Australian Curriculum Framework for Junior Doctors

Ian S Graham, Andrew J Gleason, Gregory W Keogh, Deborah Paltridge, Ian R Rogers, Merrilyn Walton, Caroline De Paola, Jagdishwar Singh and Barry P McGrath
Med J Aust 2007; 186 (7): S14. || doi: 10.5694/j.1326-5377.2007.tb00959.x
Published online: 2 April 2007

Prevocational medical education is a critical phase in the continuum from medical undergraduate to vocational training, and the lack of a defined curriculum outlining the prevocational learning objectives has been an impediment to effective and efficient vertical integration of medical education in Australia.1

The Australian Curriculum Framework for Junior Doctors consolidates the work of a national core curriculum project led by the Postgraduate Medical Council of New South Wales (now part of the NSW Institute of Medical Education and Training [IMET]) and funded by the Australian Government Department of Health and Ageing’s Medical Training Review Panel.2

Phase 1 of the project, completed in November 2004, included circulating a questionnaire to junior medical officers (JMOs) throughout NSW to outline their current clinical experiences and to identify their future learning needs. On the basis of the JMOs’ responses to the questionnaire, a draft national core curriculum was developed, overseen by a national project steering committee. Phase 2 was intended to validate the draft curriculum nationally, and develop strategies for implementation. Initial progress was slow because of lack of agreement among the states. To move the project forward, a national meeting of key stakeholders was convened in October 2005 and the Confederation of Postgraduate Medical Education Councils (CPMEC) became actively involved in developing and implementing a new curriculum framework.

In November 2005, CPMEC convened a writing group to produce a draft document that would be subjected to comprehensive review and consultation involving a wide range of potential users and key stakeholders. The writing group membership was not constituted on the basis of equal representation of states, territories or key stakeholder groups but rather on the necessity to bring together a group of people with a common interest and breadth of experience in postgraduate medical training and development.

Development of the curriculum framework

The writing group met on four occasions between February and May in 2006 and reconvened in October 2006 to consider the preliminary feedback and amend the first draft of the curriculum framework in response to that feedback. A number of key principles underpinned the development of the draft curriculum framework. These are discussed below.


The Australian Curriculum Framework for Junior Doctors is available at the CPMEC website (

Australian Curriculum Framework for Junior Doctors — Clinical Management

Safe Patient Care


Understand the complex interaction between the healthcare environment, doctor & patient
Use mechanisms that minimise error e.g. checklists, clinical pathways
Participate in continuous quality improvement e.g. clinical audit

Risk & prevention

Know the main sources of error & risk in the workplace
Understand how personal limitations contribute to risk
Promote risk awareness in the workplace by identifying & reporting potential risks to patients & staff

Adverse events & near misses

Understand the harm caused by errors & system failures
Document & report adverse events in accordance with local incident reporting systems
Recognise & manage adverse events & near misses (ADV.)

Public health

Understand the key health issues of your community
Inform authorities of 'notifiable diseases'
Understand disease outbreak management (ADV.)

Infection control

Understand prudent antibiotic/antiviral selection
Practice correct hand-washing and aseptic techniques
Always use methods to minimise transmission of infection between patients

Radiation safety

Know the risks associated with exposure to radiological investigations & procedures
Order radiological investigations & procedures appropriately
Regularly evaluate your ordering of radiological investigations & procedures (ADV.)

Medication safety

Know the medications most commonly involved in prescribing & administration errors
Prescribe & administer medications safely
Routinely report medication errors & near misses in accordance with local requirements

Patient Assessment

Patient identification

Know the stages of a verification process to ensure the correct identification of a patient
Comply with the organisation's procedures for avoiding patient misidentification
Always confirm with others the correct identification of a patient

History & Examination

Know the modes of presentation of the listed problems and conditions
Elicit symptoms & signs relevant to the presenting problem or condition
Understand the importance of a comprehensive patient assessment

Problem formulation

Know the possible differential diagnoses relevant to a patient's presenting problems or conditions
Use information gained from assessment to generate a ranked problem list & provisional diagnosis
Regularly re-evaluate the patient problem list as part of your clinical reasoning


Identify & understand the investigations relevant to a patient's presenting problems or conditions
Select investigations thoughtfully in the context of a particular patient presentation
Use investigation results appropriately to guide patient management

Referral & consultation

Understand the criteria for referral or consultation relevant to a particular problem or condition
Identify & provide relevant & succinct information
Recognise the role of other health professionals in patient assessment



Understand the abnormal physiology & manifestations of critical illness
Recognise & assess acutely ill, deteriorating or dying patients
Recognise that resuscitation may need to precede full assessment


Understand the principles of medical triage
Identify patients who require immediate resuscitation & when to call for help e.g. Code Blue / MET
Provide clinical care in order of medical priority

Basic Life Support

Understand the theory of basic airway management, ventilatory & circulatory support
Demonstrate competency in basic airway management, ventilatory & circulatory support
Demonstrate competency in the use of semi-automatic or automatic defibrillators

Advanced Life Support

Practice advanced airway management including the use of laryngeal mask
Recognise malignant arrhythmias, use resuscitation/drug protocols & manual defibrillation
Participate in decision-making & debriefing regarding cessation of resuscitation

Acute patient transfer

Understand the risks inherent in patient transfer
Identify and manage factors that need to be addressed prior to transfer (ADV.)
Acknowledge the importance of maintaining or increasing the level of care during transport (ADV.)

Patient Management

Management Options

Understand the management options for the listed problems & conditions
Develop, implement & evaluate a plan of management relevant to a patient's problems or conditions
Understand the importance of considering different management options


Understand the actions, indications, contraindications & adverse effects of medications
Recognise the role of nurses, pharmacists & allied health professionals in medication management
Evaluate the outcomes of medication therapy (ADV.)

Pain management

Understand the hierarchy of therapies & options for pain control
Appreciate that pain therapies need to be matched to the patient's analgesia requirements
Develop, implement & evaluate a plan of timely pain control appropriate to a patient's needs (ADV.)

Fluid & electrolyte management

Demonstrate a knowledge of patient fluid & electrolyte requirements in all age groups
Understand the risks of gross fluid & electrolyte imbalance
Develop, implement & evaluate an individualised plan of fluid & electrolyte management (ADV.)

Subacute care

Know the services available to patients for subacute care
Understand the indications & implications of a change to a palliative approach to management
Identify patients suitable for aged care & rehabilitation programs

Ambulatory & community care

Know the services available to patients outside of the inpatient setting
Identify patients suitable for ambulatory & community care programs
Recognise that patient care can be provided in different settings

Discharge planning

Know the elements of effective discharge planning e.g. early, continuous, multidisciplinary
Follow organisational guidelines to ensure smooth discharge
Understand indications for & regulatory requirements of various levels of residential care (ADV.)

Common Problems & Conditions


This list includes acute and chronic conditions and, unless otherwise specified, applies to patients of all ages.
The listed conditions are neither EXHAUSTIVE nor MANDATORY. They are provided to GUIDE learning and the construction of suitable junior doctor terms.

Skills & Procedures


Know the indications & contraindications for the listed procedures
Select patients appropriately for the listed procedures
Provide a full explanation of the proposed procedure to the patient

Informed consent

Understand the principles of informed consent
Always apply the principles of informed consent in day to day clinical practice
Recognise that informed consent may need to be obtained by a senior clinician e.g. major procedures

Preparation & anaesthesia

Provide appropriate sedation and/or premedication
Prepare & position the patient appropriately
Arrange local, regional or general anaesthesia as appropriate


Arrange appropriate equipment & understand its use
Arrange appropriate support staff & define their roles
Know & practice the appropriate technique


Monitor the patient & provide appropriate analgesia & aftercare
Identify & manage common complications
Interpret results & evaluate outcomes of treatment


Doctors should be able to provide safe treatment to patients through competently performing certain procedural and/or assessment skills.
The listed skills are neither EXHAUSTIVE nor MANDATORY. They are provided to GUIDE learning in the clinical workplace during the prevocational years.

Australian Curriculum Framework for Junior Doctors — Communication

Patient Interaction


Understand the impact of the environment on communication, e.g. privacy, location
Use good communication and know its role in effective healthcare relationships
Develop strategies to deal with the difficult or vulnerable patient


Treat patients courteously & respectfully, showing awareness & sensitivity to different backgrounds
Maintain privacy & confidentiality
Provide clear & honest information to patients & respect their treatment choices

Providing information

Understand the principles of good communication e.g. active listening, the role of information overload
Communicate with patients & carers in ways they understand e.g. use interpreters, diagrams, less jargon
Involve patients in discussions about their care

Meetings with families or carers

Understand the impact of family dynamics on effective communication
Ensure relevant family/carers are included appropriately in meetings and decision-making
Respect the role of families in patient health care

Breaking bad news

Understand loss & bereavement
Participate in breaking bad news to patients & carers
Show empathy & compassion

Open disclosure

Understand the principles of 'open disclosure'
Ensure patients are supported & cared for after an adverse event
Show understanding to patients following adverse events


Understand the factors likely to lead to complaints
Respond appropriately to complaints using the local procedures
Adopt behaviours to prevent complaints

Managing Information


Understand & comply with organisational policies regarding timely and accurate documentation
Demonstrate high quality written skills e.g. legible, concise & informative discharge summaries
Understand the structure & content of correspondence & orders e.g. referrals, investigation requests


Understand the uses & limitations of electronic patient information & decision-support systems
Use electronic resources in patient care e.g. obtain results, discharge summaries, pharmacopoeia
Understand & comply with policies regarding information technology e.g. passwords, e-mail & internet


Know how to accurately communicate prescriptions
Accurately document drug prescription and administration
Recognise that prescribing is a form of communication within the healthcare team

Health records

Understand legal/institutional requirements for health records
Understand the role of the health record in continuity of care
Recognise that accurate documentation is necessary for appropriate coding & classification

Evidence-based practice

Know the principles of evidence-based practice & hierarchy of evidence
Use best available evidence in clinical decision-making
Critically appraise evidence & information (ADV.)


Understand the importance of handover in patient safety & continuity of care
Perform effective handover e.g. team-member to team-member, hospital to GP
Understand the consequences of ineffective handover

Working in Teams

Team structure

Identify the different types of healthcare team e.g. medical team, multidisciplinary stroke team
Include the patient & carers in the team where possible
Respect the leadership role within a team e.g. nurse unit manager, trauma resuscitation leader

Team dynamics

Understand the characteristics of effective teams
Demonstrate an ability to work with others and resolve conflicts when they arise
Demonstrate flexibility & preparedness to change

Teams in action

Understand & respect the roles & responsibilities of team members
Participate fully in teams, recognising that teams extend outside the hospital e.g. GP, HITH
Demonstrate preparedness to adopt a variety of roles within a team (ADV.)

Case presentation

Understand the structure of an effective case presentation
Demonstrate an ability to present cases to senior medical staff & other health professionals
Recognise the importance of case presentation in patient care

Australian Curriculum Framework for Junior Doctors — Professionalism

Doctor & Society

Access to healthcare

Understand how physical or cognitive disability can limit access to healthcare services
Provide access to culturally appropriate healthcare
Adopt a non-discriminatory approach to patient care

Culture, society & healthcare

Understand the social, economic & political factors in patient illness
Understand the impact of culture, ethnicity & spirituality on health
Identify your own cultural values that may impact on your role as a doctor

Indigenous patients

Understand the impact of history & the experience of Indigenous Australians on presentations
Understand Indigenous Australians' spirituality & relationship to the land
Appreciate the diversity of indigenous cultures, experiences & communities

Professional standards

Understand the legal requirements of being a doctor
Adhere to professional standards
Respect patient privacy & confidentiality

Medicine & the law

Understand the legal requirements in patient care e.g. Mental Health Act, death certification
Complete medico-legal documentation appropriately
Liaise with legal & statutory authorities, including mandatory reporting where applicable (ADV.)

Health promotion

Understand environmental & lifestyle risks to health & advocate for healthy lifestyles
Demonstrate a non-judgemental approach to patients & their lifestyle choices
Consider the positive & negative aspects of health screening & prevention (ADV.)

Healthcare resources

Use healthcare resources wisely to achieve the best outcomes
Understand that healthcare is a finite resource
Understand the nature & costs of the healthcare system (ADV.)

Professional Behaviour

Professional responsibility

Know the professional responsibilities relevant to your position
Demonstrate an appropriate standard of professional practice & work within personal capabilities
Reflect on personal experiences, actions & decision-making

Time Management

Understand how time management impacts on patient care & hospital function
Demonstrate an ability to prioritise daily workload & multiple demands
Demonstrate punctuality in the workplace

Personal well-being

Understand the personal health risks of medical practice e.g. fatigue, stress, needle-stick injuries
Be aware of and optimise personal health & well-being
Recognise the potential risk to others from your own health status

Ethical practice

Recognise the ethical complexity of practice & follow professional & ethical codes
Consult colleagues about ethical concerns
Accept responsibility for ethical decisions

Practitioner in difficulty

Know the support services available
Recognise the signs of a practitioner in difficulty
Refer appropriately & respond with empathy

Doctors as leaders

Understand the leadership role that may be required of a doctor
Understand what makes a good leader e.g. vision, strength, humility
Show an ability to work well with and lead others

Teaching & Learning

Self-directed learning

Identify & address personal learning needs
Understand common research methodologies
Demonstrate commitment to continuous learning


Identify varied approaches to teaching & learning
Incorporate teaching into professional practice
Seek feedback on teaching


Understand the elements of good supervision
Seek & provide supervision & feedback
Participate in assessment & appraisal

Career development

Know the career options available within medicine
Explore career opportunities
Be open to various career opportunities

Australian Curriculum Framework for Junior Doctors — Common Problems & Conditions

Doctors should be able to appropriately assess patients presenting with common, important conditions, including the accurate identification of symptoms, signs and/or problems and their differential diagnosis and then use that information to further manage the patient, consistent with their level of responsibility:

Abdominal pain
Addiction (smoking, alcohol, drug)
Bleeding in the 1st trimester
Cardiac Arrhythmias
Chest pain
Child abuse
Chronic Obst. Pulmonary Disease
Cognitive or physical disability
Deliberate self-harm
Depression and anxiety
Diabetes: new cases/complications
Disturbed or aggressive patient
Domestic violence
Dysuria &/or frequent micturition
Elder abuse
Falls, especially in the elderly
Functional decline or impairment
Gastrointestinal bleeding
Genetically determined conditions
Heart failure
Ischaemic heart disease
Joint disorders
Leg ulcers
Limb ischaemia
Liver disease
Loss of consciousness
Minor trauma
Multiple trauma
Non-accidental injury
Non-specific febrile illness
Pneumonia/respiratory infection
Post-operative care
Pyelonephritis and UTIs
Reduced urinary output
Renal failure
Sexually Transmitted Infections
Seizure disorders
Spinal disease
Stroke / TIA
Subarachnoid haemorrhage
Substance abuse
Upper airway obstruction
Urinary Incontinence
Weight gain
Weight loss

Australian Curriculum Framework for Junior Doctors — Skills and Procedures

Doctors should be able to provide safe treatment to patients through competently performing certain procedural and/or assessment skills (ADV. = ADVANCED i.e. more likely to be learnt in PGY2 or above):


Blood pressure measurement
Pulse oximetry reading
Temperature measurement
Intravenous cannulation
Intravenous infusion set up
Intravenous drug administration
Intravenous fluid & electrolyte therapy
Blood sugar estimation
Blood culture
Wound swab
Oxygen therapy
Nebuliser/inhaler therapy
Anticoagulant prescription/monitoring
Antibiotic prescription/monitoring
Intramuscular injections
Subcutaneous injections
Joint aspiration or injection (ADV.)


12 lead electrocardiogram
Arterial blood gas sampling
Peak flow measurement
Pleural effusion/pneumothorax aspiration
Central venous line insertion (ADV.)


Nasogastric tube insertion
Rectal examination
Faecal occult blood analysis
Anoscopy/proctoscopy (ADV.)
Abdominal paracentesis (ADV.)


Glasgow Coma Score estimation
Neck stiffness testing
Focal neurological sign identification
Papilloedema identification (ADV.)
Lumbar puncture (ADV.)

Mental Health

Mini-mental state examination
Psychiatric Mental State Examination
Suicide risk assessment
Alcohol withdrawal scale use
Application of Mental Health Schedule

Women's Health

Fundal height assessment
Foetal heart sound detection
Urine pregnancy testing
Speculum examination
Endocervical swab / PAP smear (ADV.)
Gynaecological pelvic examination (ADV.)

Child Health

Infant respiratory distress assessment
Infant/child dehydration assessment
Apgar score estimation
Newborn examination (ADV.)
Neonatal CPR (ADV.)


Scrub, gown & glove
Assisting in the operating theatre
Surgical knots & simple wound suturing
Local anaesthesia
Simple skin lesion excision
Wound management
Suture removal
Complex wound suturing (ADV.)

Ear, Nose & Throat

Throat swab
Anterior rhinoscopy
Anterior nasal pack insertion
External auditory canal irrigation
Ext. aud. canal ear wick insertion (ADV.)


Visual field assessment
Visual acuity assessment
Direct ophthalmoscopy
Eye drop administration
Eye bandage application
Eye irrigation
Eyelid eversion
Corneal foreign body removal
Intraocular pressure estimation (ADV.)
Slit lamp examination (ADV.)


Bladder catheterisation (M&F)
Urine dipstick testing
Urethral swab


Primary trauma survey
In-line immobilisation of cervical spine
Cervical collar application
Pressure haemostasis
Volume resuscitation
Peripheral neurovascular assessment
Plaster cast/splint limb immobilisation
Joint relocation
Secondary trauma survey (ADV.)
Intercostal catheter insertion (ADV.)
  • Ian S Graham1,2
  • Andrew J Gleason3
  • Gregory W Keogh4,5
  • Deborah Paltridge6
  • Ian R Rogers8
  • Merrilyn Walton9
  • Caroline De Paola4
  • Jagdishwar Singh10
  • Barry P McGrath10,11

  • 1 Postgraduate Medical Council of Victoria, Melbourne, VIC.
  • 2 SED Health Consulting, Ballarat, VIC.
  • 3 The Alfred Hospital, Melbourne, VIC.
  • 4 NSW Institute of Medical Education and Training, Sydney, NSW.
  • 5 Prince of Wales Hospital, Sydney, NSW.
  • 6 St Vincent’s Health, Melbourne, VIC.
  • 7 Sir Charles Gairdner Hospital, Perth, WA.
  • 8 University of Western Australia, Perth, WA.
  • 9 University of Sydney, Sydney, NSW.
  • 10 Confederation of Postgraduate Medical Education Councils, Melbourne, VIC.
  • 11 Monash University, Melbourne, VIC.


Competing interests:

All the authors were members of the writing group and had their travel and accommodation expenses for writing group meetings paid for by the New South Wales Institute of Medical Education and Training, Medical Training Review Panel National Core Curriculum Project. Ian Graham was contracted as a consultant to the project to facilitate the meetings and design the draft curriculum framework.


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