematic reviews, clinical prediction rules, decision analysis and clinical practice guidelines

Discuss imperfect management and reflect on one’s own clinical reasoning process

Recognise instances of uncertainty and conflicting values, and able to alleviate their potential impact

Plan the order of an operating list and discuss with consultant

Able to explain decision making while performing a simple procedure

Present case management reports on common cases to unit meeting