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

  • 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

Related Competencies:

Collaboration and teamwork

Recognise the roles and responsibilities of other professionals within the healthcare team; respect and listen to their concerns about the patient
Collaboration and teamwork

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
Communication

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
Medical expertise

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
Professionalism

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
Communication

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
Health advocacy

Arrange appropriate support for a dying patient
Judgement and clinical decision making

Able to succinctly present the patient scenario and discuss management plan
Judgement and clinical decision making

Implement the ISBAR approach of identification, description of case, clinical background, assessment and recommendation for discussion
Judgement and clinical decision making

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
Leadership and management

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)
Communication

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
Medical expertise

Understand the actions and interactions, indications, monitoring requirements, contraindications and potential adverse effects of each medication used
Medical expertise

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
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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