RACGP CCE Exam – 102 Clinical Competencies

In the RACGP CCE, each of the 9 cases in the exam will focus on a number of competencies.

These clinical competencies are grouped under the following 12 headings:

1. Communication and consultation skills
2. Clinical information gathering and interpretation (history and examination)
3. Making a diagnosis, decision making and reasoning (investigations and diagnosis)
4. Clinical management and therapeutic reasoning (management)
5. Preventive and population health (primary prevention, secondary prevention and screening)
6. Professionalism
7. General practice systems and regulatory requirements
8. Procedural skills
9. Managing uncertainty
10. Identifying and managing the seriously ill patient
11. Aboriginal and Torres Strait Islander Health
12. Rural Health

1. Communication and Consultation Skills

1. Communication is appropriate to the person and the sociocultural context.
2. Engages the patient to gather information about their symptoms, ideas, concerns, and expectations of healthcare and the full impact of their illness experience on their lives.
3. Matches modality of communication to patient needs, health literacy, and context.
4. Communicates effectively in routine and difficult situations.
5. Demonstrates active listening skills.
6. Uses a variety of communication techniques and materials (e.g., written or electronic) to adapt explanations to the needs of the patient.
7. Uses appropriate strategies to motivate and assist patients in maintaining health behaviours.
8. Adapts the consultation to facilitate optimal patient care.
9. Consults effectively in a focused manner within the time frame of a normal consultation.
10. Prioritizes problems, attending to both the patient’s and the doctor’s agendas.
11. Safety-netting and specific follow-up arrangements are made.

2. Clinical Information Gathering and Interpretation

1. A comprehensive biopsychosocial history is taken from the patient.
2. All available sources of information are appropriately considered when taking a history.
3. An appropriate and respectful physical examination is undertaken, targeted at the patient’s presentation and likely differential diagnoses.
4. Physical examination findings are detected accurately and interpreted correctly.
5. Specific positive and negative findings are elicited.
6. Rational options for investigations are chosen using an evidence-based approach.
7. Interprets investigations in the context of the patient’s presentation.

3. Diagnosis, Decision-Making, and Reasoning

1. Integrates and synthesises knowledge to make decisions in complex clinical situations.
2. Modifies differential diagnoses based on clinical course and other data as appropriate.
3. Demonstrates diagnostic accuracy; this does not require the correct diagnosis, but that the direction of reasoning was appropriate and accurate.
4. Collects/reports clinical information in a hypothesis-driven manner.
5. Articulates an appropriate problem definition.
6. Formulates a rational list of differential diagnoses, including most likely, less likely, unlikely, and cannot miss diagnoses.
7. Directs evaluation and treatment towards high-priority diagnoses.
8. Demonstrates metacognition (thinking about own thinking).

4. Clinical Management and Therapeutic Reasoning

1. Demonstrates knowledge of common therapeutic agents, uses, dosages, adverse effects, and potential drug interactions, and the ability to prescribe safely.
2. Rational prescribing is undertaken.
3. Monitors for medication side effects and risks of polypharmacy.
4. Outlines and justifies the therapeutic options selected based on the patient’s needs and the problem list identified.
5. Safely prescribes restricted medications using appropriate permits.
6. Non-pharmacological therapies are offered and discussed.
7. A patient-centred and comprehensive management plan is developed.
8. Provides effective explanations, education, and choices to the patient.

5. Preventive and Population Health

1. Implements screening and prevention strategies to improve outcomes for individuals at risk of common causes of morbidity and mortality.
2. Uses planned and opportunistic approaches to provide screening, preventative care and health-promotion activities.
3. Coordinates a team-based approach.
4. Demonstrates understanding of available services in the local community.
5. Current and emerging public health risks are managed appropriately.
6. Educates patients and families in disease management and health-promotion skills.
7. Identifies opportunities to effect positive change through health education and promotion.
8. Uses appropriate strategies to motivate and assist patients in maintaining health behaviors.

6. Professionalism

1. Encourages scrutiny of professional behaviour, is open to feedback and demonstrates a willingness to change.
2. Exhibits high standards of moral and ethical behaviour towards patients, families, and colleagues including an awareness of appropriate doctor–patient boundaries.
3. Appropriately manages ethical dilemmas that arise.
4. Identifies and manages clinical situations where there are obstacles to provision of duty of care.
5. Implements strategies to review potential and actual critical incidents to manage consequences and reduce future risk.
6. Personal health issues are identified and managed by accessing professional support as needed.

7. General Practice Systems and Regulatory Requirements

1. Appropriately uses the computer/IT systems to improve patient care in the consultation.
2. Maintains comprehensive and accurate clinical notes.
3. Written communication is clear, unambiguous, and appropriate to the task.
4. Demonstrates efficient use of recall systems to optimise health outcomes.
5. Accurately completes legal documentation appropriate to the situation.
6. Implements best-practice guidelines for infection control measures.
7. Patient confidentiality is managed appropriately.
8. Informed consent is explained and obtained.

8. Procedural Skills

1. Demonstrates a wide range of procedural skills to a high standard and as appropriate to the community requirements.
2. Refers appropriately when a procedure is outside their level of competence.

9. Managing Uncertainty

1. Manages the uncertainty of ongoing undifferentiated conditions.
2. Addresses problems that present early and/or in an undifferentiated way by integrating all the available information to help generate differential diagnoses.
3. Recognises when to act and when to defer doing so, and uses time as a diagnostic tool.

10. Identifying and Managing the Patient with Significant Illness

1. A patient with significant illness is identified.
2. Has confidence in, and takes ownership of, own decisions while being aware of own limitations.

11. Aboriginal and Torres Strait Islander Health Context

1. Uses a range of methods to facilitate culturally safe communication with Aboriginal and Torres Strait Islander peoples.
2. Integrates cultural perspectives on, and beliefs about, the health and wellbeing of Aboriginal and Torres Strait Islander peoples into holistic clinical practice.
3. Appraises and addresses barriers to the development of effective therapeutic relationships with Aboriginal and Torres Strait Islander peoples.
4. Identifies and addresses obstacles to optimizing the management of complex health presentations in Aboriginal and Torres Strait Islander peoples.
5. Demonstrates effective diagnostic and management strategies that enhance health outcomes for Aboriginal and Torres Strait Islander patients.
6. Collaborates effectively with multidisciplinary teams to develop meaningful and holistic management plans.
7. Identifies and uses professional resources to assist with delivery of best-practice care to Aboriginal and Torres Strait Islander patients.
8. Identifies and incorporates social and cultural determinants of health into management plans.
9. Uses evidence-based preventive and population health approaches to reduce health inequalities in Aboriginal and Torres Strait Islander communities.
10. Identifies health-delivery strategies to reduce inequities and enhance self-determination.
11. Uses specific Medicare and Pharmaceutical Benefits Scheme programs to improve health outcomes.
12. Appraises the capacity of the primary healthcare model to comprehensively meet the needs of the community.
13. Develops strategies to promote a culturally safe practice environment.
14. Appropriately uses Medicare programs in the delivery of healthcare for Aboriginal and Torres Strait Islander patients.
15. Integrates knowledge of history of government policies and consequent health impacts into delivery of care.
16. Advocates for, and uses policies and initiatives that promote equity in healthcare.

12. Rural Health Context

1. Develops, maintains, and reviews effective communication strategies for communicating with patients and other health professionals who are located remotely.
2. Adapts communication to accommodate situations common in rural and remote areas, and maintains effective communication infrastructure relevant to the practice setting.
3. Identifies appropriate modes of communication in the practice and the community.
4. Links into existing networks of health professionals in rural and remote settings.
5. Identifies, cultivates, and maintains skills relevant to the practice and specific to community needs.
6. Works effectively with patients who live in isolation.
7. Demonstrates leadership in emergency situations.
8. Liaises with emergency services to enhance preparedness to deal with emergencies.
9. Develops and delivers health-promotion activities in the community to address identified risks.
10. Establishes and sustains health-education and health-promotion networks.
11. Implements strategies to minimize obstacles to accessing care.
12. Works effectively with government and non-government organisations and the community to optimise health service provision.
13. Manages public health risks according to various guidelines.
14. Effectively manages any conflicts between personal and professional roles.
15. Effectively communicates limits of role boundaries to patients, staff and community members.
16. Regularly reviews and implements plans to meet professional learning and support needs.
17. Supports and mentors colleagues in managing professional isolation.
18. Sets up systems to optimise time management for the practice in a rural community with limited resources.