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. A mobile version of this Task is available as part of the JDocs subscription and directly records results into your JDocs Portfolio.

  • 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

Related Competencies:

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
Communication

Identify and overcome communication barriers that may occur due to a patient’s age, physical impairment, cognitive ability or literacy level
Communication

Comply with organisational policies regarding comprehensive and accurate documentation
Communication

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
Health advocacy

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
Health advocacy

Show respect for patient treatment choices
Judgement and clinical decision making

Identify significant clinical issues from history and examination
Judgement and clinical decision making

Make well-reasoned diagnosis for common problems with assistance from senior clinician
Judgement and clinical decision making

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
Medical expertise

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
Medical expertise

Identify and provide relevant and succinct information when ordering investigations. Ensure tests and results are documented
Medical expertise

Recognise common symptoms and signs
Professionalism

Adhere to medical codes of practice and model professional behaviours including honesty, integrity, commitment, compassion, respect and altruism
Professionalism

Treat colleagues and other health care workers with respect
Technical expertise

Perform some generic elementary technical skills
Technical expertise

Identify common symptoms, signs, clinical problems and conditions
Communication

Can explain the common conditions of the unit effectively to patients and undertake informed consent for common elective and emergency conditions
Communication

Communicate effectively within multidisciplinary teams, reflecting an understanding of, and respect for, different health professional perspectives
Communication

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
Health advocacy

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
Judgement and clinical decision making

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

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
Medical expertise

Follow-up and interpret investigation results appropriately to guide patient management
Medical expertise

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
Medical expertise

Specify peri-operative management of anticoagulants and antiplatelet agents and recognise prescription and/or administration errors
Professionalism

Acknowledge ethical complexity of clinical practice, and follow professional and ethical codes (Australian Medical Council and Medical Council New Zealand)
Professionalism

Critically reflect on own performance and make an accurate assessment of this
Technical expertise

Perform generic elementary technical skills
Communication

Obtain fully informed consent for common elective and emergency conditions

Communication

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
Health advocacy

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
Judgement and clinical decision making

Use investigation findings to refine diagnoses for common conditions
Judgement and clinical decision making

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

Present complex cases effectively to senior medical staff and other health professionals
Medical expertise

Be aware of risks associated with common conditions and procedures and implement steps to predict or mitigate them
Medical expertise

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
Technical expertise

Competent with intermediate and many of the advanced Essential Surgical Skills constructs

The JDocs website is an initiative of the Royal Australasian College of Surgeons.

The aim is to provide career guidance to junior doctors in Australia and Aotearoa New Zealand during the early prevocational years.

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