The Confederation of Postgraduate Medical Education Councils launched the Australian Curriculum Framework for Junior Doctors in October 2006.
The curriculum framework:
balances the major areas of clinical management, communication and professionalism, and highlights the importance of an integrated approach to prevocational learning and teaching;
supports practice-based, opportunistic and continuous learning, and specifies performance and supervision requirements for junior doctors; and
has been published in both Internet and printable versions, to make the document accessible and easily usable by junior doctors and supervisors.
The implementation of the curriculum framework will be overseen by a steering group that includes representatives from key stakeholder groups, including junior doctors and medical students.
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.
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 project team sought to understand and reflect the needs of a wide range of stakeholders involved in prevocational medical training, including patients and the community, junior doctors, other hospital and practice staff, health departments, universities, professional colleges and associations.
Building on work undertaken in Australia and overseas, the writing group critically appraised existing prevocational curricula, in particular those developed or published by the:
Mindmapping software (MindManager Pro 6, Mindjet Corporation, San Francisco, Calif, USA) was then used to represent these curricula in a standardised, branching tree format.8,9 The same software was used to create a blank framework that was readily able to be restructured and progressively populated with the content of the Australian Curriculum Framework for Junior Doctors.
Reference was also made to other relevant documents, in particular the National Patient Safety Education Framework10 and the Committee of Deans of Australian Medical Schools Indigenous Health curriculum.11
The curriculum framework structure that emerged comprised three major areas (clinical management; communication; and professionalism). Each area was subdivided into three to six categories, and each category was further subdivided into four to seven topics. For every topic, a set of three capabilities has been defined. Capabilities may describe knowledge elements, skills or behaviours. An example of the structure of the curriculum framework is shown in the Box.
The entire Australian Curriculum Framework for Junior Doctors comprises 63 topics and is presented in this article (Australian Curriculum Framework for Junior Doctors). Eleven of the Clinical management topics, under the categories of Patient assessment and Patient management, refer to a list of common problems and conditions with which prevocational trainees should become familiar. The five topics relating to Skills & procedures are associated with a list of skills and procedures that should be mastered in the prevocational years.
The curriculum framework supports continuous learning from undergraduate training through to prevocational and vocational education and training, underpinned by the principles of adult learning. These include the need to respect prior learning and experience, and provide clear learning outcomes, regular feedback on performance, and opportunities for reflection.
It focuses on practice-based learning, taking place as much as possible in the context of the learner’s current work or professional environment. The curriculum framework is intended to exploit the rich opportunistic learning environment that the workplace provides.
The curriculum framework will enable individual learners to manage their own progression. Some interns may have mastered all the capabilities by the end of their internship, while others will require a longer period.
Members of the writing group recognised the importance of presenting the curriculum framework in a format that would be accessible to and usable by a wide range of stakeholders. The use of a world-wide-web interface allows all of the areas, categories and topics to be displayed on a single screen. Clicking on a topic opens up a dialogue box with a description of the three capabilities identified for that topic. There is also a provision to include links to peer-reviewed learning and assessment resources through the Internet.
A printable version of the curriculum framework has also been published and is available for download from the CPMEC website.
The curriculum framework aims to integrate learning at every opportunity. Each clinical encounter will incorporate a variety of capabilities from across the curriculum framework. It was designed to enable educational managers to support and positively reinforce the integration of prevocational training throughout the whole organisation, and also encourage innovative strategies such as interdisciplinary and team-based learning. Vertical integration across the medical education spectrum is another key aim of the curriculum framework, and a number of medical schools and colleges have indicated their interest in undertaking this work.
The curriculum framework describes required learning in terms of performance elements. This provides a useful starting point for practice-based training that relies on performance or competency-based assessment. However, developing practical, effective, valid and acceptable assessment tools remains the greatest challenge in the implementation of the curriculum framework.
Prevocational doctors are expected to be actively supervised in the workplace. Supervision is a crucial element to achieving many of the competencies within the curriculum framework. It is expected that, over the 2–3 years of prevocational training, there will be a progressive increase in the level of individual clinical responsibility and a corresponding reduction in the level of supervision that is required.
The draft Australian Curriculum Framework for Junior Doctors was made accessible through the CPMEC website from August until October 2006. The website included a feedback mechanism whereby users could generate an email to CPMEC and provide feedback on any aspect of the curriculum framework. Written feedback was also sought from hospitals, universities, professional colleges and key stakeholder organisations. Three hundred and forty comments were received over the initial 3-month consultation period. Thirty-five per cent were supportive, 53% expressed reservations, and 12% identified critical concerns.
In October 2006, the writing group met again to review the feedback. Of the 340 issues raised, 81 (24%) were able to be resolved through minor modifications to the content of the curriculum framework. However, a significant number of critical issues still remained, particularly in relation to implementation and assessment. The revised version of the curriculum framework was launched at the 11th National Prevocational Medical Education Forum in Adelaide on 31 October 2006, and received strong support.
A steering group will oversee the further development and implementation of the curriculum framework. This group and its subcommittees will guide the implementation process, identify learning resources that can be used in association with the curriculum framework, and consider issues relating to assessment. The steering group includes broad representation from postgraduate medical councils, doctors in training, medical students, and a range of peak bodies.
Undertaking a mapping process to identify elements and themes common to the Australian Curriculum Framework for Junior Doctors and university, professional college, and other curricula.
Reviewing positions, rosters and opportunities for teaching in hospitals, practices and other clinical settings in the context of the curriculum framework.
Identifying valid and reliable assessment tools that can be used in the workplace without placing undue burdens on junior medical staff and their supervisors. In the first instance, this may be achieved through the development of standardised term assessment reports that refer to the major headings of the curriculum framework.
It is essential that junior doctors themselves are closely involved in this work, and that adequate resources are allocated by the federal, state and territory governments to support the implementation of the Australian Curriculum Framework for Junior Doctors.12
The Australian Curriculum Framework for Junior Doctors is available at the CPMEC website (http://www.cpmec.org.au/curriculum).
Example of the structure of the curriculum framework
Patient management (category)
Management options (topic)
Understand the management options for the listed problems and conditions (capability — knowledge)
Australian Curriculum Framework for Junior Doctors — Clinical Management
Safe Patient Care
Understand the complex interaction between the healthcare environment, doctor & patient
Risk & prevention
Know the main sources of error & risk in the workplace
Adverse events & near misses
Understand the harm caused by errors & system failures
Understand the key health issues of your community
Understand prudent antibiotic/antiviral selection
Know the risks associated with exposure to radiological investigations & procedures
Know the medications most commonly involved in prescribing & administration errors
Know the stages of a verification process to ensure the correct identification of a patient
History & Examination
Know the modes of presentation of the listed problems and conditions
Know the possible differential diagnoses relevant to a patient's presenting problems or conditions
Identify & understand the investigations relevant to a patient's presenting problems or conditions
Referral & consultation
Understand the criteria for referral or consultation relevant to a particular problem or condition
Understand the abnormal physiology & manifestations of critical illness
Understand the principles of medical triage
Basic Life Support
Understand the theory of basic airway management, ventilatory & circulatory support
Advanced Life Support
Practice advanced airway management including the use of laryngeal mask
Acute patient transfer
Understand the risks inherent in patient transfer
Understand the management options for the listed problems & conditions
Understand the actions, indications, contraindications & adverse effects of medications
Understand the hierarchy of therapies & options for pain control
Fluid & electrolyte management
Demonstrate a knowledge of patient fluid & electrolyte requirements in all age groups
Know the services available to patients for subacute care
Ambulatory & community care
Know the services available to patients outside of the inpatient setting
Know the elements of effective discharge planning e.g. early, continuous, multidisciplinary
Common Problems & Conditions
LIST OF COMMON PROBLEMS & CONDITIONSThis 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
Understand the principles of informed consent
Preparation & anaesthesia
Provide appropriate sedation and/or premedication
Arrange appropriate equipment & understand its use
Monitor the patient & provide appropriate analgesia & aftercare
LIST OF SKILLS & PROCEDURES
Doctors should be able to provide safe treatment to patients through competently performing certain procedural and/or assessment skills.
Australian Curriculum Framework for Junior Doctors — Communication
Understand the impact of the environment on communication, e.g. privacy, location
Treat patients courteously & respectfully, showing awareness & sensitivity to different backgrounds
Understand the principles of good communication e.g. active listening, the role of information overload
Meetings with families or carers
Understand the impact of family dynamics on effective communication
Breaking bad news
Understand loss & bereavement
Understand the principles of 'open disclosure'
Understand the factors likely to lead to complaints
Understand & comply with organisational policies regarding timely and accurate documentation
Understand the uses & limitations of electronic patient information & decision-support systems
Know how to accurately communicate prescriptions
Understand legal/institutional requirements for health records
Know the principles of evidence-based practice & hierarchy of evidence
Understand the importance of handover in patient safety & continuity of care
Working in Teams
Identify the different types of healthcare team e.g. medical team, multidisciplinary stroke team
Understand the characteristics of effective teams
Teams in action
Understand & respect the roles & responsibilities of team members
Understand the structure of an effective case presentation
Australian Curriculum Framework for Junior Doctors — Professionalism
Doctor & Society
Access to healthcare
Understand how physical or cognitive disability can limit access to healthcare services
Culture, society & healthcare
Understand the social, economic & political factors in patient illness
Understand the impact of history & the experience of Indigenous Australians on presentations
Understand the legal requirements of being a doctor
Medicine & the law
Understand the legal requirements in patient care e.g. Mental Health Act, death certification
Understand environmental & lifestyle risks to health & advocate for healthy lifestyles
Use healthcare resources wisely to achieve the best outcomes
Know the professional responsibilities relevant to your position
Understand how time management impacts on patient care & hospital function
Understand the personal health risks of medical practice e.g. fatigue, stress, needle-stick injuries
Recognise the ethical complexity of practice & follow professional & ethical codes
Practitioner in difficulty
Know the support services available
Doctors as leaders
Understand the leadership role that may be required of a doctor
Teaching & Learning
Identify & address personal learning needs
Identify varied approaches to teaching & learning
Understand the elements of good supervision
Know the career options available within medicine
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
Chronic Obst. Pulmonary Disease
Cognitive or physical disability
Depression and anxiety
Diabetes: new cases/complications
Disturbed or aggressive patient
Dysuria &/or frequent micturition
Falls, especially in the elderly
|Functional decline or impairment |
Genetically determined conditions
Ischaemic heart disease
Loss of consciousness
|Minor trauma |
Non-specific febrile illness
Pyelonephritis and UTIs
Reduced urinary output
|Sexually Transmitted Infections |
Stroke / TIA
Upper airway obstruction
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
Intravenous infusion set up
Intravenous drug administration
Intravenous fluid & electrolyte therapy
Blood sugar estimation
Joint aspiration or injection (ADV.)
Cardiopulmonary12 lead electrocardiogram
Arterial blood gas sampling
Peak flow measurement
Pleural effusion/pneumothorax aspiration
Central venous line insertion (ADV.)
GastrointestinalNasogastric tube insertion
Faecal occult blood analysis
Abdominal paracentesis (ADV.)
NeurologicalGlasgow Coma Score estimation
Neck stiffness testing
Focal neurological sign identification
Papilloedema identification (ADV.)
Lumbar puncture (ADV.)
Mental HealthMini-mental state examination
Psychiatric Mental State Examination
Suicide risk assessment
Alcohol withdrawal scale use
Application of Mental Health Schedule
Women's HealthFundal height assessment
Foetal heart sound detection
Urine pregnancy testing
Endocervical swab / PAP smear (ADV.)
Gynaecological pelvic examination (ADV.)
Child HealthInfant respiratory distress assessment
Infant/child dehydration assessment
Apgar score estimation
Newborn examination (ADV.)
Neonatal CPR (ADV.)
SurgicalScrub, gown & glove
Assisting in the operating theatre
Surgical knots & simple wound suturing
Simple skin lesion excision
Complex wound suturing (ADV.)
Ear, Nose & ThroatThroat swab
Anterior nasal pack insertion
External auditory canal irrigation
Ext. aud. canal ear wick insertion (ADV.)
OpthalmicVisual field assessment
Visual acuity assessment
Eye drop administration
Eye bandage application
Corneal foreign body removal
Intraocular pressure estimation (ADV.)
Slit lamp examination (ADV.)
UrogenitalBladder catheterisation (M&F)
Urine dipstick testing
TraumaPrimary trauma survey
In-line immobilisation of cervical spine
Cervical collar application
Peripheral neurovascular assessment
Plaster cast/splint limb immobilisation
Secondary trauma survey (ADV.)
Intercostal catheter insertion (ADV.)
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